2020 Annual Psychiatric Update

Practical Psychiatry: Pragmatic Approaches
and Clinical Pearls

2020 OPPA Annual Psychiatric Update

with a special evening in honor of OPPA's 70th Anniversary!

March 14-15
Marriott University, Columbus

Saturday, March 14

Living with ADHD

Judith Hirshman, MD

Adult ADHD: what are we all missing?

David Goodman, MD

Practical Tips and Update on ABPN/MOC

     Larry Faulkner, MD

The ABPN MOC Program encourages diplomates to assess their professional knowledge and skills and engage in lifelong learning activities to address any identified deficiencies. Based on feedback from diplomates and professional societies, the ABPN has expanded options to meet MOC requirements in self-assessment (Part 2), assessment of knolwedge and skills (Part 3), and improvement in medical practice (Part 4). There are specific strategies diplomates can use to make participation in MOC less burdensome and expensive. A Pilot Project is currently underway as an alternative to the secure ABPN MOC Examination in psychiatry and child and adolescent psychiatry. As a result of positive feedback from diplomates participating in the Pilot Project, the ABPN plans to provide similar options for its other subspecialties.

Advances in Psychopharmacology 
     

The Magic Pill for Insomnia Disorder: an introduction to CBT-I

Michelle Drerup, PsyD, DBSM

Insomnia is a chronic condition for 10% of the adult population and is considered a global health care problem associated with numerous consequences for both the individual as well as society. Recent guidelines have been published by numerous organizations including the American College of Physicians recommending that all adult patients be provided cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder. However, in practice this rarely happens. Instead patients either self-medicate with alcohol or OTC sleep aids or started on prescription medication for sleep by their health care provider CBT-I is a treatment package that consists of numerous different components that are tailored to the patient’s individual presentation. This symposium will give a brief introduction to the behavioral components of CBT-I including stimulus control and sleep restriction, as well as the cognitive strategies for reducing sleep interfering thoughts and worries and calming an active mind that doesn’t turn off at night. In addition, population health management strategies for addressing insomnia will be introduced to expand the availability and access to this efficacious treatment for Insomnia Disorder.

Iatrogenic Psychiatry -  Psychopathologies Triggered by Both General Medical Prescriptions and Psychotropic Medications    

Henry Nasrallah, MD

The DSM 5 diagnostic criteria always require that general medical conditions or drug-induced symptoms are ruled out before a clinician diagnosis a patient with having a primary psychiatric disorder. There are in fact many psychiatric symptoms are triggered not only by recreational drugs, but also by prescription medications that are widely used in primary care and specialized care.

Medical conditions associated with depression include endocrinopathies, neurologic disorders, vitamin deficiencies, and cardiovascular disease. Medical disorders associated with anxiety include hyperthyroidism, COPD, asthma, diabetes, chronic pain, irritable bowel, pheochromocytoma, Lyme disease, head trauma, vascular dementia, Parkinson’s disease, Lupus, rheumatoid arthritis, loss of estrogen, and electrolyte imbalance. Symptoms of mania can be associated with infections, epilepsy, stroke, brain tumors, influenza, and hemodialysis. Psychotic symptoms can result from CNS diseases, toxins, autoimmune diseases, chromosomal abnormalities, infectious diseases, nutritional deficits, endocrine disorders, and metabolic diseases.

On the other hand, prescription drugs can also generate psychopathology symptoms. Steroids are associated with psychosis, mania, depression and anxiety. Similar symptoms can be associated with ACE inhibitors, anticholinergic drugs, anticonvulsants, barbiturates, benzodiazepines, beta-adrenergic drugs, calcium channel blockers, dopamine agonists for Parkinson’s, certain antibiotics, antihistamines, NSAIDS, opioids, procaine derivatives, salicylates, SSRIs, sulfonamides,

In summary, psychiatrists must screen for medical conditions and recreational/ prescription medications in every patient they evaluate to rule out an iatrogenic disorder (drug-induced secondary psychiatric illness) rather than a primary psychiatric disorder. Discontinuation of the offending agent may be the treatment of choice if iatrogenesis is established.

Lions and Tigers and Bears, Oh My!  The Explosive Use of Pets & Animals for Mental Health

     Victoria Kelly, MD

Animals have been used to improve hospitalized patients’ mental well-being since the 18th century, and the first articles appeared in the medical literature in the late 1980’s. However the current day psychiatrist is unprepared for the avalanche of requests for pet therapy that has occurred over the past several years. Navigating the confusing world of pet therapy, animal assisted interventions, service animals, and emotional support animals will assist attendees in understanding the current federal protections and implementing practical guidelines in addressing these requests.

 

Sunday, March 15

Medical Marijuana: Point /Counter Point

 

Lights, Camera, Action: Working with Media

    Glenn O’Neal, American Psychiatric Association


Pharmacogenetic Testing

     Jeff Strawn, MD

Ask the Expert: Case Consultations for Complex Psychiatric Cases

     Henry Nasrallah, MD

Complex psychiatric cases will be presented. Usually, such cases involve treatment -resistant mood, anxiety or psychotic disorders. Sometimes, the complex patients suffer from one or more psychiatric comorbid conditions and/or medical comorbid conditions, which complicate the clinical presentation, or interfere with achieving a good therapeutic response.

Complex cases often require a closer look at the working diagnosis , family history, substance use history,  as well as the efficacy, tolerability ad safety of previous treatment(s). Sometimes, pharmacokinetic interactions between psychotropic and other prescription medications may account for either poor response or excessive side-effects. Pharmacogentic testing may be needed for some patients.

Complex cases are often associated with polypharmacy to address disparate symptom clusters, and the consultan may sometimes require discontinuing one or more medications or replacing them with other medications that have a different mechanism of action or different pharmacokinetic profile.

The ultimate goal of a consultation on complex psychiatric cases is to clarify the diagnosis, and to prioritize what the primary target symptoms should be if the patient suffers from several co-existing neuropsychiatric conditions. Further, the role of psychosocial therapies must always be considered and implemented, in addition to pharmacotherapy.