Current Psychiatry and the American Academy of Clinical Psychiatrists were pleased to host more than 550 psychiatric practitioners for this conference, led by Meeting Chair Richard Balon, MD, and Meeting Co-Chairs Donald W. Black, MD, and Nagy Youssef, MD, April 4-6, 2013 at the Swissôtel in Chicago, IL. Attendees could earn up to 18 AMA PRA Category 1 Credits™.
THURSDAY, APRIL 4, 2013
MORNING SESSIONS
Evidence-based medicine and treatment guidelines may not address complex patients with treatment-resistant depression (TRD). Andrew A. Nierenberg, MD, Massachusetts General Hospital, reviewed newer medications for TRD, including olanzapine-fluoxetine combination, ketamine, riluzole, and L-methylfolate; however, use of these medications requires careful consideration of risks and benefits.
Many FDA-approved drugs have a “black-box” warning, but still are widely used. Henry A. Nasrallah, MD, University of Cincinnati, reviewed black-box warnings for antipsychotics, antidepressants, mood stabilizers, benzodiazepines, stimulants, opiates, and hypnotics and offered strategies on how to incorporate these warnings into clinical practice.
Dr. Nierenberg discussed the outcomes of 3 published medication effectiveness studies for bipolar disorder (BD)—STEP-BD, BALANCE, and LiTMUS—and one currently underway, CHOICE. These studies examined monotherapy and combination therapy with antidepressants, anticonvulsants, antipsychotics, and psychosocial interventions.
Although there is an association between psychosis and violence, most psychotic patients are not violent. Rajiv Tandon, MD, University of Florida, reviewed modifiable and nonmodifiable risk factors for violence, key clinical questions to consider, and scales to use when assessing a patient’s risk of violence.
AFTERNOON SESSIONS
Measuring biomarkers can augment other clinical methods to help identify metabolic, structural, and functional brain changes associated with preclinical stages of cognitive disorders. James Ellison, MD, MPH, McLean Hospital, Harvard Medical School, explained how biomarkers can improve the differential diagnosis of memory impairments and aid in identifying different types of dementia.
Donald W. Black, MD, (right) receives the 2013 George Winokur Research
Award from Carol S. North, MD, for his article on pathological gambling
Case-control studies have found a strong association between schizophrenia and type II diabetes, which contributes to higher mortality among schizophrenia patients. Along with vigilant metabolic monitoring, Dr. Tandon recommended a therapeutic approach that includes changing antipsychotics, prescribing metformin, suggesting lifestyle interventions, and treating comorbid conditions.
Depressed older adults may report anxiety, hopelessness, anhedonia, or somatic symptoms, rather than sadness. Depressive symptoms may be associated with vascular disease or cognitive impairment. Dr. Ellison reviewed psychotherapeutic and pharmacologic treatments for older depressed patients.
FRIDAY, APRIL 5, 2013
MORNING SESSIONS
Many strategies exist for treating patients with TRD; adding an atypical antipsychotic has the best evidence, but there are tolerability considerations. Dr. Nierenberg suggested using a combination of treatments.
Pregnancy is inherently risky for women who take antipsychotics. In all patients of childbearing potential, take a thorough reproductive history and ask about contraception use. Marlene P. Freeman, MD, Massachusetts General Hospital, explained that psychotropics with unfavorable FDA pregnancy ratings may be among first-line choices.
George T. Grossberg, MD, (left) speaks with attendees
Clinical symptoms, cognitive deficits, psychiatric comorbidities, genetic factors, neuroimaging features, and pharmacotherapy may overlap considerably between schizophrenia and BD. Dr. Nasrallah described clinical features that differentiate the 2 disorders.
Cognitive enhancers can improve activities of daily living, behavior, and cognition in patients with Alzheimer’s disease. George T. Grossberg, MD, St. Louis University, reviewed the evidence for acetylcholinesterase inhibitors, the NMDA receptor antagonist memantine, combination therapy, and atypical antipsychotics.
Dietary consultation for older patients might help delay or decrease their risk of dementia. Patients should consume omega-3 fatty acids, whole grains, fresh fruits and vegetables, beans, legumes, and certain spices. Dr. Grossberg also suggested patients engage in physical and mental exercises, social and spiritual activities, and stress reduction, and control cardiovascular risk factors.
AFTERNOON SESSIONS
Many women experience anxiety during pregnancy, and the risk is highest during the first trimester. Dr. Freeman reviewed prevalence, diagnosis, and treatment of panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder during pregnancy and postpartum.
Kathleen Brady, MD, PhD, Medical University of South Carolina, explained how methylenedioxypyrovalerone, also known as bath salts, and other designer drugs are not detectable on standard urine drug screens. Agitation, tachycardia, combative behavior, hyperthermia, and hallucinations have been reported.
Kathleen Brady, MD, MPH
Alcohol abuse and depression are highly comorbid and are associated with higher suicidality, more severe symptoms, and poorer treatment response than either disorder alone. Depressive symptoms often are seen during alcohol withdrawal, and may resolve with abstinence. Dr. Brady reviewed the evidence for treating depressed alcoholics with antidepressants, medications targeting alcohol dependence such as disulfiram and naltrexone, and psychotherapy.
Ralph Aquila, MD, Columbia College of Physicians and Surgeons, discussed risk factors for and consequences of treatment nonadherence in patients with schizophrenia. Leslie L. Citrome, MD, MPH, New York Medical College, covered strategies to improve adherence, including identifying and addressing barriers to adherence for individual patients, improving the therapeutic alliance, and considering long-acting injectable antipsychotics.