I started my Fellowship on January 4, 2010. Since then, I have been doing clinical as well as research rotations within the Department of Child Psychiatry at the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Centre as follows:
1. Child and Adolescent Bipolar (CABS) Clinic
A) Clinical Research Studies: I was introduced to two clinic research studies being conducted at the clinic – the Pittsburgh Bipolar Offspring Study (BIOS) and the Course and Outcome of Bipolar Youth Study (COBY). I observed intake and longitudinal follow up assessments of both studies using instruments like the Structured Clinical Interview for DSM IV (SCID), Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime (KSADS –PL), Mania Rating Scale (MRS) and the Longitudinal Interval Follow Up Evaluation (LIFE). I also observed validation of assessments made by master’s levels clinicians with experienced child and adolescent psychiatrists.
B) Ongoing weekly research supervision: I am involved in weekly clinical research meetings with an expert group of MD’s, PhD’s, Masters level clinicians and statisticians. This has enabled me to gain a better understanding of the stages involved in recruitment of patients and controls, applying double blind procedures, data storage and analysis. I am currently analyzing and writing up data from the BIOS study under supervision. This study will determine the psychosocial functioning of children of parents with bipolar disorder as compared with children of community control parents.
C) Evidence based treatments: I observed clinical assessments and treatments of bipolar patients using the latest evidence based treatments (pharmacotherapy, cognitive behavior therapy, dialectical behavior therapy and family therapy. I have become familiar with the clinical and research diagnosis of BP spectrum disorders especially BP NOS which is still a controversial diagnosis in many parts of the world.
2. Women’s Behavioural Health Care
I did a four week rotation at a clinical research program for Women’s behavioural health. This program focuses on mood disorders among women in the puerperium. I was introduced to planning and recruitment procedures for research participants, screening of post partum women for Depression using the Edinburgh Post Natal Depression Scale and full assessments for women who had positive screens using the Structured Clinical Interview for DSM IV (SCID). I was exposed to another study which involved monitoring and follow up of mothers with Bipolar disorder who had been on anti-manic agents during pregnancy with the aim of determining the course and outcome of the disorder. I was also exposed to a third study - a randomized double blind clinical trial of Setraline vs Estrogen and placebo for women with post partum depression. I was involved in weekly monitoring of the study which included assessing mothers’ symptoms and infant developmental outcomes. On the side, I also had a brief introduction to bright light therapy for depressed post partum women. I submitted an abstract for the annual Marcé Society Meeting, titled “Perinatal Mental Health Research: Harvesting the Potential” to be held in October 2010. This abstract looks at cross cultural differences in risk factors and presentations of puerperal disorders in a resource poor setting.
3. Rotations at other units. I obtained an institutional medical practice license for the state of Pennsylvania. This enabled me to rotate through the following clinical units:
A) Consultation Liaison unit at the Children’s Hospital Pittsburgh: This service is involved in the psychological management of patients with acute and chronic medical problems within a Medical hospital setting. My role included acute assessment of patients, formulating a treatment plan, communicating with families and primary physicians, and arranging follow up mental health care when indicated.
B) Child and Adolescent Inpatient Unit: On this unit I had the opportunity be involved in the acute stabilization of patients who were in need of a higher level of care, and to work with a multidisciplinary treatment team to facilitate this.
C) Partial Hospitalization program: This is an intermediate level of care within the community which is currently not available in Nigeria and most of the developing world. I have gained invaluable experience on the structure and workings of this type of service and how this can be modeled for the developing world setting.
4. Other Activities
I have had opportunities to participate in resident’s grand rounds, didactics, Journal clubs, as well as conferences on the latest evidence based treatments for mood disorders. These included a workshop on suicidal spectrum behaviours which are commonly associated with mood disorders, and treatment strategies for emotion regulation and distress tolerance among emotionally dysregulated youth.
These 6 months have been challenging and rewarding with a broad range of clinical and research exposure and I look forward to more challenges in the next half of the year.
Tolulope Bella, MD
16th June 2010