2023 ACMT Symposium - On-Demand
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Suicide is a major public health problem and leading cause of preventable death. The practice of medical toxicology often involves caring for patients who injure themselves (or attempt injury) by poisoning. Toxic exposures may affect the central nervous system, cause neuropsychiatric symptoms, and increase the likelihood of future suicidal behavior.
"Toxicologists interact on a daily basis with patients who have myriad mental health problems, and in many cases those sufferings increase the risk of suicide,” says symposium organizer Mark Su, MD, MPH, FACMT. “As providers for patients with intentional xenobiotic exposures and suicide attempts, the toxicology community must be cognizant of these complex issues and understand substantive ways to address them in real time."
On March 30, 2023 in San Diego, CA, nationally recognized experts in the field gathered together to discusses the ethics, psychology, management, and global epidemiology of the suicidal patient through the toxicology lens. These are the recordings and slides from those sessions. In them you will find talks about lethal means restriction, care of the “frequent attempter,” and strategies to prevent death by suicide. Ultimately, the material presented at this symposium will hopefully help us better understand the suicidal toxicology patient and improve their care.
Medical Toxicologists, Psychiatrists, Emergency Medicine Practitioners, Medical Ethicists, Military Medicine Specialists, Addiction Medicine Specialists, Public Health Professionals and related fields.
Continuing Education credits are NOT available for this enduring material.
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- 90-day access to the course from date of purchase
- Access to all lectures and slides from the 2023 ACMT Symposium
- Downloadable Certificate of Completion
There is no Continuing Education available for this on-demand enduring material.
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2023 ACMT Symposium - Syllabus
Caring for the Suicidal Patient: Ethical Issues in Treatment and Research | 53 min
Dr. Dominic Sisti, Associate Professor at the University of Pennsylvania, discusses ethical challenges in conducting suicide prevention research and the clinical challenge of treating suicidal patients. He will also introduce the dilemma between medical assistance in dying (MAID) for SMI and suicide prevention.
Ethical Allocation of Resources: Transplant and the Suicidal Patient | 33 min
Clinical Associate Professor at Stanford University School of Medicine, Filza Hussain reviews current guidelines related to organ transplant in suicidal patients and the role of mental health evaluations along with the ethical principles of deciding transplant eligibility.
Psychology of Suicidal Behavior and Interventions for Prevention & Access to Means Panel | 68 min
Dr. Elizabeth Ballard from the Experimental Therapeutics and Pathophysiology Branch of the National Institute of Mental Health examines the psychology of suicide behavior and intervention, including utilizing restriction to means and rapid-acting interventions, such as ketamine or safety planning.
Dr. J.J. Rasimas, Professor of Psychiatry & Emergency Medicine at the University of Minnesota, discusses access to means for intentional exposure and clinical treatment. He also details barriers than can be put in place to curb access.
The Role of Med Tox in Prevention of Suicidality | 25 min
Assistant Professor at NYU Grossman School of Medicine, Larissa K. Laskowski details the amount of poisoning-related suicides and the role medical toxicologists play in treatment and prevention.
Recurrent Suicidality & The High Utilizer Through the Lens of Suicidality | 65 min
Yaron Finkelstein, MD, FACMT, Professor of Pediatrics at the University of Toronto, examines the short and long-term outcomes of repeated suicide attempts via intentional drug overdose. Dr. Finkelstein also discusses how medical toxicologists can help prevent attempts after a patient is discharged.
Dr. Gregory Carter, Conjoint Professor in Psychiatry at the University of Newcastle, discusses the intersection between substance use disorder and suicidality.
Neuropsychiatric Consequences of Occupational and Environmental Exposures & Neuropsychiatric Consequences of Military Exposures | 60 min
A Professor of Emergency Medicine at SUNY Upstate Medical University, Dr. Michael G. Holland details the neurological effects toxic exposures, both occupational and environmental, can have.
Lieutenant Commander T. Wolfgang Klotz discusses the prevalent sources of toxic exposures that affect military service members and examines the evidence connecting said exposures to psychiatric disease.
The Intersection of Forensic Toxicology & Suicide: How To Determine Death by Suicidal Intent | 37 min
San Diego County Chief Medical Examiner Steven Campman discusses how the manner of death is determined in cases of drug intoxication and the role a medical examiner plays in the determination.
Global Perspective on Suicide by Self-Poisoning Panel | 68 min
The panel discusses the variations in local epidemiology and response in Australia, France, Lebanon, and South Asia. The speakers for this panel are: Andrew Dawson; Bruno Mégarbane, MD; CAPT Josh Schier, MD, MPH, USPHS; Michael Eddleston, MD; and Tharwat El Zahran, MD.
Elizabeth Ballard, PhD
Director of Psychology and Behavior Research, Predoctoral Training
Experimental Therapeutics and Pathophysiology Branch
Dr. Elizabeth Ballard is the Director of Psychology and Behavior Research and the Director of Predoctoral Training at the Experimental Therapeutics and Pathophysiology Branch in the National Institute of Mental Health. She is trained as a clinical psychologist from the Catholic University of America and has extensive clinical experience working with suicidal patients. She completed her predoctoral internship at the Department of Veterans Affairs Eastern Colorado Health Care System and a postdoctoral fellowship at Johns Hopkins School of Medicine. As an associate scientist, she is the Lead Associate Investigator on the Neurobiology of Suicide Protocol in the Intramural Program of the NIMH. She has published over 95 articles and her research interests include short term risk factors for suicide and rapid acting treatments for suicidal thoughts.
Steven Campman, MD
Chief Medical Examiner
San Diego County
Dr. Campman is San Diego County’s Chief Medical Examiner. He earned his B.S. in Biology from Loyola Marymount University in 1987; graduated from Creighton University School of Medicine in Omaha, in 1992, and then completed residency in Anatomic and Clinical Pathology at the University of California, Davis Medical Center, in 1997. Following fellowship training in Forensic Pathology with the Northern California Forensic Pathology Group at the Sacramento County Coroner’s Office in 1998, he went to work for the US Air Force and was stationed at the Office of the Armed Forces Medical Examiner, the Armed Forces Institute of Pathology, in Washington DC, as Associate, then Deputy and Chief Deputy Medical Examiner for Medicolegal Operations and Investigations, until he went to work for the County in 2001 (later continuing to serve in the Air Force Reserve as a Regional Medical Examiner until he retired). He is Board Certified in Anatomical/Clinical, and Forensic Pathology, and leads the Medical Examiner’s Department while continuing to regularly perform autopsies, and testify in CA Superior Court.
Gregory Carter, M.B.B.S. FRANZCP, PhD
Acting Director of Dept. Consultation Liaison Psychiatry & Conjoint Professor in Psychiatry
University of Newcastle School of Medicine and Public Health
Professor Carter is currently the Senior Staff Specialist and Acting Director of Dept. Consultation Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah; and Conjoint Professor in Psychiatry in the College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle. He is a Chief Investigator for the NHMRC Centre of Research Excellence in Suicide Prevention (CRESP 2.0). He is the Chair for the RANZCP for the Clinical Practice Guidelines for Deliberate Self-Harm, a member of the Presidents Suicide Advisory Committee and the RANZCP representative to the Prime Minister’s Suicide Advisory Group.
Current areas of clinical and research interest include; deliberate self-poisoning, suicide prevention, epidemiology of suicidal behaviours, delirium, screening for depression, somatisation, organ donation and psycho-oncology.
Andrew Dawson, FRCP, FRACP, FCCP, FAMCT, FEAPCCT
Director National Poisons Register & Clinical Toxicology
Royal Prince Alfred Hospital
Andrew Dawson is an Australian Clinical Pharmacologist and Toxicologist whose major interest is in translational clinical toxicology research to produce changes in policy and clinical practice.
He established the Australian Hunter Area Toxicology Service in Newcastle in 1987, research included interventions for deliberate self-harm, relative toxicity of drugs in overdose and prediction of toxicity.
In 2004 he moved to Sri Lanka to establish the South Asian Clinical Toxicology Research Collaboration. This group built sustainable research capacity addressing deliberate self-harm with pesticides and improved clinical practice in resource poor settings. This research contributed to policy that reduced Sri Lankan national suicide deaths by 50%
In 2010 he returned to Australia and became the Director of Clinical Toxicology Royal Prince Alfred Hospital, and the Director of the New South Wales Poison Information Centre (to 2021) at the Childrens Hospital Westmead. He is Clinical Professor Medicine, University of Sydney and Adjunct Professor School of Medicine University of NSW. Current interests include management of institutional responses to patients with challenging self-harm behaviours, substance use disorder and self-harm, evaluating the effects of regulatory changes on incidence of deliberate self-harm.
Michael Eddleston, ScD, FRCP(Edin), FBPhS, FEAPCCT, FRSE, RCPE, Cullen Gold Medalist
Professor of Clinical Toxicology
The University of Edinburgh
My work’s major aim is to reduce deaths from pesticide and plant self-poisoning in rural Asia, a cause of over 200,000 premature deaths each year and a key global means of suicide. To do this, I perform clinical trials in South Asian district hospitals to better understand the pharmacology and effectiveness of antidotes and community-based controlled trials to identify effective public health interventions. This work is complemented by translational studies of antidotes in minipig models of poisoning in a large animal critical care laboratory that I established in Edinburgh, work with sociologists and anthropologists to better under-stand the meaning of self-harm, and work with the WHO and FAO to aid implementation. I work with pesticide regulators through the Centre for Pesticide Suicide Prevention. I also perform clinical and animal research in Edinburgh to improve treatment of other forms of poisoning (such as from cyanide, alcohol, and contrast media) by developing and/or testing novel antidotes.
Tharwat El Zahran, MD
Medical Director, Assistant Professor of Emergency Medicine
American University of Beirut Medical Center
Dr. Tharwat El Zahran is an Assistant Professor of Emergency Medicine and the Medical director for the emergency department at the American University of Beirut Medical Center (AUBMC)
She completed a fellowship training in medical toxicology at Emory University and CDC, and currently co-directs the medical toxicology service at AUBMC.
Yaron Finkelstein, MD, FACMT
Professor of Pediatrics, Pharmacology and Toxicology
The Hospital for Sick Children, University of Toronto
Dr. Finkelstein is a Professor of Pediatrics, Pharmacology and Toxicology, University of Toronto and a Senior Clinician-Scientist at The Hospital for Sick Children.
He holds the Canada Research Chair in Pediatric Drug Safety and Efficacy (Tier I). Dr. Finkelstein is triple-trained in medical toxicology, clinical pharmacology and pediatric emergency medicine. Since 2016, he has served as a “Thought Leader” for NIH’s Pediatric Trials Network, an alliance of >200 hospitals, working for drug label modifications for children at FDA. He also established and leads the ACMT Pediatric Marijuana & Opioids (PEDMOP) Toxicology Investigators Consortium (ToxIC) sub-registries.
The overarching goal of his research program focuses on optimizing therapeutics and outcomes of sick and injured children in acute care settings and prevention of accidental and intentional drug overdose and subsequent suicide, employing epidemiological, randomized clinical trials and precision tools.
Michael G. Holland, MD, FEAPCCT, FAACT, FACOEM, FACMT, FACEP
Director of Occupational Medicine
Dr. Holland is the Director of Occupational Medicine for the Saratoga Hospital Medical Group, and is the Saratoga Hospital Employee Health Medical Director, where he oversees the health and safety of over 3100 employees and staff. He also serves as Employee Health Medical Director at Glens Falls Hospital in Glens Falls, NY, covering 2500 employees.
Dr. Holland is Clinical Professor of Emergency Medicine at SUNY Upstate Medical University in Syracuse, NY where he is on the faculty of the Medical Toxicology Fellowship Training Program and is a Consulting Medical Toxicologist at the Upstate New York Poison Center and at the Onondaga County Medical Examiner’s Office-both in Syracuse, NY.
He is also Principal Medical Toxicologist at the Center for Toxicology and Environmental Health (CTEH) in Little Rock, AR.
Filza Hussain, MD
Clinical Associate Professor
Filza Hussain, MD, is a Clinical Associate Professor of Psychiatry at Stanford University School of Medicine. She attended medical school in Pakistan and completed her residency training at the Mayo Clinic, Minnesota and a Consultation Liaison Psychiatry fellowship at Columbia University in New York. Her clinical focus is transplant psychiatry and she serves as the liaison to the Liver and Kidney transplant programs at Stanford. Other areas of clinical/research interests include Personality disorders, Suicidology, Cultural Psychiatry, and medical pedagogy.
T. Wolfgang Klotz, MD
United States Navy
Dr. Klotz received his undergraduate degree from the University of Southern California in International Relations, his medical degree from the Uniformed Services University of the Health Sciences, and completed his residency in Psychiatry at Naval Medical Center San Diego. He is a member of the Gold Humanism and Alpha Omega Alpha honor societies. He is currently the embedded psychiatric provider for the 5th Marine Regiment in San Clemente California.
Larissa Laskowski, DO
NYU Grossman School of Medicine, NYU Langone Health, Health + Hospitals Bellevue
Larissa Laskowski is a clinical assistant professor and medical toxicologist at NYU Grossman School of Medicine, and serves as a consultant for the New York City Poison Control Center. She is also cofounder and director of The Prevention Education Partnership (PEP), an initiative dedicated to decreasing the incidence of preventable illness and injury commonly seen in the emergency department. Through PEP Talks, a harm-reduction drug education curriculum, she deploys doctors into local schools to educate middle and high school students, teachers, and parents, in an effort to keep NYC youth safe, healthy, and out of the ER. Due to the rapidly evolving threat of teen fentanyl overdose, she is currently laser-focused on ensuring that every student, teacher, and parent knows how to recognize an opioid overdose and save a life by administering naloxone.
She currently resides in Manhattan with her husband Mike and two small children Frida and Miles.
Bruno Megarbane, MD, PhD
Head of the Department of Medical and Toxicological Critical Care
Paris Cité University Lariboisière Hospital
Bruno Mégarbane is Professor of critical care medicine at Paris University and directs a research team at INSERM UMRS-1144. He is the Head of the Department of Medical and Toxicological Critical Care at Lariboisière Hospital, Paris, France. He conducted several clinical and experimental studies in clinical toxicology.
J.J. Rasimas, MD, PhD, FAACT, FACLP, FACMT, FACPsych
Professor of Psychiatry & Emergency Medicine
University of Minnesota & Penn State College of Medicine
Dr. Rasimas attended the University of Scranton and graduated summa cum laude with degrees in biochemistry, mathematics, and philosophy. He completed the Medical Scientist Training Program at Penn State University, earning a Ph.D. in chemical biology (2002) and M.D. (2003). Upon graduation from the Penn State College of Medicine, Dr. Rasimas matriculated to psychiatry residency training at the Mayo Clinic in Rochester, Minnesota. He was a clinical fellow at the NIMH, training in consultation-liaison psychiatry, bioethics, and clinical research. Dr. Rasimas has studied psychoanalytic psychotherapy at the Minnesota Psychoanalytic Society and Institute and the Washington School of Psychiatry. He served as a C-L psychiatrist for Milton S. Hershey Medical Center and remains an Associate Professor of Psychiatry and Emergency Medicine for the Penn State College of Medicine, there. He completed the critical care based medical toxicology fellowship at Penn State, obtained board certification in addiction medicine, and then returned to NIMH to join the Undiagnosed Diseases Program and the Intramural Research Program to oversee clinical trials in mood and anxiety disorders. He is also a Fellow of the Academy of Psychosomatic Medicine and a Laughlin Fellow with membership in the American College of Psychiatrists. Dr. Rasimas is a Professor at the University of Minnesota, pursuing an academic medical career at the interface of psychosomatic medicine, medical toxicology, and psychodynamic psychotherapy with a primary clinical interest in the phenomenology of suicide. His current clinical position is the director of Consultation-Liaison Psychiatry services for the Queen Elizabeth Hospital in Charlottetown, Prince Edward Island.
Dominic Sisti, PhD
Associate Professor, Department of Medical Ethics & Health Policy
University of Pennsylvania
Dominic Sisti, PhD, is an associate professor in the Department of Medical Ethics & Health Policy at the University of Pennsylvania. He directs the Scattergood Program for the Applied Ethics of Behavioral Health Care and holds secondary appointments in the Department of Psychiatry, where he directs the ethics curriculum in the residency program, and the Department of Philosophy. Dr. Sisti examines ethical and policy challenges in mental health care, including long-term psychiatric care for individuals with serious mental illness and clinical ethics issues in correctional settings. Sisti's research also explores ethical issues in psychedelic research and clinical application.