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Psychiatric Interventions

Mental health professionals are constantly challenged by diagnosis and screening, co-morbidities, treatment strategies and algorithms, pharmacology, long-term management, medico-legal risk, and current research related to the most common psychiatric disorders. In this series, Dr. Paul E. Keck, Jr. and colleagues will address these challenges.

Moderated By:
Paul E. Keck, Jr., MD
Professor of Psychiatry & Neuroscience and Executive Vice Chairman, Department of Psychiatry, University of Cincinnati College of Medicine
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Latest Comments
"This was an exceptional, well-organized succinct presentation entitled an “common and difficult problems clinicians face when treating depression,” in your series on psychiatric interventions.  You thoroughly defined response, remission and relapse in depression.  Approaches to augment, combine, switch, medications or provide alternative therapy through ECT, VNS, TMS and DBS were examined.  Your research studies correlating co-morbid medical conditions i.e. DM vs. pts without diabetes was significant.  In addition, the correct dosage and adequate duration of medication before switching or adding another drug was reviewed. 

You methodically provided information on treatment resistant depression vs. psychotic depression, as well as, the loss of antidepressant response.  Guidelines on the MGT of particular S/S and S/E i.e. sexual dysfunction, weight gain, anxiety and sleep disturbances were also examined.  I will be checking out this screening instrument ATHF tool on-line.

Thank You!

Valerie"
Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
114 Comments, last 9 hours ago
"This was an exceptional, well-organized succinct presentation entitled an “should mood disorders be reclassified as metabolic syndrome type II?” in your series on psychiatric interventions.  You thoroughly reviewed the comorbidities i.e. ADHD, GAD impulse control, personality disorder, substance abuse, migraine, pain disorders, obesity, CD and DM for bipolar disorder.  The emphasis on the importance of understanding the link between the neurobiology and bipolar disorders and they are more likely to be interrelated to other medical and mental conditions i.e. obesity, CVD, DM, ADHD GAD etc.  You discussed that the neuro-cognitive deficits that contribute to psychosocial difficulties with bipolar disease and how it can impact employment, with up to 65 days off in a year.  No wonder these pts can’t keep a job. 

Very interesting information related to the trait link and neurobiology 1st degree relatives without the diagnosis of bipolar disease exhibit neuro-cognitive changes.  Also, abnormalities in brain morphology i.e. abnormal brain volume was interesting.  Relating to metabolic and mood disorders a shared common pathophysiology which correlates with BDNF levels is diminished in both obese and diabetic pts.  Moreover, the similarity of DM  with the cognitive changes and interacting networks i.e. neuro-inflammatory, neuro-endocrine and neuro-metabolic networks which are seen in bi-polar pts.  These mediating factors related to brain changes in bipolar disorder and brain volume changes are clinical relevant. 

Interesting perspective regarding brain changes with wear and tear of metabolic alterations with bipolar disorder where mediating variables may be categorized as metabolic syndrome type II.  The impact of bipolar manic episodes as a disturbance in neuro-biology resulting in an accumulation of deficits was analyzed.  The fact that patients experiencing multi manic episodes have a progressive process which indicates that the more occurrences that take place the more likely the pt will have more disturbances in their neuro-biology and an accumulation of deficits with more pronounced changes. 

Again, interesting information regarding the decrease in BDNF diminished in mood disorders whether the pt is bipolar I, II or depression and that those changes observed in pts treated and untreated. It is not just a function of treatment, but brain derived neurotrophic factor are altered and it is believed to be an important mediator in these changes.  It is believed that metabolic and mood disorders share a common pathophysiology which correlates to diminished BDNF levels in obese and diabetic pts.

Yes, I agree that the treatment strategies for dealing with a chronic medical disorder takes a multidisciplinary approach to properly care for the pt.  As PCP knowing that the pathophysiology of mood disorders is a chronic, progressive and neuro-degenerative in vital to truly understanding your pt.  Also, understanding that the neuro-metabolic, neuro-inflammatory, neuro-endocrine all interplay as metabolic syndrome type II with these pts. 

Your perspective regarding brain changes with wear and tear of metabolic alterations with bipolar disorder where mediating variables may be categorized as metabolic syndrome type II seems like the right name for this diagnosis.  I agree, that the impact of bipolar manic episodes can result in a disturbance in neuro-biology resulting in an accumulation of deficits.  Patients experiencing multi manic episodes have a progressive process which indicates that the more occurrences that take place the more likely it is that the pt will have more disturbances their neuro-biology and an accumulation of deficits with possibly even more pronounced changes, great info. 

Interesting information regarding a decrease in BDNF which is diminished in mood disorders whether the pt is bipolar I, II or depression and that those changes observed in pts whether they are treated or untreated. It is not just a function of treatment, but altered brain derived neurotrophic and I too, believe that it is an important mediator in these changes.

 

Future therapies i.e. anti-inflammatory, exercise therapy, insulin sensitizers, thiazolidinediones, and incretins seem great for bi-polar pts. 

When I was in school it would have been great to have this type of technology to review the information over again.  I thoroughly enjoyed your pathophysiology explanation in this program.  You are a great instructor and your students should be happy to have someone like you in their corner.

Thank You!

Valerie"
Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
189 Comments, last 9 hours ago
 
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