Expected Outcomes. Assumptions. Borderline Personality Disorder: Pharmacologic Intervention

Size: px
Start display at page:

Download "Expected Outcomes. Assumptions. Borderline Personality Disorder: Pharmacologic Intervention"

Transcription

1 Borderline Personality Disorder: Pharmacologic Intervention Barbara J. Limandri, DNSc, APRN, BC Associate Professor Linfield College School of Nursing PMHNP Portland Dialectical Behavior Therapy Program Expected Outcomes 1. Describe imputed neurophysiologic mechanisms underlying borderline personality disorder & trauma. 2. Analyze the effects of different classes of medications as they related to these neurophysiologic mechanisms 3. Synthesize pharmacologic interventions through a case study analysis. Assumptions Personality disorders are complex psychopathologies that involve the interaction of biology, development, and social environment. Treatment necessarily involves intervention in all of these areas.

2 Assumptions Continued Pharmacologic agents act on neurophysiologic mechanisms only, i.e., are not specific to DSM diagnoses Pharmacologic treatment requires a collaborative relationship with the client and working together as a team. Assumptions Continued Brain creates the mind; the mind activates the brain. Therefore mindfulness is essential in treatment. Neural integration permits mindfulness and self-regulation. Interrelationship of PTSD & Borderline PD Environmental events during brain development influences neural circuitry that may become permanent Not all who have experienced childhood trauma develop PTSD or BPD; not all who have BPD have experienced childhood abuse (Herman, et al; Gunderson & Sabo) Hypothalamic-pituitary-adrenal axis

3 Diagnostic Elements of BPD Interpersonal instability Affective dysregulation Marked impulsivity Hypersensitivity Suicidal and parasuicidal behaviors Chronic feelings of emptiness Diagnostic Elements of PTSD Actual or threatened bodily harm Traumatic event is persistently reexperienced Persistent avoidance of stimuli associated with the event Persistent symptoms of increased arousal Emotional Regulation Dysfunction

4 Dialectic Dimensions of BPD Emotional Vulnerability Unrelenting Crises Activity Passivity Biological Social Apparent Competence Self- Invalidation Inhibited Grieving Acceptance and Change Dialectic Neurophysiologic Correlates Brain System Neuromodulators Behavioral Response Behavioral activation Prefrontal cortex Cingulate Caudate Behavioral inhibition Medial prefrontal cortex Anterior paralimbic Social attachment Nucleus accumbens Persistence Orbital medial cortex Nucleus accumbens (Cloninger, 1998) Dopamine GABA Serotonin Norepinephrine Serotonin Glutamate Serotonin Novelty seeking, appetitive approach, active avoidance Harm avoidance Aversive conditioning Reward dependence Appetitive conditioning Resistance to extinction Long term continuation of symptoms

5 Neurotransmitter Function Serotonin Inversely related to aggression &/or impulsivity 5-HT receptor subtypes mediate responses (5-HT 2c, 5-HT 1a ) Platelet serotonin receptor Neurotransmitter Function Con t d Dopamine Related to psychotic-like behaviors (e.g. ego syntonic hallucinations, magical thinking, suspiciousness, ideas of reference) Norepinephrine Impulsivity & aggression, irritability Autonomic hyperarousal Neurotransmitter Function Con t d Acetylcholine Emotional sensitivity (limited research) Emotional lability & mood shifts GABA Mostly GABA a in thalamus, cerebellum, cortex Anxiety, panic

6 Structures Affecting Emotion & Behavior Limbic System: mediates emotional aspects of experience Memory Cognition Mood & anxiety Social behavior Drives & impulses Limbic System Structures Affecting Emotion & Behavior Hippocampal Cingulate Sensory processing Conscious coding of experience Integrates thoughts, feelings & actions Cognitive processing (new learning, regulation of mood) Local GABA-ergic, dopaminergic, noradrenergic & serotonergic tracts

7 Structures Affecting Emotion & Behavior Amygdala Attaches emotional color & social meaning to experiences Regulates appetite, mood, aggression, sexual & social behavior, comprehension of social cues Emotional memory Rich in noradrenergic tracts Structures Affecting Emotion & Behavior Prefrontal cortex Dorsolateral: cognitive speed, flexibility, task sequencing, working memory Paralimbic orbitofrontal: regulation of impulses, mood & personality, motivation Anterior cingulate gyrus: attention, drive, motivation, memory, initiation of speech Structures Affecting Emotion & Behavior Basal ganglia & ventral striatum Caudate, putamen, nucleus accumbens Motivation, movement, cognition, emotion Reward center Rich in dopamine-1 & 2 receptors

8 Pharmacological Concepts Recategorize drug classes away from diagnostic referent to neurophysiologic Antidepressants: serotonin reuptake inhibitors, norepinephrine reuptake inhibitor, etc Permits broader recognition of use Drugs and supplements effect on production of neurotransmitters Serotonin Reuptake Inhibitors Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro) Serotonin Antagonist & Reuptake Inhibitor Nefazadone (Serzone) Blocks 5-HT 2 Puts serotonin primarily in 5-HT 1a What would you expect for symptom relief? What would you expect for side effects?

9 Serotonin-Norepinephrine Reuptake Inhibitor Venlafaxine (Effexor) Duloxetine (Cymbalta) What effect would you expect on symptom relief? What side effects would you expect? Norepinephrine Reuptake Inhibitor Atomoxetine (Strattera) What effect would you expect on symptom relief? What side effects would you expect? GABA-ergics Benzodiazepines Lamotrigine (Lamictal) Gabapentine (Neurontin) Valproate (Depakote) Topiramate (Topamax) Tiagabine (Gabitril) Pregabalin (Lyrica)

10 Serotonin-Dopamine Antagonists Affect medial prefrontal cortex & nucleus accumbens Blocks 5-HT 2a, 5-HT 1a, D 2 Risperidone (Risperdal) Olanzapine (Zyprexa) Ziprasidone (Geodon) Quetiapine (Seroquel) Adrenergics Alpha agonist (clonidine/catapres) Beta blockers (propranolol, atenolol, labetolol) Calcium channel blockers (verapamil, nifedipine) Sleep Major disturbance in both PTSD & BPD Altered sleep architecture Delayed onset, frequent awakening, premature awakening Reduction of stage 3 & 4 and REM Sleep avoidance

11 Treatment of Sleep Disturbance Sleep hygiene most important Sedatives Zolpidem (Ambien) Eszapiclone (Lunesta) Ramelteon (Rozerem) Quetiapine (Seroquel) Supplements and CAM Vitamin B s L-methylfolate Omega-3 Fish Oil Melatonin S-adenosylmethionine (SAMe) Questions What questions do you have? What have been your experiences? Walk through case studies?

12 Case Study: Trauma AB 55 yo white woman Multiple traumas: childhood sexual & physical abuse, college rape, abusive husband Multiple hospitalizations, ED visits Dx: complex PTSD, substance abuse (BZD), r/o borderline personality d/o Meds on referral: Adderal XR; Adderal IR, alprazolam hs, lorazepam, valproate, venlafaxine Current meds: prazosin, venlafaxine Case Study: Emotional & Interpersonal Sensitivity CD 43 year old divorced man, non custodial parent of an 12 year old boy and 8 year old girl Target symptoms: Marijuana abuse, irritability, difficulty sleeping, sensitive to rejection, impulsivity, verbal aggression Doesn t want to take medications, devaluing prescribers Hypersensitive to all medications Selective Resources American Psychological Association. (APA report on evidence based treatment) Behavioral Tech, LLC. D= &CFTOKEN=

13 Selective Resources Con t Portland DBT. Siegel, D.J. (2007). The Mindful Brain. NY: WW Norton. Silk, K.R. (ed) (1998). Biology of Personality Disorders. Washington, DC: Am. Psychiatric Press, Inc.

CONFLUENCE OF PRESCRIBING AND PSYCHOTHERAPY USING DBT PRINCIPLES

CONFLUENCE OF PRESCRIBING AND PSYCHOTHERAPY USING DBT PRINCIPLES CONFLUENCE OF PRESCRIBING AND PSYCHOTHERAPY USING DBT PRINCIPLES Barbara J. Limandri, PhD, PMHCNS, BC PMHNP at Portland DBT and Professor of Nursing at Linfield College Portland Dialectical Behavior Therapy

More information

BIOSOCIAL MODEL BIOSOCIAL MODEL CON T DISCLOSURE STATEMENT LEARNING OUTCOMES BASIC ASSUMPTIONS

BIOSOCIAL MODEL BIOSOCIAL MODEL CON T DISCLOSURE STATEMENT LEARNING OUTCOMES BASIC ASSUMPTIONS CONFLUENCE OF PRESCRIBING AND PSYCHOTHERAPY USING DBT PRINCIPLES Barbara J. Limandri, PhD, PMHCNS, BC PMHNP at Portland DBT and Professor of Nursing at Linfield College BIOSOCIAL MODEL Personality disorders

More information

Thinking Outside the Box: Prescribing by Synthesis & Integration

Thinking Outside the Box: Prescribing by Synthesis & Integration Thinking Outside the Box: Prescribing by Synthesis & Integration Barbara J. Limandri, DNSc, APRN, BC Linfield College School of Nursing Portland DBT Program AGENDA Neuroanatomy and neurophysiology review

More information

Agenda. Treating the Suffering of Mood and Behavioral Dysregulation

Agenda. Treating the Suffering of Mood and Behavioral Dysregulation Treating the Suffering of Mood and Behavioral Dysregulation Barbara J. Limandri, DNSc, APRN, BC Linfield College School of Nursing Agenda Behavioral and biological processes of mood dysregulation Similarities

More information

PSYCHIATRY INTAKE FORM

PSYCHIATRY INTAKE FORM Please complete all information on this form. PSYCHIATRY INTAKE FORM Name Date Date of Birth Primary Care Physician Current Therapist/Counselor What are the problem(s) for which you are seeking help? 1.

More information

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines

More information

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally

More information

Richard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA

Richard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA *We are not accepting any New Patients who are currently taking any controlled pain medications *We are *Note: not completion accepting of the any following New Patients paperwork who and Initial are Screening

More information

Psychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis

Psychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis Psychiatric Illness In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis 12,000,000 children infants through 18 y/o nation wide 5,000,000 suffer severely Serious

More information

Happy Daisy Ltd. New Client intake Form. What are the issues for which you are seeking care?

Happy Daisy Ltd. New Client intake Form. What are the issues for which you are seeking care? Happy Daisy Ltd. New Client intake Form Name Date Preferred name Pronouns Referred by Date of birth Age Race What are the issues for which you are seeking care? 1. 2. 3. Please check of any of the symptoms

More information

Mental Health Intake Form

Mental Health Intake Form Current Symptoms Checklist: (check once for any symptoms present, twice for major symptoms) ( ) ( ) Depressed mood ( ) ( ) Racing thoughts ( ) ( ) Excessive worry ( ) ( ) Unable to enjoy activities ( )

More information

Barbara J. Limandri, DNSc, APRN, BC 1

Barbara J. Limandri, DNSc, APRN, BC 1 Barbara J. Limandri, DNSc, APRN, BC Linfield College Portland Dialectical Behavior Therapy Program At the conclusion of this workshop, the participant can: 1. Associate key regions of the brain with psychiatric

More information

Mental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling

Mental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Mental Illness Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Moodiness Changing Bodies Narcissism Self-Esteem Ignorant Naïve Insecure Self-Centered Independent Adolescence Disorders Affecting

More information

Medications, By Class, in TBI

Medications, By Class, in TBI Medications, By Class, in TBI Generic/Brand Name Drawback Advantage Mood Stabilizers (anti-seizure medications) Carbamazepine (Carbatrol ) (Equetro ) (Tegretol ) Gabapentin (Neurontin ) Lamotrigine (Lamictal

More information

New Patient Questionnaire

New Patient Questionnaire 4 Embarcadero Center, Suite 1400, San Francisco, CA 94111 (415) 926-7774 phone; (415) 591-7760 office@sanfranciscopsych.com New Patient Questionnaire Thank you for trusting San Francisco Psychiatry with

More information

Barbara J. Limandri, DNSc, APRN, BC Linfield College Portland Dialectical Behavior Therapy Program

Barbara J. Limandri, DNSc, APRN, BC Linfield College Portland Dialectical Behavior Therapy Program Barbara J. Limandri, DNSc, APRN, BC J,,, Linfield College Portland Dialectical Behavior Therapy Program At the conclusion of this workshop, the participant i t can: 1. Associate key regions of the brain

More information

Mental Health Intake Form

Mental Health Intake Form 38600 Van Dyke Ave., Suite 200 Sterling Heights, MI 48313 Phone: (586) 933-5395 Fax: (586) 935-0159 Mental Health Intake Form Please complete all information on this form and bring it to the first visit.

More information

Guide to Psychiatric Medications for Children and Adolescents

Guide to Psychiatric Medications for Children and Adolescents Guide to Psychiatric Medications for Children and Adolescents by Glenn S. Hirsch, M.D. The following guide includes most of the medications used to treat child and adolescent mental disorders. It lists

More information

Study Guidelines for Quiz #1

Study Guidelines for Quiz #1 Annex to Section J Page 1 Study Guidelines for Quiz #1 Theory and Principles of Psychopharmacology, Classifications and Neurotransmitters, Anxiolytics/Antianxiety/Minor Tranquilizers, Stimulants, Nursing

More information

Psychobiology Handout

Psychobiology Handout Nsg 85A / Psychiatric Page 1 of 7 Psychobiology Handout STRUCTURE AND FUNCTION OF THE BRAIN Psychiatric illness and the treatment of psychiatric illness alter brain functioning. Some examples of this are

More information

In Memory of the American Tragedy

In Memory of the American Tragedy Evolving Pharmacologic Strategies in the Treatment of PTSD John J. Miller, M.D. Medical Director Brain Health Exeter, NH In Memory of the American Tragedy September 11, 2001 jjm@brain-health.co 1 Overview

More information

A Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer

A Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.

More information

Identification and Management of Posttraumatic Stress Disorder after Traumatic Brain Injury

Identification and Management of Posttraumatic Stress Disorder after Traumatic Brain Injury Identification and Management of Posttraumatic Stress Disorder after Traumatic Brain Injury Curtis McKnight, MD Saturday March 23 rd, 2019 @DrCaMcKnight 2019 Barrow Traumatic Brain Injury Symposium Creighton

More information

Katrina Kuzyszyn-Jones, Psy.D. Lepage Associates

Katrina Kuzyszyn-Jones, Psy.D. Lepage Associates Katrina Kuzyszyn-Jones, Psy.D. Lepage Associates www.lepageassociates.com Acute Stress Disorder Posttraumatic Stress Disorder (PTSD) Major Depressive Disorder (MDD) Bipolar Disorder Suicidal Behaviors

More information

Review of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)

Review of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder

More information

Post Traumatic Stress Disorder (PTSD) versus Bipolar Disorder: Confusion in the face of chaos.

Post Traumatic Stress Disorder (PTSD) versus Bipolar Disorder: Confusion in the face of chaos. Post Traumatic Stress Disorder (PTSD) versus Bipolar Disorder: Confusion in the face of chaos. Randall Ricardi D.O. Child and Adolescent Psychiatry Phoenix Children s Hospital 6-24-17 10:50am Disclosures

More information

8/15/17. Managing Psychiatric Conditions in Primary Care Beyond the Basics. Speaker s Biography. Situation

8/15/17. Managing Psychiatric Conditions in Primary Care Beyond the Basics. Speaker s Biography. Situation Managing Psychiatric Conditions in Primary Care Beyond the Basics Source: US National Library of Medicine, Images from the History of Medicine Luis Berrios, DNP, MHA, ANP, PMHNP Internal Medicine & Primary

More information

Complex Trauma in Children and Adolescents

Complex Trauma in Children and Adolescents Complex Trauma in Children and Adolescents Sara Coffey, D.O. Assistant Professor Department of Psychiatry and Behavioral Sciences Oklahoma State University Center for Health Sciences Overview of trauma

More information

Medications for Borderline Personality Disorder

Medications for Borderline Personality Disorder Medications for Borderline Personality Disorder Sarah Roff MD, PhD Attending Psychiatrist, DBT Unit, Oregon State Hospital Assistant Professor, Public Psychiatry, OHSU sarah.roff@dhsoha.state.or.us Skills

More information

Schedule FDA & literature based indications

Schedule FDA & literature based indications Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for

More information

Cannabinoids and Mental Health

Cannabinoids and Mental Health Cannabinoids and Mental Health https://upload.wikimedia.org/wikipedia/commons Karen M. Lounsbury, PhD Professor of Pharmacology 802-656-3231, Karen.lounsbury@uvm.edu Objectives Describe the underlying

More information

Medications and Children Disorders

Medications and Children Disorders Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for

More information

COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications*

COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications* COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications* Bupropion (Wellbutrin) Start: IR-100 mg bid X 4d then to 100 mg tid; SR-150

More information

Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD

Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD IN PRIMARY CARE June 17, 2010 Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington Defining and assessing Approach for doing differential diagnosis of Best

More information

Index. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers

Index. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) a-adrenergic blockers for PTSD, 798 b-adrenergic blockers for PTSD, 798 Adrenergic

More information

Depression. University of Illinois at Chicago College of Nursing

Depression. University of Illinois at Chicago College of Nursing Depression University of Illinois at Chicago College of Nursing 1 Learning Objectives Upon completion of this session, participants will be better able to: 1. Recognize depression, its symptoms and behaviors

More information

Neurobiology of Addiction JeanAnne Johnson Talbert, DHA, APRN BC, FNP, CARN AP

Neurobiology of Addiction JeanAnne Johnson Talbert, DHA, APRN BC, FNP, CARN AP Neurobiology of Addiction JeanAnne Johnson Talbert, DHA, APRN BC, FNP, CARN AP Disclosures This speaker has no conflicts of interest to disclose Objectives Define drug abuse and addiction Identify the

More information

Psychiatric Medication Guide

Psychiatric Medication Guide Psychiatric Medication Guide F O R : N E O N P R I M A R Y H E A L T H C A R E P R O V I D E R S B Y : M I C H E L L E R O M E R O, D O M A Y, 2 0 1 3 Anti-depressants TCA s & MAOI s (Tricyclic Antidepressants

More information

It s Not Just Serotonin: Neurosignaling in Mental Illness

It s Not Just Serotonin: Neurosignaling in Mental Illness It s Not Just Serotonin: Neurosignaling in Mental Illness Barbara J. Limandri, DNSc, APRN, BC Professor of Nursing Linfield College Learning Outcomes Distinguish between metabotropic and ionotropic neuroreceptors

More information

Psychopharmacology: An Overview

Psychopharmacology: An Overview Psychopharmacology: An Overview John Tanquary, M.D. Clinical Assistant Professor Department of Psychiatry Upstate Medical University Psychpharmacology Consultant Le Moyne College Syracuse University Financial

More information

Session ID: 1001 June 14, 2012

Session ID: 1001 June 14, 2012 It s Not Just Serotonin: Neurosignaling in Mental Illness Barbara J. Limandri, DNSc, APRN, BC Professor of Nursing Linfield College Learning Outcomes Distinguish between metabotropic and ionotropic neuroreceptors

More information

Antidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry

Antidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry Antidepressant Medication Strategies We ve Come a Long Way or Have We? Joe Wegmann, PD, LCSW The PharmaTherapist Joe@ThePharmaTherapist.com 504.587.9798 www.pharmatherapist.com Are you receiving our free

More information

Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D.

Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Sources: National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and from the American Psychological Association

More information

Class: Treatment with Medication:

Class: Treatment with Medication: Class: As we have not finished all the material covering disorders, I wanted to give you and overview of some disorders we have not had a chance to discuss. I feel you are well prepared in different types

More information

HDSA Annual Convention June 2013 Behavior Issues: Irritability and Depression Peg Nopoulos, M.D.

HDSA Annual Convention June 2013 Behavior Issues: Irritability and Depression Peg Nopoulos, M.D. HDSA Annual Convention June 2013 Behavior Issues: Irritability and Depression Peg Nopoulos, M.D. Professor of Psychiatry, Neurology, and Pediatrics University of Iowa, Iowa City, Iowa The information provided

More information

Psychiatric Medications. Positive and negative effects in the classroom

Psychiatric Medications. Positive and negative effects in the classroom Psychiatric Medications Positive and negative effects in the classroom Teaching the Medicated Child Beverly Bryant, M.D. Hattiesburg Clinic 9/17/14 Introduction According to the National Survey of Children

More information

Table 1: Price increases for Brand Name Drugs with Generic Equivalents

Table 1: Price increases for Brand Name Drugs with Generic Equivalents Table 1: Price increases for Brand Name Drugs with Generic Equivalents Brand Name Medication and Dose Total % Change Since 10/2012 ACTOS 15 MG TABLET 6.36 11.03 73.39% ACTOS 30 MG TABLET 9.7 16.80 73.23%

More information

Tourette Syndrome. Biological Basis, Clinical Symptoms, Treatment. Drake D. Duane, MS, MD

Tourette Syndrome. Biological Basis, Clinical Symptoms, Treatment. Drake D. Duane, MS, MD Tourette Syndrome Biological Basis, Clinical Symptoms, Treatment Drake D. Duane, MS, MD Director, Institute for Developmental Behavioral Neurology Adjunct Professor, Arizona State University Scottsdale/Tempe,

More information

Impact of Psychotropics in School

Impact of Psychotropics in School Impact of Psychotropics in School H O W T O C O O R D I N A T E C A R E A C R O S S S E T T I N G S W I L L I A M P U G A, M D C H I L D A N D A D O L E S C E N T P S Y C H I A T R I S T Age of onset

More information

Diagnosis & Management of Major Depression: A Review of What s Old and New. Cerrone Cohen, MD

Diagnosis & Management of Major Depression: A Review of What s Old and New. Cerrone Cohen, MD Diagnosis & Management of Major Depression: A Review of What s Old and New Cerrone Cohen, MD Why You re Treating So Much Mental Health 59% of Psychiatrists Are Over the Age of 55 AAMC 2014 Physician specialty

More information

For: NEON Primary Healthcare Providers By: Michelle Romero, DO June 2013

For: NEON Primary Healthcare Providers By: Michelle Romero, DO June 2013 For: NEON Primary Healthcare Providers By: Michelle Romero, DO June 2013 This power point is only a guideline for recommendations in the treatment of psychiatric disorders. This is not comprehensive. Please

More information

Depression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms

Depression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms Depression and Anxiety By Christopher Okiishi, MD Spring 2016 What is Depression? Not just being sad A syndrome of symptoms Depressed mood Sleep disturbance Decreased interest in usual activities (anhedonia)

More information

PTSD HISTORY PTSD DEFINED BY SONNY CLINE M.A., M.DIV. PA C. PTSD: Post Traumatic Stress Disorder

PTSD HISTORY PTSD DEFINED BY SONNY CLINE M.A., M.DIV. PA C. PTSD: Post Traumatic Stress Disorder PTSD BY SONNY CLINE M.A., M.DIV. PA C HISTORY PTSD: Post Traumatic Stress Disorder The term was coined in the mid 70 s during the anti Vietnam war protest. The condition was more pronounced in those returning

More information

ADHD and. Shaw Wendi Fortuchang, M.D. Board certified in Child & Adolescent, Adult, and Forensic Psychiatry

ADHD and. Shaw Wendi Fortuchang, M.D. Board certified in Child & Adolescent, Adult, and Forensic Psychiatry ADHD and Beyond Shaw Wendi Fortuchang, M.D. Board certified in Child & Adolescent, Adult, and Forensic Psychiatry Overview Use of medications in children How do medications work in the brain? Risperdal?

More information

Medically Accepted Indications for Pediatric Use of Psychotropic Medications by

Medically Accepted Indications for Pediatric Use of Psychotropic Medications by Key: White Background: Medically Accepted Indication Yellow Backgroun: Medically Accepted Indication Status Not Ascertained Orange Background: Pediatric Indication cited, but not supported Red Background:

More information

Using Drugs to Improve the Behavior of People with Autism: A Skeptical Appraisal. Alan Poling, Ph.D., BCBA-D Western Michigan University

Using Drugs to Improve the Behavior of People with Autism: A Skeptical Appraisal. Alan Poling, Ph.D., BCBA-D Western Michigan University Using Drugs to Improve the Behavior of People with Autism: A Skeptical Appraisal Alan Poling, Ph.D., BCBA-D Western Michigan University In a 2010 study of 60,641 children Mandell et al. found that: 56%

More information

Judges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children

Judges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages 13-17

More information

The Benefits and Limitations of Medication Treatment for Executive Dysfunctions and ADHD

The Benefits and Limitations of Medication Treatment for Executive Dysfunctions and ADHD The Benefits and Limitations of Medication Treatment for Executive Dysfunctions and ADHD Damon Korb, MD Behavioral and Developmental Pediatrician Director of the Center for Developing Minds Los Gatos,

More information

Drugs, Sleep & Wakefulness. Brian Koo Reena Mehra MD MS Kingman Strohl MD

Drugs, Sleep & Wakefulness. Brian Koo Reena Mehra MD MS Kingman Strohl MD Drugs, Sleep & Wakefulness Brian Koo Reena Mehra MD MS Kingman Strohl MD Things To Keep In Mind Many drugs effect sleep either causing insomnia or sedation Disruption of sleep and wakefulness may not be

More information

176 Stahl s Illustrated. in this web service Cambridge University Press

176 Stahl s Illustrated. in this web service Cambridge University Press Stahl s Illustrated acamprosate, 104, 122 3, 148, 149 acceptance and commitment therapy (ACT), 135, 139, 147, 153 accidents, and risk of PTSD, 36 adherence, to medication by PTSD patients with traumatic

More information

Quick Guide to Common Antidepressants-Adults

Quick Guide to Common Antidepressants-Adults Quick Guide to Common Antidepressants-Adults Medication Therapeutic Range (mg/day) Initial Suggested Serotonin Reuptake Inhibitors (SSRIs) All available as generic FLUOXETINE (Prozac) CITALOPRAM (Celexa

More information

TRANSCRANIAL MAGNETIC STIMULATION & BRAIN MUSIC THERAPY

TRANSCRANIAL MAGNETIC STIMULATION & BRAIN MUSIC THERAPY TMS - DEPRESSION HISTORY Date: Patient Name: DOB: How did you hear about TMS? What do you know about TMS? Referring Physician? Name of Practice: Name of Inpatient Treatment for Depression: Name of Inpatient

More information

PRACTICAL APPLICATIONS OF CANNABIS IN TREATING POST- TRAUMATIC STRESS DISORDER (PTSD) Bryan Krumm, CNP

PRACTICAL APPLICATIONS OF CANNABIS IN TREATING POST- TRAUMATIC STRESS DISORDER (PTSD) Bryan Krumm, CNP PRACTICAL APPLICATIONS OF CANNABIS IN TREATING POST- TRAUMATIC STRESS DISORDER (PTSD) Bryan Krumm, CNP What is Post-Traumatic Stress Disorder? The person experiences, witnesses, or is confronted with an

More information

PTSD: Treatment Opportunities

PTSD: Treatment Opportunities PTSD: Treatment Opportunities Professor Malcolm Hopwood Department of Psychiatry University of Melbourne Professorial Psychiatry Unit, Albert Road Clinic DSM 5: PTSD CRITERION A exposure to: actual or

More information

Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials

Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials SPEAKER NOTES Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials Summarized by Thomas T. Thomas New psychotropic medications are coming on the

More information

4/2/13 COMMON CLASSES OF MEDICATIONS. Child & Adolescent Behavioral Medicine & Medication Therapies. Behavioral Medicine & Medication Therapies

4/2/13 COMMON CLASSES OF MEDICATIONS. Child & Adolescent Behavioral Medicine & Medication Therapies. Behavioral Medicine & Medication Therapies Child & Adolescent Behavioral Medicine & Medication Therapies Brian J Cowles, PharmD Associate Professor of Pharmacy Practice Albany College of Pharmacy & Health Sciences; Vermont Campus Behavioral Medicine

More information

Disclosure. Objective 1. Objective 2. Naval Health Center New England. Objective 3. APNA 27th Annual Conference Session 1036: October 9, 2013

Disclosure. Objective 1. Objective 2. Naval Health Center New England. Objective 3. APNA 27th Annual Conference Session 1036: October 9, 2013 Understanding Sleep and Antidepressants: Lessons from Research Literature and Clinical Practice Joseph M. Holshoe, PMHNP-BC Commander, U.S. Public Health Service Behavioral Health Consultant, Primary Care

More information

Delirium, Dementia, and Amnestic Disorders. Dr.Al-Azzam 1

Delirium, Dementia, and Amnestic Disorders. Dr.Al-Azzam 1 Delirium, Dementia, and Amnestic Disorders Dr.Al-Azzam 1 Introduction Disorders in which a clinically significant deficit in cognition or memory exists The number of people with these disorders is growing

More information

John E. Kraus, M.D., Ph.D.

John E. Kraus, M.D., Ph.D. John E. Kraus, M.D., Ph.D. Chief, Adult Psychiatry, Dorothea Dix Hospital, Raleigh, NC Assistant Professor/Associate Director of Residency Training, Dept. of Psychiatry, UNC Hospitals, Chapel Hill, NC

More information

NorthSTAR. Pharmacy Manual

NorthSTAR. Pharmacy Manual NorthSTAR Pharmacy Manual Revised October, 2008 Table of I. Introduction II. III. IV. Antidepressants New Generation Antipsychotic Medications Mood Stabilizers V. ADHD Medications VI. Anxiolytics and Sedative-Hypnotics

More information

APNA 25th Annual Conference October 19, Session 1022

APNA 25th Annual Conference October 19, Session 1022 When Words Are Not Enough The Use of Sensory Modulation Techniques to Replace Self- Injurious Behaviors in Patients with Borderline Personality Disorder General Organization of the Brain Lita Sabonis,

More information

HDSA welcomes you to Caregiver s Corner. Funded by an educational grant from

HDSA welcomes you to Caregiver s Corner. Funded by an educational grant from HDSA welcomes you to Caregiver s Corner Funded by an educational grant from Caregiver s Corner Webinar, DATE Managing Psychiatric Symptoms Peg Nopoulos, M.D. Professor of Psychiatry, Neurology, and Pediatrics

More information

Depression & Anxiety in Adolescents

Depression & Anxiety in Adolescents Depression & Anxiety in Adolescents Objectives 1) Review diagnosis of anxiety and depression in adolescents 2) Provide overview of evidence-based treatment options 3) Increase provider comfort level with

More information

Child & Adolescent Psychiatry (a brief overview)

Child & Adolescent Psychiatry (a brief overview) Child & Adolescent Psychiatry (a brief overview) Lance Feldman, MD, FAPA, MBA, BSN Vice Chair Clinical Affairs, Department of Psychiatry Affiliate Clinical Assistant Professor, University of South Carolina

More information

FROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD OF ANXIETY

FROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD OF ANXIETY 13 th Pearl Leibovitch Clinical Day November 18th, 2014 Mounir H. Samy, MD, FRCP(C) Associate Professor of Psychiatry McGill University (ret.) FROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD

More information

Presented by Dr. Craig Strickland

Presented by Dr. Craig Strickland Presented by Dr. Craig Strickland https://sites.google.com/site/bioedcon strickkat@verizon.net List three psychosocial factors that can influence the development of addiction in the elderly Summarize basic

More information

NEUROBIOLOGY ALCOHOLISM

NEUROBIOLOGY ALCOHOLISM NEUROBIOLOGY ALCOHOLISM THERE HAS BEEN A MAJOR THEORETICAL SHIFT IN MEDICATION DEVELOPMENT IN ALCOHOLISM Driven by animal models of intermittent ethanol administration followed by termination, then access

More information

Manual of Clinical Psychopharmacology

Manual of Clinical Psychopharmacology Manual of Clinical Psychopharmacology Fourth Edition Alan F. Schatzberg, M.D. Kenneth T. Norris, Jr., Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Stanford University School

More information

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XV, 2013 INDEX

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XV, 2013 INDEX A acceptance and commitment therapy Posttraumatic Stress, 69 ADHD Adjunctive Fatty Acids, 5 Adjunctive Guanfacine Pharmacokinetics, 27 Amantadine, 21 Atomoxetine, 23 Cancer Risk, 31 CBT for Comorbid Anxiety,

More information

TOP APS DRUGS TRAZODONE BRAND NAMES: OLEPTRO, DESYREL (DIVIDOSE) & TRIALODINE

TOP APS DRUGS TRAZODONE BRAND NAMES: OLEPTRO, DESYREL (DIVIDOSE) & TRIALODINE trazodone TOP APS DRUGS TRAZODONE BRAND NAMES: OLEPTRO, DESYREL (DIVIDOSE) & TRIALODINE Pharmacodynamics study of what a drug does to the body Studies show that trazodone selectively inhibits neuronal

More information

Major Depression and Anxiety in Adolescents and Adults

Major Depression and Anxiety in Adolescents and Adults Major Depression and Anxiety in Adolescents and Adults Miggie Greenberg, M.D. Associate Professor of Psychiatry St. Louis University School of Medicine greenbml@slu.edu *NO DISCLOSURES* OBJECTIVES * Recognize

More information

Presenter Disclosure. Objectives 6/5/2017. Depression, Anxiety, PTSD: A Focus on Pharmacotherapy

Presenter Disclosure. Objectives 6/5/2017. Depression, Anxiety, PTSD: A Focus on Pharmacotherapy Depression, Anxiety, PTSD: A Focus on Pharmacotherapy Robert L Page II, Pharm.D., MSPH, FHFSA, FCCP, FAHA Professor of Clinical Pharmacy Clinical Specialist, Division of Cardiology University of Colorado

More information

Ohio Psychotropic Medication Quality Improvement Collaborative. Minds Matter. Toolkit. for You and Your Family. This is the property of

Ohio Psychotropic Medication Quality Improvement Collaborative. Minds Matter. Toolkit. for You and Your Family. This is the property of Minds Matter Ohio Psychotropic Medication Quality Improvement Collaborative Minds Matter Toolkit for You and Your Family This is the property of About Minds Matter Minds Matter is a project to help teens,

More information

Medications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation

Medications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral

More information

Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults

Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults Cherie Simpson, PhD, APRN, CNS-BC Myth vs Fact All old people get depressed. Depression in late life is more enduring and

More information

Change Your Brain, Change Your Life. The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness

Change Your Brain, Change Your Life. The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness Change Your Brain, Change Your Life The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness Daniel G Amen Three Rivers Press New York Appendix Medication 1.

More information

LAGUNA BEHAVIORAL Crown Valley Parkway, Suite 140 Phone: (949) Laguna Niguel, CA Fax: (949)

LAGUNA BEHAVIORAL Crown Valley Parkway, Suite 140 Phone: (949) Laguna Niguel, CA Fax: (949) NEW PATIENT INFORMATION - ADULTS CLIENT INFORMATION Patient s Name: Today s Date: Other Names: Date of Birth: Age: Address: Street Apartment City State ZIP E-mail Address: May we contact you via e-mail

More information

Study Guide Unit 3 Psych 2022, Fall 2003

Study Guide Unit 3 Psych 2022, Fall 2003 Psychological Disorders: General Study Guide Unit 3 Psych 2022, Fall 2003 1. What are psychological disorders? 2. What was the main treatment for some psychological disorders prior to the 1950 s? 3. What

More information

Evidenced Based Prescribing Practices in Treating Post Traumatic Stress Disorder in Military Combat Veterans DISCLOSURES. Learning Objectives

Evidenced Based Prescribing Practices in Treating Post Traumatic Stress Disorder in Military Combat Veterans DISCLOSURES. Learning Objectives Evidenced Based Prescribing Practices in Treating Post Traumatic Stress Disorder in Military Combat Veterans Jess Calohan, DNP, MN, PMHNP BC Lieutenant Colonel, United States Army Program Chair, Psychiatric

More information

Steps for Initiating Electroconvulsive Therapy Treatment

Steps for Initiating Electroconvulsive Therapy Treatment Steps for Initiating Electroconvulsive Therapy Treatment PSYCHIATRISTS CAN REFER PATIENTS FOR ECT TREATMENT AT EL CAMINO HOSPITAL BY CALLING THE ECT NURSE COORDINATOR AT 650-962-5795. Once the referral

More information

John Roberts, MD Addiction Psychiatrist Pavillon. Studies. Co-Occurring Disorders are the expectation rather than the exception

John Roberts, MD Addiction Psychiatrist Pavillon. Studies. Co-Occurring Disorders are the expectation rather than the exception Prevalence John Roberts, MD Addiction Psychiatrist Pavillon Approximately 5 million US Adults have a serious mental illness and a cooccurring substance use disorder (SAMHSA,2006) Mental health settings

More information

Psychiatry curbside: Answers to a primary care doctor s top mental health questions

Psychiatry curbside: Answers to a primary care doctor s top mental health questions Psychiatry curbside: Answers to a primary care doctor s top mental health questions April 27, 2018 Laurel Ralston, DO Psychiatrist, Taussig Cancer Institute Objectives Review current diagnostic and prescribing

More information

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX A Adderall Counterfeit, 31 addiction, internet CBT, 55 ADHD Adjunctive Guanfacine, 11 Counterfeit Adderall, 31 Developmental Trajectory and Risk Factors, 5 Dopamine Transporter Alterations, 14 Extended-Release

More information

NEW PATIENT INTAKE FORM

NEW PATIENT INTAKE FORM NEW PATIENT INTAKE FORM Please fill out the following form to the best of your ability. Some sections may not apply to you. We will discuss your responses in greater detail during your first appointment.

More information

Common Psychiatric Conditions in Children. Steven Klamerus, M.D. Child and Adolescent Psychiatrist Marquette General Hospital

Common Psychiatric Conditions in Children. Steven Klamerus, M.D. Child and Adolescent Psychiatrist Marquette General Hospital Common Psychiatric Conditions in Children Steven Klamerus, M.D. Child and Adolescent Psychiatrist Marquette General Hospital (Child) Psychiatry is different Phenomenological diagnoses verses pathologic

More information

ADHD Medications & How They Work. Gail C. Rodin, Ph.D. January 21, 2008

ADHD Medications & How They Work. Gail C. Rodin, Ph.D. January 21, 2008 ADHD Medications & How They Work Gail C. Rodin, Ph.D. January 21, 2008 Agenda How the (ADHD) Brain Works (or doesn t) Neurons and neurotransmitters NE & DA: the major players in ADHD Channel vs. state

More information

Ruby Williams, M.D. Drugs, Alcohol and Sleep February 24, 2018

Ruby Williams, M.D. Drugs, Alcohol and Sleep February 24, 2018 Ruby Williams, M.D. Drugs, Alcohol and Sleep February 24, 2018 Objectives Describe pharmacology of commonly prescribed drugs for stimulants and hypnotics Brief review of common drugs that affect sleep

More information

VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress. Core Module

VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress. Core Module VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress Core Module Module A Acute Stress Continue Treatment for ASD Treatment for ACUTE Stress Disorder Module B PTSD Continue Treatment

More information