Biobehavioral health, fetal development, World Psychiatric Association: Upstate's HealthLink on Air for Feb. 2, 2025

[00:00:00] Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," we'll hear about a new unit for children with mental health needs and developmental disabilities.

"...We typically see that children have about three different behaviors that need to be addressed while they're inpatient. And they also need to have their medications adjusted or stabilized..." Then we'll discuss the importance of monitoring fetal growth during pregnancy.

[00:00:23] Timothy Canavan, MD: "...Heart defects occur in approximately one in every hundred pregnancies. The actual is actually 0.8%. So just about 1% of moms who get pregnant have a baby with a heart defect..."

[00:00:34] Host Amber Smith: And we'll learn about the role of an Upstate psychiatrist who will become president of the World Psychiatric Association.

[00:00:40] Thomas Schulze, MD: "...It's the umbrella organization trying to advance psychiatry. That's the mission: Advance psychiatry all over the world, advance mental health all over the world..."

[00:00:50] Host Amber Smith: All that and a visit from The Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll learn some steps moms can take to reduce the risk of birth defects. Then, Dr. Thomas Schulze will tell about the World Psychiatric Association. But first, a look at Upstate's new biobehavioral health unit.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Upstate recently opened a biobehavioral health unit to treat children with mental health needs and developmental disabilities. Today I'm talking with Dr. Henry Roane, the program director. He's also a professor of pediatrics and the executive director of the Golisano Center for Special Needs at Upstate. Welcome back to "HealthLink on Air," Dr. Roane.

[00:01:52] Henry Roane, PhD: Thanks, Amber. Thanks for having me.

[00:01:55] Host Amber Smith: I understand this is the first facility of its kind in New York state and one of only a handful nationwide. Can you tell us about it?

[00:02:03] Henry Roane, PhD: Sure, yeah. There are probably about 15 of these programs in the United States, which functionally is, all of the programs that exist in the world are in the United States, save one. So it's really a unique program. And the reason it's unique is that it cares for children with developmental disabilities, specifically who have comorbid psychological conditions like anxiety. And a lot of times those behaviors come out as very forceful, aggressive behavior toward other people or toward their surroundings or toward themselves.

And so developing a program like this requires a certain level of staffing that most places don't have. It requires a certain physical environment that most people have difficulty building. And then it requires a certain level of expertise from the providers that there just aren't a lot of people who specialize in this. And we have a collection of them here at Upstate.

[00:03:05] Host Amber Smith: So what ages, when we talk about children, what ages are we talking about?

[00:03:10] Henry Roane, PhD: It's five to 17. Generally we see that children under the age of five tend to have behaviors that we can handle on an outpatient basis or maybe toward a little bit milder forms of parent training or things that we might not require an inpatient admission. And then 17 is just the regulatory guidelines. So a child can turn 18 while they're in the program, but they cannot be admitted if they're 18.

[00:03:36] Host Amber Smith: And do they come from the counties surrounding Syracuse?

[00:03:40] Henry Roane, PhD: So right now all of the children are in kind of a two-hour radius of Syracuse. When we opened, we opened with two beds, and then we're slowly ramping up as we hire more staff. And so we anticipate serving children from across New York State. When we developed this program, it was in collaboration with the Office of Mental Health and the Office for Persons with Developmental Disabilities, both of which were based out of Albany, and they were quite clear that they wanted us to serve the entire state.

[00:04:09] Host Amber Smith: Now is the unit part of the hospital?

[00:04:12] Henry Roane, PhD: It operates, I believe, under the hospital's operating certificate, with kind of a mental health coverage umbrella for the services that we provide, as well as the adolescent psychiatry services that are also provided elsewhere in the building.

[00:04:27] Host Amber Smith: I see. And how long might the inpatient stay be?

[00:04:33] Henry Roane, PhD: We target about six weeks. And so it's an intense program, but there is flexibility in that. You know, if it takes seven weeks or five weeks, that's perfectly fine too. But we generally plan, in terms of sort of where we want to be in the progression of therapy, we generally plan that around a six-week window.

[00:04:57] Host Amber Smith: Now before this unit opened, what did families do that needed this care?

[00:05:04] Henry Roane, PhD: Well, a family from Syracuse faced about a five-hour drive to get inpatient care, so that would probably be Baltimore. Or there's a place, I think, in Rhode Island that has a program that does stuff like this. Many of these children, unfortunately end up getting placed out of their homes, and they might go live in a residential placement where there's, say, a special school or something like that. And so, the goal, really, and the best outcomes for the child, in most cases, is to keep them with their family as long as you can and to keep them with their loved ones. And so that's the goal of this program is to sort of return them into those environments.

[00:05:41] Host Amber Smith: And I understand that you use family centered care. Can you explain what that is and what that involves?

[00:05:46] Henry Roane, PhD: Mm-hmm. Yeah, sure. So the admission is broken up into kind of two phases, and families are involved in both.

And even prior to admission, all of the intake information that we get comes from a family. So they fill out this questionnaire, rather lengthy, to say, these are the problems and basically this is how much, how impactful it is on our daily life. And then of course when the child's admitted, we do a full orientation with the family. We have visitations so parents can come and observe the therapy that we're doing, or also just come and spend time with their child.

In terms of the first phase of therapy, that's really driven by our clinical staff, and the notion there is to develop a treatment where we start to understand the reason why the child engages in the behavior. So, say, why they engage in an aggressive behavior. And then we start to develop a treatment to teach the child a set of replacement behaviors, but oftentimes communication. So instead of hitting people to get what you want, I teach them to ask to get what they want. It's obviously not quite that simple.

And then we do that with medication adjustments as well, as many of these children are on a range of medications. And so our staff kind of take it on the front end, and then the parents come in and they can observe. They meet with the clinical supervisors, and so we're kind of, at that point, teaching the rationale for the treatments and showing them kind of what we're doing. Then the second component is moving past that teaching and showing to more of a doing phase, and we do that actually a little bit on inpatient, but also a lot on outpatient after discharge where that's when the parents are the ones conducting the therapy. And so we train them just like we would train staff, but instead of training staff to do a whole host of different interventions, we train the parents to do the intervention specifically for their child.

And we do that because they're the ones who are going to be owning it in the real world. And so we've got to make sure they feel pretty competent to do it.

[00:07:46] Host Amber Smith: Are siblings involved along with the parents?

[00:07:49] Henry Roane, PhD: Absolutely. Siblings are huge part of it. Sometimes we see children who aggress almost exclusively toward their siblings, and so we have to have a plan for that. But sometimes the siblings are part of that caretaker team. So are aunts, uncles, grandparents, whoever else. And so we certainly will train any of those folks who might be helpful for the long-term care of the child.

[00:08:11] Host Amber Smith: So what happens when the child is ready for discharge?

[00:08:16] Henry Roane, PhD: So we determine discharge based on the child's unique goals.

We typically see that children have about three different behaviors that need to be addressed while they're inpatient. And they also need to have their medications adjusted or stabilized, or essentially worked out. And so, in order to do that, when the child's on the inpatient unit, we're collecting a ton of data on the amount of times that they engage in aggressive behavior or how often they communicate to get what they want or what have you -- bowel movements, eating, I mean, we have a ton of data that we collect.

All those things are used to show us how is the medication affecting behavior, how is the other treatment affecting behavior, and we set the treatment targets to where when a child's admitted, we collect what we call baseline data, and that just tells us in the absence of treatment, here's how much this behavior occurs. And so we might find a child who engages in something, hits themselves two times a minute, say. And from that we develop a percent reduction we want to get at, so we want to reduce the behavior by 80 to 90%. And so we continue to modify the treatments until we get to that point, and then we introduce it at multiple places across the building and, so classroom, living room, a bedroom, et cetera.

And then when the child shows mastery of those skills across multiple settings, and with sustained reductions in problem behavior, that's when they've met their discharge goals, with medications being stable as well.

[00:09:48] Host Amber Smith: This is Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking with Dr. Henry Roane about the new biobehavioral health unit, of which he is the director.

So how would families connect with you? Are they referred by their pediatrician or do they arrive from the emergency department?

[00:10:06] Henry Roane, PhD: Right now they can be referred by pediatricians, psychiatrists, Office of Mental Health, Office of Persons with Developmental Disabilities, community agencies, or they can refer themselves. We are not able to take admissions directly from the emergency room at this time. We don't have a system in place for that. We're designing a complimentary system to do that. But right now, the children are all referred from a variety of sources.

We meet a couple of times a week to review all of the referrals that come in. We have someone who's a nurse navigator who essentially coordinates all of the intake information that's coming in. And then we have a group discussion involving a number of different disciplines to assess whether or not the child's appropriate. And then, if they are, they slot into the schedule in terms of when they would be admitted.

[00:10:58] Host Amber Smith: So what can the family expect if they're recommended for services? Do they wait to hear when they'll be able to get in?

[00:11:07] Henry Roane, PhD: So the first step is that, they'll be referred and we'll send a screener packet, which is just really kind of a short questionnaire to get a sense of, is the child displays the kind of common behaviors and diagnoses that we think we can help. And so, a child who has intellectual disabilities, autism and who is aggressive and has some anxiety, would be an appropriate candidate. Someone who's a youth who had been a violent sex offender would not be appropriate.

And so we have a screener that tells us that. Once you get through that point, we send them a formal packet to complete, an intake packet. And that gets into a much deeper dive in terms of the child's history and medical history and their behavioral concerns, who the care providers are, all of these other things. And then from that we slot them into an admission date.

And so we, as I said, we're growing the program in a stepwise fashion. And so, we opened with two rooms. Next month we're going to go to four rooms and then gradually increase from there. And so children are kind of the combination of the acuity of the case when the referral came in, and then when we have a slot open. And we work with the families for repeated contacts from our nurse navigator to just kind of keep them apprised of that.

[00:12:26] Host Amber Smith: What, if anything, does the child bring with them from home?

[00:12:30] Henry Roane, PhD: They bring all kinds of stuff. We had a child, actually our first patient, broughta bunch of stuffed animal, or stuffed toys that were kind of Christmas themed and favorite blankets. Many of the children do bring in iPads because that's what they communicate on. A lot of the children we see don't speak, or they don't speak very well, and so they use what is called an augmentative communication device, which is often an app on an iPad. And so a lot of children will bring that in.

And then we have, certainly, we're open to them bringing in favorite toys. If they have a Thomas the Tank Engines that they love, they certainly can bring those in. But, we've also done quite a bit of work to figure out what kind of toys to stock the unit with. And so we have a lot of things there as well. We certainly are open them to bring in education materials, family pictures, blankets, all those things.

[00:13:25] Host Amber Smith: What about schooling while they're there? Do they bring studies from their school?

[00:13:31] Henry Roane, PhD: They do.It's technically the responsibility of the school to coordinate that, but we help to facilitate that.

We have a teacher on site, and so that kids get a certain amount of schooling every day. The amount depends on their age. We have two classrooms in the building. And so, one of the classrooms is set up for more group academic instruction, so sort of traditional academics like say, working on language arts, for example.

And we have another classroom that's set up for people whose education goals might be more vocational focused or life skill focused. And so that room looks a little bit less like a traditional classroom but is also an educational space. And then the teacher, along with our staff, are responsible for implementing the education plan every day.

[00:14:20] Host Amber Smith: How much interaction do patients have with other patients?

[00:14:25] Henry Roane, PhD: That's a really good question because we don't, we can't really do group therapy with patients like this because they tend to be aggressive, and they aggress sort of indiscriminately for the most part toward other people. And so we can't really put two patients sitting side by side in, like, a circle, for example, because they'll likely do something to each other. And so we can do group, like, living room activities, for example, or kind of social skills where we have two kids, for example, and then maybe three staff members who are in the room with the child just to sort of make sure they're not getting too close to each other, just so we can make sure they're staying safe.

[00:15:08] Host Amber Smith: And do the parents participate every day? Are they present there at some point every day?

[00:15:13] Henry Roane, PhD: Right now parents are not there every day because of who the patients are and their unique situations and how far away their families live. It's just not practical for them to come every day.

There are visiting hours every day, so that option's there. But at this point we don't mandate daily parent attendance. I think down the road when a child gets closer to discharge, when they're ready to leave the program, then we do have sort of these mandated days where the parents need to come in.

But they certainly can come visit every day. I would expect a very local family would probably do that.

Well thank you so much for making time to tell us about the biobehavioral health unit.

Yeah. Well thank you for having me.

[00:15:57] Host Amber Smith: My guest has been Dr. Henry Roane, the director of Upstate's new biobehavioral health unit. He's also a professor of pediatrics and the executive director of the Golisano Center for Special Needs at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Monitoring fetal growth can detect potential birth defects - next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Today I am talking about the importance of fetal development with Dr. Timothy Canavan, professor and chair of obstetrics and gynecology at Upstate. Welcome to "HealthLink on Air," Dr. Canavan.

[00:16:38] Timothy Canavan, MD: Thank you for inviting me.

[00:16:41] Host Amber Smith: I know your area of expertise is maternal and fetal medicine. So let's start by talking about fetal growth. How does a woman and her doctor know that her baby is developing in a healthy way?

[00:16:53] Timothy Canavan, MD: So, doctors do a number of things when people come in for a prenatal visit to make sure that the baby is growing effectively.

First, you focus on the mother, so we get the mom's weight. We get her urine to check and make sure that's good. We get her blood pressure. And we measure her fundal height, which is the size of her belly, how big is her belly getting. We actually measure it from the bone, just under your belt buckle to the top of the uterus, which by five months is about at your belly button. And just making sure that that is slowly increasing in size as the woman gets more pregnant.

[00:17:33] Host Amber Smith: And then what about the baby? How are you able to monitor the baby's development?

[00:17:39] Timothy Canavan, MD: So the baby's growth is partially by the fundal height, but also women will get a routine ultrasound in the majority of cases around five months. So that will take a look at the size of the baby. The size of the baby is determined by comparing the baby on that ultrasound to other babies that were considered to be normal at birth, comparing the sizes of various things, the size of the head, the size of the belly, the size of the upper part of the leg to normal women that had normal births, to make sure the size of the baby is where we would expect it on that ultrasound.

Whether we get another ultrasound depends on other things like the mom's weight gain and her health and the fundal height as to whether we might check the size of the baby later. But a majority of women do get a second ultrasound or sometimes a third one later in pregnancy to monitor the actual size of the baby.

[00:18:34] Host Amber Smith: So is five months, at that first ultrasound, is that the earliest that abnormalities are detected typically?

[00:18:42] Timothy Canavan, MD: Most of the times that's the ideal time to start with looking at the baby with ultrasound. It's big enough now that at that point we can get measurements that give us more information about the size of the baby. But you can actually detect growth abnormalities, even going back to four months, which would be 16 weeks. And so sometimes we will do that in women that have had early pregnancy complications in the past or are at risk to have pregnancy complications.

[00:19:08] Host Amber Smith: What are the most common abnormalities in fetal growth?

[00:19:13] Timothy Canavan, MD: So fetal growth is kind of evaluated in two aspects. One is referred to symmetrical growth restriction, or basically slowed growth. Everything is small, and that usually indicates a certain classification of problems, as opposed to asymmetrical growth where the baby is favoring growth of the heart and the brain. So the chest and the head tend to be a fairly normal size, but the rest of the baby, the limbs are small because the baby is shunting blood nutrition to the heart and brain in favor of those organs because there is an environment of low nutrition that the baby recognizes and therefore is shunting the blood to those particular organs because they're the most important, and you end up with an asymmetric growth pattern.

[00:20:07] Host Amber Smith: So if you notice that asymmetric growth pattern, can it be corrected in the last part of the pregnancy?

[00:20:16] Timothy Canavan, MD: There's certain things we do, but we can't completely fix it most of the times. But certainly if the woman is in a situation where her nutrition is poor, and that happens in countries in war torn areas where nutrition is hard to get by, people who are in poverty and have food scarcity, which happens in the United States as well. You know, sometimes if we recognize that, we can use nutrition to drive fetal growth and we can correct some of that.

Those babies that are undernourished tend to be symmetrically small, although not always. Babies who are small asymmetrically -- this may be due to a placental issue. It may be due to a maternal issue, like the mom has a poor heart, or she has diabetes, or she has lung disease, or she's had an event in her pregnancy that has affected her lungs, like COVID, that have resulted in the baby getting a sudden loss of nutrition, and therefore asymmetric growth restriction can occur.

[00:21:15] Host Amber Smith: Can you detect cancer before a baby is born?

[00:21:18] Timothy Canavan, MD: In terms of the baby having cancer?

[00:21:20] Host Amber Smith: Right.

[00:21:21] Timothy Canavan, MD: We can see tumors growing, so we can know that. We can't pick up all types of cancers, but the majority of cancers in babies tend to lead to growths that we can clearly see on ultrasound. And so we know that we have a problem, basically on the fact that there's a mass growing.

[00:21:40] Host Amber Smith: What do you ask moms to do to reduce the risk of birth defects?

[00:21:46] Timothy Canavan, MD: The most obvious, and anybody who's been pregnant gets this kind of discussion with their doctor, is obviously you want to avoid cigarette smoking, tobacco use in general, vaping. We're a little skeptical about vaping because we're just not exactly sure what's in those fluids that people are vaping. Some of it's nicotine, but a lot of it's chemicals that provide flavors that we don't know what it does in pregnancy.

Alcohol consumption can cause problems. Medications, there are some medications that can affect babies and so if you're on a medication for a medical problem, you should talk to your doctor. You shouldn't just stop the medicine because the disease might be more dangerous to the baby than the medication. So it has to be checked.

We also like women to take folic acid before they actually conceive in order to protect the nervous system, which relies on folic acid for regular development.

Clearly light exercise is important. You don't want to start an exercise program once you're pregnant, but being in good physical condition, a good weight, is also important. All these kind of things reduce the risks for growth problems and birth defects prior to getting pregnant. That's why we really want women to think about being pregnant, prepare, and then get pregnant, which doesn't usually happen, but we always like to try to encourage it.

[00:23:02] Host Amber Smith: This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with Dr. Timothy Canavan, the professor and chair of obstetrics and gynecology at Upstate.

I'd like to ask you about heart defects. How often are babies born with a heart defect?

[00:23:18] Timothy Canavan, MD: Heart defects occur in approximately one in every hundred pregnancies. The actual is actually 0.8%. So just about 1% of moms who get pregnant have a baby with a heart defect.

[00:23:29] Host Amber Smith: And can you detect this before the baby's born?

[00:23:32] Timothy Canavan, MD: They usually detect heart defects at that 20 week, that five month ultrasound. Although ultrasound can only pick up about, say, 70% to maybe 80% on a good day of heart defects in babies. Some heart defects are too small or do not manifest obviously on ultrasound until later in the pregnancy. So at 20 weeks, it's about 70% that we can pick up heart defects.

[00:23:57] Host Amber Smith: Now, are these generally problems with the heart valve or the heart pumping function? What is typically a heart defect? What does that typically mean?

[00:24:07] Timothy Canavan, MD: There's two classifications of heart defects. One is structural, and that's what we pick up the most, the most common one being a ventricular septal defect, which is a hole in the little membrane that separates the two sides of the heart. And although that's the most common, it's also the least problematic. Many of those will close spontaneously without any intervention by physicians, like surgery.

The other things are problems with the valves where a valve is too small, where a valve doesn't develop, or where the big blood vessels that come out of the heart do not go in the right directions. You know, the right side of the heart should feed the lungs, and the left side of the heart feeds the body with blood. And sometimes those two sides do not orient themselves right, and you have transposition, or the vessels switch, and the left side of the heart is pumping blood into the lungs, and the right side of the heart is pumping blood around the body. So there's a number of different types of heart defects that can occur.

[00:25:05] Host Amber Smith: And are most of them treated surgically after the baby's born?

[00:25:10] Timothy Canavan, MD: There are some which require no intervention, like the small hole between the two sides of the heart can close spontaneously. Critical heart defects -- which are about one in every four babies who have a heart defect, have a critical heart defect -- those are almost always treated surgically. Some of them are very complicated. Some of them require more than one surgery to repair.

[00:25:34] Host Amber Smith: Can you explain what the placenta is and its role in congenital heart disease?

[00:25:40] Timothy Canavan, MD: The placenta sort of takes two roles. The first is, its primary role is nutritional support of the pregnancy, so it provides oxygen and nutrients to the baby so that it grows effectively. It also sort of protects the baby. It provides an isolated environment so that another person can grow within a person and not be rejected, right? Because when you give an organ to somebody, you have to give them medication to protect that organ because our body wants to destroy it. A baby is a foreign body too, and so the placenta protects that.

The other thing the placenta also performs is, it provides fluid that surrounds the baby. Some of the fluid does come from the baby as well. The placenta also is sort of the black box of the pregnancy. It sort of gives us a historical record of how the pregnancy proceeded so that doctors can sometimes use the placenta to figure out why a baby didn't do as well as we perceived it should have. And so it's sort of a retrospective way for us to investigate a pregnancy that may have had some complications.

[00:26:47] Host Amber Smith: Can you tell us about the fetal origins of adult disease hypothesis?

[00:26:52] Timothy Canavan, MD: So there was a physician in the UK, the United Kingdom, England, who in 1986 was looking at ischemic heart disease, so heart problems like heart attacks, blocked blood vessels, in Wales and England. He noticed that the rate of ischemic heart disease in older adults, 50-, 40-years old, correlated with neonatal or baby deaths in the same areas. And when he looked, he found that babies that had poor nutrition or babies that had very poor growth, either during fetal life, pregnancy, or shortly after neonatal life, had a higher rate of ischemic heart disease in these geographic areas.

And so he hypothesized that there is a fetal origin to adult disease, and that's where that hypothesis came from. He published his paper in 1986 in Lancet, which is an English publication, a medical journal, and this is where that whole hypothesis came about, that a fetus or a neonate that has poor nutrition or poor support of growth can lead to adult diseases.

[00:28:03] Host Amber Smith: So is this seen in both developed and developing countries, equally?

[00:28:09] Timothy Canavan, MD: Yeah, it's seen equally throughout the entire world. It's seen more obviously in developed countries because our health is better. So when someone has poor health, it's easily recognized. And in developing countries, countries that have a lot of poverty, there's a lot of disease related to the poverty itself and the infrastructure of those countries. So it's a little hard to tease out, but it occurs universally. It's a human, it's a human being problem, in terms of fetal growth and adult disease.

[00:28:42] Host Amber Smith: So in addition to heart disease, what are some other examples of fetal conditions that lead to adult disease?

[00:28:50] Timothy Canavan, MD: So, nutrition and fetal growth seem to be the primary factor that influences later disease in adults. But most of the times it's ischemic heart disease, diabetes, obesity, and some people have related it to possibly blood pressure and stroke. Although the data on those is a little weaker, probably because there's a number of factors that would play a role in those problems, not just the fetal origins, but also our environment and our lifestyle. But those are the major things that influence the fetal origins of adult disease.

[00:29:28] Host Amber Smith: So are you saying that things like the mom's, when the mom is pregnant and if she chooses to smoke or she has a bad diet or she doesn't exercise, does that contribute to later adult disease for her child?

[00:29:42] Timothy Canavan, MD: There is an hypothesis that yes, it does. More than likely it is severe malnutrition that either comes from food scarcity as a result of poverty or potentially war torn areas or areas that have plagues or major disease factors that result in women having an environment that's not as protective for a healthy pregnancy. Maybe the woman doesn't smoke, but she lives in a home with five other people that smoke. And so she's exposed to secondhand cigarette smoke, which people don't pay a lot of attention to but can certainly be almost like smoking.

Women who have drug disorders. That's why we're very aggressive trying to help women who have opiate use disorder and addiction because those kind of things lead to women not paying attention to their health. It's not only that they take a drug that affects their cognitive abilities, it also makes them not pay attention to their own health. So it's really related to nutrition and the health of their environment.

[00:30:44] Host Amber Smith: What about stress? Because I'm thinking of, like you mentioned, the war torn countries and the stress. Does that have an impact on the developing baby?

[00:30:52] Timothy Canavan, MD: Accumulating evidence that significantly stressful environments for women who are pregnant affect fetal growth and development.

I don't think the data is as conclusive as it is for malnutrition, but certainly women who are under the significant stress and that could be living in a home where there's a violent individual, not just in a war-torn country with that day in and day out stress of possible being the recipient of violence or mental abuse can certainly have an adverse effect on fetal development. And that goes even into behavioral health and mental health for women who are pregnant, who have significant environments that lead to mental health disorders, probably that affects their fetal development and growth.

[00:31:34] Host Amber Smith: So can proper prenatal care reverse this?

[00:31:40] Timothy Canavan, MD: Certainly there is a point at which there is no return, so certainly early good prenatal care can prevent these outcomes. Once we start seeing these kind of changes, it's very hard for us to reverse them unless it's a significant malnutrition issue. Certainly taking women out of stressful environments, putting them in safe environments, getting them good nutrition definitely improves their outcome for their pregnancy, regardless of when we identify those problems. But there is a point at which we can't really make a big change. You know, once you're within the eighth month of pregnancy, we're probably not going to be able to have an impact on that.

[00:32:18] Host Amber Smith: Well, Dr. Canavan, your work is very interesting. Thank you for taking time to tell us about it.

[00:32:23] Timothy Canavan, MD: You're welcome. And I'm delighted to have gotten an opportunity to speak a little bit about the health and wellbeing of pregnant women.

[00:32:29] Host Amber Smith: My guest has been Dr. Timothy Canavan, professor and chair of obstetrics and gynecology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" - the president-elect of the World Psychiatric Association is an Upstate psychiatrist.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Dr. Thomas Schulze is the president-elect of the World Psychiatric Association, which is a global group representing 147 psychiatric societies in 123 countries. Dr. Schulze is a professor of psychiatry and behavioral sciences at Upstate, and he agreed to talk about the association and his upcoming role.

Welcome back to "HealthLink on Air," Dr. Schulze.

[00:33:17] Thomas Schulze, MD: Well, thanks very much. Thanks for having me. It's a pleasure and an honor.

[00:33:21] Host Amber Smith: Please tell us about the World Psychiatric Association. When and why did it begin?

[00:33:27] Thomas Schulze, MD: Well, the World Psychiatric Association has been around for over 60 years now. It is the global umbrella organization, as I may say, for national psychiatric associations.

So what does it mean in national psychiatric associations? In America, you have the American Psychiatric Association. So I'm here in America, and in Germany, we have the German Psychiatric Association, and so, many countries have their psychiatric association or several basically professional organizations representing the psychiatrists in that country, in that region.

And at one point, several of these associations thought, well, it would be a good idea to join forces and to have an international body representing our core values, our core ideas and our core mission. And that's how the World Psychiatric Association came into existence, and now, as you pointed out, there are 147 member societies and, like, 120 countries or something like this; the numbers always change because we get new members.

So it's the umbrella organization trying to advance psychiatry. That's the mission: Advance psychiatry all over the world, advance mental health all over the world, and help the local societies also fulfill their mission. So when you have a bigger group behind you, you have, of course, more power and more clout to maybe advance your goals or to convince policy makers, stakeholders in your respective country or region. And very often we actually do have these, we have requests from national societies to support them in their missions or in their dealings with government or other stakeholders that are important for mental health.

So then we will help our societies, we will support them, and by doing this, we can advance the mission that we have.

[00:35:27] Host Amber Smith: So how do you communicate when you have members from so many different countries speaking different languages?

[00:35:34] Thomas Schulze, MD: Well, first of all, we are all connected. We have various bodies, so we have the member societies, then we have regions, we have zonal representatives. So the world is divided up into regions, and these zonal representatives have close contact with representatives of these national societies. So if we want to get the word out, first of all, of course, there is email communication. But we will also go directly to these zonal representatives, who know many of these leaders of these individual national societies personally, for instance, so we can get out the word quickly. Also, we have 65 scientific sections. These are research leaders in their respective fields, and they are connected.

As president-elect, I am on the executive committee, and I've been on the executive committee for quite some while. I was the secretary for sections before. And if we, let's say, have one common topic that we want to address research-wise or policy-wise, we then send an email to the zonal representatives. We send an email to our sections, and actually within no time, we get response from all over the world.

And of course, the language that we use is English.

[00:36:47] Host Amber Smith: I see. Now, the association's focus has broadened in recent years, from treating and rehabilitating psychiatric patients to include the prevention of mental health problems and promotion of good mental health. Where did that come from? Why did that evolve to that?

[00:37:05] Thomas Schulze, MD: Well, I think psychiatry has always had, I would say, an agenda to not only treat mental illness, psychiatric disturbances, but also to prevent them. But I would agree that this part of our field, maybe for many years, was not that developed, or people wouldn't focus on that. That's why I think there are many, let's say, prejudices against psychiatry and misconceptions that we guys only give people pills and want to make them sleep, whatever. There's some misconceptions, and sometimes it's our own fault because we have not, or for many years maybe we didn't emphasize, this, but we now know there are biological causes, reasons, genetic factors and so forth, that are main drivers of mental illness.

But we also know that there are environmental factors that do play a role and that the awareness is important. So it is very critical that psychiatric disorders be dealt with early on. If you do not treat the disorder, then it gets worse, and bad things can happen. So that's why educating the general public, going into schools, going into the workplace, is so important, I think. And now, we also think of exercise. There's a lot of evidence showing that exercise, physical exercise, helps in the treatment of mental illness.

So I think it's a very important mission, and I cannot really tell you when it started. It should have always been there, but maybe we were not so good about it. But now, prevention, going out to the public and also maybe talking with you, what I'm doing right now, is a very important thing.

[00:38:50] Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Thomas Schulze. He's a professor of psychiatry and behavioral sciences at Upstate, and he's president-elect of the World Psychiatric Association, which he's been telling us about.

The World Health Organization says one of every eight people lives with a mental health disorder. What sorts of disorders does that include?

[00:39:13] Thomas Schulze, MD: Very important point. I always tend to say, these are the most frequent disorders in the world. And we say one in eight. I would say even the lifetime prevalence, that means that the likelihood of having a psychiatric disorder in one's lifetime is around, like, even 30%.

What it entails? Well, we have the things that people have heard about: depression, major depression. We have bipolar disorder; that is mania and depression together, these ups and downs. We have the large field of anxiety disorders, panic disorders, social phobia and maybe phobia -- fear -- of height, and all these things.

Then, of course, these primary psychotic disorders, like schizophrenia, where you hear voices, where you feel persecuted, where you have these delusions.

Then, of course, the whole field of addiction is part of psychiatry. Very often it's not considered, or it's not named, as a psychiatric disorder addiction, but they do fall into our field, our discipline, so professionals who specialize in addiction are typically psychiatrists or psychologists.

So these are definitely these main disorders, and then you have definitely other disorders, like the big group of dementias, right? That's old-age psychiatry.

Then you personality disorders. You all have heard about borderline personality disorders and things like that. So it is a vast array of disorders. One may say that, well, they share symptoms, and that's true. They sometimes overlap, and there's not always a clear cut, and you can have several. When you have addiction problems, you may also have depression or any other way around.

[00:40:55] Host Amber Smith: So do mental health concerns differ much country to country?

[00:41:01] Thomas Schulze, MD: Well, not really. The main disorders that I've just mentioned do not really differ. There has always been a discussion whether some disorders are more prevalent in certain countries, certain regions, certain cultural backgrounds.

But the disorders I've just mentioned are basically present at the same rate across populations. There may be, of course, disorders where environment actually has a strong impact. And that may be eating disorders, for instance, disorders where the public perception, public concepts, of fashion, of the ideal body, may play a role. And that, of course, may be influenced by culture-specific factors. And there you may see differences between countries, like, let's say, Western and Asian societies.

But overall, I would say that, especially in a very globalized world, also problems become very globalized, and we are not so isolated anymore. Even if you are on a far-flung island somewhere in the Pacific, you have your smartphone, and you are confronted with the same problems and challenges. So I would say, on average, these disorders are present at the same frequency all across the world.

[00:42:23] Host Amber Smith: Is there a country or countries that are doing a particularly good job treating mental health disorders?

[00:42:31] Thomas Schulze, MD: Well, that's a good one now, and actually that's a very political one. I'm German, and I'm an American and live in both countries. I love them both, and I work in both countries. I go back and forth. And I see great things in Germany and great things in America and bad things in Germany, bad things in America. And I would love to actually weed out the bad things in either country, but we know it's not possible. I think it comes down to this big issue of mental health parity. That means: Do we treat mental disorders with the same energy, with the same persistence, with the same will to succeed as somatic (physical or bodily) disorders -- so cardiac disorders or cancer? And do insurance companies pay for that?

So for instance, in Germany, I must say, it's quite good. If you have depression, and you need three, four months of treatment, well, you get three, four months of treatment, the same way you would get your heart surgery.

Now, in the U.S., it depends on your health insurance, whether you'll stay in the hospital for the time you need or whether you get the treatment you need.

So here, especially the U.S., not everywhere have we achieved mental health parity, and I think there's a lot to be done. I get calls from many people that cannot find doctors, even if they wanted to pay out of pocket. There's a shortage, so we need to do more in having skilled psychiatrists, psychologists, mental health experts, and then we need to work with insurance companies or health care providers because the mental health of the population is, I think, very important for the well-being of society and success of a society as a whole as well.

[00:44:15] Host Amber Smith: Do you have members from countries that are at war? I'm wondering if war impacts psychiatric care?

[00:44:23] Thomas Schulze, MD: Of course. We have, of course, the Russian Psychiatric Association, and we have the Ukrainians. We have two Ukrainian member societies. And at the beginning of the war, there was of course a lot of upheaval in a sense that some of the Ukrainian colleagues wanted us to kick out the Russians, to be blunt.

And there was a lot of discussion because our statutes don't allow for that, because only if you commit crimes against psychiatry, basically, or if you act against psychiatry, against the patients and so forth, then we would be able to take action. However, now with the situation in Russia, we know under which political and totalitarian pressure they are, we are in contact with them, but we don't have any more meetings there. And of course we support Ukraine in their fight to survive.

And also we have come up with special programs, training young psychiatrists. I was at a training session in Krakow, Poland, for young psychiatrists from Ukraine. We have specialized programs, we have online programs, how to deal with the situation. And I know there's a lot about veteran mental health now being done, where we try to bundle our expertise.

The WPA, we are headquartered in Geneva. We are a few people, the executive committee. We are not paid for that, right? We are kind of volunteers, but we are in touch with colleagues, and the idea is that we bring together the best people for a specific cause in a specific moment of time, like a war zone, we'll do that. Yes.

[00:45:57] Host Amber Smith: What do you plan to prioritize during your presidency?

[00:46:02] Thomas Schulze, MD: Actually the mental health parity is a very important aspect, and I outlined that in a small paper. So mental health parity to assess, first of all, the state of the art. How is mental health treated compared to somatic health in the world?

And then we have the WPA collaborating centers, expert centers all over the world. I want to strengthen their work. And currently I'm working with a small group of people to lay out plans how we can, with not much money actually, with limited resources in certain countries of the global South, how can we increase the quality of psychiatric education, of young psychiatrists, because that's really what's urgently needed when we think of a country like Ethiopia, with a 100,000,000-plus inhabitants, we have maybe 50 psychiatrists, and they're all clustered in the capital, Addis Ababa.

So we need to do something about training new psychiatrists and have online programs and what have you, so this is something where I'm working on a plan and also maybe hopefully getting funding from philanthropic organizations that would support that.

And another factor is human rights. We just saw things that happened in Iran, where now, ladies who do not wear the hijab are sent to special clinics because they're now considered psychiatric patients because they don't want to wear hijab.

So we, in the letter, protested against that, and even the psychiatric organization of Iran, they protested against that. Or the situation, the mental health situation, of the Uyghurs in China. And there are many other persecuted ethnicities in the world where mental health is severely impaired because of persecution that is going on. That is a very personal issue, very dear to my heart, and I would like to focus on that as well.

So mental health parity, training of young psychiatrists in the global South and human rights, in connection with mental health. These are the three topics that I would like to focus on in my three years, which will start in two years.

[00:48:04] Host Amber Smith: Well, Dr. Schulze, thank you so much for making time to tell us about this. I appreciate it.

[00:48:08] Thomas Schulze, MD: Well, thank you for having me. It was a pleasure, and I'm always happy to do similar things again. .

[00:48:14] Host Amber Smith: My guest has been Dr. Thomas Schulze. He's a professor of psychiatry and behavioral sciences at Upstate, and he's the president-elect of the World Psychiatric Association.

I'm Amber Smith for Upstate's "HealthLink on Air."

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD

Sylvia O'Connor is a Syracuse poet and writer whose poem "The Refugees" asks us to reconsider our stereotypes of assisted-living facilities, the people who live there and especially the stories of how they got there.

"The Refugees"

Ann extends an empty palm, offering

the life she left just one month ago

before coming to the Home.

I was very sick, she said.

Only one month gone and all

my things distributed.

My daughter says I don't need

those things anymore,

my favorite things.

She packed my life

into a powerboat.

I sit as on the beach of an island

in my wheelchair.

I am a refugee.

We are all refugees here.

I could bring only a few

of my things with me.

Just one month ago

they took me to the hospital.

Late at night they came.

Now, I will live out my life here,

but I want you to know that

just one month ago I had

beautiful things --

I had a beautiful life.

This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at HealthLinkonAir.Org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron. This is your host, Amber Smith, thanking you for listening.