Competitive psychiatry got a boost in April when three young researchers
stepped into the arena and presented their results before throngs (well,
dozens) of fellow residents and other members of the Brooklyn Psychiatric
In the town that gave the world the Dodgers, a famous bridge, Nathan's hot
dogs, and the transgressive poetry of Walt Whitman, residents from the
borough's three psychiatry programs squared off at Brookdale University
Hospital Medical Center for the 19th annual contest sponsored by the Brooklyn
"It's the Super Bowl of Brooklyn," said Ramaswamy Viswanathan,
M.D., D.Sc., an associate professor of clinical psychiatry and director of the
consultation-liaison service at the State University of New York Downstate
Medical Center. He founded the competition in
Sports were more than a metaphor, as a member of the audience was appointed
to ring a bell for the two-minute warning near the end of each 15-minute
Watching the proceedings were partisans from all programs and three judges
who had reviewed their share of papers in their careers: Deborah Cross, M.D.,
president of the New York State Psychiatric Association and director of the
adult outpatient psychiatric clinic at Westchester Medical Center in Valhalla,
N.Y., and an associate professor of clinical psychiatry at New York Medical
College; Fryderyka Shabry, M.D., director of psychiatry at Coney Island
Hospital; and Alan Schatzberg, M.D., a professor of psychiatry and behavior
sciences at Stanford University and APA's president-elect. Contestants were
judged on both the content and style of their presentations.
Peng Pang, M.D., representing Maimonides Medical Center in Brooklyn, got
the evening off to a smooth start with a talk on the utility of tai chi chuan
in improving the quality of life and reducing depression and anxiety for
cancer survivors. Tai chi evolved from Chinese martial arts 700 years ago. It
emphasizes controlled, fluid movements and includes both physical and
Her review of prior literature found 13 randomized, controlled studies with
730 subjects on the topic. Most patients had some sort of physical limitations
restricting their participation in conventional exercise.
Some studies used sham exercise as a control and found there was no
difference physiologically, but sham exercise produced different outcomes
compared with tai chi, said Pang. The theoretical basis of any effect was
unknown, despite comparisons with physical exercise, reading, and
A meta-analysis of the studies found positive outcomes for quality of life
in cancer patients. However, studies of anxiety and depression were so varied
that it was impossible to draw significant conclusions of tai chi's
Pang also presented the design of a study intended to answer many of the
questions raised by her meta-analysis, including intragroup differences and
Next, Brookdale's own Marina Smirnov, M.D., stepped into the ring,
accompanied by raucous cheers from her disproportionately numerous fellow
residents in the hall.
Smirnov discussed the role of clinicians' religious and spiritual beliefs
in clinical practice.
"Psychiatry and religion provide alternative ways of looking at
life," she said. The two have not always played together nicely,
reminding the crowd of Freud's view that religion was an obsessional system
bordering on mental illness.
While religion and spirituality are often used interchangeably, the former
should be seen as organized systems of beliefs and practices, while the latter
is more of a subjective, internal appreciation of the divine, she said.
In a survey of fellow Brookdale clinicians, Smirnov found few significant
differences in their spiritual beliefs when viewed through the lenses of
gender, religious attitudes, and prescribing status. The only significant
variable was how much patients talk about these issues.
"Clinicians didn't let their own beliefs influence discussions with
patients on religious or spiritual issues," she said. "If patients
talk more about these concerns, the clinician became more willing to include
them in the discussion."
Regardless of their own religious or spiritual beliefs, clinicians should
be sensitive to patients' beliefs, she concluded before leaving the stage to
loud cheers from her fans.
After those two presentations, Carolina Klein, M.D., carrying the flag for
SUNY Downstate Medical Center, had her work cut out for her. She rocked the
audience immediately with a sudden shift in strategy to biological
Carolina Klein, M.D., a fourth-year resident at SUNY Downstate Medical
Center, took first place in the competition.
Credit: Aaron Levin
Klein reported on a study examining the interaction of early life stress
and Substance P in bonnet macaques. Substance P is a neuropeptide associated
with psychopathology. The monkeys were stressed with variable foraging demands
(VFD), in which they always received enough food but sometimes it was hidden
within their cages, forcing them to search for it more intensively. Klein and
her fellow researchers found that presented with these alternating high and
low foraging demands, the macaques tended to cling more to their mothers after
weaning but also showed less "huddling," a measure of social
interaction. However, there were no significant differences in Substance P
levels between VFD and non-VFD
Upon closer examination of the VFD group, they found that infant macaques
that had clung more closely to their mothers had higher levels of Substance P
as adolescents, while those that were more independent as infants had lower
Substance P levels as adolescents.
"The lesson is not that Substance P causes elevated dysregulation of
neurochemicals, but that it shows the vulnerabilities of the
Klein, too, left the stage to cheers from her visiting fans.
The three judges did some huddling of their own outside the hall as Pang
retook the stage for a brief demonstration of the stately art of tai chi.
Cross, Shabry, and Schatzberg returned with a unanimous decision in Klein's
favor, a decision that garnered her bragging rights in Brooklyn for the next
year and a check for $250. The runners up each received $125 for their
Klein is not on a research track in residency, but getting involved in
research adds scientific rigor to residents' training, she said, as she took
congratulations from fellow Downstaters.
"We gain a skill in doing research instead of just learning the
outcomes," she said. "I think it also allows us to read the
literature more critically."
"All the presentations were excellent, but Klein's won the consensus
vote of the judges," commented Schatzberg afterward.
But there was more to the competition than intraborough glory and the
winner's check, he added. "It promotes the intellectual and professional
development of the residents and it gets them involved with their district
branch and APA."
Inspired by the Brooklyn DB contest, a similar contest has been started by
the Queens DB, and a written-paper contest has been started by the New York
State Psychiatric Association, said Viswanathan.
Schatzberg would like to see a similar program with nationwide scope. In
any case, while he was the first APA president-elect to judge the proceedings,
he will not be the last. The incoming president-elect, Carol Bernstein, M.D.,
has agreed to be a judge of next year's contest, and Viswanathan hopes that
creates another new tradition. ▪