DIVISION OF BRAIN AND THERAPEUTICS. Addiction Psychiatry

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1 DIVISION OF BRAIN AND THERAPEUTICS Addiction Psychiatry Code Title Contact Info Description ADDP- CE-01 Addiction Psychiatry Inquiries: Dr. Pamela Stewart ext or Marina Bourlak, ext or This elective provides residents with opportunities to gain exposure to specific aspects of addictions, which are of relevance to the psychiatry Dr. Peter Selby at area of their preference. The following are examples of topics to be considered; residents with other interests are encouraged to contact Dr. Stewart in order to explore the possibilities. ADDP- CE-02 WCH Substance Use Service Elective D. Digiacomo, M.D., FRCP(C), DABPN B. Ballon, M.D., FRCP(C) Daniela Lobo FRCP Dr. Kam Balchand FRCPC Dr. Julie Henderson FRCPC ABAM P. Westlind, M.D., FRCP(C) P. Stewart, M.D., FRCP(C) ABAM J. Malat, M.D., FRCP(C) ABAM Dr. Andriy Samokhvalov FRCPC Place: Addiction Psychiatry Program, Queen Street Site. Time: Flexible No. of Residents: Variable (1 full-time or 2 part-time) For more information, please contact Inbal Gafni at Inbal.Gafni@wchospital.ca Pharmacotherapy of addictions and co morbid disorders Schizophrenia and addiction Detoxification treatments in patients with psychiatric co morbidity Eating Disorders and addiction Non-pharmacological treatment of anxiety disorders in addicted patients Modified dynamic group psychotherapy with patients with substance use disorders Comprehensive assessment and treatment for concurrent disorders Youth Concurrent Disorders Problem Gambling and concurrent disorders Integrative approaches to working with concurrent disorders in clients Multidimensional integrated treatment for concurrent eating disorders and substance abuse Women s College Hospital has recently started an innovative ambulatory addiction service focused on the needs of women. It is staffed by a multidisciplinary team comprised of addiction psychiatry, addiction medicine and social work. This elective will provide an opportunity for residents to participate in all aspects of the clinic, including out-patient withdrawal management for alcohol and opioid dependence, addiction consultations and medication management for substance use. The use of buprenorphine for opioid dependence is a unique feature of this clinic. The elective will also provide opportunities to practice and receive direct supervision in a variety of psychosocial interventions for substance use disorders, including motivational

2 interviewing, cognitive behavioural therapy and group therapy. In addition, as this program is growing and evolving, interested residents will have an opportunity to observe and participate in program development and evaluation. This elective will be available starting in July 2013 for 1 or 2 days per week. ADDP- CE-03 Addiction Psychiatry Inquiries: Dr. A. Quastel, ext Supervisor(s): Dr. A. Quastel Place: St. Michael s Hospital This elective provides a broad introduction to the field of Addiction Psychiatry. Education is imparted through clinical practice, rounds, tutorials, guided and independent studies, and seminars. The curriculum spans over a wide range of topics: epidemiology, nosology, diagnostic criteria, differential diagnosis, genetics, neurobiology, pharmacotherapy, and current psychotherapy approaches. The resident will be part of a psychiatric team, which provides detoxification and consultation/supervision services within the hospital. The resident will have direct responsibility for about 4 addiction psychiatry beds at any point in time, and will provide ambulatory/continuing care at both the hospital and the Addiction Research Foundation s Mental Health Clinic. ADDP- CE-04 Clinical and Research Elective in Psychiatric Neurostimulation Inquiries: Dr. Jonathan Downar Supervisor(s): Drs. Peter Giacobbe (UHN - DBS and ECT), Jonathan Downar (UHN - rtms and MST), Daniel Blumberger (CAMH - MST and ECT), and Z. Jeff Daskalakis (CAMH - rtms, ECT, and MST) Place: University Health Network and Centre for Addiction and Mental Health For further information, please contact Dr. Jonathan Downar at jonathan.downar@uhn.ca<mailto:jonathan.downar@uhn.ca> Neurostimulation is an emerging and fast-growing alternative to medications and psychotherapy in the treatment of psychiatric disorders. There are now a variety of neurostimulation technologies in use, including not only electroconvulsive therapy (ECT) but also newer techniques such as repetitive transcranial magnetic stimulation (rtms), magnetic seizure therapy (MST), transcranial direct current stimulation (tdcs), and deep brain stimulation (DBS). These techniques will likely come to play a significant role in the armamentarium of psychiatric treatments in the near future. However, at present, few centres offer formal training in the skills necessary for assessment, treatment administration, and follow-up in patients for whom neurostimulation is indicated. The University Health Network pioneered the use of DBS in the treatment of major depression, and is now exploring the use of this treatment in a variety of other psychiatric disorders as well. The UHN's recentlyestablished MRI-Guided rtms Clinic, with the support of the Buchan Family Foundation, is also exploring new stimulation targets and parameters, new treatment indications, and new care models for rtms to facilitate its use as a mainstream treatment for refractory psychiatric illness. The Centre for Addiction and Mental Health is also a world leader in neurostimulation research, having recently opened the Temerty Centre for Therapeutic Brain Intervention. In addition to a longstanding program of basic and clinical research on the therapeutic use of rtms, CAMH also operates one of the largest ECT services in North America. It is also the first and so far only site in Canada to obtain Health Canada approval to offer magnetic seizure therapy (MST) as an alternative to conventional ECT. Together, CAMH and UHN offer a depth and breadth of neurostimulation expertise that few

3 other sites in the world can match, thus providing an ideal environment for subspecialty training. We are currently accepting residents for clinical and research electives in psychiatric neurostimulation. Senior residents may pursue either 6 or 12 months of training, as of July 1, Junior residents with shorter periods of elective time available may request a shorter elective, effective immediately. Key features of the elective are as follows: - 50% of time devoted to research activities and the remaining 50% of time to clinical training. - Clinical and research training in rtms (~40%), MST (~20%), ECT (~20%), and DBS (~20%) - Supervisors: Drs. Peter Giacobbe (UHN - DBS and ECT), Jonathan Downar (UHN - rtms and MST), Daniel Blumberger (CAMH - MST and ECT), and Z. Jeff Daskalakis (CAMH - rtms, ECT, and MST) Clinical objectives - To achieve proficiency in the delivery of rtms, MST, ECT, and DBS treatments, as well as in the assessment, follow-up, and use of adjunctive treatment (psycho- and pharmacotherapy) of patients undergoing these treatments. - To participate in the development of more efficient systems for facilitating patient referrals, high-patient-volume clinical care models, and improved systems for integrating neurostimulation with adjuctive treatment modalities such as psychotherapy and pharmacotherapy. - To participate in the design, execution, and publication of ongoing basic research and clinical trials involving some or all of the neurostimulation treatments listed above, under the supervision of the clinician-scientist staff members above at UHN and CAMH. Residents with previous research training at the MSc or PhD level will be given preference. However, residents from all backgrounds are encouraged to apply for this elective. ADDP- CE-05 GENP-CE-19) Substance Abuse and Mental Illness (SAMI) Program, Addiction Psychiatry Inquiries: Dr. A. Quastel, (416) Supervisor(s): Dr. A. Quastel Place: St. Michael s Hospital This elective provides a sub-specialty training in concurrent disorders through involvement with the SAMI (Substance Abuse and Mental Illness) Program at St. Michael s Hospital Mental Health Service. This program provides a number of clinical interventions -- including concurrent disorders assessments, motivational interventions and targeted addictions treatment to individuals with severe and persistent mental illness that are available for resident participation as part of a clinically based experience in addictions psychiatry. Mood and Anxiety Disorders

4 Code Title Contact Info Description MADP-CE-01 Anxiety Disorders Clinic Inquiries: Dr. Rector, (416) ext Supervisor(s): Drs. P. Richter/N. Rector/D. Bourdeau -Clarke Division No. of Residents: 2 The Anxiety Disorders Clinic of the Mood and Anxiety Program at the Clarke site sees the full range of anxiety patients. There are opportunities to develop skills in assessment, use of structured diagnostic interviews and common rating scales, pharmacotherapy, and cognitive-behavioural therapy with this highly rewarding population. This elective offers the following: supervised interviewing and direct teaching about all aspects of anxiety disorders, as well s training and supervision in the most current evidence-based interventions. Residents are also offered the opportunity to participate in a wide range of ongoing research activities, or may develop their own research project. MADP-CE-02 Consultation in Mood Disorder Inquiries: Dr. Pollock, (416) Supervisor(s): Dr. D. Pollock Place: North York General Hospital, Mood Disorder Clinic Time: Monday Mornings MADP-CE-03 Mood Disorders Program Inquiries: Dr. Cooke (416) , ext Supervisor(s): Drs. R. Cooke/R. Levitan Place: Centre for Addiction and Mental Health No. of Residents: MADP-CE-04 GENP-CE-15) Mood Disorders Elective Inquiries: Dr. R.S. McIntyre (416) ext roger.mcintyre@uhn.ca Supervisor(s): Dr. R.S. McIntyre Place: Mood Disorder Clinic, Toronto Western Hospital Time: ½ to 1 day No. of Residents: 1 A one-half day elective is offered to a resident wishing to see a broad variety of mood disorders referred to a busy Mood Disorder Clinic in a community hospital. The cases are varied, generally acute and offer a good example of the disorders seen in a community psychiatric practice. The assessments are evaluated by a multidisciplinary team of psychiatrist, psychologist and social worker. The resident would be supervised by the staff psychiatrist. The Mood Disorders section of the Mood and Anxiety Program at the Clarke site offers a clinical elective in depressive and bipolar disorders. The aim of this elective is to provide clinical experience interviewing and learning about people with depression and bipolar illness, through supervised interviewing and direct teaching about mood disorders. Residents are also offered an opportunity to become involved in existing research protocols or to initiate new projects under supervision ranging from epidemiology to molecular biology, basic science to direct clinical research. Residents can design their own program to acquire skills in psychopharmacology, cognitive therapy, community consultation, and combined medication/psychotherapy approaches. Residents will have the opportunity to be involved in the assessment and treatment of adults with Major Depressive Disorder or Bipolar Disorders. The Mood Disorders Psychopharmacology Unit at the UHN and is internationally known for its research into the causes, consequences, and treatment of mood disorders. Along with conventional pharmacological approaches, residents will also be given training on efficient assessment techniques as well as demonstration of comprehensive and efficient preparation of consultation notes to referring physicians. Residents are encouraged to involve themselves in not only clinical assessment, but also to familiarize themselves with measurementbased care in mood disorders. MADP-CE/RE- 01 Clinic for OCD & Related Disorders Inquiries: Dr. Peggy Richter, (416) peggy.richter@sunnybrook.ca Supervisors(s): Dr. Peggy Richter Place: Sunnybrook Health Sciences Centre No. of Residents: 2 The Clinic for OCD & Related Disorders provides assessment and treatment to patients with OCD and OCD spectrum conditions, including hoarding, trichotillomania, and body dysmorphic disorder. In this elective, there are opportunities to develop skills in assessment, use of structured diagnostic interviews and common rating scales, pharmacotherapy, and cognitivebehavioural therapy (individual and group) with this highly rewarding population. This elective offers the following: supervised interviewing and direct teaching about all aspects of anxiety disorders, as well as training and supervision in the most current evidence-based interventions. Residents are also offered the opportunity to participate in a wide range of ongoing

5 MADP-CE/RE- 02 Mood Disorders Inquiries: Dr. A. Levitt, (416) Dr. A. Schaffer (416) Supervisor(s): Drs. A. Levitt, G. Chandler, A. Schaffer Place: Sunnybrook HSC No. of Residents: 2 research activities, or may develop their own research project. The Mood Disorders Program offers a clinical and/or research elective in Mood Disorders. The aim of the elective is twofold: first, to enhance clinical experience with patients suffering from major depression and bipolar disorder; and second to expose residents to the practical aspects of Mood Disorder research as well as the principals of research in general. The elective is designed to allow the resident to participate in a research project that will lead to the opportunity to analyse data and present data in written and/or oral format. The areas of clinical and research interest for the Program are: mood disorders across the lifespan, treatment resistant depression and mania, population health / epidemiology of mood disorders, seasonal depression, the role of nutrition in depression, the phenomenology of depression and mania, principals of maintenance therapy for depression. Schizophrenia Program Code Title Contact Info Description SCHZ-CE-01 Dual Diagnosis: Psychiatry of the Developmental Disabilities Inquiries: Dr. T. Gofine (905) x 6641 gofinet@ontarioshores.ca Supervisor(s): T. Gofine Place: Ontario Shores Time: TBA No. of Residents: TBA The Dual Diagnosis Service (DDS) at Ontario Shores Centre for Mental Health Sciences is one of the largest dual diagnosis services in Canada. The interested resident through an elective experience can gain expertise in this fascinating subspecialty, expertise that is in demand locally, nationally and internationally. Few psychiatrists realize that the incidence of schizophrenia in the intellectually disabled, for instance, is estimated to be three times that of the general population, or that anxiety disorders are estimated to be found in 75% of the mildly intellectually disabled. The challenge of discerning psychiatric symptoms within the severely disabled, or distinguishing autistic spectrum disorder from schizophrenia can be one of the most exciting clinical situations in contemporary psychiatry. The treatment philosophy of the service is based on the primary importance of crafting a diagnostic formulation that considers biologic, psychodynamic and social factors with detailed accuracy so that treatment plans can be rational and effective. Less common syndromes that have disordered behaviour, such as Smith-Magenis syndrome fall within the dual diagnosis population and are seen in both the outpatient and inpatient components of the service. The psychiatric assessment of the dually diagnosed includes clarifying at times complex medical issues; investigating the root cause of the disability from a clinical genetic point of view; and exploring developmental factors first seen in childhood and adolescence. The resident will have the opportunity to be directly involved in the assessment of patients via outpatient consultation and in the treatment of inpatients on the dedicated inpatient unit. Opportunities to be with patients in the community can be enlisted. The treatment team is multidisciplinary and a model of inter professional practice is followed; as a result, opportunities to learn the how the allied professions integrate into psychiatric care will be first hand. This

6 elective will enhance the training of a resident following a variety of care interests, from child and adolescent psychiatry (what is the natural course of autism in the adult?) to general psychiatry how does bipolar disorder present in the deaf intellectually disabled individual?) to geriatrics ( what are the needs of the ageing person with mild intellectual disability and chronic health issues?). The elective can be tailored for any duration. Academic interest through readings and participation in rounds and interest in a research project, would be supported. As well, blending an elective with a related clinical area within Ontario Shores such as adolescence or forensic would certainly be open for discussion. SCHZ-CE-02 SCHZ-CE-03 SCHZ-CE-04 Home Treatment of First Episode Psychosis Neuropsychology/Experimental Psychopathology Schizophrenia: the interface of clinical, environmental, and biological Inquiries: Ofer Agid, MD, (416) ext Supervisor(s): Ofer Agid, MD Clarke Site Time: three months (negotiable) No. of Residents: One Inquiries: Dr. B. Christensen, Supervisor(s):/Elective Titles: Dr. J.Addington, Psychotherapy/Early Psychosis Dr. A.Bassett, Clinical Genetics Dr. B.Christensen, Neuropsychology Dr. J.Daskalakis, Transcranial Magnetic Stimulation Dr. N.Kabani, Neuroanatomy/Structural Neuroimaging Dr. S.Kapur, PET Receptor Studies Drs.G.Papatheodorou & I.Epstein, Early Intervention Drs.G.Remington & S.Shammi, Pharmacotherapy of Schizophrenia Drs. M.Seeman, C.Benes & M.Dudek, Women and Schizophrenia Dr. A.Wong, Molecular Biology Dr. R.Zipursky, Studies of First Episode Psychosis Inquiries: Dr. G. Remington, ext Supervisor(s):/Elective Titles Drs. O.Agid, C. Balyut, G.Papatheodorou, Early Intervention Dr. A.Bassett,J.Kennedy,D.Mueller: Genetics Dr. J.Daskalakis: Transcranial Magnetic Stimulation Drs. A.Graff,M.Menon,R.Mizrahi,A.Voineskos: Neuroimaging Dr.T.George: Addictions Residents will serve as an intrinsic part of the Home Intervention Program for Psychosis (HIP) team. This team provides rapid homebased assessment and treatment of young patients experiencing their first episode of psychosis. Residents will gain experience working on a mobile multidisciplinary treatment team. Residents will gain expertise in the assessment, engagement and treatment of patients and their families who are experiencing their first episode of psychosis. These electives permit residents to understand the mechanisms of psychopathology in psychosis in terms of brain structure and function and interactive effects, to understand mechanisms of recovery in terms of drug action, learning, skills training, emotional and sociocultural influences, as well as to understand the subjective experience of psychosis. Residents can focus on specific issues of their choice. The electives will include supervised reading and academic discussions, supervision of clinical assessment skills, and differential diagnosis and formulation. These electives permit residents to understand schizophrenia from a number of perspectives. Residents can focus on a theme of their choice and negotiate with an identified supervisor to establish a strategy that is attainable and meets identified objectives.

7 Dr.S.Kidd: Rehabilitation Dr.K.McKenzie: Ethnocultural Dr.M.Menon: Neuropsychology Dr.G.Remington: Pharmacotherapy Dr. A.Wong: Molecular Biology SCHZ-RE-05 Neurobiology of Schizophrenia Inquiries: Dr Albert Wong, (416) ext Supervisor(s): Dr Albert Wong Time: Flexible No. of Residents: Flexible Residents will have the opportunity to participate in research projects in behavioural neuroscience. Examples of specific projects include analysis of neurodevelopment and histology of Disc1 mutant mice, testing of preventative interventions to alter developmental trajectory, and investigating gene x environment interactions in rodent models. Other topics include epigenomics, transgenerational heritability of epigenetic information, and DNA methylation correlation networks. Clinical projects include the use of virtual reality environments and fmri to probe spatial navigation and other cognitive functions in schizophrenia. SCHZ-RE-06 Schizophrenia: Pathophysiology/Treatment Inquiries: Dr. Anne Bassett, 416/ x2732 Supervisor(s): Dr. Anne Bassett Time: Flexible (Clinical Genetics) No. of Residents: 1 These electives permit residents to explore different aspect of schizophrenia and related psychoses, ranging from biological mechanisms to phenomenology and treatment. Residents can focus on specific issues of their choice. The electives will include supervised reading and academic discussions, supervision of clinical assessment skills, and differential diagnosis and formulation. SCHZ-RE-07 GENP-CE- 17) Schizophrenia and Continuing Care Inquiries: Dr. Soni, (416) ext Supervisor(s): Dr. J. Soni -Queen Street Division No. of Residents: 1 This elective allows residents to gain experience in the treatment of the severely mentally ill. Treatment will be based on inpatient with involvement with community outreach and assertive community treatment teams. In addition, the residents may wish to gain experience in management, planning and designing of mental health services. SCHZ-RE-08 GENP-CE- 18) Schizophrenia: Pathophysiology/Treatment Inquiries: Dr. B. Christensen x 6843 Supervisor(s)/lective Titles: Dr. J.Addington - Psychotherapy/Early Psychosis Dr. A.Bassett - Clinical Genetics Dr. B.Christensen - Neuropsychology Dr. J.Daskalakis - Transcranial Magnetic Stimulation Drs.G.Papatheodorou, I. Epstein - Early Intervention Drs.G.Remington, C. Shammi - Pharmacotherapy of Schizophrenia Dr. A.Wong - Molecular Biology These electives permit residents to explore different aspect of schizophrenia and related psychoses, ranging from biological mechanisms to phenomenology and treatment. Residents can focus on specific issues of their choice. The electives will include supervised reading and academic discussions, supervision of clinical assessment skills, and differential diagnosis and formulation.