Offered by the Department of Psychiatry at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School.

*A Master Class On Emerging Strategies in the Assessment and Treatment of Depression and Anxiety: Integrating Psychopharmacology and Psychotherapy

Russell Vasile, MD

August 1 – 5, 2022 • Monday – Friday
See Accreditation

This seminar will familiarize the clinician with emerging strategies in the assessment and treatment of major depression, bipolar illness and anxiety disorders. The course will also highlight key comorbid conditions associated with mood and anxiety disorders, including Axis II personality disorders, management of patients with medical conditions and management of the geriatric patient. An essential theme of the seminar will be formulating an integrated psychopharmacologic and psychotherapeutic treatment approach.

Issues around the choice of specific antidepressants, mood stabilizers and anti-anxiety medications and psychopharmacologic management of the treatment resistant patient will be highlighted with a discussion of the use of augmenting medication strategies and combinations of psychopharmacologic agents. Psychotherapeutic approaches to mood and anxiety disorders will be studied with a focus on differing strategies including psychodynamic psychotherapy, cognitive and behavioral therapy, interpersonal psychotherapy for depression and other psychotherapeutic approaches. Emerging data on the role of exercise in the treatment of depressed mood and data on nutraceuticals as a supplement to antidepressant treatment will be examined.

The seminar will update the clinician on recent developments in neuropsychiatry, including brain imaging and therapeutic stimulation techniques.

Recent data on the therapeutic efficacy of TMS, and different TMS modalities will be presented; emerging data on the therapeutic efficacy and risks associated with different modalities of ketamine administration will be presented as well as ketamine’s effects on suicidality. The range of anxiety disorders to be reviewed will include anxiety disorders in the Obsessive- Compulsive Disorder Spectrum including skin-picking disorder, trichotillomania and body dysmorphic disorder; anxiety disorders related to trauma including posttraumatic stress disorder. Emphasis will be placed on the integration of psychopharmacology and cognitive behavioral therapy in the treatment of anxiety disorders.

Management of anxiety in patients vulnerable to abuse of alcohol and psychological dependence on marijuana will be examined and the role of non-benzodiazepine anti-anxiety medications, such as pregabalin, will be explored in detail.

Upon completion of this activity, participants will be able to:

Evaluate emerging strategies in the use of psychotropic medications in the treatment of major depression and anxiety disorders and integrate psychopharmacologic treatments into psychotherapy strategies in treating depressed and anxious patents;
Describe strategies for the psychopharmacological and psychotherapeutic management of treatment resistant depression;
Summarize the emerging role of ketamine in the treatment of major depression and suicidal behavior;
Explore the role of novel enhancements to treatment of mood disorders including omega 3 fatty acids, 1 methylfolate and zinc;
Discuss the role of electroconvulsive therapy and Transcranial Magnetic Stimulation in treatment resistant depressive disorders;
Examine new developments in the treatment of depression in bipolar patients with a focus on newer medications including lurasidone and cariprazine;
Identify an evidence-based approach to suicide risk assessment and prevention of suicide;
Appreciate the role of lithium carbonate in combination with other mood stabilizing agents;
Give examples of recent developments in psychotherapeutic approaches to treating Bipolar patients, including cognitive, behavioral and expressive psychotherapy techniques;
Integrate psychodynamic assessment, psychotherapy and psychopharmacology into management of depression and anxiety disorders;
Assess the role of Cognitive Behavioral Therapy (CBT) in the treatment of depression and anxiety disorders;
Compare recent developments in the implementation of CBT, including Commitment and Acceptance Therapy and inclusion of exposure therapy in CBT;
Report on the latest applications for computer- based treatment of OCD and other anxiety disorders;
Describe new psychopharmacological and psychotherapeutic techniques in the treatment of PTSD including exposure and response prevention and virtual reality techniques utilized to treat PTSD secondary to exposure to combat;
Formulate an integrated psychopharmacological and psychotherapeutic approach to personality-disordered patients in the borderline and severely narcissistic spectrum presenting with depression and anxiety;
Manage anxiety disorders in patients vulnerable to alcohol abuse and psychological dependence on marijuana, including the use of non-benzodiazepine anti-anxiety agents such as pregabalin and buspirone;
Formulate strategies for treating patients with marijuana abuse disorder, including discussion of newly emerging psychopharmacological and psychotherapeutic techniques.

FACULTY

Russell G. Vasile, MD is an Associate Professor of Psychiatry, Harvard Medical School and Director of the Affective Disorders Consultation Program at the Beth Israel Deaconess Medical Center. Dr. Vasile has published in diverse areas related to the assessment and treatment of anxiety and affective disorders. Dr. Vasile is also a graduate of the Boston Psychoanalytic Society and Institute. He is a past recipient of the Elvin V. Semrad Award for Excellence in Teaching at the Massachusetts Mental Health Center and The Beth Israel Deaconess Medical Center Faculty Award for Teaching and Mentorship, September 2021.

*Risk Management Credits: This activity meets the criteria of the Massachusetts Board of Registration in Medicine for 2.25 credits of Risk Management Study. This includes 2.25 credits of Medical Marijuana. Please check your individual state licensing board. This activity covers topics required by the Massachusetts Department of Public Health to be included in continuing professional development programs that physicians registered with the state’s Medical Use of Marijuana Program must complete as a condition to issuing written certifications to qualifying patients.

Date and time	Agenda Item
Monday, August 1
8:30am – 9:00am	Registration
9:00am – 10:15am	DSM-V assessment and treatment of subtypes of depression; new SNRI medications and traditional SSRIs, MAO inhibitors; augmenting agents for depression including lithium, thyroid, low dose stimulant; combinations of antidepressants tricyclics and SSRIs; assessing and treating refractory depression; the role of ECT and transcranial magnetic stimulation; what clinical factors predict a positive response to transcranial magnetic stimulation (TMS).
10:15am – 10:30am	Coffee Break
10:30am – 12:15pm	When to augment or combine antidepressants; treatment of psychotic depression; MAO inhibitors in treatment resistant depression, including the use of the MAO-I transdermal patch; mood disorders in pregnancy and post-partum; novel neuroleptics as antidepressant boosters; adjunctive use of novel neuroleptics such as quetiapine, olanzapine, lurasidone in the treatment of unipolar depression; differing techniques in administering TMS; review of different modes of administration of ketamine and differential effects of intranasal versus intravenous administration; role of ketamine in suicide prevention.
Tuesday, August 2
9:00am – 10:15am	Assessment and treatment of Bipolar Disorder; new DSM-V classification of Bipolar Spectrum Disorders and its clinical implications; lithium, lamotrigine, lurasidone and quetiapine in bipolar depression; managing both prevention of cycling and acute mania -use of olanzapine, risperidone, quetiapine and other novel neuroleptics; role of clozapine in refractory mood disorder.
10:15am – 10:30am	Coffee Break
10:30am – 12:15pm	Bipolar Depression and different psychopharmacological interventions; new psychopharmacologic options for treatment of bipolar depression; bipolarity in relation to personality disorder, attention deficit disorder; long term management of mood cycling; mitigating risks of chronic lithium administration; combinations of mood stabilizers for rapid cycling bipolar disorder; practical issues in medication management; approaches for treating bipolar depression; the role of lithium in suicide prevention in bipolar disorder; approaches to assessment of risk and prevention of suicide.
Wednesday, August 3
9:00am – 10:15am	DSM-V diagnostic changes in formulation of Anxiety Disorders; assessment and treatment of anxiety disorders including panic, post-traumatic stress, generalized anxiety and social anxiety disorders; OCD and role of risperidone in the management of obsessive-compulsive spectrum disorders; OCD related disorders, skin picking disorder- their management and treatment; management of refractory OCD; new data on TMS for OCD; use of benzodiazepine and non-benzodiazepine anxiolytics; role of SSRI, SNRI, tricyclic and MAO-I medications for the treatment of anxiety and panic disorder; alternative medications for generalized anxiety disorder including agomelatine, and pregabalin; different non-benzodiazepine medications for the treatment of anxiety in patients with alcohol or substance abuse vulnerability; new treatments for PTSD, new developments in the medication management of chronic marijuana abuse; meditation and relaxation apps found on cell phone or computer for treatment of anxiety.
10:15am – 10:30am	Coffee Break
10:30am – 12:15pm	Management of refractory PTSD; strategies for discontinuation of chronic benzodiazepine use; psychotherapeutic approaches to Anxiety Disorders, including CBT, relaxation and meditation and exposure and response prevention; efficacy of computer apps for administration of CBT for treatment of anxiety disorders.
Thursday, August 4
9:00am – 10:15am	Psychodynamic perspectives on depression and anxiety; different psychotherapies of depression – CBT, psychodynamic expressive psychotherapy and behavioral strategies; new developments in CBT including perspectives on Acceptance and Commitment Therapy; new data on internet programs focused on patient alone based CBT treatment versus internet based plus therapist assisted CBT treatment- does the interaction with a therapist matter? 3-4-day CBT “bootcamp” programs; how psychodynamic understanding of the origin of borderline and narcissistic disorders may inform choice of psychotherapeutic strategy; psychopharmacological management of disorders of impulse and anger; evidence based psychopharmacology as a component of the management of borderline personality disorder.
10:15am – 10:30am	Coffee Break
10:30am – 12:15pm	Psychodynamic vulnerability to depression; psychotherapy of depressive and anxiety disorders differing strategies; biological treatments for anger and impulse disorders; integrating psychotherapy and medication management in depressed and/or anxious patients with personality disorders. Examination of the spectrum of persistent depressive disorder, psychobiological and psychodynamic factors. Q&A.
Friday, August 5
9:00am – 10:15am	Brain imaging in anxiety and depressive disorders documenting brain imaging changes on MRI in response to psychotherapy alone and in combination with antidepressant medications; baseline brain imaging predicting when CBT will work to treat anxiety or depression; brain imaging in depressed patients – clinical implications; repetitive transcranial magnetic stimulation and other emerging brain stimulation techniques; efficacy data on transcranial magnetic stimulation- clinical factors that may predict response to TMS; ECT versus TMS -how to choose between them?
10:15am – 10:30am	Coffee Break
10:30am – 12:15pm	Assessment and treatment of the geriatric patient; psychopharmacological management of the geriatric patient with depression and/or anxiety, including the use of stimulants as an adjunctive treatment in geriatric depression; complex bereavement disorder, including discussion of reminiscence psychotherapy for complex bereavement disorder; medical illness and depression with an emphasis on cardiac disease and neurological conditions; assessing dementia versus the pseudo-dementia secondary to depression; does the use of benzodiazepines cause dementia in the elderly?; depression in Medical Illness.
12:15pm	Adjourn