2010 Psychopharmacology Update

A one-day psychopharmacology symposium

Save the date!

Saturday, October 23, 2010, 7:45 am – 5:00 pm
Kingsgate Marriott Conference Hotel*
Cincinnati, Ohio

Join us for this interactive, live symposium where nationally renowned faculty will address:

• Treatment Resistant Depression: A Multi-Functional Pharmacologic Approach
• The Philosophy, Process, and Application of Evidence-Based Psychopharmacology

Symposium Director
Henry Nasrallah, MD
Professor of Psychiatry and Neuroscience
University of Cincinnati College of Medicine

Faculty
Stephen M. Stahl, MD, PhD
Adjunct Professor of Psychiatry
University of California, San Diego

Leslie Citrome, MD, MPH
Professor of Psychiatry
New York University School of Medicine

*A discounted room rate will be available for participants of the Psychopharmacology Update.

Email Updates
To receive email updates about this conference directly to your inbox, please contact: kathy.wenzler@qhc.com

To receive a copy of the invitation to this conference please send your full name and address to: kathy.wenzler@qhc.com

Adjunctive anticonvulsants in alcohol withdrawal

David R. Spiegel, MD, Associate professor, Department of psychiatry and behavioral sciences, Director of consultation-liaison services, Eastern Virginia Medical School, Norfolk, VA

Daiana Radac, MD, Resident, Eastern Virginia Medical School, Norfolk, VA

Benzodiazepines are the mainstay of alcohol detoxification treatment, with extensive evidence supporting their efficacy and relative safety. The risk of benzodiazepine-alcohol interaction, however, and psychomotor and cognitive impairments associated with benzodiazepine use may limit early rehabilitation efforts in hospitalized patients. Cross-tolerance with alcohol also limits benzodiazepines’ potential benefit in outpatients with substance use disorders.

Adding anticonvulsants to acute benzodiazepine therapy has been shown to decrease alcohol withdrawal symptom severity, reduce seizure risk, and support recovery, particularly in patients with multiple alcohol withdrawal episodes. After detoxification, long-term anticonvulsant use may reduce relapse risk by decreasing post-cessation craving, without abuse liability.

Although not all studies endorse adding anticonvulsants to benzodiazepines for managing alcohol withdrawal syndrome (AWS), we present 3 cases in which anticonvulsants were used successfully as adjuncts to lorazepam. Valproic acid, levetiracetam, and gabapentin offer advantages in acute and long-term therapy of alcohol dependence with efficacy in AWS, low abuse potential, benign safety profile, and mood-stabilizing properties.

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PTSD and mood disorders

Steven C. Dilsaver, MD, Comprehensive Doctors Medical Group, Inc., Arcadia, CA

Major depressive disorder (MDD) and bipolar spectrum disorders are associated with some symptoms of—and fully defined—posttraumatic stress disorder (PTSD). Many traumatic experiences can lead to this comorbidity, the most common being exposure to or witnessing combat for men and rape and sexual molestation for women.Trauma has major prognostic and treatment implications for affectively ill patients, including those whose symptoms do not meet PTSD’s full diagnostic criteria.

This article aims to help clinicians by:

• presenting evidence characterizing the overlap between affective disorders and PTSD
• reviewing evidence that the bipolar spectrum may be broader than generally thought, an insight that affects PTSD treatment
• making a case for routine PTSD screening for all patients with affective illnesses
• recommending PTSD treatments tailored to the patient’s comorbid affective disorder

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A psychiatric manifesto

Henry A. Nasrallah, MD
Editor-in-Chief

Psychiatry is one of the most rapidly evolving medical disciplines. Its scientific foundation is neuroscience, which is growing at the most explosive pace in science. Yet the public and even other medical specialists still envision psychiatrists sitting behind a couch scribbling Freudian jargon on a yellow pad. For that reason, I propose that we create a manifesto that promulgates the basic tenets of psychiatry and make it a permanent, living document on CurrentPsychiatry.com.

So I present my initial iteration of a psychiatric manifesto here. I invite all readers and CurrentPsychiatry.com visitors to suggest valid additions and/or modifications. I will serve as the custodian and editor of the manifesto, in charge of its continuous update as a living document

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Antidepressant discontinuation syndrome

David J. Muzina, MD, Vice president and national practice leader for neurosciences, Medco Health Solutions, Fort Worth, TX 

Most psychiatrists have encountered patients who report distressing symptoms when they have forgotten to take their antidepressant for a few days or during changes in the medication regimen. A discontinuation syndrome can occur with almost any antidepressant, highlighting the need to slowly taper these medications when discontinuation is part of a treatment plan.

This article discusses antidepressant discontinuation syndrome (ADS) in a patient who experienced substantial distress after a rapid antidepressant taper in preparation for electroconvulsive therapy (ECT). My goal is to raise awareness of ADS, promote early detection of the syndrome, and address proper prevention and management strategies.

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Children with tic disorders

Elana Harris, MD, PhD, Assistant professor, Division of child and adolescent psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 

Steve W. Wu, MD, Assistant professor, Division of child neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Tics, such as strong eye blinks or repetitive shoulder shrugs, can distress a child or his/her parents, but the conditions associated with tic disorders often are more problematic than the tic disorder itself. High rates of comorbid conditions are recognized in persons with Tourette syndrome, including:

• obsessive-compulsive disorder (OCD) in >80%
• attention-deficit/hyperactivity disorder (ADHD) in ≤70%
• anxiety disorders in 30%
• rage, aggression, learning disabilities, and autism less commonly.
  

The strategy we recommend for managing tic disorders includes assessing tic severity, educating the family about the illness, determining whether a comorbid condition is present, and managing these conditions appropriately. Above all, we emphasize a risk-benefit analysis guided by the Hippocratic principle of “do no harm.”

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Connecting the dots: Psychiatrists are virtuosos

Henry A. Nasrallah, MD
Editor-in-Chief

“Connecting the dots” has emerged as a buzzword in our media and popular culture. This expression is a picturesque way to denote competence and implies an uncanny ability to recognize and integrate what appear to be multiple unrelated data points into an important, actionable pattern. An incisive decision or intervention often follows.

When I hear this expression, I contemplate the centrality of connecting the dots in psychiatric practice. In fact, it is a ubiquitous and indispensable approach to diagnosing and treating our patients. Psychiatrists are trained to be highly skilled at connecting not only one set of dots, but often a bewildering array of complex and disparate sets of dots related to each patient we evaluate and manage. It is impossible to arrive at an accurate psychiatric diagnosis and construct an appropriate and comprehensive treatment plan without connecting countless overt and covert dots related to interconnected pathologies across a patient’s brain, mind, and body. As part of the assessment, psychiatrists often presage the existence of dots that are not yet on their clinical radar and inquire about them with the patient and multiple corroborative sources. That’s what a good psychiatric interview and history taking usually entails.

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