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Psychotic and Cognitive Disorders: Solving Clinical Challenges, Improving Patient Care

2011; Frontline Medical Communications; Volume: 10; Issue: 6 Linguagem: Inglês

1537-8276

John Lauriello, Rajiv Tandon, S. Charles Schulz, Henry A. Nasrallah,

Mental Health and Psychiatry

CURRENT PSYCHIATRY and the American Academy of Clinical Psychiatrists were pleased to host 450 psychiatric practitioners for this conference, led by Meeting Chair Richard Balon, MD, and Meeting Co-Chairs Donald W. Black, MD, and Nagy Youssef, MD, April 15-17, 2011 at McCormick Place in Chicago, IL. Attendees could earn up to 18 AMA PRA Category 1 Credits[TM]. [ILLUSTRATION OMITTED] FRIDAY, APRIL 15, 2011 MORNING SESSIONS Rajiv Tandon, MD, University of Florida, spoke about identifying psychotic I symptoms in patients in the years before they experience their first psychotic I episode. He said recognizing prodromal symptoms may allow early interventions to prevent deterioration. [ILLUSTRATION OMITTED] John Lauriello, MD, University of Missouri, discussed monitoring all patients taking antipsychotics for weight gain, elevated triglyceride levels, and other metabolic side effects. He recommended that clinicians not sacrifice therapeutic I efficacy to reduce side effects. S. Charles Schulz, MD, University of Minnesota, spoke about how techniques to reduce aggression and violence among patients with schizophrenia differ in inpatient and outpatient settings. He emphasized recognizing antecedent behaviors to aggression, such as pacing, angry expressions, raised voice, and threatening behaviors. Henry A. Nasrallah, MD, University of Cincinnati, examined the unique properties and side effect profiles of and differences among several new antipsychotics, including the oral agents asenapine, iloperidone, and lurasidone and injectable formulations of paliperidone and olanzapine. [ILLUSTRATION OMITTED] In a luncheon symposium titled Challenges and Opportunities in the Treatment of Schizophrenia: An Interactive Case-Based Update, Greg Mattingly, MD, Washington University, discussed brain findings in schizophrenia, including functional abnormalities such as hypofrontality and structural abnormalities such as enlarged ventricles and loss of grey matter. Dr. Nasrallah explored several clinical issues in treating patients with schizophrenia, such as high burden of cardiovascular risk factors and medical illnesses, difficulty predicting individual treatment response, and challenges in maximizing adherence and minimizing side effects. Peter Weiden, MD, University of Illinois at Chicago, examined how nonadherence can influence schizophrenia treatment outcomes. AFTERNOON SESSIONS Dr. Lauriello discussed extrapyramidal side effects of antipsychotics, which include parkinsonism, akathisia, tardive dyskinesia, and neuroleptic malignant syndrome. Dr. Nasrallah and Dr. Tandon ended the day by leading a lively point/counterpoint discussion of the pros and cons of emphasizing efficacy over tolerability when treating patients with antipsychotics. They debated the merits of typical vs atypical antipsychotics, the role of evidence-based medicine in schizophrenia treatment, and the impact of different types of adverse effects. SATURDAY, APRIL 16, 2011 MORNING SESSIONS Dr. Schulz explained that although clozapine is associated with serious adverse effects, the drug may help many patients who don't respond to other antipsychotics. He examined evidence for add-on medications for treatment-resistant schizophrenia, such as lithium or anticonvulsants. [ILLUSTRATION OMITTED] George T. Grossberg, MD, St. Louis University, discussed the role of neuroimaging, genetic considerations, and neuropsychological testing in assessing cognitive deficits, and suggested that we are moving toward combining biomarkers with clinical symptoms for earlier, more accurate diagnosis of Alzheimer's disease and other dementias. …