Emerging Strategies in the Assessment and Treatment of Depression and Anxiety: Integrating Psychopharmacology and Psychotherapy
Russell Vasile, MD

July 23 – 27, 2018 • Monday – Friday

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The objective of this seminar is to familiarize the clinician with emerging strategies in the assessment and treatment of major depression, bipolar illness and anxiety disorders. The course will also highlight key comorbid conditions associated with mood and anxiety disorders, including axis II personality disorders, management of patients with medical conditions and management of the geriatric patient. An essential theme of the seminar will be formulating an integrated psychopharmacologic and psychotherapeutic treatment approach. The psychotherapy of the mood and/or anxiety disorder patient, including those with comorbid personality disorder will be examined in detail. Issues around the choice of specific antidepressants, mood stabilizers and anti-anxiety medications and psychopharmacologic management of the treatment resistant patient will be highlighted with a discussion of the use of augmenting medication strategies and combinations of psychopharmacologic agents. Psychotherapeutic approaches to mood and anxiety disorders will be studied with a focus on differing strategies including psychodynamic psychotherapy, cognitive and behavioral therapy, interpersonal psychotherapy for depression and other psychotherapeutic approaches. The seminar will update the clinician on recent developments in neuropsychiatry, including brain imaging and therapeutic stimulation techniques. Issues related to the clinical efficacy of transcranial magnetic stimulation (TMS) and its role as an alternative to electroconvulsive therapy (ECT)will be explored. Emerging data on which subgroups of depressive disorders may respond to TMS will be presented. The role of Ketamine infusion in the treatment of acute depression and suicidal ideation will be presented; the risks and benefits of this controversial treatment will be examined. Emerging issues in the assessment and treatment of depression and anxiety disorders will be discussed including the new DSM V diagnosis of Complicated Grief Disorder; Neuro-psychiatric presentations of depression secondary to head trauma, post-concussive syndrome, post-stroke depression and ischemic brain disease as a source of depression will be discussed. The range of anxiety disorders to be reviewed will include anxiety disorders in the Obsessive Compulsive Disorder Spectrum including skin-picking disorder, trichotillomania and body dysmorphic disorder; anxiety disorders related to trauma including posttraumatic stress disorder will be reviewed in detail. Emphasis will be placed on the integration of psychopharmacology and cognitive behavioral therapy in the treatment of anxiety disorders including generalized anxiety disorder, post-traumatic stress disorder and panic disorder.

 

Upon completion of this course, participants will be able to:

 

  • Evaluate emerging strategies in the use of psychotropic medications in the treatment of major depression and anxiety disorders and integrate psychopharmacologic treatments into patient care;
  • Integrate psychodynamic assessment, psychotherapy and psychopharmacology into the management of depression and anxiety disorders;
  • Describe strategies for the psychopharmacological and psychotherapeutic management of treatment resistant depression;
  • Evaluate new developments in the treatment of depression in bipolar patients;
  • Describe an evidence based approach to suicide risk assessment and prevention of suicide;
  • Develop psychopharmacologic management strategies for geriatric depression and anxiety including in patients with cognitive deficits;
  • Determine the specific role for vigorous exercise in the treatment of mood disorders;
  • Evaluate emerging brain stimulation antidepressant treatment techniques, including transcranial magnetic stimulation;
  • Describe new psychopharmacological and psychotherapeutic techniques in the treatment of PTSD;
  • Discuss the treatment of depression and anxiety in patients with personality disorders including Borderline Personality Disorder;
  • Explore the role of novel enhancements to treatment of mood disorders including omega-3 fatty acids, 1-methylfolate and zinc;
  • Formulate an integrated psychopharmacological and psychotherapeutic approach to personality disordered patients in the borderline and severely narcissistic spectrum presenting with depression and anxiety;
  • Manage anxiety disorders in patients vulnerable to alcohol abuse and psychological dependence on marijuana;
  • Finding relaxation and meditation applications on your cell phone and computer for treatment of anxiety disorders.

 

SCHEDULE

 

July 23, 2018

9:00-10:15 AM

DSM-V assessment and treatment of subtypes of depression; new SNRI medications and traditional SSRI’s, SNRI’s MAO inhibitors; augmenting agents for depression including lithium, thyroid, low dose stimulant; combinations of antidepressants tricyclics and SSRI’s; assessing and treating refractory depression; the role of ECT and transcranial magnetic stimulation.

10:15-10:30 AM

Break

10:30-12:15 PM

Psychopharmacologic management of melancholia, dysthymia, and depression with medical comorbidity; when to augment or combine  antidepressants; treatment of psychotic depression; MAO inhibitors in treatment resistant depression; mood disorders in pregnancy and post-partum; Novel neuroleptics as antidepressant boosters; The role of ketamine infusion in treatment of acute depression-  risks and potential  benefits. Q&A

 

July 24, 2018

9:00-10:15 AM

Assessment and treatment of Bipolar Disorder; new DSM-V classification of Bipolar Spectrum Disorders and its clinical implications; lithium, lamotrigine, lurasidone and quetiapine in bipolar depression; managing both prevention of cycling and acute mania -use of olanzapine, risperidone, quetiapine and other novel neuroleptics; role of clozapine in refractory mood disorder.

10:15-10:30 AM

Break

10:30-12:15 PM

Bipolar Depression and different psychopharmacological interventions; New psychopharmacologic options for treatment of bipolar depression; bipolarity in relation to personality disorder, attention deficit disorder; long term management of mood cycling; mitigating risks of chronic lithium administration; combinations of mood stabilizers for rapid cycling bipolar disorder.

 

July 25, 2018

9:00-10:15 AM

DSM-V diagnostic changes in formulation of Anxiety Disorders; assessment and treatment of anxiety disorders including panic, obsessive compulsive disorder, post-traumatic stress, generalized anxiety and social anxiety disorders; use ofbenzodiazepine and non-benzodiazepine anxiolytics; role of SSRI, SNRI, tricyclic and MAO-I medications for the treatment of anxiety and panic disorder; new treatments for PTSD including clonidine and other alpha blocking medications; assessment and prevention of suicide risk in depression, anxiety and co-morbid anxiety and depression ;management of anxiety in the recovering alcoholic; new developments in the medication management of chronic marijuana abuse. Meditation and relaxation apps found on cell phone or computer for treatment of anxiety.

10:15-10:30 AM

Break

10:30-12:15 PM

Continued discussion of risk management issues in treatment of anxiety and depression; assessing and treating complex, refractory anxiety including of obsessive disorder complicated by psychosis and other obsessive disorder spectrum clinical presentations, such as skin picking disorder; management of refractory PTSD; clonidine and prazosin for PTSD nightmares.

 

July 26, 2018

9:00-10:15 AM

Psychodynamic perspectives on depression and anxiety; different psychotherapies of depression -  CBT, psychodynamic expressive psychotherapy and behavioral strategies; the assessment and treatment of axis II disorders in relation to depression and anxiety. Integrating psychodynamic and biological perspectives on treatment of borderline personality disorder; discussion of factors in the development of healthy and pathological narcissism in relation to vulnerability to depression; psychopharmacological management of disorders of impulse and anger.

10:15-10:30 AM

Break

10:30-12:15 PM

Psychodynamic vulnerability to depression; psychotherapy of depressive  and anxiety disorders differing strategies; biological  treatments for anger and impulse disorders; integrating psychotherapy and  medication

management in depressed and/or anxious patients with personality disorders. Examination of the spectrum of persistent depressive disorder, psychobiological and psychodynamic factors.

 

July 27, 2018

9:00-10:15 AM

Assessment and treatment of the Geriatric

patient; psychopharmacological management of the geriatric patient with depression and/or anxiety; a focus on complex bereavement disorder; medical illness and depression with an emphasis on cardiac disease and neurological conditions; Assessing dementia versus the pseudo-dementia secondary to depression.

10:15-10:30 AM

Break

10:30-12:15 PM

Post-concussive syndrome and depression; brain imaging in depressed patients - clinical implications; repetitive transcranial magnetic stimulation and other emerging brain stimulation techniques; Examining efficacy data on transcranial magnetic stimulation- clinical factors that may predict response to TMS; ECT versus TMS -how to choose between them? Q&A

10:30-12:15 PM

Psychopharmacologic management of melancholia, dysthymia, and depression with medical comorbidity; when to augment or combine  antidepressants; treatment of psychotic depression; MAO inhibitors in treatment resistant depression; mood disorders in pregnancy and post-partum; Novel neuroleptics as antidepressant boosters; The role of ketamine infusion in treatment of acute depression-  risks and potential  benefits. Q&A