Psych Congress is turning 30, and to celebrate that, we are looking back to see how far psychiatry has come since the meeting started, as well as looking toward the future to see what is in store for the next 30 years. Join the co-Chairs, Drs. Jain and Raison, as they review the most notable developments in psychiatry and speculate what mental health treatment could look like in the future.
This session will review new developments in social anxiety disorder (SAD), focusing on state-of-the-art pharmacologic and psychotherapy treatments. Dr. Schneier will also review diagnosis and comorbidities, and will describe future directions in SAD research.
Within the last few years, progress has been made in our understanding of personality disorders (PDs). The essential dimensional nature of PDs has been recognized for decades, yet our diagnostic terminology continues to be based on categorical disease-based definitions. However, an Alternative Model for DSM-5 Personality Disorders (AMPD) was developed that is included in Section III of DSM-5—the section for “Emerging Measures and Models.” Dr. Oldham was Co-Chair of the Work Group that developed the model and will describe the model and summarize the substantial body of new research focusing on this new step in a dimensional direction for PDs.
“Solving Clinical Challenges” addresses complex conundrums that are faced by Psych Congress attendees in managing their patients with major depression. Dr. Thase will discuss and respond to real cases and real issues from attendees who were surveyed prior to the conference. Challenges that may be covered include: 1) diagnostic nosology, accurate diagnosis, and screening; 2) pharmacologic treatments; 3) side effect management; and 4) non-pharmacologic treatments.
While most mental health professionals believe they are engaging in shared decision making, they may be unaware of aspects of the power differential that can impact patients. This session will familiarize attendees with the concept and practice of shared decision making (SDM). Dr. Velligan will review pre-existing preferences and cognitive appraisal biases that complicate decision-making for patients and caregivers. New models of SDM that take into account both doctor and patient behaviors necessary for success will also be presented.
Despite a growing literature on the life course of attention-deficit/hyperactivity disorder (ADHD), a comprehensive understanding of one of the most feared outcomes, substance use disorders (SUD), is lacking. Moreover, many adolescents and adults with SUD may have undiagnosed and untreated ADHD. Dr. Wilens will discuss the relationship of ADHD and SUD across the lifespan. Data on prevention of SUD in ADHD individuals growing up will be presented. Treatment strategies including psychotherapy and/or medication treatment in individuals with comorbid ADHD and SUD will be presented, along with recent data about stimulant misuse and diversion.
Current practice environments demand that mental health professionals complete new diagnostic evaluations with more frequency, skill, and savvy, and often across lifespan and diagnostic neighborhoods. The DSM-5 has changed the approach to diagnosis of mood disorders across the lifespan, leaving clinicians with questions as to how to best address complexities such as mixed states, rapid cycling, and differential diagnosis. This session will use clinical cases to synthesize complex patient symptoms with diagnostic criteria, integrating diagnostic tools and tips for educating patients about their diagnosis and the diagnostic process.
Suicide is the leading cause of mental health malpractice. The Joint Commission noted that insufficient patient assessment is the root cause in over 80% of suicidal deaths. One-half of inpatient suicides result in a lawsuit. This session will provide the latest research on risk and protective factors for suicide. Persons who have decided to commit suicide view their therapist as adversaries rather than allies. The implications of this for assessment of suicidal patients will be delineated.
Many people have been diagnosed with Asperger’s disorder, and the world has been comfortable with this term. Despite the removal of Asperger’s disorder from the DSM-5 and inclusion now as autism spectrum disorder, is the term Asperger’s syndrome gone? There is considerable difficulty for patients and families to accept the new category and the loss of a distinct personality type. This session will provide some thought provoking points of view about why it may live on, despite the DSM-5.
The prevalence of SUDs is rising dramatically, with rates as high as 17 million for alcohol use disorder (AUD) and over 2 million for opioid use disorder (OUD). More than 100 American deaths per day are attributable to OUD alone. Despite available treatments, SUDs remain undertreated, perpetuating poor patient outcomes. This session will examine the latest research and evidence surrounding SUD treatment advances, including differences among oral and depot formulations, efficacy of available options within long-term management, implications on patient adherence, potential for illicit diversion, and associated genetic predilections to treatment response. In addition, as it is common for SUDs to co-exist with psychiatric disorders, evidence-based strategies for addressing concomitant SUD and other psychiatric disorders will be explored.
Supported by an educational grant from Alkermes, Inc.
Transcranial magnetic stimulation (TMS) remains an emerging science and a treatment modality that few fully understand, and it remains underutilized. This session will review the history and scientific underpinnings of transcranial magnetic stimulation (TMS), as well as review the new literature available from the last 12 months for the busy clinician.
Obsessive-compulsive disorder (OCD) is a common and disabling illness. Research suggests that most clinicians do not know how to properly diagnose and treat OCD. This session will describe how to diagnose OCD, understand its clinical presentations, and develop an evidence-based approach to treatment using psychotherapy and medications.
Traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) are commonly seen on the news and featured in public media. Falls are the leading cause of TBI in the elderly worldwide, while CTE is a growing hazard often linked to repetitive mild concussions to the brain, often starting in childhood with exposure to violent sports. TBI is a risk factor in older adults for Alzheimer’s disease (AD), and CTE is a risk factor for early AD, Parkinson’s disease, and even suicide. This session will focus on prevalence, pathophysiology, symptoms, and treatment of TBI and CTE and their unique relationship to aging and AD.
Recent research into the pathophysiology of MDD is revealing novel treatment targets that go beyond monoamines and include other targets, such as glutamate neurotransmission (e.g. ketamine and other modulators); modulation of cholinergic and gamma-aminobutyric acid (GABA)-ergic transmission; neuronal plasticity; stress/hypothalamic pituitary adrenal (HPA)-axis; neuroinflammation; and the reward system via modulation of opioid receptors and beta endorphins. In this session, Dr. Maletic will compare the safety and efficacy of novel MDD agents and their complementary role within the current treatment armamentarium.
Supported by an educational grant from Alkermes, Inc.
As of January 2017, 28 states and Washington, DC have implemented medical cannabis policies, and nine states and Washington, DC have legalized recreational cannabis. As more states consider medical cannabis and recreational cannabis policies, mental health professionals are left to wonder about the effects of these policies on their practices. Dr. Hill will take an evidence-based look at the impact of cannabis policies in the states that have implemented them with an eye to the future.
Back by popular demand, 2015 Keynote Speaker Vijay Gupta, MM, will explore the connection between music and mental health, explaining why music’s redemptive power may hold more potential than we realize. Mr. Gupta draws from his work as director of Street Symphony — a classical musical outreach non-profit organization — to illustrate how music can bring people back from the brink of their darkest times. The presentation will include a performance by Mr. Gupta and members of his Street Symphony. This is a featured session you don’t want to miss.
Women of reproductive age are often treated for psychiatric disorders and are on maintenance treatment. Approximately 50% of pregnancies in the United States are unplanned. Dr. Freeman will discuss the considerations for stopping or continuing different pharmacologic treatments during pregnancy for common psychiatric disorders, including mood disorders, anxiety disorders, attention-deficit/hyperactivity disorder, and psychotic disorders.
“Solving Clinical Challenges” addresses complex conundrums that are faced by Psych Congress attendees in managing their patients with bipolar disorder. Dr. Ketter will discuss and respond to real cases and real issues from attendees who were surveyed prior to the conference. Challenges that may be covered include: 1) diagnostic nosology, accurate diagnosis, and screening; 2) pharmacologic treatments; 3) side effect management; and 4) non-pharmacologic treatments.
Major advances in our understanding of autism spectrum disorders and their treatments have occurred in the last several years. This session will provide an overview of autism and related disorders, including new developments in diagnosis, treatment, and changes in outcome with earlier intervention. Common comorbid conditions will be discussed and treatment strategies summarized. Our increased understanding of the neural and genetic mechanisms underlying autism will be reviewed.
Telepsychiatry is reaching maturity as a field, and increasingly is being used in both individual providers and organizations to increase both the quality and availability of mental healthcare, particularly for underserved populations. This session will educate mental health professionals about the 7 most common and critical issues in developing, administering, and providing clinical telepsychiatry services. These “7 perils” include navigating regulatory issues; developing fiscally sustainable services/programs; building an effective virtual team; attending to the interface of cultural and technology; handling psychiatric emergencies; management of the virtual doctor-patient relationship; and growing services beyond a pilot clinic. Dr. Shore will focus on identifying key issues related to these perils, and pragmatic approaches to successfully addressing these challenges.
Postpartum mood disorders include postpartum depression, postpartum bipolar episodes, and postpartum psychosis, which is usually an affective disorder. Postpartum anxiety must also be considered, as it is extremely common for postpartum women to experience anxiety, and they are at particularly high risk of obsessive symptoms. In this session, Dr. Freeman will discuss presentation and risk factors for these disorders, treatment considerations, and breastfeeding and sleep considerations.
The opioid epidemic is the most significant current problem in the medical community, yet we get little education on treatment. We have patients that are in pain and require opioids for treatment, and some will transition into opioid addiction. Dr. Podesta will discuss some alternatives and ways to screen and treat this population, and discuss rational prescribing of partial opioid agonists.
Early life adversity and relationship disturbances significantly influence presentation of psychiatric disorders and their treatment outcomes. In addition to contributing to disease vulnerability and psychopathology, early life adversity and relationship disturbances also precipitate a host of autonomic, endocrine, and immune perturbations. Our goal is to increase awareness of these important clinical issues and promote appropriate treatment interventions.
New consumer and digital health technologies have proliferated, covering a wide variety of disorders such as depression, anxiety, eating disorders, and even addictions. However, the quality of these apps is variable, as little to no regulation exists. Consumer apps and devices do not have the same robust efficacy and safety studies as FDA-approved treatments. Despite this, clinicians have an opportunity to incorporate these connected health technologies into their practice and prepare for future consumer technologies. Dr. Chan will discuss how to critically evaluate tools for use and implementation in clinical practice.
Speaker: Michelle Cochran, MD
Presented by Genomind
The high frequency of anxiety disorders in patients with depression makes their recognition and treatment clinically important. Evidence suggests that anxiety disorders are underdiagnosed in patients with depression, despite being associated with increased psychosocial morbidity and possibly with differential treatment response. It is important for clinicians to be aware of which treatment approaches have been found to be as effective for depressed patients with and without comorbid anxiety, and which treatments have been found to be more effective than others. It is also important for clinicians to become familiar with the DSM-5 anxious distress specifier, as this may be a simpler approach toward assessing anxiety in patients with depression than the assessment of comorbid anxiety disorders.
Violence in the workplace has reached epidemic levels nationally in psychiatry, with studies showing over 50% of mental health professionals having endured both verbal and physical assaults in their career. This session will address the issue of physiological state dysregulation regardless of psychiatric etymology, and how to best interpret and control the relational milieu using proven neurophysiological cuing techniques based on the Polyvagal Theory. Mental health professionals will be able to monitor and downregulate their own stress response to not endure the persistent physical and psychological sequelae that become secondary posttraumatic stress disorder.
Despite decades of pharmacologic advances, schizophrenia remains one of the most serious mental disorders, with high relapse and low recovery rates. This session will: 1) Identify the challenges that patients with schizophrenia face at different stages of their illness and to help clinicians select matching treatment options; 2) Determine ways to increase patient engagement and delivery of multimodal, integrated care aiming to balance efficacy and safety of pharmacologic treatments; and 3) Individualize the available maintenance treatment options for patients with schizophrenia, weighing their respective pros and cons using sensible shared decision-making approaches.
This session will provide insights into how people with autism think and feel. Problems with obtaining employment is a major issue for many individuals with autism. Dr. Grandin will extensively discuss how to be successful in the workplace.
“Solving Clinical Challenges” addresses complex conundrums that are faced by Psych Congress attendees in managing their patients with substance use disorders. Dr. Kosten will discuss and respond to real cases and real issues from attendees who were surveyed prior to the conference. Challenges that may be covered include: 1) diagnostic nosology, accurate diagnosis, and screening; 2) pharmacologic treatments; 3) side effect management; 4) non-pharmacologic treatments.
This session will provide mental health professionals with an update on treatment-resistant major depressive disorder. Dr. Papakostas will review the evidence in favor of or against various therapies. In addition, ongoing cutting-edge research in this area will be presented.
This session will summarize recent efforts to enhance cognitive behavioral therapies (CBT) with pharmacological agents as a backdrop to a more specific discussion related to increasing noradrenergic activity (with yohimbine, an alpha-2 adrenergic receptor antagonist), or decreasing it (with prazosin, an alpha-1 adrenergic antagonist) during prolonged exposure therapy for posttraumatic stress disorder. The overarching aim is to use these 2 contrasting examples, in context with the literature, to highlight how current augmentation studies have applied specified research designs, methods, and objective measurement paradigms that have actionable impact for practitioners and researchers beyond study-specific findings. These studies are laying the long-awaited methodological foundations for individualizing treatments by discovering for whom, when, and under what circumstances evidence-based treatments will be effective. Mental health professionals should be able to synthesize evidence-informed pros and cons related to treatment choices for their patients. Moreover, although the rapidly expanding literature base related to CBT treatment augmentation with pharmacotherapy can be specialized, especially in translational extinction learning contexts, the methods and outcomes of many of these studies are relevant to a general audience of practitioners and to their patients.
Insomnia is a common problem that is highly prevalent among people with mental health disorders. The treatment of insomnia often is challenging due to the multiple influences that can undermine sleep quality and quantity. Dr. Neubauer will briefly review the problem of insomnia and provide an overview of therapeutic approaches. The primary focus of this session will be targeted pharmacologic approaches that address specific patient populations and symptoms complexes. The consideration of medications for insomnia should include both pharmacokinetic and pharmacodynamic properties. In this way, pharmacotherapy can be customized for individual patients.
Best practices in attention-deficit/hyperactivity disorder (ADHD) management require skilled use of alternative treatments in conjunction with evidence-based medication use. This session will review the practical use of cognitive-behavioral therapy, mindfulness/meditation, and exercise therapies. Dr. Mason will also discuss primary use of non-stimulant medication with stimulant augmentation in partial responders, which can be an effective and tolerable alternative to stimulant monotherapy.
Have you completed your American Board of Psychiatry and Neurology, Inc. (ABPN) Maintenance of Certification (MOC) requirements? All psychiatrists certified by the ABPN after 1994 are required to take part in the MOC program, yet many remain unclear as to where to begin the process. This session, led by an MOC Ambassador, will provide an easy-to-follow roadmap to MOC, outlining the rationale and background of MOC, as well as the 4-part ABPN MOC program components.
Benzodiazepines are some of the America’s most widely used medications, and they undeniably have helped a large number of patients. However, recent data shows that they harm a previously unknown, large number of patients. Risks include physical dependence, addiction, withdrawal seizures, memory problems, dementia risk elevation, and falls. A new black box warning regarding co-administration of these drugs is now part of the U.S. Food and Drug Administration directive to us clinicians. Despite clear reasons for concern, these drugs are also necessary and effective in multiple acute and chronic settings. The goal of this session is to offer state-of-the-art information on the risk–benefit profile of these medications and offer clear, practical advice to clinicians in order to minimize harm and maximize benefits.
We strive for wellness through a healthy diet, exercise, and prioritizing time for adequate sleep. Recent evidence confirms the important role of sleep for optimum cognitive, metabolic, endocrine, and immune functioning. Emerging data now shows that the timing of our sleep-wake patterns, as well as what we eat and when we eat it, further influences our biological rhythms and impacts our health. This session will provide an update of recent scientific literature focused on sleep, diet, and biological rhythms, and then review translational approaches that highlight modifiable behaviors that can help us enhance our health.
This session will review the evidence base for the safety and efficacy of pharmacologic treatments for children and adolescents with mood disorders to enhance mental health professionals’ knowledge regarding treatment decisions.
Psychedelic-assisted psychotherapy is a new area of clinical research unknown to most clinicians. This session will report on the history of psychedelic-assisted psychotherapy for cancer-related psychological and existential distress. Dr. Ross will discuss findings of a recently published randomized controlled trial of psilocybin-assisted psychotherapy for cancer-related psychological and existential distress.
New information is available regarding more recently approved antipsychotics, as well as studies examining the risk of metabolic abnormalities in patients with schizophrenia. This session will focus on factors related to metabolic health in patients with schizophrenia. New findings regarding the propensity of second-generation antipsychotics to be associated with weight gain and metabolic abnormalities, as well as interventions designed to reduce weight gain and/or metabolic abnormalities, will be discussed.
Although DSM-5 has been utilized for over three years, most mental health professionals remain unaware of some key high-level changes and are therefore unable to apply some of its most useful tools to their clinical practice. This session will review these changes (diagnosis as a three-step process; new tools to more precisely implement this process) and their clinical implications, and application to treatment will be discussed with the use of clinical vignettes.
No scientific discovery in the last decade has been more shocking than the realization of just how thoroughly physical health depends upon the trillions of microbes that call our bodies home. While this discovery has been increasingly integrated into how we understand and treat a range of immune-related physical conditions, it is only now that the full impact of these human-microbial interactions for mental health are being understood. Dr. Raison will provide a cutting-edge view of the biology of microbial-human interactions relevant for a range of psychiatric conditions, including depression and autism, with a focus on evidence that the current epidemic of immune-related mental disorders has arisen in large measure as a result of disruptions in ancient co-evolved relationships with the microbial world. This session will conclude by reviewing evidence suggesting that microbial products may hold promise for the treatment of a range of psychiatric conditions.
The topic of treatment boundaries often presents some subtle dilemmas for clinical assessment. Yet many clinicians struggle with boundary questions and issues. These dilemmas, questions, and uncertainties are far from merely academic; a number of civil suits, ethics complaints, and—more seriously—boards of registration cases, which threaten a clinician’s livelihood, show that this is an area in which clarity is essential. This session will address these matters in depth.
This session will examine the research literature on the diagnostic validity of the “major depressive disorder” concept, and the alternative diagnoses of “manic-depressive illness” and “neurotic depression.” The treatment of the types of depressive states, specifically melancholia, mixed depression, vascular, and neurotic depression, will be examined. The limitations of antidepressants in specific subtypes will be reviewed, as well as data on the benefits of neuroleptics (dopamine blockers) and mood stabilizers. This session will provide attendees with a means of applying that knowledge in clinical practice. Clinical applications will be emphasized.
Cognitive remediation therapy (CRT) is widely disseminated and has become commonplace. Meta-analyses of the efficacy of CRT have generally concluded that CRT offers statistically significant, but small, effects in several different conditions including schizophrenia, major depression, traumatic brain injury and stroke, and mild cognitive impairment. However, these reviews have also suggested that CRT improves cognitive performance, but not functional skills. Combining skills training programs and functional skills training leads to systematic functional gains, particularly in terms of employment as an outcome. Topics that will be communicated and discussed in this session include: Who benefits from CRT (age and diagnosis, early course vs. chronic)? How is CRT best delivered (in person/over the internet)? What additional skills training should be offered? How are outcomes measured? Are there different strategies required for public sector and private rehabilitation services?
Ketamine is a U.S. Food and Drug Administration-approved anesthetic agent, which is increasingly being used “off label” for various psychiatric conditions. This session will educate practicing clinicians about the use of ketamine for psychiatric disorders, especially its use in treatment-resistant mood disorders and posttraumatic stress disorder. An overview of data from controlled research studies and experience in clinical practice settings will be presented. Important unresolved issues will be examined, including patient selection, treatment implementation (dose optimization, route of administration, maintenance treatment), and risk management, with the goal of providing a balanced view of a controversial “off-label” therapy.
In mental health, we’re trained to focus on reduction of symptoms, achieving remission, and improving outcomes; and as a result, may overlook the power of wellness as a treatment strategy. The goal of this session is to highlight the importance of wellness in everyday clinical practice. Dr. Jain will review different elements of wellness and the neurobiological changes seen as a result of wellness behaviors and activities. Four mental wellness traits—happiness, enthusiasm, resilience, and optimism—will also be discussed, along with practical tips on how these traits can be enhanced through wellness interventions in our practices.
Successful aging has been well-characterized for older individuals with normal age-associated problems, but does the concept even apply when someone has a progressive dementia? Similarly, most life cycle theories have a lot to say about aging individuals up to and until they suffer from more severe conditions such as dementia, but what happens afterward? Do they still even apply at that point? My answer is that it is possible to characterize an optimal life course for those with dementia, including healthy lifestyle factors such as physical and mental exercise, adequate sleep, and nutrition, as well as more transcendent strengths such as wisdom, resilience, and creativity. This understanding is critical to enabling mental health professionals to both humanize and help their patients with dementia.
Dopamine and its receptors are intimately involved in the pathogenesis of nearly every psychiatric disorder. While we clinicians use multiple treatments that affect these receptors, lack of deep knowledge of these receptors often leads to “blind” prescribing, resulting in suboptimal prescribing. To compound it further, many new psychotropics have vastly different and more precise effects on dopamine receptor family. There is urgent need for continuing medical education on the dopamine family of receptors and means by which we clinicians can target it precisely.
The 60-year-old classification system of the approximately 150 medications utilized for the treatment of psychiatric disorders (antipsychotics, antidepressants, mood stabilizers, sedative-hypnotics, etc.) is being replaced by a neuroscience-based nomenclature. Most clinicians are unaware of this change or its implications. In this session, the rationale and nature of this change will be discussed and its clinical implications will be reviewed. Using clinical vignettes, the application of this system to the pharmacological treatment of different psychiatric disorders will be summarized.
While illicit use of hallucinogens, cannabinoids, and opioids has been stigmatized in the past, emerging research demonstrates therapeutic benefits from selective use of psychedelics, cannabinoid derivatives, and kappa- and mu-opioid receptor modulators in controlled circumstances for the treatment of different psychiatric conditions, including mood disorders, anxiety disorders, posttraumatic stress disorder, and schizophrenia. The role of endocannabinoids and endogenous opioids in regulation of stress response and mood will be discussed, as well as relevant receptor pharmacology. Finally, available scientific research supporting their therapeutic use will be critically reviewed.
Join Psych Congress 2017 Co-Chairs Drs. Rakesh Jain and Charles Raison, and the entire Steering Committee, for an interactive “wrap up” and panel discussion, focusing on conference highlights from the previous four days of educational sessions.
