Climate change presents the mental health professions with profound challenges in responding to and preparing for acute and chronic, multifaceted, mental health needs in individual patients, families, communities and our larger society. Mental health professionals can be as disoriented as others in integrating the evolving realities of climate change and our multiple social crises. However, we do have understandings and skills that are pathways out of disorientation. This presentation will assist the clinician in being more comfortable and capable in responding to and working with climate change realities and climate change material in treatment. Particular attention will be paid to issues for adolescents, young adults, and parents and what is required for “containment” of climate-related experience. There will be emphasis on the public health aspects of our work and the requirement that we deeply understand our predicament, as we must now “skate to where the puck is going to be”.

This presentation will explore the relational aspects of psychopharmacological work with youth and families. While technical and scientific knowledge can be taught and examined during medical education, the therapeutic skills also known as “nonspecific” treatment factors or “common factors” are more elusive and harder to describe. Differences in culture between the prescriber and the patient often lead to differing perspectives and, if not explored, can interfere with the treatment alliance and subsequently with treatment adherence and/or resistance. Cultural concordance is crucial to teach physicians how to appreciate the cultural background unique to each patient in a way that values and honors our similarities and our differences. In keeping with the adage, The formulation must always precede the prescription, recent work has highlighted the use of the DSM-5 Cultural Formulation Interview as an important tool to more fully understand a young person in the context of their daily life, as part of comprehensive treatment planning. We propose that the term ‘med check’ is not only a misnomer that simply doesn’t exist in child and adolescent psychiatric treatment (as if the patient just comes to us wanting to ‘talk about their meds’), but more importantly it is a disservice to the nature and intention of our work with youth and families. For such time-limited visits where the medication issues are a primary focus, we propose the term, ‘brief pharmacotherapy visits’, which allows us to retain our role as therapists (as an inextricable part of psychopharmacology). An effective pharmacotherapy appointment necessitates the appreciation of many things that inform treatment, and thus pharmacotherapy decisions, including the intricacies of an individual’s culturally informed, biopsychosocial story. It has consistently been shown that strong therapeutic alliances between a patient and their mental health provider, as well as empathy demonstrated by the latter, lead to more positive clinical and functional outcomes- and thus to the primary goal of evaluating and promoting mental health and well-being.

Unlike bipolar I disorder (BD I), which has been extensively studied and depicted in popular literature and on screen, bipolar II disorder (BD II) is poorly understood, underdiagnosed, and insufficiently treated. This has often resulted in an over 10-year delay in diagnosis. BD II is mistakenly described a “lesser form” of BD I, despite numerous studies showing comparable illness severity and risk of suicide in these two BD subtypes. Perhaps because of its under-recognition, treatment studies of BD II are limited, and too often results from studies of patients with BD I are simply applied to those with BD II with no direct evidence supporting this practice. BD II is an understudied and unmet treatment challenge in psychiatry. This talk will provide a broad overview of BD II including differential diagnosis, course of illness, suicide risk and evidence-based treatment options.

Many patients with depression cannot be brought into a state of sustained symptom remission. Sometimes called “treatment resistant” depression, they may be better understood as “difficult to treat depressions” (DTD) because this clinical heuristic promotes the search for treatable pharmacological, psychosocial, and biological/medical obstacles to achieving or sustaining remission. Furthermore, the DTD heuristic recognizes that some depressions may be better managed by optimizing symptom control, quality of life, and daily function, rather than by conducting multiple revisions in treatment from which little, longer-term benefit may be expected. The clinical challenges (e.g., selecting assessments for treatable causes; identifying treatment sequences for specific patients) as well as the research challenges (e.g., defining types of DTD; assessing outcomes) are discussed.