PRE-CONFERENCE COURSES
Wednesday, November 10, 2010
Marco Island Marriot Resort & Spa
Marco Island, Florida

UPDATES IN PSYCHOSOMATIC MEDICINE

HALF-DAY SKILLS COURSES

8:00 am – Noon
1. Update in Internal Medicine for the Consultation-Liaison Psychiatrist (sponsored by the Association of Medicine and Psychiatry)

Faculty:

• Thomas W. Heinrich, MD, FAPM
  Medical College of Wisconsin
• Anjan Bhattacharyya, MD
  St. Louis University School of Medicine
• Robert M. McCarron, DO
  University of California School of Medicine, Davis
• Jennifer M. Knight, MD
  University of Rochester School of Medicine
• Xavier Preud'homme, MD
  Duke University School of Medicine

Physicians who practice C-L psychiatry regularly work with patients who are suffering from co-occurring medical and psychiatric illnesses.  Knowledge of these medical conditions is often critical if we are to practice our psychiatric subspecialty competently.  Despite our best efforts, it can be difficult to stay current on the latest advances in the diagnosis and management of the numerous medical problems which afflict the patients we are asked to evaluate and treat. 

This course is meant to help update the busy C-L psychiatrist in five commonly encountered medical presentations and illnesses that are present in both the general medical hospital settings and ambulatory practices.  

• Dr. Heinrich will discuss the identification and management of common toxic syndromes resulting from overdose. 
• Dr. Bhattacharya will talk about the treatment of cirrhosis and the evaluation of abnormal liver function tests. 
• Dr. McCarron will provide up-to-date information on the diagnosis and management of the metabolic syndrome. 
• Dr. Knight will talk about the evaluation and management of chest pain. 
• Dr. Preud'homme will discuss sleep apnea, one of the most common sleep disorders often encountered by the physician specializing in psychosomatic medicine.

The course will conclude with a 20-minute question and answer period.

8:00 am – Noon
2. Pediatric Psychosomatic Medicine: Mending Hearts and Minds

Faculty:

• Stacy S. Drury, MD, PhD
  Tulane University School of Medicine
  
• David R. DeMaso, MD
  Harvard Medical School
  
• Maryland Pao, MD, FAPM
  National Institutes of Health
  

This course will cover three important areas of pediatric PM:

• Assessing and Treating Preschool Medical Traumatic Stress: From Neurobiology to Intervention

  Increasing evidence is finding that preschool children are negatively impacted by severe medical illness and other traumatic and stressful experiences. These experiences can have lasting impacts across domains, yet there is a paucity of clinicians with specific training in the assessment and treatment of preschool children, particularly those with medical illness. This presentation will focus on defining what is known about the impact of early traumatic experiences from injuries, severe medical illness, and other early life stressors in preschool children. Assessment of psychiatric symptoms using developmental appropriate measures as well as assessment of the parent-child dyad in medically ill children is important and can provide specific targets for intervention approaches. Evidenced-based intervention such as CBT for preschool traumatic experiences does exist and is effective in treating medical traumatic stress. There are also less well-studied interventions available to minimize initial distress, improve children's coping strategies, and work with the parent-child dyad to potentially improve both long-term and short-term outcomes. Intervention and treatment in preschool children has the potential to decrease distress and potentially alter early neurobiological trajectories and improve long-term outcomes.

• Mending Hearts & Minds: Understanding Children with Pediatric Heart Disease

  Pediatric heart disease is not one disorder or defect, but rather a constellation of heart disorders that can range from those that spontaneously resolve to those that are life threatening. While innovative medical and surgical techniques have allowed countless numbers of youngsters to survive, many pediatric heart abnormalities require surgical repair and/or chronic medications, and in severe instances, even transplantation. While allowing for greatly improved medical outcomes, pediatric heart disease can place substantial cognitive and emotional burdens on children and their families. This talk seeks to serve as a guide for understanding and managing children and adolescents facing these disorders.

• Psychopharmacology in Medically Ill Children: Is There A Role?

  Although many children cope well with and adapt to medical trauma, symptoms of depression, anxiety, and pain may respond to additional pharmacologic intervention. Clinically, psychotropic medications have been useful for treating conditions such as delirium, anxiety, and depression in medically ill children, but there is a dearth of research in the use of psychotropic medications in this population; for example, there have been no controlled antidepressant trials in depressed medically ill children, and the dose of psychiatric medications for children with medical illnesses has not been systematically studied. Comprehensive, multimodal, and multidisciplinary care may include psychopharmacologic management as a useful adjunct to decrease symptoms and improve functioning of medically ill children.

1:00 – 5:00 pm
1. The Business of Building Psychosomatic Medicine Services

Faculty:

• Lawson Wulsin, MD, FAPM, Moderator
  University of Cincinnati
  Chair, APM Business of Psychosomatic Medicine Subcommittee
• Jürgen Unützer, MD, MA, MPH
  University of Washington Medical Center
• Christopher White, MD, JD, FCLM
  University of Cincinnati
• Brian Tilow, Senior Vice President, Cleveland Clinic Health System

This course will engage participants to develop strategies for thriving in competitive medical center economies, including new service designs, smart negotiation approaches, and maximizing reimbursement on existing services.

• Dr. Unützer will outline the major economic forces to be managed and the essential business tasks for designing and launching a new kind of service.
• Mr. Tilow will describe effective approaches to negotiating with your healthcare system for establishing or growing your service in a competitive medical center.
• Dr. White will present strategies for minimizing billing errors and maximizing revenue.

Each 25-minute talk will be followed by 30 minutes of lively discussion of current business dilemmas faced by the participants. The final hour will feature a panel discussion of selected business problems posed by the participants.

1:00 – 5:00 pm
2. Psychopharmacology for the Psychosomatic Psychiatrist

Faculty:

• Stephen J. Ferrando, MD, FAPM
  New York Presbyterian Hospital, Weill Cornell Medical College
• James L. Levenson, MD, FAPM
  Virginal Commonwealth University School of Medicine
• James Owen, PhD
  Queen's University, Kingston, Ontario, Canada

This course will provide in-depth and practical information regarding the use of psychopharmacological agents to the medically ill.

• Dr. Owen will provide an overview of key aspects of drug-drug interactions and pharmacokinetic alterations in organ system disease and will then focus heavily on an important and little-discussed topic in prescribing to the medically ill: alternate routes of drug administration.
• Drs. Levenson and Ferrando will present information on selected practical clinical questions related to psychopharmacology in organ system diseases, surgery, critical care, and transplantation. For example, “SSRI/SNRI/TCAs have been suggested to increase the risk of GI bleeding especially when combined with NSAIDS. Is this a clinically significant concern?” The presenters will discuss the literature evidence for this phenomenon, its clinical implications, and management strategies.

Case examples will be provided; each presentation will last approximately 40-45 minutes with 15-20 minutes for discussion.

1:00 – 5:00 pm
3. Neuropsychiatric Masquerades: Medical and Neurological Disorders that Present with Psychiatric Symptoms

Instructor:

• José R. Maldonado, MD, FAPM
  Stanford University School of Medicine

Psychiatric masquerades are medical and/or neurological conditions which present primarily with psychiatric or behavioral symptoms. The conditions included in this category range from neurological disorders (e.g., seizure disorders and MS), to infectious diseases (e.g., syphilis, herpes and HIV), to connective tissue disorders (e.g., vasculitis and SLE), to malignancies (e.g., paraneoplastic syndromes and pancreatic cancer), to metabolic disorders (e.g., Wilson’s disease and prophyria), to various toxins and substances our patients may be exposed to. In this lecture, we will discuss the presentation and symptoms of the most common masquerades, focusing on pearls for timely diagnosis, and discuss potential management and treatment strategies.

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