SportsPsychiatryPortableDidacticElectiveCurriculumAuthors:ClaudiaL.Reardon,MD,UniversityofWisconsinSchoolofMedicineandPublicHealth(clreardon@wisc.edu)VuongVu,MD,UniversityofWisconsinHospitalandClinics(vvu@uwhealth.org)AllieDyer,MedicalCollegeofWisconsin(adyer@mcw.edu)RobertM.Factor,MD,PhD,UniversityofWisconsinSchoolofMedicineandPublicHealth(rmfactor@wisc.edu)IraGlick,MD,StanfordUniversity(iraglick@stanford.edu)PratikMehta,MD,UCLA(PMehta@mednet.ucla.edu)ToddStull,MD,UniversityofNebraska(tstull@huskers.com)onbehalfoftheInternationalSocietyforSportsPsychiatryCurriculumReleaseDate:May2018IntendedLearners:

• Psychiatryresidentsdesiringanelectiveinsportspsychiatry• Psychiatryfellows(especiallychildandadolescent,addiction,orsleep)

desiringanelectiveinsportspsychiatry• Primarycare(familymedicine,internalmedicine,pediatrics)residents

desiringanelectiveinsportspsychiatry• Sportsmedicinefellowsdesiringanelectiveinsportspsychiatry• Seniormedicalstudentsintendingacareerinpsychiatry,sportsmedicine,or

primarycareanddesiringanelectiveinsportspsychiatryIntroduction:Sportspsychiatryisthesub-specialtywithinpsychiatrylargelyfocusingondiagnosisandtreatmentofpsychiatricillnessinathletes.Whileutilizationofpsychologicalapproachestoenhanceperformancemayalsobepartoftheworkofthesportspsychiatrist,ittendstobelesssoascomparedtoaddressingactualmentalillnessinthispopulation.Theworkofsportspsychiatrymayalsoinvolvetheuseofexerciseasatherapeuticorpreventativeinterventionformentalillness.Thefieldisrelativelynew,suchthatmostmedicalschoolsandresidency/fellowshipprogramsdonothavecurricularofferingsdedicatedtothetopic.Moreover,withthepopulationofsportspsychiatristsrelativelysmall,andwitharelativelysmallresearchbase,whenhealthcareprovidersdodeliverpsychiatriccaretoathletes,theymaydosowithoutafullunderstandingofthediagnosticandtherapeuticissues

uniquetothispopulation.Thus,thiscurriculumaimstoenhancetheknowledgebaseofphysiciansandphysicians-to-beinthescienceofsportspsychiatry,andtoincreasetheskillwithwhichthesecliniciansprovidepsychiatrichealthcaretoathletepopulations.ResourcesRequired:Faculty:Ideally,anon-sitepsychiatristwithexpertiseinsportspsychiatrywouldsupervisethiselectiveexperience.However,itisacknowledgedthatthefieldofsportspsychiatryisrelativelysmall,suchthatmedicalschoolsandresidencyprogramsmaynothaveafacultymember/attendingwhoidentifiesasanexpertinsportspsychiatry.Inthatcase,alocalfacultymemberwithaninterestinthefield,eveniflittleexperienceinit,couldsupervisethecurriculum.Afinaloptionisthatafacultymember/attendingfromaninstitutiondifferentthanthatatwhichthetraineetakingthecurriculumisenrolledcouldremotelysupervisethedidacticportionofthecurriculum.Inthelattercase,therewouldbenodirectclinicalaspecttotherotation.Inanycase,ideallytherewouldberegular(e.g.,weekly)meetingsbetweenthelearnerandsupervisorfordiscussionofreadingsandwritingassignments.Patientpopulation:Aclinicalpopulationofathlete-patientscouldprovideaclinicalcomponenttothiselective.Careofsuchpatientswouldbesupervisedbyanon-sitefacultymember/attending.However,thiselectivecanalsobecompletedassimplyadidactic/readingelective,inwhichthelearnercompletesthe“Readingsandassignments”and“Finalproject”describedbelow.Ifthelatter,afacultymentor/attendingshouldstillbeavailabletoreviewassignmentswiththelearnerandtoprovideaccountabilityinthatmanner.Materials:Theliteraturearticleslistedinthe“Readingsandassignments”sectionbelowareavailableonPubMed.Thetwoassignedbookchapterarticlesareavailableinthetext“ClinicalSportsPsychiatry:AnInternationalPerspective”(Wiley,2013).Ifthelearnerdoesnothaveaccesstothistext,eitherthroughtheirinstitution’slibrarylendingsystemortheirownortheirmentors’bookcollections,thenthesetopicsmaybeskippedorcompletedinmodifiedform,astherearenoequivalentjournalarticlesintheliterature.Ofnote,anyproceedsfromtheWiley,2013textgototheInternationalSocietyforSportsPsychiatryandnottoindividualeditorsorauthors.Layoutoftheelective:Theelectivecentersaroundadidactic/readingcomponent(see“Readingsandassignments”below).Theratewithwhichthelearnergoesthroughthereadings/assignmentswilldependonthetimeallottedfor,anddurationof,theelective,aswellaswhetherornotthelearnerhasclinicalrequirementsthatalsomustbecompletedduringthetimeoftheelective.Forexample,ifthelearnerissolelycompletingadidactic/readingelectiveduring½dayperweekofprotectedtime,theymightcomplete2topic“blocks”perweek(readingandaccompaniedassignment),andspendtheremainderofthetimeduringthat½dayeachweekworkingontheirfinalprojectandmeetingwiththesupervisor.Ifthelearneris

completingasportspsychiatryclinicalexperiencealongwiththedidactic/readingcomponent,theymightcompletejust1“block”perweek,andspendtheremainderofthetimeduringtheelectiveeachweekseeingpatients,workingontheirfinalproject,andmeetingwiththeirsupervisor.Dependingonthedurationoftheelective,thelearnerandfacultysupervisormightselectanappropriatenumberoftopics(thosefelttobeofgreatestindividualinterestorofhighestrelevance)tobecoveredduringthattime,omittingtheothers.Detailedtimekeepingbyearlylearnersdemonstratedthateachtopic(includingtimeforreadingthefullarticle(s)andansweringthequestionsthoroughly)takesbetween30minutesand2.5hoursforthelearnertocomplete(mostinthe1-2hourrange).GoalsandObjectivesofthecurriculum:Goals:Bytheendofthisrotation,learnerswill:

1. Understandtheepidemiologyof,riskfactorsfor,anduniquemanifestationsofavarietyofpsychiatricdisordersandpsychosocialstressorsinathletes.

2. Understandhowtreatmentsforpsychiatricdisordersinathletesmaybesimilartoanddifferentfromtreatmentsforpsychiatricdisordersinthegeneralpopulation.

3. Appreciatethatthereareindividualleveltreatmentsaswellassystemwideinterventionstoaddressmentalillnessinathletes.

4. Developfamiliaritywiththemedicalliteratureonavarietyoftopicsrelatedtosportspsychiatry.

Objectives: Specificobjectivesarecoveredbythereadingassignmentquestions.Bythe endofthisrotation,learnerswillbeabletoanswerallofthequestionsposed inthereadingassignments.Finalproject:Learnerscompletingthiselectivearetoproduceascholarlyproductrelevanttothefieldofsportspsychiatry.Thetopicandformatoftheproductissubjecttoapprovalbythesupervisingfacultymember/attending.Optionsincludeamanuscript(e.g.,astandardresearchstudy,reviewpaper,opinionpieceinajournal,AmericanJournalofPsychiatryResidents’Journalarticle,etc.),posterpresentation(local,regional,national,orinternational),apresentation,talk,orworkshop(local,regional,national,orinternational),educationalsession(e.g.,aone-hourdidacticsessionforotherlearnersintheiracademicprogram,oraGrandRounds),oreducationalcolumn(e.g.,intheInternationalSocietyforSportsPsychiatrynewsletter,statepsychiatricassociationnewsletter,etc.).Theexactprojectchosendependsoninterestofthelearner,durationoftheelective,timeavailableforworkontheproject,mentorshipavailableatthetimeoftheelective,andscholarlyopportunitiesatthetimeoftheelective.Evaluationofthelearner:Seeattachedforasampleevaluationformthatmaybeespeciallyrelevanttopsychiatryresidents,asitiswrittentoalignwiththeACGMEMilestonesforpsychiatryresidents(availablehere:https://www.acgme.org/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf).

Thus,thisevaluationformcanbepartofanoverallMilestones-basedassessmentofaresident,asthatistheapproachthatmostresidencyprogramsarenowtaking.NotethatMilestonelevelsonthisevaluationformonlygouptolevel4,aslevel5isregardedbytheACGMEas“stretch”goalsthatmany/mostresidentswillnothaveachievedbythetimeofgraduation,andthiscurriculumisnotdesignedtoachievelevel5Milestones.Theevaluationformismostlybasedonspecificanswersprovidedbythelearnertovariousreadingassignments,andthus,itwouldbehelpfulforthesupervisortocollecttheassignmentsastherotationgoeson,soastobeabletoreferencethemwhencompletingtheevaluation.Thisevaluationformcanbesupplementedwithorreplacedbyanystandardevaluationformsusedforlearnerscompletingotherrotations/electivesatalearner’sinstitution.Answerkey:Uponalearnercompletingthiscurriculum,theymayemailDr.Reardon(clreardon@wisc.edu)torequestananswerkey,ifdesired,fortheirownlearningpurposes.Inmakingsucharequest,theyshouldattestthattheyhavecompletedtheirelectiveandshouldcctheirattendingsupervisor(toensureanswersarenotgivenoutpriortocompletingthecurriculum).Ifanattendingsupervisordesirestheanswerkeypriortotheirlearnercompletingthecurriculum,theymayemailDr.Reardonwiththatrequest.PleasedonotdisseminatetheanswerkeybeyondthecurrentlearnerandattendingsupervisorwithoutpermissionfromDr.Reardon.Evaluationofthecurriculumbythelearnerandbytheattendingsupervisor:Whenyouhavecompletedyoursportspsychiatryelective,thelearnerandattendingsupervisorareaskedtopleasecompleteanonymous,approximately5-minute,evaluationsofthecurriculum.Thesewillhelpshapefutureiterationsofthecurriculum.Curriculumauthorswillnotviewsurveyresultsuntilatleast5responsesarecollected.Thelinkstothesurveysareasfollows:Learnersurvey:https://uwmadison.co1.qualtrics.com/jfe/form/SV_cSkILWffb7RlJRjAttendingsupervisorsurvey:https://uwmadison.co1.qualtrics.com/jfe/form/SV_dgqInTEZhJDcvZPReadingsandassignments:Block# Topic Reading/assignment1 Thefieldofsportspsychiatry Reading:ReardonCL,Factor

RM.Sportpsychiatry:asystematicreviewofdiagnosisandmedicaltreatmentofmentalillnessinathletes.SportsMedicine2010;40(11):961-980.

Writingassignment:• Whatisthefieldofsports

psychiatry?Howdoesitdifferfromsportspsychology?

• List3causalrelationshipsbetweensportandmentalillness,andatleast1example(eitherfromthisarticleorfromanyotherinformationyouhave)ofeachofthoserelationships.

2 Depressioninathletes Reading:WolaninA,HongE,MarksD,etal.Prevalenceofclinicallyelevateddepressivesymptomsincollegeathletesanddifferencesbygenderandsport.BritishJournalofSportsMedicine2016;50:167-171.Writingassignment:

• WhatNCAAsporthadthehighestratesofdepressioninthisstudy?Listatleast3reasonswhythissportmighthavehigherratesofdepressionthanothersportsinthestudy.

• Findatleastoneotherresearcharticlethatdiscussesdifferencesinratesofdepressionbetweenindividualandteamsportathletes.Givethecitationforthearticle,andwrite2-4sentencestosummarizeanyhypothesesdiscussedinthearticleaboutwhytheremightbesuchdifferences.

3 Anxietyinathletes Reading:ReardonCL.Psychiatriccomorbiditiesin

sports.NeurologicClinics2017;35:537-546.Writingassignment:

• Imagineyouhaveapatientwhoisa19yearoldcollegiateswimmerwhohasdevelopedsport-relatedperformanceanxiety.Shebecomesveryanxiousleadinguptoallcompetitionstothepointthatshehasfeignedillnessesandinjuriestoavoidhavingtocompete.Whenshedoescompete,shefeelsthatherperformancesuffersrelatedtotheanxiety.Thisanxietyseemedtohavestartedwhenshehadasinglepoorperformancemuchbelowthatexpectedofher.Shedoesnothavesignificantanxietyoutsideoftheathleticsphere.Howwouldyoutreatheranxietyinthissituation?Commentonanypsychotherapeutic,psychopharmacologic,orotherapproachesyoumighttake.

• Describewhypanicdisordersufferersmayexperienceaworseningofsymptomsduringacuteexercise.

• Find2examplesfromthelaypressthatillustratewhatyouwouldconsidersuperstitiousritualsinathletes(asopposedtoactualobsessive-

compulsivedisorder).Whatpsychologicalroledoyousupposetheseritualsplayfortheathletes?

4 Post-traumaticstressdisorderandothertrauma-relateddisordersinathletes(*Note:Theassignedreadingisfromatextbooktowhichlearnersmightnothaveaccessthroughtheirinstitution’slibrarylendingsystemsortheirownortheirmentors’bookcollections.Ifthelearnerhasnoaccess,thenthistopicmaybeskipped,asthereisnoequivalentjournalarticleintheliterature).

Reading:Posttraumaticstressinathletes.WenzelT,ZhuLJ.In:BaronDA,ReardonCL,BaronSH,eds.ClinicalSportsPsychiatry:AnInternationalPerspective.UnitedKingdom:Wiley,2013.Writingassignment:

• ListeventsthatmayleadtoPTSDsymptomsinathletes,andwhysomeofthesesameeventsmaybelesslikelytocausePTSDsymptominnon-athletes.

• DescribehowPTSDsymptomsinanathletecanspecificallyinterferewithathleticperformance.

• Youhavea25yearoldmaleprofessionaltrackandfieldathletewhotrippedoverahurdleinamajorinternationalcompetition,sufferedaseriousleginjuryrequiringseveralsurgeriesandayearofrecovery,andhasnowcompletedallnecessaryrehabilitationtobeabletofullyreturntosport.However,heisexhibitingPTSDsymptomsandishavinggreatdifficultyreturningtosport.Whenhetriestopractice,heclearsthehurdleswithhesitationanddoesnot

getlowenoughtothehurdles.Describeyourgeneraltreatmentapproach,includingpsychotherapyandpsychopharmacologyasappropriate.

5 Eatingdisordersandotherbodyimagedisordersinathletes

Reading1:• JoyE,KussmanA,Nattiv

A.2016updateoneatingdisordersinathletes:acomprehensivenarrativereviewwithafocusonclinicalassessmentandmanagement.BritishJournalofSportsMedicine2016;50:154-162.

Writingassignment1:

• Whichsportsareassociatedwiththehighestriskfordevelopmentofeatingdisorders?

• Listatleast5factorsthatshouldbetakenintoaccountwhenconsideringclearance/returntoplayforanathletewithaneatingdisorder.

• Find1researcharticleonthefemaleathletetriadand1researcharticleonRelativeEnergyDeficiencyinSport(RED-S).Givethecitationsforthearticles,andwrite1paragraphcomparingandcontrastingtheconceptsofRED-Sandthefemaleathletetriad.Itisnotuniversallyacceptedthat1oftheseconstructsis

morevalidthantheother,butwhichdoyoufindmorecompelling?

Reading2:

• MurraySB,RiegerE,TouyzSW,etal.MuscledysmorphiaandtheDSM-Vconundrum:wheredoesitbelong?Areviewpaper.IntJEatDisord2010;43:483-491.

Writingassignment2:

• MuscledysmorphiaisnotanofficialdiagnosisincludedintheDiagnosticandStatisticalManualofMentalDisorders.However,listtheproposeddiagnosticcriteriaforthiscondition.

• Describewaysinwhichmuscledysmorphiaissimilarto:bodydysmorphicdisorder;obsessive-compulsivedisorder;andeatingdisorders.

6 Substanceusedisordersinathletes:Part1

Reading:• ReardonCL,CreadoS.

Drugabuseinathletes.SubstanceAbuseandRehabilitation2014;5:95-105.

Writingassignment:

• Listatleast4reasonswhyathletesasauniquepopulationmayusesubstances.

• A21yearoldfemalecollegiatebasketballplayerhasbeenreferredtoyoubyherteam

trainerforanxiety.ShereportsusinghighdosesofAdderall(mixedamphetaminesalts)fromafriend,asitseemstohelpherspeedandfocusonthecourt.Shedoesnotnoticeittobecausinganyproblemsforher.Herultimategoalistogotomedicalschooltobecomeanorthopedicsurgeonorsportsmedicinephysician.Listfourstatements,usingeachofthe4importantelementsofmotivationalinterviewingthatarementionedinthearticle,thatyoumightmaketoheraspartofamotivationalinterviewingapproachtohersubstanceuse.Forexample,toillustratetheuseofclinicianempathy,youmightstate,“Itgoeswithoutsayingthatyouhavesomanypressuresanddemandsonyourtime,thatIcanjustimaginewhenyoufindsomethingthatseemstohelpanddoesn’tseemtocauseanyproblems,onewouldbehardpressednottowanttouseit.”

7 Substanceusedisordersinathletes:Part2

Reading:HainlineB,BellL,WilfertM.Chapter3.Substanceuseandabuse.In:Mind,Body,andSport:UnderstandingandSupportingStudent-AthleteMentalWellness.NCAA.2014.Availableat:http://www.ncaa.org/sport-

science-institute/introduction-mind-body-and-sport(scrolltoseespecificchaptersub-topicassigned)Writingassignment:

• Howdoratesofalcoholandmarijuanausebycollegestudent-athletescomparetousebynon-athletecollegestudents?

• Listatleast3potentialnegativeeffectsonsportsperformanceforstudent-athletesforuseofeachofthefollowingsubstances:alcohol,stimulants,andmarijuana.

8 Gamblingdisorderinathletes Reading:DerevenskyJ,PaskusT.Chapter3.Gamblingamongstudent-athletes:causeforconcern.In:Mind,Body,andSport:UnderstandingandSupportingStudent-AthleteMentalWellness.NCAA.2014.Availableat:http://www.ncaa.org/sport-science-institute/introduction-mind-body-and-sport(scrolltoseespecificchaptersub-topicassigned)Writingassignment:

• Describethedemographicsofgamblingincollegiatestudent-athletesbyansweringthefollowing:1)whatpercentageofmaleandfemalestudent-athletesexhibitclinicalsignsofproblemgambling?;2)athletesfromwhichsportareatgreatestriskforproblem

gambling?;3)inwhattypeofgamblingarestudent-athletesrelativelymorelikelytoparticipatecomparedtotheirpeers?

• DescribeNCAAregulationssurroundingstudent-athleteparticipationingambling.Whatdoyouthinkisthepointofhavingtheseregulations?Canyouthinkof1possiblewaytotrytoimprovecompliancewiththeseregulations?

• Describeatleasttwowaystechnologyhasinfluencedtrendsingambling.

9 Bipolardisorderinathletes Reading:• SylviaLG,FriedmanES,

KocsisJH,etal.Associationofexercisewithqualityoflifeandmoodsymptomsinacomparativeeffectivenessstudyofbipolardisorder.JournalofAffectiveDisorders2013;151(2):722-727.

Writingassignment:

• Whatistherelationshipbetweenfrequencyofexerciseandmoodstatesasdescribedinthisstudy,andwhatareatleast2possibleexplanationsforthisfinding?

• Doyouthinktheabovefindingwouldbecompellingenoughtochangeyourpracticein

anywaywhenworkingwithathleteswhohavebipolardisorder?Ifso,inwhatway(s)?

10 Attention-deficit/hyperactivitydisorderinathletes

Readings:• ReardonCL,FactorRM.

Considerationsintheuseofstimulantsinsport.SportsMedicine2016;46:611-617.

• GarnerAA,HansenAA,BaxleyC,etal.Theuseofstimulantmedicationtotreatattention-deficit/hyperactivitydisorderineliteathletes:aperformanceandhealthperspective.SportsMed2018;48:507-512.

Writingassignment:

• List3argumentsforand3againststimulantsbeingprescribedtoeliteathletes.

• Withwhichoftheabovearticlesdoyouagreemorewhenitcomestoprescriptionofstimulantmedicationsforeliteathletes?Write1paragraphwithyourrationale.

11 Sleepinathletes Reading:HalsonSL.Stealingsleep:issportorsocietytoblame?BritishJournalofSportsMedicine2016;5:381.Writingassignment:

• Listatleast5reasonswhyathletesmaybeatuniqueriskforsleepdeprivation.

• Youareworkinginadministrativeleadership

ataDivisionIcollegeathleticdepartmentandhavebeenputinchargeofdevelopinginitiativestoimproveoverallsleepofthestudent-athletepopulationatyourinstitution.Describe2initiativesyoumightundertake,andbarriersthatmightexisttoimplementationofeachone.

12 Suicideinathletes Reading:LesterD.Chapter3.Suicidaltendencies.In:Mind,Body,andSport:UnderstandingandSupportingStudent-AthleteMentalWellness.NCAA.2014.Availableat:http://www.ncaa.org/sport-science-institute/introduction-mind-body-and-sport(scrolltoseespecificchaptersub-topicassigned)Writingassignment:

• Whatistherelativeriskofsuicideincollegestudent-athletescomparedtothegeneralcollegepopulation?Describespecificdemographicvariableswithinthatgenerality.

• List6riskfactorsforsuicideinprofessionalathletes.

13 Mentalhealthimpactofconcussionsinathletes:Part1

Reading:McCrory,Paul,MeeuwisseW,DvorakJ,etal.Consensusstatementonconcussioninsport—the5thinternationalconferenceonconcussioninsportheldinBerlin,October2016.BritishJournalofSportsMedicine

2017;51:838-847.Writingassignment:

• Definesport-relatedconcussion,includingseveralclinicallydefiningfeaturesaslaidoutbythe5thinternationalconferenceonconcussioninsport.

• Return-to-sportandreturn-to-schoolstrategiesfollowingsport-relatedconcussionhaveevolvedovertime.Thispapernotesthatafterabriefperiodofinitialrest(24-48hours)followingasport-relatedconcussion,symptom-limitedactivitycanbebegun.Onceconcussion-relatedsymptomshaveresolvedatagivenlevelofactivity,theathleteshouldcontinuetothenextlevel.Generally,eachstepshouldtakeaminimumof24hours.Listthe6aims(levels)ofagraduatedreturn-to-sportstrategyandthe4aims(levels)ofagraduatedreturn-to-schoolstrategy(specificactivitiesandgoalsofeachaimneednotbelisted).

• List6clinicaldomainsthatcanleadtoasuspecteddiagnosisofsport-relatedconcussion.

• Themanuscriptnotesthatthelargemajorityofathleteswithsport-

relatedconcussionrecover,fromaclinicalperspective,withinthefirstmonth,thoughtherearedefiniteexceptions.Listatleast5riskfactorsfordelayedrecovery,includingspecificmentionofthestrongestandmostconsistentpredictorofslowerrecoveryfromsport-relatedconcussion.

14 Mentalhealthimpactofconcussionsinathletes:Part2

Reading:RiceSM,ParkerAG,RosenbaumS,etal.Sport-relatedconcussionandmentalhealthoutcomesineliteathletes:asystematicreview.SportsMedicine2018;48:447-465.Writingassignment:

• Describethelevelofevidenceforanyassociationbetweensport-relatedconcussionanddepression,andbetweensport-relatedconcussionandanxiety.

• Describeabiopsychosocialmodelfornegativeoutcomesinsport-relatedconcussion.

15 Relationshipbetweeninjuriesandmentalillness

Reading1:PutukianM.Chapter4.Howbeinginjuredaffectsmentalhealth.In:Mind,Body,andSport:UnderstandingandSupportingStudent-AthleteMentalWellness.NCAA.2014.Availableat:http://www.ncaa.org/sport-science-institute/introduction-mind-body-and-sport(scrolltoseespecificchaptersub-topicassigned)

Writingassignment1:

• Describehowaneatingdisordermayresultfromanathleticinjury.

• Provide3reasonswhybeinginjuredwithaconcussionisdifferentfromotherinjuriesinhow/whyitmayaffectmentalhealth.

• Describeonepotentialnegativeimpactofincreasedmediaattentiononchronictraumaticencephalopathyamongathletes.

Reading2:Psychologicalissuesrelatedtoillnessandinjuryinathletesandtheteamphysician:aconsensusstatement-2016update.CurrentSportsMedicineReports2017;16(3):189-201.Writingassignment2:

• Describeatleast2waysinwhichpsychologicalstressmaypredisposetoathleticinjury.

• List3prominentpsychologicalfactorsthathavebeenshowntobeimportantinillnessandinjurytreatmentandoutcomes.Foreachofthese,explaintheimpactin1-2sentences.

• List9characteristicsofpoorprogressionofrecoveryfrominjury.

16 Medicationuseforpsychiatricdisordersinathletes

Reading:ReardonCL,CreadoS.Psychiatricmedicationpreferencesofsports

psychiatrists.ThePhysicianandSportsmedicine2016;44(4):397-402.Writingassignment:

• List3importantvariablestoconsiderinprescribingpsychiatricmedicationstoathletes.

• Consideringtheresultsdescribedintheassignedreading,aswellasyourownclinicalexperienceswithmedications,whatwouldbeyourfirstchoiceforapsychiatricmedicationforanathleteineachofthefollowingcategories:depressionwithoutanxietyandwithoutbipolarspectrumdisorder;generalizedanxietydisorder;insomnia;ADHD;bipolarspectrumdisorders;psychoticdisorders?Forresidents/fellowsonly(thiswouldbeanadvancedquestionformedicalstudents):Whatwouldbeyourfirstchoiceforapsychiatricmedication,andwhy,foranathleteinthefollowingdiagnosticcategoriesnotconsideredexplicitlyinthisarticle:OCD;PTSD;panicdisorder?

• How,ifatall,doyourfirst-linechoicesinallofthesecategoriesdifferfromyourfirst-linechoicesforgeneral,non-athletepatients?Ifthere

aredifferences,aretheyjustifiable(inotherwords,doanydifferencessuggestthatwewouldn’tbetreatingathletes“aggressively”enoughwithmedication,orthatwearetootolerantofsideeffectsinnon-athletepatients?)?

17 Psychotherapyforpsychiatricdisordersinathletes

Reading:StillmanMA,BrownT,RitvoEC,etal.Sportpsychiatryandpsychotherapeuticintervention,circa2016.InternationalReviewofPsychiatry2016;28(6):614-622.Writingassignment:

• Listatleast1reasonwhyeachofthefollowingtypesofpsychotherapy,incertaincircumstances,maybeuniquelyhelpfuland/orcomfortableforathlete-patients:CBT;marital/familypsychotherapy;grouppsychotherapy.

• A21yearoldfemaleswimmerisreferredtoyouforpsychiatricassessmentandtreatmentforsymptomsofsevereanxietyandpossibleeatingdisorder.Youcontacthertoscheduleanintakeappointment,andofferheravarietyoftimeslotsinwhichyouseepatients(8:30-4pm,exceptfor12-1forlunchbreak/meetings)andduringwhichyourcollegecounselingcenterisopen.

However,theswimmer,whoisinthemidstofaveryheavyswimpracticescheduleasshepreparesfortheOlympicTrials,saysthatitwouldbeverydifficultforhertoseeyouduringyouropentimeslots,andshewondersifyoucouldseeherat4pm.Howwouldyoudealwiththissituation?Whataretheprosandconstoavarietyofoptionsforscheduling?

18 Exerciseaddiction Reading:FreimuthM,MonizS,KimSR.Clarifyingexerciseaddiction:differentialdiagnosis,co-occurringdisorders,andphasesofaddiction.InternationalJournalofEnvironmentalResearchandPublicHealth2011;8:4069-4081.Writingassignment:

• List7proposedcriteriaforexerciseaddictionthatparallelDSM-5criteriaforsubstanceusedisorders.

• Distinguishprimaryexerciseaddictionfromsecondaryexerciseaddiction.

• Listthe4proposedphasesofexerciseaddiction.Writeonesentencetodescribeeachphase(4sentencestotal).

19 Harassmentandabuse(non-accidentalviolence)insport:Part1

Reading:DiamondAB,CallahanST,ChainKF,etal.Qualitativereviewofhazingincollegiateandschoolsports:consequencesfromalackofculture,

knowledgeandresponsiveness.BritishJournalofSportsMedicine2016;50:149-153.Writingassignment:

• Definesports-specifichazing.

• Listthe3maincategoriesofhazing,andprovide1-3specificexamplesofhazingactivitieswithineachofthosecategories.

• Table2listspossiblerolesforadministrators,coaches,studentathletes,andteamcaptainstoplaywithregardstohazingawarenessandprevention.Arethereanypossiblerolesinthisregardforthesportspsychiatristand/orsportsmedicinephysician?If,asthephysician,youwouldtalktoyourathlete-patientsaboutthisissue,shareexamplelanguagethatyoumightuse.

20 Harassmentandabuse(non-accidentalviolence)insport:Part2

Reading:MarksS,MountjoyM,MarcusM.Sexualharassmentandabuseinsport:theroleoftheteamdoctor.BritishJournalofSportsMedicine2012;46:905-908.Writingassignment:

• Definesexualharassmentandsexualabuse.

• Riskfactorsforsexualabuse/harassmentinsportcanbebrokendownintoathlete,coach,andsportvariables.List1-3specificriskfactors

withineachofthesecategories.

• Listseveralpotentialpsychologicalconsequencesofsexualharassmentandabuseinsport.

• YouhavebeenaskedtogiveatalktotheprimarycaresportsmedicinephysiciansataDivisionINCAAinstitutiononthetopicofsexualharassmentandabuseinsport.Listatleast6keytenetstosharewiththeteamphysiciansastohowtheyshouldrespondanddealwithasituationinwhichanathletehasdisclosedsexualabuseorharassmentinsport.

21 Childandadolescentsportspsychiatry

Reading:Conant-NorvilleDO.ChildandadolescentsportspsychiatryintheUS.InternationalReviewofPsychiatry2016;28(6):556-563.Writingassignment:

• Definephysicalliteracy,includingdefinitionsofthe3componentsofit.Listatleast4groupsofyouthwho,underthecurrentmodelofyouthsportsintheUS,haveinsufficientopportunitiesfordevelopmentofphysicalliteracy.

• List8challenges,identifiedbytheAspenInstitute’sProjectPlayworkgroup,thatlimityouthsportsinvolvementintheUS.Imagineyouaretaskedwith

developingasummeryouthsportsprogramfor5-6yearoldsinyourcommunity.Howwouldyoustructuretheprogram,keepinginmindsomeofthe8challengesyoulisted.

• Distinguish“earlyspecializationinsport”versus“sportsampling”inyouth,andlistatleast3benefitsofthelatter.

22 Retirementinathletes Reading:KnightsS,SherryE,Ruddock-HudsonM.Investigatingeliteend-of-athletic-careertransition:Asystematicreview.JournalofAppliedSportPsychology2016;28:291-308. Writingassignment:

• Distinguishbetweenthe2typesoftransitionsthatathleteswillfacethroughouttheirathleticcareer,andgiveexamplesofeach.

• Listatleast3factorsthatmayleadtoamoredifficulttimetransitioning,andatleast3factorsthatmaybeprotectiveagainstadifficulttransition.

• Listatleast3strategiesthatmighthelpathletestotransitionmoresmoothly.

23 Exerciseasatreatmentformentalillness

Readings:• CooneyGM,DwanK,

GreigCA,etal.Exercisefordepression.Cochranedatabaseofsystematicreviews2013.

• EnsariI,GreenleeTA,MotlRW,etal.Meta-analysisofacuteexerciseeffectsonstateanxiety:anupdateofrandomizedcontrolledtrialsoverthepast25years.DepressionandAnxiety2015;32:624-634.

Writingassignment:

• Listatleast4hypothesesastowhyexercisemighthaveanantidepressanteffect.

• In3-4sentences,summarizetheresultsoftheCochranereviewonexerciseasatreatmentfordepression.Basedontheseresultsandanyotherinformationyouhave,doyoufinditjustifiedtorecommendexerciseforyourpatientsasatreatmentfordepression?Whyorwhynot?

• In1-2sentences,summarizetheresultsoftheEnsaristudyonanacuteboutofexerciseasatreatmentforanxiety.Basedontheseresultsandanyotherinformationyouhave,doyoufinditjustifiedtorecommendexerciseforyourpatientsasatreatmentforanxiety?Whyorwhynot?

24 Overtrainingsyndrome Reading:ReardonCL.Psychiatriccomorbiditiesinsports.NeurologicClinics2017;35:537-546.

Writingassignment:

• List2waystohelpdistinguishovertraininganddepressioninathletes.

• Findoneotherscientificarticleonovertrainingsyndromethatprovidesdefinitionsofrelevantterms.Specifically,listthearticlecitationandprovidedefinitionsfromthatarticlefor:1)overtrainingsyndrome,and2)overreaching/nonfunctionaloverreaching.

25 Barrierstoathletesaccessingmentalhealthresources

Reading:GulliverA,GriffithsKM,ChristensenH.Barriersandfacilitatorstomentalhealthhelp-seekingforyoungeliteathletes:aqualitativestudy.BMCPsychiatry2012;12:157..Writingassignment:

• Listatleast5potentialbarriersforathleteswhenitcomestoseekingmentalhealthtreatment.

• Howdoestheroleofstigmadifferwhenitcomestoathletesseekinghelpforclinicalconditionsversusforathleticperformanceconcerns?

• Inwhatconcretewayscouldamentalhealthprofessionalhelpimprovefacilitativefactorswhenitcomestoathletesseekingmentalhealthtreatment?

Specifically,listonewaythementalhealthprofessionalcoulddosothatmightinvolvecoaches,onethatmightinvolveadministration,andonethatmightinvolvetheathletesdirectly.

26 Theroleofcultureinsports Reading:GillD.Genderandculturaldiversityinsport,exercise,andperformancepsychology.OxfordResearchEncyclopediaofPsychology.2017.Availableat:http://psychology.oxfordre.com/view/10.1093/acrefore/9780190236557.001.0001/acrefore-9780190236557-e-148Writingassignment:

• Describehowgenderstereotypesanddifferentialmediacoverageofmen’sversuswomen’ssportsmayinfluencesportsperformanceand/orparticipation.

• Describehowstereotypethreatmightimpactathleticperformanceforathletesofracialorethnicminorities.

• Listatleast3barrierstosportsparticipationforpeoplewithphysicaldisabilities.

• FindatleastoneotherresearcharticlethatdiscussesanymentalhealthrisksorconcernswithinanLGBTQathletepopulation.Providethecitation,andwrite2-4

sentencestosummarizethefindingsdescribedinthearticle.

• Reflectonyourownculturalbackgroundand,ifapplicable,yourownhistoryofsportsparticipation.Writeaparagraphonhowthisbackgroundmightaffectinteractionswithathlete-patientsfromavarietyofdemographicgroups.

27 Ethicalissuesinsportspsychiatry(*Note:Theassignedreadingisfromatextbooktowhichlearnersmightnothaveaccessthroughtheirinstitution’slibrarylendingsystemsortheirownortheirmentors’bookcollections.Ifthelearnerhasnoaccess,thenthistopicmaybecompletedwithoutreferencingtheassignedchapter,knowingthatitwillbemoredifficulttodoso,butwillstillgeneratereflectiononanddiscussionofthetopic).

Reading:Sportspsychiatristsworkingincollegeathleticdepartments.MorseED.In:BaronDA,ReardonCL,BaronSH,eds.ClinicalSportsPsychiatry:AnInternationalPerspective.UnitedKingdom:Wiley,2013.Writingassignment:

• Describehowyouwouldhandlethefollowingethicalchallenges:a) Youareasalaried

employeeintheathleticdepartmentataDivisionIuniversity,employedtotreatstudentathletes.Youaretreatingafemalesoftballplayerforrecurrentmajordepressivedisorder,PTSD,andborderlinepersonalitydisorder.Shehashad3hospitalizationsinthelast18months,andthishasprovendisruptivetoherteam.Theathlete’s

athletictrainerandcoachcontactyoutoaskaboutprognosisandlikelihoodoffuturedecompensationsandhospitalizations,astheyareconsideringcuttingherfromtheteamduetohermentalhealthabsences.Commentonthisspecificsituation,aswellasanylargerstrategiesforaddressingthepotentialconflictofinterestinrolesyoufill.

b) YouaretreatingafootballplayerataDivisionIuniversityforgeneralizedanxietydisorderandalcoholusedisorder.YouareawarethatitiscommonknowledgeamongthefootballplayersthatinternaldrugtestinghappensonMondayafternoons.Herecentlyadmitstohavingbeenusingafriend’smethylphenidatetohelpwithstudying.HeisawareofNCAAprohibitionsagainstthis,intheabsenceofanofficialdiagnosisandappropriatedocumentation.Heasksifyouareabletomakethatdiagnosis,

ashebelievesitispresent,andinthemeantime,heasksaboutthehalf-lifeofmethylphenidatesothathecanavoidtestingpositiveonMondayafternoons.

c) YouaretreatingasprinterataDivisionIuniversityforpanicdisorderandmajordepressivedisorder.ShewinstheNCAANationalChampionship100meterdash.Shewouldliketogiveyouhertrackjerseytoaddtoyourofficedecorasatokenofherappreciation(sheobservesthatyouhavesomegenericsportsdecorationsbutnothingrelatedtotrackandfield,anditwouldmakeherfeelgoodtohavehersportrepresentedonyourwalls).Shepointsoutthatnothingonthejerseywillindicatefromwhomitcame.

Nowthatyouhavecompletedthecurriculum,thelearnerandattendingsupervisorareaskedtopleasecompletebriefevaluationsofthecurriculum.Seeaboveforweblinkstodoso.

Otherinformation:MembershipintheInternationalSocietyforSportsPsychiatry(ISSP)isavailabletomedicalstudents,residents,andfellowswhoareinterestedinthefield,atdiscountedratesfortrainees.Moreinformationisavailableat:https://sportspsychiatry.org.TheISSPholdsitsannualBusinessMeetingandScientificSessioninconjunctionwiththeAmericanPsychiatricAssociationAnnualMeetingeveryMay,andanyonewithinterestisinvitedtoattend(informationaboutthiseventpostedontheISSPwebsiteinadvanceofthemeeting).Additionally,amentorshipprogramisavailabletointerestedmedicalstudents,residents,fellows,andearlycareerpsychiatristsaspartofISSPmembership.Additionalreferenceforthoseinterestedinfurtherreading:BaronDA,ReardonCL,BaronSH,eds.ClinicalSportsPsychiatry:AnInternationalPerspective.UnitedKingdom:Wiley,2013.BegelD,BurtonRW,eds.SportPsychiatry.NewYork:NortonProfessionalBooks,2000.GlickI,KamisD,StullT,eds.TheISSPManualofSportsPsychiatry.NewYork:RoutledgePress,2018.McDuffDR,GarvinM.Workingwithsportsorganizationsandteams.InternationalReviewofPsychiatry2016;28(6):595-605.McDuffDR.SportsPsychiatry:StrategiesforLifeBalanceandPeakPerformance.Arlington(USA):AmericanPsychiatricPublishing,2012.