Conference Coverage

PSYCHIATRY UPDATE 2013


 

SATURDAY, APRIL 6, 2013

MORNING SESSIONS

Forty-six percent of depressed patients will stop pharmacotherapy before they have a chance to respond. To minimize short-term side effects, Andrew J. Cutler, MD, Florida Clinical Research Center, suggested educating patients and slowly titrating medications; options for reducing long-term side effects or residual symptoms include switching or augmenting pharmacotherapy.

When treating patients addicted to opioids, outcome measures go beyond general health to obtaining employment and reducing criminal activity. Pharmacotherapy options include methadone maintenance therapy, oral and injectable naltrexone, and oral, sublingual, and implantable buprenorphine. Walter Ling, MD, David Geffen School of Medicine at UCLA, described factors that may improve patient outcomes.

Geriatric BD is relatively common in clinical settings, but there is a lack of evidence-based clinical practice guidelines. James W. Jefferson, MD, University of Wisconsin School of Medicine and Public Health, recommended choosing a treatment based on the illness phase and balancing the benefit of certain pharmacotherapies against short- and long-term risks.



Most medications for treating alcohol dependence work by modulating functions of opioids, glutamate, GABA, and serotonin. Dr. Ling reviewed the evidence base, dosing guidelines, and clinical recommendations for disulfiram, oral and injectable naltrexone, and acamprosate, which are FDA-approved for treating alcohol dependence. He also recommended combining medications with nonpharmacologic treatments, such as 12-step programs.

Most people who die by suicide deny suicide ideation at their last mental health visit. Risk factors for suicide include family history of suicide, childhood or adult trauma, substance abuse, stressful life events, chronic illness, and psychiatric disorders. Dr. Jefferson described suicide rating and tracking scales and encouraged clinicians to document suicide risk evaluations.

AFTERNOON SESSION


Roger S. McIntyre, MD, FRCPCRobert M.A. Hirschfeld, MD, University of Texas Medical Branch, discussed how the concept of allostatic load—bodily “wear and tear” that emerges with sustained allostatic states—may help explain cognitive and physical decline associated with BD. Roger S. McIntyre, MD, FRCPC, University of Toronto, emphasized that BD is a progressive disorder and comorbidities such as metabolic problems may promote this progression. Terence A. Ketter, MD, Stanford School of Medicine, covered new developments in BD treatment, including certain second-generation antipsychotics, dopaminergic neurotransmission enhancers, mood stabilizers, adjunctive antidepressants, and adjunctive psychotherapy.

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