5/23/06 TORONTO, CANADA
NOTE: The 2006 HAPA Annual Meeting Minutes was approved by the HAPA executive committee and were ratified at the 8th HAPA Annual Meeting in May 2007 in San Diego.
Honorary Guests at the HAPA 2006 Meeting:
APA President Steven Sharfstein and WPA President Juan Enrique Mezzich.
Members Present: Drs Christodoulou, Latoussakis, Lymberis, Papakostas, Vidalis, Papastrat, Daskalakis, Giouzepas J and Giouzepas C, Papatriantaphyllou, Stathopoulou, Doxas, Pramateutakis, Askitis, Marmarokopou,Singelakis, Grigoriou, Papakostas, Foussias Athanasios and Foussias Agoritsa, Zaphirapoulos, Georgiopoulos, Gatos, Albright, Petrides, Karagon, Zaphirapoulos, Eliot Sorel.
Members unable to attend: Drs Kalogerakis, Kentros, Agallianos, Stratas, Cassimatis, Cardasis, Lyketsos, Besseghini, Kanellopoulou, Kachoris,Pantelis-Siotis, Gerothanasis.
(1) Introductions
HAPA President Dr. Petrides opened the meeting at 7:00PM. He welcomed everyone to our meeting. He noted that he was very pleased to see so many members of the Hellenic Psychiatric Association attending. He expressed his interest in promoting greater collaboration between our two organizations and encouraged more HPA members to joint HAPA.
Dr Petrides welcomed our special honorary guests and introduced Drs Sharfstein and Mezzich.
(2) Presentation by Honorary Guests
Dr Sharfstein briefly spoke and welcomed all to the APA Annual Meeting. He expressed his appreciation for our invitation to our meeting. He praised our efforts in fostering greater cooperation and communication between APA HAPA members and members of the Hellenic Psychiatric Association. He noted that he recently had visited Greece for the 19th Pan Hellenic Congress. He loves going to Greece having attended several meetings there. He praised the quality of the scientific sessions and the Greek hospitality. He looks forward to future meetings in Greece. He expressed his interest in our scientific program and noted his regrets for being unable to stay to the conclusion of our meeting.
Dr Mezzich also spoke and expressed his appreciation for our invitation to our meeting. He talked about WPA’s close relationship with the Hellenic Psychiatric Association. He has attended several meetings of the Pan Hellenic Psychiatric Congresses and expressed his appreciation for the KOS Declaration of 2004 which was endorsed by WPA. He made a short presentation on WPA’s role in fighting mental illness. HAPA is honored to have had Dr Mezzich attend our meeting. He greatly contributed to our discussions.
(3) HAPA 2006 Annual Meeting Minutes
Dr Lymberis presented the minutes of the HAPA 2005 Annual Meeting which took place in Atlanta, Georgia . The minutes are posted on the HAPA Website. They were approved as written with minor corrections.
(4) Report on the 19th Pan Hellenic Congress
Dr Lymberis reported on the just concluded Athens Congress. This was yet another highly successful meeting. This was the 20th Anniversary of HPA. The occasion was celebrated with an Opening Ceremony at the newly built Athens Concert Hall. This was an impressive evening. The presentation of Greek songs by the Friends of Music was very moving. This Congress was a very well organized with high quality scientific presentations.
HAPA sponsored a special panel presentation chaired by Maria T Lymberis, MD on ECT Practice in Greece and USA. Our own President, George Petrides, MD gave the main presentation on “The use of ECT for the treatment of acute major depression and relapse prevention: results from a multicenter trial by the CORE group”. His outstanding presentation was followed by very good and comprehensive presentations by HAPA-HPA distinguished members: Ioannis Zervas, MD on “Cognitive Disturbances in ECT: A Review” and Ioannis Papakostas, MD on “Mechanism of ECT action”. This hour and a half session was attended by over 35 people who actively participated during the discussion period.
The 19th Congress was the last Congress to be organized by HPA under the leadership of Dr Christodoulou whose presidency of HPA concluded with the election of the next HPA President Nikolaos Tzavaras, MD at the end of the meeting. HAPA will be contacting Professor Tzavaras to congratulate him on his election, invite him to our organization and assure him of our continuing interest in maintaining the close relationship and collaboration that Dr. Christodoulou helped built between our two organizations over the last 7 years.
Dr Christodoulou will remain active in HAPA and work with HAPA in his capacity as Chair, WPA Standing Committee on Ethics; President, Hellenic Centre of Mental Health and Chair, European Division, Royal College of Psychiatrists
(5) HAPA President Elect Report
Dr Cassimatis was unable to attend. He send his regrets and wishes for a very successful meeting.
(6) Treasurer’s and Membership Report
Dr Latoussakis noted that HAPA’s membership has not been growing as much as we need it to. Our annual meetings are now our only source of income. Our expenses are our annual meeting and they include postage for mailings, the dinner and CME. These meetings are costly. We have no secretarial expenses and all of the work is by email. He noted that we may face a deficit next year unless we get more members or are lucky and receive a generous tax deductible contribution.
INCOME
HAPA Account balance as of 8/2005: $4,110.30
Dues received: $1,523.59
Total Income: $5,633.89
EXPENSES
HAPA 2006 Annual Meeting
1) Food & Taxes/Gratuity $3,145.20
2) Audio Visual/Taxes $753.83
3) CME and mailings $500.00
Total Expenses: $4,399.03
BALANCE AS OF 8/06: $1,234.86
(7) Hellenic Psychiatric Association Reports
Full reports on news from Greece were not presented due to the limitations of time. Dr Christodoulou gave a brief update about the WPA’s East European Division which is now heading. He is organizing major meetings and will send us their announcement to post on our website. Dr Vidalis has been very active in the north of Greece. He is continuing his work in the psychiatric community of Thessaloniki, a major center for psychiatry in the north of Greece. Due to the limitation of time he also was not able to give us an update on the various psychiatric meetings he is organizing. HAPA is already a cosponsor of one of his meetings the 4th Pan Hellenic General Hospital Congress. This meeting is scheduled for the spring of 2007 in Thessaloniki, Greece. Dr Vidalis will submit an announcement for this meeting to be posted on our website.
Dr Vidalis also reminded everyone that the Pan-Hellenic Society of General Hospital Psychiatry is inviting HAPA members to send articles for its journal “”Hellenic Psychiatry of the General Hospital Journal””. For more information visit their website <http://www.psychiatryjournal.gr.>
(8) HAPA Election of Councilor
Dr Cassimatis was absent and Dr Lymberis presented the report of the Nominating Committee for HAPA Councilor 2006-2009.
Kanellos Charalambous, M.D. has concluded his term of office as Councilor. We are thanking him for his work and support of HAPA. The office of HAPA Councilor 2006-2009 was opened for nominations. Ioannis Papakostas, MD was unanimously nominated for this office. There were no further nominations from the floor.
ACTION: The nomination of Dr Papakostas was accepted unanimously.
(9) HAPA BY LAWS AMENDMENT
The By Laws Committee submitted this for consideration.
Members are invited to submit comments by email.
A) PROBLEM
The current By-Laws need to be amended to provide for PhD psychologists to be full members of HAPA provided they are Members in Good Standing of the American Psychological Association or the corresponding professional organization of their own country. This change will not compromise HAPA’s plans to apply to the APA Assembly for designation as an Allied organization. The APA criteria for this designation are as follows:
1. the organization must have a minimum of 100 members.
2. 80% or more of the members are psychiatrists.
3. Two-thirds of the psychiatrist members are members of the American Psychiatric Association
Application should be made to the Committee on Procedures.
B) CURRENT BY LAWS AMENDMENT
The relevant current HAPA By Laws are as follows:
ARTICLE III Membership
Section 1. Eligibility. Only members of the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the Hellenic Psychiatric Association or comparable psychiatric associations in countries other than the United States will be eligible for membership in HAPA. The word, “”members,”” as used in the paragraph, will include any category of physician membership in that association.
Section 2f. Affiliate Members. Affiliate members are non-psychiatric physicians, other mental health professionals who are of Greek origin or Greek identified and live in the USA, Canada or in other countries.
C) PROPOSED AMENDMENT
1. ARTICLE III Membership
Amend Section 1. Eligibility. Members of the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the Hellenic Psychiatric Association or comparable psychiatric associations in countries other than the United States will be eligible for membership in HAPA. In addition, PhD psychologists members of the the American Psychological Association, the Hellenic Psychological Association or comparable psychological association can be eligible for membership upon the recommendation of the HAPA Membership Committee and approval by the HAPA Executive Committee that must ensure that HAPA remains in compliance with the APA Assembly rules.
2. Article III Membership
NO change in Section 2f
Voting on this amendment was deferred until we had more time for comments and discussion.
(10) Scientific Program
The presentations at this annual meeting were again excellent and generated a lot of discussion.
(I) The first presentation was by Ismene L Petrakis, MD
Associate Professor of Psychiatry Yale University School of Medicine. A summary of her presentation follows:
“Advances in the Treatment of Alcohol Dependence”
The lecture presented an overview of the use of medications in the treatment of alcohol dependence. By way of an introduction, the use of alcohol within our culture was reviewed. Alcohol has been used for thousands of years and the earliest fermented beverages were made from grains, fruits, cereals and honey. There are early references to the virtues of strong drink in the Talmud and Old Testament. Alcohol use was important culturally in Ancient Greece, and many references to alcohol use are seen in the literature. There was also early recognition that alcohol use could be problematic as well, with references to strong wine and intoxication in Old Testament, from Plato and Hippocrates.
Today, in US the lifetime prevalence is thought to be about 13% and 12-month prevalence about 8% of the general population. Alcohol use is associated with high cost to society in terms of health care cost. In Greece today, rates of problematic alcohol consumption are thought to be lower than that and may be as low as 2-6%.
In terms of treatment, pharmacotherapy can be an important component of treatment and medications can be used to treat alcohol withdrawal symptoms, to prevent relapse, craving and consumption and to treat psychiatric symptoms or disorders. Currently, there are 3 FDA approved medications to treat alcohol dependence and they include disulfiram (Antabuse), naltrexone (Revia) and acamprosate (Campral). Disulfiram is an aldehyde dehyrogenase inhibitor, and individuals who consume alcohol while taking disulfiram get an alcohol-disulfiram reaction characterized by flushing, shortness of breath, nausea and headache. Important research questions still being evaluated with disulfiram include what is its role in dually diagnosed populations? Naltrexone is an opioid antagonist with a modest effect on alcohol consumption. Recently an injectable form of naltrexone was approved for use by FDA. Acamprosate is a homotaurine derivative, recently approved in US and recommended for use only in post-detoxification phase. All three medications are approved for use in uncomplicated alcoholism, but many patients are dually diagnosed and research is still needed to develop treatment for these patients.
Three studies about dual diagnosis that were conducted using different methods and perspectives were presented. The first was a pilot study evaluating naltrexone in patients with schizophrenia and alcohol dependence. This study was a 12-week outpatient study and patients who were stable on neuroleptic, were randomized to naltrexone (50mg) or placebo. Patients assigned to naltrexone had a lower number of heavy drinking days and decreased craving compared to those assigned to placebo. There were no differences in scores of psychosis (Petrakis et al. 2004). The second study was a study of administrative data looking at naltrexone utilization in the VA system nationally. All patients with an alcohol dependence diagnosis treated within a certain window were included. Data from the pharmacy records were used to see how many patients were prescribed naltrexone. The rate of naltrexone utilization was very low, <2%, and factors associated with naltrexone use included presence of comorbid psychiatric disorders and recent psychiatric hospitalization, suggesting clinicians are more likely to use naltrexone in complicated alcoholism (Petrakis et al. 2003). The third study was a multi-site study evaluating naltrexone, disulfiram or the combination in a 12-week randomized trial in patients with alcohol dependence and comorbid Axis I psychiatric disorders. In this study, there was an open label randomization to disulfiram or no-disulfiram and a double-blind randomization to naltrexone or placebo leading to 4 cells: naltrexone alone, placebo alone, disulfiram +naltrexone, disulfiram + placebo. Those patients treated with active medication had a higher rate of consecutive days of abstinence compared to those on placebo, but there was no advantage of the combination (Petrakis et al. 2005). In a secondary analysis, patients with PTSD did well on active medication, particularly disulfiram (Petrakis et al. in press).
These studies focused on prevention of relapse, but there are other potential areas for treatment of alcohol dependence. One of the important areas clinically in the life course of alcohol dependence is the time between early sampling of alcohol (around adolescence) and the transition to alcohol dependence (by age 25). This is particularly important in individuals with a strong family history of alcoholism.
Acute alcohol subjective effects include both positive (high, feeling good) and negative (sedated, incoordinated) effects. Hypothetically if an individual experiences alcohol as particularly pleasurable or without negative effects, s/he may be more likely to drink. In fact, there is evidence that individuals with a family history of alcoholism, who are at higher risk to develop alcoholism, are less sensitive to the negative effects of alcohol ingestion.
In trying to understand this, several researchers are using “pharmacologic probes” to understand the underlying neurobiology of this effect. The most common neurotransmitter systems studied to date are the glutamate system and the GABA system. Ketamine is a NMDA glutamate antagonist, which has been used in our laboratory as a probe. Ketamine has alcohol-like effects and has more negative effects in healthy subjects than in recovering alcohol dependent patients (Krystal et al. 2003). In a study evaluating ketamine effects in healthy subjects with and without a family history, those with a family history of alcoholism had fewer negative effects to ketamine than those with out a family history of alcoholism (Petrakis et al. 2004). In fact the pattern of response was similar to the pattern in the alcohol dependent subjects compared to the healthy subjects. Ongoing studies are using similar methods to evaluate the GABA system using thiopental as a probe.
The implication of this research is that alterations in the glutamate and GABA systems has a role in alcohol dependence and in the vulnerability to develop alcohol dependence. Treatments aimed at “normalizing” these systems have not been tried but are intriguing possibilities for future research.
References:
Krystal, J. H., I. L. Petrakis, et al. (2003). “”Altered NMDA glutamate receptor antagonist response in recovering ethanol-dependent patients.”” Neuropsychopharmacology 28(11): 2020-8.
Petrakis, I. L., D. Leslie, et al. (2003). “”Use of Naltrexone in the Treatment of Alcoholism Nationally in the Department of Veterans Affairs.”” Alcoholism: Clinical & Experimental Research 27 (11): 1780-1784.
Petrakis, I. L., D. Limoncelli, et al. (2004). “”Altered NMDA glutamate receptor antagonist response in individuals with a family vulnerability to alcoholism.[see comment].”” American Journal of Psychiatry 161(10): 1776-82.
Petrakis, I. L., S. O’Malley, et al. (2004). “”Naltrexone Augmentation of Neuroleptic Treatment in Alcohol Abusing Patients with Schizophrenia.”” Psychopharmacology 172: 291-297.
Petrakis, I. L., J. Poling, et al. (in press). “”Naltrexone and Disulfiram in Patients with Alcohol Dependence and Comorbid Depression or Post Traumatic Stress Disorder.”” Biological Psychiatry.
Petrakis, I. L., J. Poling, et al. (2005). “”Naltrexone and Disulfiram in Patients with Alcohol Dependence and Comorbid Psychiatric Disorders.”” Biological Psychiatry 57: 1128-1137.
(II) The second presentation was by George N. Christodoulou, MD
Professor of Psychiatry, University of Athens, Greece and Immediate Past President of the Hellenic Psychiatric Association; Chair, Standing Committee on Ethics, World Psychiatric Association; President of the European Division of the Royal College of Psychiatrists.
His talk on ETHICS IN PSYCHIATRY: FROM HIPPOCRATES TO THE WPA DECLARATION ON ETHICS was a power point slide presentation. You can access it as follows: The presentation was a very comprehensive and generated a lot of interest.
To download the presentation as a PDF file, CLICK HERE.
(11) Adjournment
The meeting was adjourned at 10:30PM
The next HAPA Annual Meeting will take place on 5/22/07 in San Diego, California in connection with the APA 2007 Annual Meeting.
Respectfully Submitted
Maria T. Lymberis, MD
HAPA Founder & Past President”
