Opinions on the Treatment of MDD. Results of Surveys from the New York, North Carolina, and California PsychU Communities

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Opinions on the Treatment of MDD Results of Surveys from the New York, North Carolina, and California PsychU Communities January 27 th, 2017 Otsuka Pharmaceutical Development & Commercialization, Inc. 2017 Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD 1 advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.

Speakers North Carolina Richard Weisler, MD Position: Dr. Weisler is a board-certified psychiatrist and an Adjunct Professor of Psychiatry at University of North Carolina at Chapel Hill School of Medicine and Duke University Medical Center in Durham, North Carolina. His areas of clinical interest include bipolar disorder, attentiondeficit/hyperactivity disorder, major depressive disorder, anxiety disorders, Alzheimer s memory, and post-traumatic stress disorder. Education: Dr. Weisler earned his medical degree from the University of North Carolina at Chapel Hill. He completed his residency training in Psychiatry at University of North Carolina and North Carolina Memorial Hospital. North Carolina Sloan Manning, MD Position: Dr. Manning serves as the Medical Director at Novant Health Urgent Care & Occupational Medicine in Greensboro/Winston-Salem, North Carolina. He also serves as an Adjunct Associate Professor at the University of North Carolina School of Medicine and as the Co-Director of the Mood Disorder Clinic at Moses Cone s Family Medicine Residency Program, in Greensboro, North Carolina. His areas of clinical interest include integrated mental health systems and physician education in primary care psychiatry. Education: Dr. Manning completed his medical studies at the University of Mississippi Medical Center in Jackson, Mississippi. He completed his residency at the Family Practice Baptist Memorial Hospital in Gadsden, Alabama and is certified by the American Board of Family Practice. 2

Speakers New York Christine Moutier, MD Position: Dr. Moutier is the Chief Medical Officer at the American Foundation for Suicide Prevention (AFSP), and was previously a Professor of Psychiatry and Assistant Dean of Student Affairs and Medical Education at the University of California, San Diego School of Medicine. Education: Dr. Moutier earned her MD and completed her residency training in Psychiatry at the University of California, San Diego. Los Angeles/Southern California Clayton Chau, MD Position: Dr. Chau is the Senior Medical Director for Health Services at LA Care Health Plan. He is the Co-Principal Investigator for a multiyear Center for Medicare & Medicaid Services Innovation grant in Transforming Clinical Practice. He is also a Lecturer for the UCLA School of Public Health and an Associate Clinical Professor of Psychiatry at UC Irvine School of Medicine. Dr. Chau has conducted training in the areas of health care integration, health care system reform, cultural competency, veteran s health, homelessness and mental health policy. Education: Dr. Chau obtained his MD degree from the University of Minnesota and PhD in Clinical Psychology from Chelsea University. He completed his psychiatry residency at UCLA/San Fernando Valley followed by a fellowship with the National Institute of Mental Health in psychoneuroimmunology focusing on substance abuse and HIV. Dr. Chau is board certified by the American Board of Hospital Physicians and the American College of Ethical Physicians. 3

This program was developed with the support of Otsuka Pharmaceutical Development & Commercialization, Inc. The speakers are either employees or paid contractors of Otsuka Pharmaceutical Development & Commercialization, Inc. 2017 Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD 4 advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.

Objectives Provide feedback and perspective from the live programs in New York, North Carolina, and California Discuss the survey results from each live program Discuss what remaining challenges exist in the treatment of MDD Deliberate on how the PsychU community can be utilized to: Address remaining challenges and unmet needs in treating MDD, with a focus on the need for optimizing integrated care Increase our understanding of MDD treatment nationally Promote sharing of best practices with practitioners across the country Act to improve treatment of mental health in our local communities Engage the primary care community regarding their role in the treatment of MDD MDD, Major Depressive Disorder. 5

North Carolina, California, and New York s MDD Panel Events: Key Points Collaborative Treatment Approaches and Perspectives of Major Depressive Disorder (MDD) within the North Carolina Healthcare Landscape Date: October 26 th, 2016 Panel Members: Richard Weisler, MD Sloan Manning, MD Andrew Muzyk, PharmD Ashwin Patkar, MD Michelle Jacobs, PharmD, BCPS, BC-ADM, R.Ph Collaborative Treatment Approaches and Perspectives of Major Depressive Disorder (MDD) Within the Greater Los Angeles Area Healthcare Landscape Date: October 27th, 2016 Panel Members: Clayton Chau, MD, PhD Gustavo Alva, MD, DFAPA Michael Hochman, MD, MPH Samantha Min Sweeney, PharmD, MBA Collaborative Treatment Approaches and Perspectives of Major Depressive Disorder (MDD) within the New York Healthcare Landscape Date: May 5th, 2016 Panel Members: Christine Moutier, MD Prakash Masand, MD Charlotte Ostman, LCSW-R Manish Zinzuvadia, MD Roland Larkin, PhD, NP MDD, Major Depressive Disorder. 6

Survey Background Survey completed by attendees of local PsychU meetings in Raleigh, North Carolina; New York City, New York; and Los Angeles, California Average scores were collected for survey questions pertaining to challenges in treating MDD MDD, Major Depressive Disorder. 7

Question #1 Percent of Respondents (%) 60 50 40 30 20 10 0 How would you describe your satisfaction with the healthcare landscape in the NYC/NC area as it relates to the delivery of mental health services to patients with MDD? New York (n=73) North Carolina (n=108) Los Angeles (n=27) MDD, Major Depressive Disorder; NC, North Carolina; NYC, New York City. 10

Question #2 Percentage of Respondents (%) 50 45 40 35 30 25 20 15 10 5 0 What percentage of your patients currently experience residual symptoms on current therapy? 0% to 25% 26% to 50% 51% to 75% 76% - 100% New York (n=73) North Carolina (n=108) Los Angeles (n=26) * North Carolina had no registrants select the 76-100% option 11

Question #3 Percent of Respondents (%) 45 40 35 30 25 20 15 10 5 0 What residual symptoms do you find most difficult to treat in your patients with MDD? Mood Anxiety Fatigue Insomnia Irritability Other New York (n=73) North Carolina (n=108) Los Angeles (n=27) * Los Angeles had no registrants select the Other option MDD, Major Depressive Disorder. 12

Question #4 Percent of Respondents (%) 50 45 40 35 30 25 20 15 10 5 0 How often do you use scales in your practice as a tool for MBC? Routinely Occasionally Never New York (n=73) North Carolina (n=108) MBC, measurement-based care. 13

Question #5 Please provide your assessment of the following barriers / challenges in treating and managing patients with MDD from 1 (LEAST challenging) to 10 (MOST challenging)* Adherenece to medication Stigma Underdiagnosis / Misdiagnosis Access to medication/coverage issues Side effect management Need more evidence base for treatment decisions North Carolina (n=108) New York (n=73) No consensus on treatment guidelines Lack of HCP psychopharmacology knowledge 0 2 4 6 8 10 Average Score (+ SEM) HCP, healthcare provider; MDD, Major Depressive Disorder; SEM, standard error of the mean. 14

DISCUSSION 13

Discussion What challenges do you experience in treating MDD within your clinical practice? MDD, Major Depressive Disorder. 16

Discussion What can members of the PsychU community do to increase their understanding of best practices in MDD treatment? MDD, Major Depressive Disorder. 17

Discussion How can members of the PsychU community promote sharing of best practices with mental health professionals across the country? 18

Discussion Looking forward, how can members of the PsychU community act to improve treatment of MDD in our local communities and nationally? MDD, Major Depressive Disorder. 19

Discussion How can the PsychU community contribute to addressing unmet needs in the treatment of MDD, such as promoting and optimizing integration of care? MDD, Major Depressive Disorder. 19

CONCLUSIONS 19

Opinion on the Treatment of MDD Results of Surveys from the New York, North Carolina, and California PsychU Communities January 27 th, 2017 Otsuka Pharmaceutical Development & Commercialization, Inc. 2017 Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD 21 advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.