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.

“Treatment resistant depression (TRD)” is defined when a patient’s depression has failed to respond to two consecutive adequate trails of different antidepressants. This begs the question as to who or what is “resistant”. TRD focuses on non-response, does not take into account the equally challenging situations of lack of a sustained response or intolerance/contraindication/non-acceptance of treatment. “Difficult-to-treat depression (DTD)” is an alternative, more clinically orientated, concept of depression with poor outcomes. It describes depression that continues to cause a burden to the patient despite usual treatment efforts by the clinician. Most importantly, DTD is associated with a chronic, rather than acute, illness model of care. Key to this is holistic, individualised, management identifying factors that may contribute to the poor outcome and which may be tractable. While remission of symptoms is the primary goal of treatment, if this is difficult to achieve, the focus might more appropriately shift towards optimal management of residual symptoms and most importantly improvement in psychosocial functioning and quality of life. This presentation will discuss how to manage DTD systematically using the DTD model of care to optimize not only symptomatic improvement of patients, but also reducing risks of relapse and maximizing improvements in patient’s quality of life.

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.

The differential diagnosis of children with severe emotional dysregulation now includes bipolar disorder. Yet, the diagnosis of mania can be difficult to make because of the developmentally different presentation and high rates of comorbidity. Distinguishing bipolar depression from unipolar depression can be difficult and mania and ADHD share many symptoms. This presentation will review the diagnosis of mania in children including research addressing clinical characteristics, comorbidity, course, and treatment.

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.

This presentation was originally reviewed on October 10, 2023, and broadcast live online on October 11, 2023, from 12:oo PM – 1:00 PM ET.

This presentation was originally reviewed on September 29, 2023, and broadcast live online on July 22, 2020 from 12:00 PM- 1:00 PM ET. 

This talk will review the behavioral pharmacology and treatment of substance use disorders with psilocybin and other classic psychedelics (5HT2A agonists). Early research from the 1950s to 1970s investigated classic psychedelics, primarily LSD, in the treatment of alcoholism and cancer-related distress. Over the last 20 years research has once again investigated psychedelics in the treatment of psychiatric disorders including substance use disorders, cancer-related distress, and depression. This talk will provide a current description of this work as well as a vision for the future.

This presentation was originally reviewed on September 11, 2023, and broadcast live online on September 15, 2023, from 12:oo PM – 1:00 PM ET.

Anxiety is a well-recognized co-occurring condition or feature of autism. However, how anxiety impacts autistic individuals is less recognized especially when considering variations at different developmental stages. This presentation will review key differences in how autistic individuals may experience anxiety and how this can manifest in communication, behavior, and functioning. Developmental considerations for the experience and expression of anxiety will be reviewed. The presentation will conclude with reviewing how anxiety needs to be considered integrally for person-centered care.