Clinical Fellowship in Geriatric Psychiatry

Director: Jules Rosen, MD
Associate Director: Benoit H. Mulsant, MD

Overview

The Geriatric Psychiatry Clinical Fellowship, based at the University of Pittsburgh School of Medicine’s Department of Psychiatry, is a one-year PGY-5 program fully accredited by the Ac­creditation Council for Graduate Medical Education (ACGME). The department’s Division of Geriatrics and Neuropsychiatry has an interna­tional reputation as a research leader for its study of late-life mood and cognitive disorders and a national reputation as a provider of state-of-the-art clinical care to elderly patients with mental disorders. Fellows completing this program are eligible for the ABPN’s “Added Qualification in Geriat­ric Psychiatry”.

Philosophy of Fellowship Education

Fellows are exposed to a complete spectrum of clinical and academic experiences in geriatric psychiatry, geriatrics, and gerontology. In addi­tion to acquiring expertise in using pharmaco­therapy and psychosocial interventions to treat elderly patients with late-life mental disorders, fellows gain experience in understanding their elderly patients in relation to their families and environment. Fellows, under the supervision of faculty, function as the team leaders in all set­tings with supervisory responsibility for resi­dents, medical students, and professional members of the multidisciplinary treatment team. The importance of continuity of care is stressed. Fel­lows have the opportunity to assess and treat patients in multiple settings (inpatient, outpatient, partial hospital, consultation-liaison, and nursing home) and gain experience with all modalities of treatment during the course of their fellowship year. Finally, fellows  have the opportunity to work with mentors in developing research projects and aca­demic pursuits.

Clinical Training Sites

• Inpatient geropsychiatry program, Western Psychiatric Institute and Clinic
• Benedum Geriatrics Center
• UPMC-Shadyside Medical Center- Seniorcare Clinic
• Memory Disorders Clinic and Hill Satellite, Alzheimer Disease Research Center
• Geriatric Psychiatry Consultation/Liaison Service
• Nursing home consultation program
• In-home program
• Oakland VAMC – GREC- (multi-disciplinary assessments)
• Highland Drive Veterans Affairs Medical Center ---  Neuropsychiatry, behavioral neurology, PTSD, and palliative care 
• Electives in neuropsychiatry, ECT, emergency psychiatry, administrative psychiatry, psychopharmacology, partial hospitalization, geriatric intervention research, and psychotherapy

Inpatient Geropsychiatry Program

The geriatric psychiatry inpatient program at Western Psychiatric Institute and Clinic provides comprehensive evaluation and short-term hospi­talization for older adults experiencing depres­sion, psychosis, anxiety, sleep disturbances, memory or behavioral problems, and other men­tal health problems associated with aging. All patients receive a complete medical, psychiatric, and social/functional assessment. Treatment mo­dalities include pharmacotherapy, psychosocial interventions, family therapy, and electroconvul­sive therapy. The program serves the local community as well as being a tertiary care center for western Penn­sylvania and the surrounding tri-state region.

Ambulatory Care Rotation

Benedum Geriatric Center

The ambulatory care program of the Benedum Geriatric Center provides outpatient evaluation and treatment for older persons who have com­plex problems requiring multidisciplinary care. The Benedum Geriatric Center focuses primarily on the frail elderly who have multiple medical, psychiatric, or psychosocial problems. Its main goal is preserving their health, independence, and well being. Services include comprehensive medical, psychiatric, and social assessment; con­sultation with referring physicians and other community health care providers; environmental planning to help maintain the patient’s residence at home for as long as possible; health care education, counseling, and psychotherapy for patients and families; ongoing medical and psychi­at­ric treatment; and referral to community resources. The center averages over 750 patient visits per month and has more than 2200 active patients.   In addition to a three-month rotation, all fellows participate in a weekly clinic throughout the year to gain experience in longitudinal ambulatory care. 

UPMC-Shadyside / Shea Medical Center

Fellows see elderly patients at this community-based site during a weekly clinic under faculty supervision.

Memory Disorders Clinic

The Memory Disorders Clinic associated with the Alzheimer Disease Research Center (ADRC) provides evaluation and treatment of patients with memory and other cognitive disorders. In this setting, diagnosis is established through comprehensive neurological, psychiatric, neurop­sychological, medical, and social assessments. Family support and counseling, behavior man­agement, and pharmacotherapy for behavior dis­turbance are coordinated through this clinic. The Memory Disorders Clinic serves more than 600 patients and their families annually. Another re­source available at the ADRC is the Dementia Treatment Clinic, a recently established clinic that focuses on treatment of Alzheimer’s disease with new medi­cations.   In addition, fellows participate in the ADRC sponsored Hill Satellite Clinic, which serves the needs of a predominantly African-American community. 

Geriatric In-Home Support Program

The Geriatric In-Home Support Program currently follows more than 100 homebound older persons with psychiatric and physical illness who would otherwise not receive care or receive it only in a hospital or long-term care setting. The program’s target population are those chronically and persistently mentally ill older patients (60 years of age and older) who are unwilling or un­able to keep appointments in an outpatient setting and are at risk for institutionalization. These pa­tients are usually the older elderly with medical problems and functional disability, cognitive or psychiatric disorders, and poor social support.

Consultation/Liaison Service

The Geriatric Consultation/Liaison Service pro­vides consultation and assessment services to older patients with psychiatric or behavioral problems who are undergoing treatment in the UPMC’s acute care hospitals and medical spe­cialty services. This program provides consulta­tion and education to a variety of medical and surgical services, for both inpatient and ambula­tory care cases.

Long-Term Care

The Division of Geriatric Psychiatry maintains contracts with a variety of long-term care facili­ties in western Pennsylvania and has established several facilities as training sites.  Fellows round weekly at their assigned nursing home under faculty supervision.  Pharmacotherapy and psychosocial/family interventions are the primary modes of treatment. Drug interactions, medical comorbidity, psychosocial stressors, and medico-legal aspects of treating the frail elderly in long-term care settings are emphasized.

Veterans Affairs Medical Center

The Highland Drive VAMC provides important training components within the fellowship. Train­ing in late-life neuropsychiatry, behavioral neurology, PTSD, and palliative care are provided at this site through a combination of ambulatory and consultative services.

Veterans Affairs Medical Center-Oakland

The Geriatric Research and Education Center (GREC) at the Oakland VAMC provides an opportunity to work closely with a specialists in geriatric medicine in a multi-disciplinary team.

Geriatric Partial Hospital Program

The Geriatric Partial Program was created to provide acute care treatment to severely depressed elders as an alternative to hospitalization.

Electives

Elective time is provided throughout the year (see rotation schedule). Fellows are encouraged to identify an area of interest within which, during the fellowship, they will participate in a working research project, complete a review article, or gain intensive clinical experience. Supervision and mentorship are provided by faculty with ex­pertise in the chosen area. In recent years, elec­tives have included research projects with mentorship provided by faculty associated with the Intervention Research Center for Late-Life Mood Disorders, the Geriatric Psychopharmacology Program, and the Alzheimer Disease Research Center as well as clinical work specializing in neuropsychiatry and electroconvulsive therapy. Alternative electives can be independently ar­ranged by the fellow with approval by the program director.

Research

Fellows are given the opportunity to participate in multiple areas of research.  The NIMH-funded Advanced Center for Intervention and Services Research in Late-Life Mood and Anxiety Disorders (Charles F. Reynolds MD, PI), the NIA-funded Alzheimer’s Disease Research Center are only two of the research resources available to fellows.  Fellows who are interested in continuing their research training can apply to the NIMH Research Fellowship in Geriatric Psychiatry.  This two-year program, directed by Charles F. Reynolds, MD, will accept qualified candidates who have completed their clinical fellowship.  Close collaboration between the clinical and research fellowships has provided  a more comprehensive clinical and research training experience for fellows interested in pursuing that career path.. 

Didactic Teaching / Seminars

A lecture series focusing on the multi-disciplinary aspects of geriatric psychiatry is offered bi-weekly as well as an ongoing psychotherapy seminar.  In addition, each rotation offers individual didactic / learning opportunities, such as the consulatation / liaison series,  joint lectures with geriatric medicine fellows during the Oakland VAMC rotation and inpatient clinical case conferences.  Fellows also have the opportunity to train residents and medical students. 

In addition to the formal educational opportunities, the Geriatric Psychiatry Journal Club scheduled at the home of the faculty encourages an atmosphere of collegiality and scholarship.   Fellows also are invited as the guests of the Drs. Rosen and Mulsant for a monthly lunch gathering to promote the spirit of collegiality and learning.

Rotation Schedule

Fellows are assigned to each of the five “rotations” for 10-week  period. 

Inpatient Rotation 

Ambulatory Care Rotation 

Consultation/Liaison rotation 

Highland Drive VA rotation  

Oakland VAMC  

Application Process

All application requests should be addressed to:

Jules Rosen, MD
Director  Geriatric Psychiatry Fellowship Program
Western Psychiatric Institute and Clinic
3811 O’Hara St.
Pittsburgh, PA 15213
Phone: (412) 246-5900
Fax: (412) 586-9300
E-mail: rosenji@upmc.edu

Applications should be received by Dec. 15 and will be reviewed by the Geriatric Psychiatry Fellowship Committee.

Qualifications

Applicants must have completed an ACGME-approved residency training program in general psychiatry and be ABPN board eligible. They must also be eligible to obtain a license to practice medicine in the Commonwealth of Pennsylvania.

Faculty

Geriatric Psychiatry Fellowship
Department of Psychiatry
University of Pittsburgh School of Medicine

Chairman: David A. Lewis, MD

Jules Rosen, MD
Professor of Psychiatry
Director, Geriatric Psychiatry Fellowship
Academic interest: nursing home psychiatry

Benoit H. Mulsant, MD
Professor of Psychiatry
Associate Dir., Geriatric Psychiatry Fellowship
Academic interest:  depression

Howard Aizenstein, MD
Assistant Professor of Psychiatry
Academic interests:  neuropsychology / dementia

Ashok Bharucha, MD
Assistant Professor of Psychiatry
Academic interest: nursing homes

Paul Bulgarelli, MD
Assistant Professor of Psychiatry
Academic interest: education

Umapathy Channamalappa, MD
Assistant Professor of Psychiatry
Academic interest:  inpatient

Mary Ganguli, MD, MPH
Professor of Psychiatry and Epidemiology
Director, Benedum Geriatric Center
Academic interest: epidemiology of dementia

N.J. Jacob, MD
Assistant Professor of Psychiatry
Academic interest: education and training

William Klunk, MD, PhD
Associate Professor of Psychiatry
Academic interest: Alzheimer’s Disease / PET Amyloid-Imaging

Eric Lenze, MD
Assistant Professor of Psychiatry
Academic interest:  anxiety disorders; medical rehabilitation

Robert S. Marin, MD
Associate Professor of Psychiatry
Academic interest: neuropsychiatry

Mark Miller, MD
Associate Professor of Psychiatry
Academic interest: psychotherapy

Richard Morycz, PhD, LSW
Associate Professor of Psychiatry
Chief of Geriatric Service
Academic interest: family burden

Eric Ogren, M.D. 
Assistant Professor of Neurology
Academic interest:  behavioral neurology

Bruce S. Pollock, MD, PhD
Professor of Psychiatry
Academic Chief: Geriatric Psychiatry
Director, Geriatric Psychopharmacology 
Academic interest:  psychopharmacology

Charles F. Reynolds III, MD
Professor of Psychiatry and Neurology
Director, Intervention Research Center for
Late-Life Mood Disorders
Academic interest: treatment of late life mood, anxiety, and sleep disorders

Stephanie S. Richards, MD
Assistant Professor of Psychiatry
Chief, Division of Psychiatry, UPMC Shadyside
Academic interest: dementia, psychiatry in primary care

Robert A. Sweet, MD
Professor of Psychiatry
Chief Psychiatrist, Geriatric Service Line
Academic interest: neurobiology and genetics of psychosis

Ellen Whyte, MD
Assistant Professor of Psychiatry
NIMH Research Fellow
Academic interest: depression and cerebrovascular disease