STEP-BD. Methods. STEP-BD Baseline Findings. Lessons from STEP-BD for the Treatment of Bipolar Disorder

Size: px
Start display at page:

Download "STEP-BD. Methods. STEP-BD Baseline Findings. Lessons from STEP-BD for the Treatment of Bipolar Disorder"

Transcription

1 Lessons from for the Treatment of Bipolar Disorder Andrew A. Nierenberg, MD Massachusetts General Hospital Harvard Medical School Systematic Treatment Enhancement Program for Bipolar Disorder Evidence guided treatment Specialty bipolar clinics Integration of measurement and management Embedded randomized trials Methods Mini International Neuropsychiatric Interview Affective Disorders Evaluation Form Clinical Monitoring form Self-administered waiting room form Quarterly and yearly evaluations Participants followed for up to years Collaborative Care: Integration of Measurement and Management Shared measurement Symptoms Depression Mania/hypomania Anxiety Irritability Stress, alcohol, smoking, weight Side effects Functioning Collaborative Care: Integration of Measurement and Management Shared measurement Mood monitoring Medication concordance Non-concordance open for discussion Negotiate Goals Medication changes Menu of reasonable choices Collaborative Care Workbook Baseline Findings 1

2 Most Bipolar Patients report onset in childhood or adolescence Age of Onset in Bipolar Disorder (STEP-1) 8% 7% mean age of onset (SD 8.67) 3% > 18 < to 18 8% Only 3% with onset > 18 About 6% with onset < 18 Almost a third with onset < 13 6% % 4% 3% % 1% 37% % Perlis RH for the group, Biol Psych 4;: Age of Onset Perlis RH for the group, Biol Psych Childhood Onset With Greater Anxiety Comorbid Conditions Any Anxiety Onset < 13 Onset 13 to 18 Panic w Agor Onset > 18 Agor w/o Panic Social Phobia N=983 GAD PTSD Childhood and Adolescent Onset With Greater Comorbid Substance Abuse/Dependence and ADHD Onset < 13 Onset 13 to 18 Onset > 18 N=983 Any Anxiety Alcohol Substance ADHD Perlis RH for the group, Biol Psych 4;: Perlis RH for the group, Biol Psych 4;: Depressive Polarity of First Episode: More lifetime depression Lifetime Anxiety Comorbidity in Bipolar Disorder STEP 6 1% 17% 9% % 1% 17% 18% BP I BP II Any Panic ± Agor Agor Without Panic SAD OCD PTSD GAD P<.1; P<. Perlis et al., Biological Psychiatry ;8:49 3 Agor=agoraphobia; GAD=generalized anxiety disorder; OCD=obsessive-compulsive disorder; PTSD=posttraumatic stress disorder; SAD=social anxiety disorder. Simon N, et al. Am J Psychiatry. 4;161:-9.

3 Euthymic, d Anxiety Comorbidity Associated With Reduction in Longest Time Euthymic in Bipolar Disorder in Past Years (N=469) No Anxiety (n=33, 33) Any Anxiety (n=36, 137) PD w/ AGOR (n=81, 37) Current Anxiety Disorder Lifetime Anxiety Disorder PD w/out AGOR (n 3, 17) P<.; P<.1; P<.1; P<.1 SAD (n=99, ) OCD (n=49, 6) PTSD (n=79, ) GAD (n=86, 6) % ADHD Comorbidity in Bipolar Adults 9. Lifetime ADHD.9 Current ADHD ADHD Comorbid Shorter periods of wellness More likely BPI Symptomatic > lifetime manic episodes EtOH and drug abuse Less likely: Recovered Simon NM, et al. Am J Psychiatry. 4;161:-9. N = 1; Nierenberg et al., Biol Psychiatry ;7: % 1 1 Comorbid ADHD with more lifetime problems > Manic Episodes Lifetime suicide attempts Lifetime violence Lifetime legal problems N = 1; Nierenberg et al., Biol Psychiatry ;7: ADHD No ADHD Prevalence of ADHD with Mood Disorders % With % Without Other Comorbid Comorbid Conditions Odds Ratio MDD Dysthymia Bipolar Any Mood Disorder eg, 1.% of those with Bipolar Disorder during the previous 1 months have ADHD compared to 3.% of those without MDD who have ADHD. Kessler RC, et al. Am J Psychiatry. 6;163: Prevalence of Mood Disorders with Adult ADHD % With % Without ADHD ADHD MDD Dysthymia Bipolar Any Mood Disorder eg, 19.4% of those with ADHD during the previous 1 months have Bipolar Disorder compared to 3.1% of those without ADHD who have Bipolar Disorder. Kessler RC, et al. Am J Psychiatry. 6;163: Most bipolar patients with lifetime comorbid substance use disorder recover from SUD 36% + 1% = 48% of bipolar patients have lifetime SUD. 36%/48% (3/4) of those with lifetime comorbid SUD recover from SUD % No SUD Weiss RD, Ostacher M, et.al. Recovery from Substance Use in Bipolar Disorder: Does it Matter J Clin Psychiatry. ; J Clin Psych. ; 66: % Past SUD 1% Current SUD 48% lifetime SUD 3

4 Higher bipolar relapse rate with residual symptoms Results: Observational Prospective Findings Without residual symptoms Without residual symptoms With residual symptoms With residual symptoms Perlis et al., Am J Psychiatry. 6 Feb;163():17-4. Less than 1/3 of symptomatic bipolar patients reach recovery and remain well over years in Achieved recovery 8.% (< mood symptoms for at least 8 weeks) Relapse into depression 34.7% Relapse into mood elevation 13.8% Total relapse rate 48.% Total that stayed recovered over years (1%-48.%) 1.% Total who recovered and remained free of depressive and mood elevation recurrences over years (1.% out of 8.% who achieved remission) 3.1% N=1469 who entered symptomatic Perlis et al., Am J Psychiatry. 6 Feb;163():17-4. Anxiety comorbid conditions with lower probability of recovery from bipolar depression in without anxiety with anxiety Otto et al., Br J Psychiatry 6 Jul;189:-. N=48 Overall recovery rate = 8.7% Overall Hazard Ratio (HR)=.661 (Chi sq=.41, P=.) HR=.4 for social anxiety disorder Anxiety comorbid conditions with higher risk of relapse in bipolar disorder in with anxiety without anxiety N=489 Overall relapse rate = 41.4% Overall Hazard Ratio (HR)= ( =1.9, P=.1) HR=1. for one disorder HR=.17 for two or more disorders HR=.7 for social anxiety disorder HR=.4 for PTSD Embedded Randomized Trials Otto et al., Br J Psychiatry 6 Jul;189:-. 4

5 No Advantage or Disadvantage to Adding AD to Mood Stabilizers for Bipolar Depression Adjunctive Psychosocial Interventions with Empirical Support for Adult Bipolar Disorder Cognitive-Behavioral Therapy (CBT) Family-Focused Therapy (FFT) Interpersonal and Social Rhythm Therapy (IPSRT) Collaborative Care Plus Sachs G et al. N Engl J Med 7;1.16/NEJMoa6413 Intensive psychosocial interventions for bipolar depression better than collaborative care Treatment Resistant Bipolar Depression: Lamotrigine Added Might Help 8 7 Intensive Treatment Collaborative Care 6 % Well Month 1-year recovery rate for intensive group, 1/163 [64.4%]; for CC, 67/13 [1.%]; log-rank χ (1) = 6., p =.13; hazard ratio (HR) = 1.47; 9% CI = Miklowitz et al., Arch Gen Psychiatry, in press Nierenberg et al., Am J Psychiatry 6;163;1-8 Valproate Associated Polycsytic Ovarian Syndrome (PCOS) PCOS Menstrual cycle irregularities < or = 9 cycles per year Hyperandrogenism Hirsuitism Acne Male pattern alopecia Elevated serum androgens Obesity, insulin resistance, polycystic ovarian morphology % New Onset Oligoamenorrhea with Hyperandrogenism with Valproate with new onset PCOS 1.4 No Valproate 1. Valproate /44 9/86 Median time to onset = 3 months Joffe et al. Valproate is associated with new-onset oligoamenorrhea with hyper- Androgenism in women with bipolar disorder. Biol Psych 6;9:

6 Questions that remain after What are the best acute and long-term treatments for bipolar depression? What are the best treatments to prevent mood episodes and restore functioning in generalizable populations? Questions that remain after What are the best treatments for comorbid conditions (anxiety, substance abuse, ADHD)? Substance use disorders are untreated What can decrease medical morbidity and overall mortality, including suicide? Questions that remain after What biomarkers can be used to personalize acute and long-term treatment? Molecular Genetic Imaging Cognitive assessments Other biomarkers What are the best treatments of bipolar depression? Novel therapeutic interventions Do patients with BPII depression need mood stabilizers? After recovery from bipolar depression, what treatments promote long-term functioning and prevent relapse? What are the best treatments for comorbid conditions and symptoms? Anxiety Pharmacologic Psychotherapeutic Substance abuse Unique challenge of difficult to treat patients ADHD Benefits and risks of psychostimulants Cognitive dysfunction Medical burdens What is the best treatment for bipolar disorder with comorbid anxiety? Anxiety comorbidity 1% of cohort associated with poorer outcomes No evidence-based treatment options Antidepressants can exacerbate disease course Benzodiazepines of concern due to high comorbid substance abuse rates in BP No studies of psychotherapies for comorbid anxiety Novel psychosocial interventions needed 6

7 The sun and moon allude to the cyclical nature of bipolar disorder and the mission of the BTN: enduring commitment to clinical research on behalf of patients with bipolar disorder and their families. Designed by Gianna Marzilli Ericson 7

PAPEL DE LA PSICOTERAPIA EN EL TRATAMIENTO DEL TRASTORNO BIPOLAR

PAPEL DE LA PSICOTERAPIA EN EL TRATAMIENTO DEL TRASTORNO BIPOLAR PAPEL DE LA PSICOTERAPIA EN EL TRATAMIENTO DEL TRASTORNO BIPOLAR Dr. Francesc Colom PsyD, MSc, PhD Bipolar Disorders Program IDIBAPS- CIBERSAM -Hospital Clínic Barcelona, University of Barcelona Centro

More information

Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD

Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Post Traumatic Stress Disorder (PTSD) Karen Elmore MD Robert K. Schneider MD Revised 5-11-2001 by Robert K. Schneider MD Definition and Criteria PTSD is unlike any other anxiety disorder. It requires that

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

Psychiatric Comorbidity in Methamphetamine-Dependent Patients

Psychiatric Comorbidity in Methamphetamine-Dependent Patients Psychiatric Comorbidity in Methamphetamine-Dependent Patients Suzette Glasner-Edwards, Ph.D. UCLA Integrated Substance Abuse Programs August11 th, 2010 Overview Comorbidity in substance users Risk factors

More information

Improving the Recognition and Treatment of Bipolar Depression

Improving the Recognition and Treatment of Bipolar Depression Handout for the Neuroscience Education Institute (NEI) online activity: Improving the Recognition and Treatment of Bipolar Depression Learning Objectives Apply evidence-based tools that aid in differentiating

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information

SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS

SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS E-Resource December, 2013 SLEEP DISTURBANCE AND PSYCHIATRIC DISORDERS Between 10-18% of adults in the general population and up to 50% of adults in the primary care setting have difficulty sleeping. Sleep

More information

Update on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice

Update on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological

More information

Brief Review of Common Mental Illnesses and Treatment

Brief Review of Common Mental Illnesses and Treatment Brief Review of Common Mental Illnesses and Treatment Presentations to the Joint Subcommittee to Study Mental Health Services in the 21st Century September 9, 2014 Jack Barber, M.D. Medical Director Virginia

More information

Bipolar Disorder: Advances in Psychotherapy

Bipolar Disorder: Advances in Psychotherapy Bipolar Disorder: Advances in Psychotherapy Questions from chapter 1 1) Which is characterized by one or more major depressive episodes with at least one hypomanic episode in which the patient s functioning

More information

How to Recognize Depression and Its Related Mood and Emotional Disorders

How to Recognize Depression and Its Related Mood and Emotional Disorders How to Recognize Depression and Its Related Mood and Emotional Disorders Dr. David H. Brendel Depression s Devastating Toll on the Individual Reduces or eliminates pleasure and jo Compromises and destroys

More information

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include: Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic

More information

BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS

BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS The future of our country depends on the mental health and strength of our young people. However, many children have mental health problems

More information

Psychosocial treatment of late-life depression with comorbid anxiety

Psychosocial treatment of late-life depression with comorbid anxiety Psychosocial treatment of late-life depression with comorbid anxiety Viviana Wuthrich Centre for Emotional Health Macquarie University, Sydney, Australia Why Comorbidity? Comorbidity is Common Common disorders,

More information

Major Depressive Disorders Questions submitted for consideration by workshop participants

Major Depressive Disorders Questions submitted for consideration by workshop participants Major Depressive Disorders Questions submitted for consideration by workshop participants Prioritizing Comparative Effectiveness Research Questions: PCORI Stakeholder Workshops June 9, 2015 Patient-Centered

More information

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1 What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

More information

Diagnostic Boundaries of Bipolar Disorders. Terence A. Ketter, M.D.

Diagnostic Boundaries of Bipolar Disorders. Terence A. Ketter, M.D. Diagnostic Boundaries of Bipolar Disorders Terence A. Ketter, M.D. Disclosure Information Research Support / Consultant / Speaker Abbott Laboratories, Inc. AstraZeneca Pharmaceuticals LP Bristol Myers

More information

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa Cognitive Behavioral Therapy for PTSD Presented by Dr. Edna B. Foa Center for the Treatment and Study of Anxiety University of Pennsylvania Ref # 3 Diagnosis of PTSD Definition of a Trauma The person has

More information

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller School of Medicine/University of Miami Question 1 You

More information

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,

More information

Child & Adolescent Anxiety: Psychopathology and Neuroscience

Child & Adolescent Anxiety: Psychopathology and Neuroscience bbrfoundation.org Child & Adolescent Anxiety: Psychopathology and Neuroscience Daniel S. Pine, M.D. Chief, Child & Adolescent Research Mood & Anxiety Disorders Program National Institute of Mental Health

More information

Frequently Asked Questions About Prescription Opioids

Frequently Asked Questions About Prescription Opioids Mental Health Consequences of Prescription Drug Addictions Opioids, Hypnotics and Benzodiazepines Learning Objectives 1. To review epidemiological data on prescription drug use disorders Ayal Schaffer,

More information

Naomi M. Simon, MD, MSc

Naomi M. Simon, MD, MSc Generalized Anxiety Disorder and Psychiatric Comorbidities Such as Depression, Bipolar Disorder, and Substance Abuse Naomi M. Simon, MD, MSc Generalized anxiety disorder (GAD) has a high rate of comorbidity

More information

Integrating the Treatment of Substance Use Disorders and Co-occurring Psychiatric Disorders in Adolescents

Integrating the Treatment of Substance Use Disorders and Co-occurring Psychiatric Disorders in Adolescents Integrating the Treatment of Substance Use Disorders and Co-occurring Psychiatric Disorders in Adolescents Paula Riggs, M.D. University of Colorado School of Medicine Denver, CO Disclosures Source Consultant

More information

Depression and Mental Health:

Depression and Mental Health: Depression and Mental Health: A Psychiatrist s Perspective Peter M. Lake, MD Medical Director Rogers Memorial Hospital Oconomowoc Depression The Intersection of Hope, Medicine and Research Marquette University

More information

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Dr. Joti Samra PhD, R.Psych. Adjunct Professor & Research Scientist CARMHA www.carmha.ca Dr. Merv Gilbert PhD, R.Psych. Principal

More information

TREATMENT-RESISTANT DEPRESSION AND ANXIETY

TREATMENT-RESISTANT DEPRESSION AND ANXIETY University of Washington 2012 TREATMENT-RESISTANT DEPRESSION AND ANXIETY Catherine Howe, MD, PhD University of Washington School of Medicine Definition of treatment resistance Failure to remit after 2

More information

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999 Feeling Moody? Is it just a bad mood or is it a disorder? Major Depressive Disorder Prevalence: 7%; 18-29 years old; Female>Male DDx: Manic episodes with irritable mood or mixed episodes, mood disorder

More information

Bipolar Disorder: Psychosocial Factors and Psychological Therapies. Steve Jones Spectrum Centre for Mental Health Research

Bipolar Disorder: Psychosocial Factors and Psychological Therapies. Steve Jones Spectrum Centre for Mental Health Research Bipolar Disorder: Psychosocial Factors and Psychological Therapies Steve Jones Spectrum Centre for Mental Health Research Overview Scale of the Problem Factors associated with Bipolar course and outcome

More information

Recognizing and Treating Depression in Children and Adolescents.

Recognizing and Treating Depression in Children and Adolescents. Recognizing and Treating Depression in Children and Adolescents. KAREN KANDO, MD Division of Child and Adolescent Psychiatry Center for Neuroscience and Behavioral Medicine Phoenix Children s Hospital

More information

3/17/2014. Pediatric Bipolar Disorder

3/17/2014. Pediatric Bipolar Disorder Pediatric Bipolar Disorder 1 Highlighted Topics 1. Review the current DSM-5 definition and criteria for bipolar disorder 2. Highlight major historical developments in the scientific understanding of bipolar

More information

Topics In Addictions and Mental Health: Concurrent disorders and Community resources. Laurence Bosley, MD, FRCPC

Topics In Addictions and Mental Health: Concurrent disorders and Community resources. Laurence Bosley, MD, FRCPC Topics In Addictions and Mental Health: Concurrent disorders and Community resources Laurence Bosley, MD, FRCPC Overview Understanding concurrent disorders. Developing approaches to treatment Definitions

More information

OCD & Anxiety: Helen Blair Simpson, M.D., Ph.D.

OCD & Anxiety: Helen Blair Simpson, M.D., Ph.D. OCD & Anxiety: Symptoms, Treatment, & How to Cope Helen Blair Simpson, M.D., Ph.D. Professor of Clinical Psychiatry, Columbia University Director of the Anxiety Disorders Clinic, New York State Psychiatric

More information

Mental Health Ombudsman Training Manual. Advocacy and the Adult Home Resident. Module V: Substance Abuse and Common Mental Health Disorders

Mental Health Ombudsman Training Manual. Advocacy and the Adult Home Resident. Module V: Substance Abuse and Common Mental Health Disorders Mental Health Ombudsman Training Manual Advocacy and the Adult Home Resident Module V: Substance Abuse and Common Mental Health Disorders S WEHRY 2004 Goals Increase personal comfort and confidence Increase

More information

Working with young people who have mental health and substance use issues. Samar Zakaria

Working with young people who have mental health and substance use issues. Samar Zakaria Working with young people who have mental health and substance use issues. Samar Zakaria Main points Challenges faced while treating young adults in a dual diagnosis rehab unit Define dual diagnosis in

More information

FACT SHEET 4. Bipolar Disorder. What Is Bipolar Disorder?

FACT SHEET 4. Bipolar Disorder. What Is Bipolar Disorder? FACT SHEET 4 What Is? Bipolar disorder, also known as manic depression, affects about 1 percent of the general population. Bipolar disorder is a psychiatric disorder that causes extreme mood swings that

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

Table of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression

Table of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression Table of Contents Visit www.healthreferenceseries.com to view A Contents Guide to the Health Reference Series, a listing of more than 16,000 topics and the volumes in which they are covered. Preface...xv

More information

Assessment of depression in adults in primary care

Assessment of depression in adults in primary care Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and

More information

Treating Mood and Anxiety Disorders in Children & Adolescents

Treating Mood and Anxiety Disorders in Children & Adolescents Treating Mood and Anxiety Disorders in Children & Adolescents Daniel S. Pine, MD Section on Development & Affective Neuroscience Disclosures: Conflicts Sources of Research Support National Institute of

More information

Healthy Coping in Diabetes Self Management

Healthy Coping in Diabetes Self Management Healthy Coping in Diabetes Self Management Support for this product was provided by a grant from the Robert Wood Johnson Foundation in Princeton, New Jersey, 2009 Objectives Describe the relationship among

More information

Treatment of PTSD and Comorbid Disorders

Treatment of PTSD and Comorbid Disorders TREATMENT GUIDELINES Treatment of PTSD and Comorbid Disorders Guideline 18 Treatment of PTSD and Comorbid Disorders Description Approximately 80% of people with posttraumatic stress disorder (PTSD) have

More information

OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY. 1 Overview of Cognitive Behavioral Therapy

OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY. 1 Overview of Cognitive Behavioral Therapy OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY 1 Overview of Cognitive Behavioral Therapy TABLE OF CONTENTS Introduction 3 What is Cognitive-Behavioral Therapy? 4 CBT is an Effective Therapy 7 Addictions Treated

More information

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT June, 2014 Dean L. Babcock, LCAC, LCSW Associate Vice President Eskenazi Health Midtown Community Mental Health Centers Why is Evidence-Based

More information

Depression Assessment & Treatment

Depression Assessment & Treatment Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting

More information

Managing depression after stroke. Presented by Maree Hackett

Managing depression after stroke. Presented by Maree Hackett Managing depression after stroke Presented by Maree Hackett After stroke Physical changes We can see these Depression Emotionalism Anxiety Confusion Communication problems What is depression? Category

More information

Eating Disorders: Anorexia Nervosa and Bulimia Nervosa Preferred Practice Guideline

Eating Disorders: Anorexia Nervosa and Bulimia Nervosa Preferred Practice Guideline Introduction Eating Disorders are described as severe disturbances in eating behavior which manifest as refusal to maintain a minimally normal body weight (Anorexia Nervosa) or repeated episodes of binge

More information

MOLINA HEALTHCARE OF CALIFORNIA

MOLINA HEALTHCARE OF CALIFORNIA MOLINA HEALTHCARE OF CALIFORNIA MAJOR DEPRESSION IN ADULTS IN PRIMARY CARE HEALTH CARE GUIDELINE (ICSI) Health Care Guideline Twelfth Edition May 2009. The guideline was reviewed and adopted by the Molina

More information

DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D.

DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D. DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D. GOALS Learn DSM 5 criteria for DMDD Understand the theoretical background of DMDD Discuss background, pathophysiology and treatment

More information

Bipolar Disorder. When people with bipolar disorder feel very happy and "up," they are also much more active than usual. This is called mania.

Bipolar Disorder. When people with bipolar disorder feel very happy and up, they are also much more active than usual. This is called mania. Bipolar Disorder Introduction Bipolar disorder is a serious mental disorder. People who have bipolar disorder feel very happy and energized some days, and very sad and depressed on other days. Abnormal

More information

[KQ 804] FEBRUARY 2007 Sub. Code: 9105

[KQ 804] FEBRUARY 2007 Sub. Code: 9105 [KQ 804] FEBRUARY 2007 Sub. Code: 9105 (Revised Regulations) Theory : Two hours and forty minutes Q.P. Code: 419105 Maximum : 100 marks Theory : 80 marks M.C.Q. : Twenty minutes M.C.Q. : 20 marks 1. A

More information

PREVALENCE AND RISK FACTORS FOR PSYCHIATRIC COMORBIDITY IN PATIENTS WITH ALCOHOL DEPENDENCE SYNDROME Davis Manuel 1, Linus Francis 2, K. S.

PREVALENCE AND RISK FACTORS FOR PSYCHIATRIC COMORBIDITY IN PATIENTS WITH ALCOHOL DEPENDENCE SYNDROME Davis Manuel 1, Linus Francis 2, K. S. PREVALENCE AND RISK FACTORS FOR PSYCHIATRIC COMORBIDITY IN PATIENTS WITH ALCOHOL DEPENDENCE SYNDROME Davis Manuel 1, Linus Francis 2, K. S. Shaji 3 HOW TO CITE THIS ARTICLE: Davis Manuel, Linus Francis,

More information

Depression in Older Persons

Depression in Older Persons Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression

More information

See also www.thiswayup.org.au/clinic for an online treatment course.

See also www.thiswayup.org.au/clinic for an online treatment course. Depression What is depression? Depression is one of the common human emotional states. It is common to experience feelings of sadness and tiredness in response to life events, such as losses or disappointments.

More information

Determinants, Key Players and Possible Interventions

Determinants, Key Players and Possible Interventions Major in Human Health, Nutrition and Environment, FS 2010 Public Health Concepts Determinants, Key Players and Possible Interventions David Fäh Aims Have an idea about which parameters can influence health

More information

Suicide in Bipolar Disorder. Julie Anderson, MD Oregon State Hospital Psychiatrist OHSU Assistant Professor September 25, 2012

Suicide in Bipolar Disorder. Julie Anderson, MD Oregon State Hospital Psychiatrist OHSU Assistant Professor September 25, 2012 Suicide in Bipolar Disorder Julie Anderson, MD Oregon State Hospital Psychiatrist OHSU Assistant Professor September 25, 2012 Disclosure Statement I have no significant financial relationships to disclose...

More information

in young people Management of depression in primary care Key recommendations: 1 Management

in young people Management of depression in primary care Key recommendations: 1 Management Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

More information

B i p o l a r D i s o r d e r

B i p o l a r D i s o r d e r B i p o l a r D i s o r d e r Professor Ian Jones Director National Centre for Mental Health www.ncmh.info @ncmh_wales /WalesMentalHealth 029 2074 4392 info@ncmh.info Robert Schumann 1810-1856 Schumann's

More information

Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis, MD, MPH

Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis, MD, MPH CBT for Youth with Co-Occurring Post Traumatic Stress Disorder and Substance Disorders Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis,

More information

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Co-Occurring Substance Use and Mental Health Disorders Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Introduction Overview of the evolving field of Co-Occurring Disorders Addiction and

More information

Conjoint Professor Brian Draper

Conjoint Professor Brian Draper Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course

More information

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study Amanda Dudley, Bruce Tonge, Sarah Ford, Glenn Melvin, & Michael Gordon Centre for Developmental Psychiatry & Psychology

More information

Co-occurring Disorders Treatment. Bob Werstlein PhD Training Director Daymark Recovery Services

Co-occurring Disorders Treatment. Bob Werstlein PhD Training Director Daymark Recovery Services Co-occurring Disorders Treatment Bob Werstlein PhD Training Director Daymark Recovery Services Co-occurring Disorders Definition Co-occurring disorders refers to co-occurring Substance Abuse(SA) and Mental

More information

The role of psychoeducation in the complex treatment of bipolar disorder

The role of psychoeducation in the complex treatment of bipolar disorder The role of psychoeducation in the complex treatment of bipolar disorder Bartosz Grabski, Grzegorz Mączka, Dominika Dudek Summary The importance of psychosocial interventions in bipolar disorder has recently

More information

ADHD AND ANXIETY AND DEPRESSION AN OVERVIEW

ADHD AND ANXIETY AND DEPRESSION AN OVERVIEW ADHD AND ANXIETY AND DEPRESSION AN OVERVIEW A/Professor Alasdair Vance Head, Academic Child Psychiatry Department of Paediatrics University of Melbourne Telephone: 9345 4666 Facsimile: 9345 6002 Email:

More information

Depression in the Elderly: Recognition, Diagnosis, and Treatment

Depression in the Elderly: Recognition, Diagnosis, and Treatment Depression in the Elderly: Recognition, Diagnosis, and Treatment LOUIS A. CANCELLARO, PhD, MD, EFAC Psych Professor Emeritus and Interim Chair ETSU Department of Psychiatry & Behavioral Sciences Diagnosis

More information

How To Treat Cannabis

How To Treat Cannabis Cannabis Treatment EMCDDA Insights series publication Marica Ferri, Eva Hoch and Roland Simon Lisbon, 25 th September 2014 EDR 2014 Cannabis: Europe s most commonly used drug 73.6 million adults ever used

More information

Psychotherapy Treatment of Bipolar Disorders

Psychotherapy Treatment of Bipolar Disorders Psychotherapy Treatment of Bipolar Disorders Jenifer L. Culver, Ph.D. Clinical Assistant Professor Bipolar Disorders Clinic Stanford University School of Medicine Overview Overview of research-based psychotherapies

More information

Pennsylvania Depression Quality Improvement Collaborative

Pennsylvania Depression Quality Improvement Collaborative Pennsylvania Depression Quality Improvement Collaborative Carol Hann, RN, MSN, CPHQ, Collaborative Manager Southeastern Pennsylvania Association for Healthcare Quality (SPAHQ) David Payne, Psy.D., Senior

More information

MOOD AND ANXIETY DISORDERS CLINIC Department of Child Psychiatry, Children's and Women's Health Center of British Columbia

MOOD AND ANXIETY DISORDERS CLINIC Department of Child Psychiatry, Children's and Women's Health Center of British Columbia MOOD AND ANXIETY DISORDERS CLINIC Department of Child Psychiatry, Children's and Women's Health Center of British Columbia 1. Clinic Mandate CLINICAL PRACTICE GUIDELINES 1.1. Referral Criteria: The clinic

More information

Sleep Medicine and Psychiatry. Roobal Sekhon, D.O.

Sleep Medicine and Psychiatry. Roobal Sekhon, D.O. Sleep Medicine and Psychiatry Roobal Sekhon, D.O. Common Diagnoses Mood Disorders: Depression Bipolar Disorder Anxiety Disorders PTSD and other traumatic disorders Schizophrenia Depression and Sleep: Overview

More information

Adolescent Depression. Danielle Bradshaw, DO Diplomate of the American Board of Psychiatry and Neurology Adult and Child/Adolescent Psychiatry

Adolescent Depression. Danielle Bradshaw, DO Diplomate of the American Board of Psychiatry and Neurology Adult and Child/Adolescent Psychiatry Adolescent Depression Danielle Bradshaw, DO Diplomate of the American Board of Psychiatry and Neurology Adult and Child/Adolescent Psychiatry Adolescence When does it start? When does it end? Characteristics:

More information

The Clinical Presentation of Mood Disorders. Bob Boland MD

The Clinical Presentation of Mood Disorders. Bob Boland MD The Clinical Presentation of Mood Disorders. Bob Boland MD 1 The Clinical Presentation of Mood Disorders 2 Concentrating On Depression Major Depression Mania Bipolar Disorder (Manic-Depression) For the

More information

When is psychological therapy warranted for patients with mental health problems?

When is psychological therapy warranted for patients with mental health problems? The Guidelines Advisory Committee (GAC) is empowered by the Ministry of Health and Long-Term Care and the Ontario Medical Association to promote evidence-based health care in Ontario, by encouraging physicians

More information

Psychopharmacotherapy for Children and Adolescents

Psychopharmacotherapy for Children and Adolescents TREATMENT GUIDELINES Psychopharmacotherapy for Children and Adolescents Guideline 7 Psychopharmacotherapy for Children and Adolescents Description There are few controlled trials to guide practitioners

More information

MANAGEMENT OF PATIENTS WITH MOOD DISORDERS AND COMORBID ANXIETY DISORDERS. BACKGROUND: Comorbid mood and anxiety disorders are commonly seen

MANAGEMENT OF PATIENTS WITH MOOD DISORDERS AND COMORBID ANXIETY DISORDERS. BACKGROUND: Comorbid mood and anxiety disorders are commonly seen ANNALS OF CLINICAL PSYCHIATRY 2012;24(1):6-22 REVIEW ARTICLE The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders

More information

Total sample Problem gamblers. 1 Includes seven respondents with Bipolar-I disorder

Total sample Problem gamblers. 1 Includes seven respondents with Bipolar-I disorder Appendix Table 1. The distribution of lifetime gambling frequency in the total sample, among people with lifetime gambling problems, and among people with lifetime Pathological Gambling (PG) Total sample

More information

TREATING MAJOR DEPRESSIVE DISORDER

TREATING MAJOR DEPRESSIVE DISORDER TREATING MAJOR DEPRESSIVE DISORDER A Quick Reference Guide Based on Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition, originally published in April 2000.

More information

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions Major Depressive Disorder Major Depressive Disorder (MDD) Guideline Diagnostic omenclature for Clinical Depressive Conditions Conditions Diagnostic Criteria Duration Major Depression 5 of the following

More information

Irritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children

Irritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children Irritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders National Institute

More information

Drugs PSYCHOSIS. Depression. Stress Medical Illness. Mania. Schizophrenia

Drugs PSYCHOSIS. Depression. Stress Medical Illness. Mania. Schizophrenia Drugs Stress Medical Illness PSYCHOSIS Depression Schizophrenia Mania Disorders In preschool children imaginary friends and belief in monsters under the bed is normal (it may be normal in older developmentally

More information

Schizoaffective Disorder

Schizoaffective Disorder FACT SHEET 10 What Is? Schizoaffective disorder is a psychiatric disorder that affects about 0.5 percent of the population (one person in every two hundred). Similar to schizophrenia, this disorder is

More information

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 ed #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 effects of alcohol in the brain 100 Top 30 698 heroin addiction 100

More information

Depression and Anxiety in Parkinson s disease

Depression and Anxiety in Parkinson s disease Depression and Anxiety in Parkinson s disease Greg Pontone, MD Director, Movement Disorders Psychiatry Clinical Programs at Johns Hopkins Morris K. Udall Parkinson's Disease Research Center Johns Hopkins

More information

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults Professional Reference Series Depression and Anxiety, Volume 1 Depression and Anxiety Prevention for Older Adults TA C M I S S I O N The mission of the Older Americans Substance Abuse and Mental Health

More information

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität

More information

COUNTY OF LOS ANGELES - DEPARTMENT OF MENTAL HEALTH OFFICE OF THE MEDICAL DIRECTOR. 3.4 PARAMETERS FOR THE USE OF ANXIOLYTIC MEDICATIONS October 2014

COUNTY OF LOS ANGELES - DEPARTMENT OF MENTAL HEALTH OFFICE OF THE MEDICAL DIRECTOR. 3.4 PARAMETERS FOR THE USE OF ANXIOLYTIC MEDICATIONS October 2014 COUNTY OF LOS ANGELES - DEPARTMENT OF MENTAL HEALTH OFFICE OF THE MEDICAL DIRECTOR 3.4 PARAMETERS FOR THE USE OF ANXIOLYTIC MEDICATIONS October 2014 I. GENERAL CONSIDERATIONS A. Definition: Anxiolytic

More information

Addiction Billing. Kimber Debelak, CMC, CMOM, CMIS Director, Recovery Pathways

Addiction Billing. Kimber Debelak, CMC, CMOM, CMIS Director, Recovery Pathways Addiction Billing Kimber Debelak, CMC, CMOM, CMIS Director, Recovery Pathways Objectives Provide overview of addiction billing contrasting E&M vs. behavioral health codes Present system changes in ICD-9

More information

information for service providers Schizophrenia & Substance Use

information for service providers Schizophrenia & Substance Use information for service providers Schizophrenia & Substance Use Schizophrenia and Substance Use Index 2 2 3 5 6 7 8 9 How prevalent are substance use disorders among people with schizophrenia? How prevalent

More information

Overview of the Adverse Childhood Experiences (ACE) Study. Robert F. Anda, MD, MS Co-Principal Investigator. www.robertandamd.com

Overview of the Adverse Childhood Experiences (ACE) Study. Robert F. Anda, MD, MS Co-Principal Investigator. www.robertandamd.com Overview of the Adverse Childhood Experiences (ACE) Study Robert F. Anda, MD, MS Co-Principal Investigator www.robertandamd.com Death Early Death Disease, Disability and Social Problems Adoption of Health-risk

More information

Medical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015

Medical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Medical marijuana for pain and anxiety: A primer for methadone physicians Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Conflict of interest statement No conflict of interest to

More information

Psychology & Psychophysiology of Disordered Eating & Eating Disorders Claus Vögele Institute for Health and Behaviour University of Luxembourg

Psychology & Psychophysiology of Disordered Eating & Eating Disorders Claus Vögele Institute for Health and Behaviour University of Luxembourg Psychology & Psychophysiology of Disordered Eating & Eating Claus Vögele Institute for Health and Behaviour University of Luxembourg 1 Don t worry, eat happy! Eating as emotion-regulation strategy but

More information

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Bipolar Disorder, Schizophrenia and Schizoaffective Disorder Symptoms and Prevalence of Bipolar Disorder Bipolar disorder, formerly known

More information

309.28 F43.22 Adjustment disorder with mixed anxiety and depressed mood Adjustment disorder with disturbance of conduct

309.28 F43.22 Adjustment disorder with mixed anxiety and depressed mood Adjustment disorder with disturbance of conduct Description ICD-9-CM Code ICD-10-CM Code Adjustment reaction with adjustment disorder with depressed mood 309.0 F43.21 Adjustment disorder with depressed mood Adjustment disorder with anxiety 309.24 F43.22

More information

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION Executive summary of recommendations Details of recommendations can be found in the main text at the pages indicated. Clinical evaluation D The basic

More information

Success factors in Behavioral Medicine

Success factors in Behavioral Medicine Success factors in Behavioral Medicine interventions post myocardial infarction Depression Gunilla post myocardial Burell, PhD infarction Department of Public Health, Uppsala University, Sweden XIII Svenska

More information

GAIN and DSM. Presentation Objectives. Using the GAIN Diagnostically

GAIN and DSM. Presentation Objectives. Using the GAIN Diagnostically GAIN and DSM GAIN National Clinical Training Team 2011 Version 2 Materials Presentation Objectives Understand which DSM diagnoses are generated by GAIN ABS for the GAIN reports and which ones must be added

More information

Predictors of Substance Abuse Treatment Engagement among Rural Appalachian Prescription Drug Users

Predictors of Substance Abuse Treatment Engagement among Rural Appalachian Prescription Drug Users Predictors of Substance Abuse Treatment Engagement among Rural Appalachian Prescription Drug Users Jennifer R. Havens, PhD, MPH Carrie B. Oser, PhD Carl G. Leukefeld, PhD Study Objective The objective

More information

kaiser medicaid uninsured commission on The Role of Medicaid for People with Behavioral Health Conditions November 2012

kaiser medicaid uninsured commission on The Role of Medicaid for People with Behavioral Health Conditions November 2012 on on medicaid and and the the uninsured November 2012 The Role of Medicaid for People with Behavioral Health Conditions Introduction Behavioral health conditions encompass a broad range of illnesses,

More information

Schizoaffective disorder

Schizoaffective disorder Schizoaffective disorder Dr.Varunee Mekareeya,M.D.,FRCPsychT Schizoaffective disorder is a psychiatric disorder that affects about 0.5 to 0.8 percent of the population. It is characterized by disordered

More information