Deborah Brauser

May 12, 2011

May 12, 2011 — Maternal mental health, military issues, and novel treatments for neurodevelopmental disorders are among the hot button topics at this week's American Psychiatric Association's (APA's) 2011 Annual Meeting in Honolulu, Hawaii.

"There are 2 things we hope clinicians will take from the meeting this year. One is practical, clinical tips they can apply right away. The second is translating the research into clinical practice, which is where we depend on our clinical scientists and clinical educators," APA Scientific Program Committee cochair Don Hilty, MD, told Medscape Medical News.

According to Dr. Hilty, who is also a professor of psychiatry and behavioral sciences at the University of California–Davis (UC-Davis) in Sacramento, the meeting presentations will reflect some of the most important issues facing the field of psychiatry today.

"We try to offer a wide variety of sessions across the board, but I think things like genetics, imaging, and topics that have to do with hormones are going to be pretty key," said Dr. Hilty, noting that genetics includes more than just having a predisposition toward having a disorder.

"It's also trying to understand how genetics predict what medications can be used, and it has to do with which disorders co-occur together."

The theme of this year's meeting, which will run from May 14 through May 18, is Transforming Mental Health Through Leadership, Discovery, and Collaboration — and the meeting will feature lectures, educational courses, oral scientific presentations, and more than 600 new research posters. The full schedule of events is posted online on the APA Web site.

Women's Mental Health

According to the APA, nearly twice as many women as men are affected by a depressive or anxiety disorder.

Dr. Donald Hilty

At the upcoming meeting, a wide variety of sessions and workshops will be presented on mental health issues during a woman's entire reproductive lifecycle, including treating pregnant women with bipolar disorder, the challenges of prenatal and newborn genetic screening, and how a woman's mood may predict her survival rate from metastatic breast cancer.

"We have a lot to learn about all of this," said Dr. Hilty. "Over the decades we haven't had as many researchers in that area. But with more women in psychiatry and in education, clinical care, and research, there is more interest. It's a really nice-growing area now."

The APA noted in a release that posttraumatic stress disorder (PTSD) is an issue now being acknowledged by some clinicians for new moms after traumatic births.

"Although this is an area I don't know a tremendous amount about, it fits with other traumatic experiences. If your child dies, you may develop acute distress disorder. Then, if it's not managed appropriately, it can turn into something more chronic, like PTSD. So this is a really interesting development," explained Dr. Hilty.

The presidential symposium on translating neuroscience for advancing PTSD prevention is scheduled for Monday May 16 and will include a presentation on treating maternal PTSD.

Military Issues, Telepsychiatry Continue to Grow

The APA notes that PTSD is just one of the issues psychiatrists are increasingly treating in their military patients. Clinicians are also dealing with comorbidities, stigmas, substance abuse, and problems for family members during and after service.

"This area is huge. It's always been an issue for our patients and for our country. But with the recent war-time activities and prevention activities, we have a lot of new veterans. So we have to learn how to take care of them, and I think it's key that we not assume that we know how to do that," noted Dr. Hilty.

"We have a different generation now, and we have a lot more women involved. So we have to adapt what we know to better treat them."

In addition, he said that technology is becoming increasingly important for this patient population.

"Some of the grants I've seen from the NIH [National Institutes of Health] and other bodies are looking at using technology to reach out to veterans who sometimes may not want to come in for treatment — but may feel connected through telephone, email, or other mechanism. Particularly in a group format, they feel connected. And we're right on the cusp of those findings coming out."

Dr. Hilty helped launch psychiatry telecommunication services through the UC-Davis Telemedicine Program and is also a telemedicine consultant to the APA.

"The area of telepsychiatry will continue to be very important. There is providing service to the battlefield and providing service to rural areas after they return. There are also new technologies coming out to prepare people before they go into service to see if PTSD and things like that can be prevented," he explained.

Neurodevelopment — A 'Blockbuster' Topic

The National Institute of Mental Health (NIMH) will be sponsoring several sessions at the meeting, including one on novel treatments for neurodevelopmental disorders, such as autism, and one on fast-acting medications for depression.

"We're very lucky to have the NIMH's involvement. They do a series every year, and this particular area is blockbuster. We finally have research, and a lot of it comes from UC-Davis, on early diagnostic studies for neurodevelopmental disorders. And now people across the country have spent a lot of time and energy and allocated a lot of money to interventions," said Dr. Hilty.

"I think this, along with women's health and technologic innovations, are going to be an incredible area for the next 10 years. And it's going to be fantastic for patients and their families. We've been learning how to diagnose early, and now we have to do something about it."

The novel treatments session, which is scheduled for Sunday May 15, will include a presentation on a new virtual reality training program to help kids with autism to improve social difficulties.

"Virtual reality has been around for 2 decades and it's a great idea. When you can do virtual reality and standardize a learning module or simulate training, you can have a very high quality product. It can also help patients develop skills for coping and for developing the parts of the brain that are functioning really well and then reroute other activities that can compensate for the deficits. It's all very interesting and just going to keep getting better," enthused Dr. Hilty.

Disaster Psychiatry — A Timely Topic

In light of the recent natural disasters in Alabama and across the Southeast, as well as in Japan, the sessions on psychiatric response to disasters are especially timely. They will include vicarious trauma among mental healthcare providers and the increasing use of integrated response teams in predisaster and postdisaster settings.

"This is an important topic; we actually have a grant to develop an online, Web-based training program for disaster response in California," reported Dr. Hilty. "The good news about these kinds of seminars at the APA is that the core principles of responding to disasters in trauma are the same, even though there are different kinds of disasters and different responses people have to the trauma.

"I think the key thing for clinicians is to understand that there's a difference between this and regular treatment. For example, with this you may not jump right into doing intensive psychotherapy. You may triage them to services and help them get their basic security and help them realize what their issues are. I think these kinds of presentations will help us really see the fine differences between disaster response and psychiatry treatment, although they overlap certainly."

Once again the annual meeting will also include several sessions reporting on various aspects of the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is scheduled to be published in 2013.

Members of the Mood Disorders Work Group will address the diagnosis of major depression, bipolar disorder, and other mood disorders across the lifespan; the NIH will sponsor a symposium on patient-reported outcomes; and an interactive workshop will ask for audience feedback on newly proposed DSM-5 criteria.

"Back in the day, the criteria was just developed. But with the last few editions, they actually do field trials to make sure that what they conclude is evidence based. Psychiatry is moving forward. And as we move forward, in some ways we'll be better in line with some of the systems that are used in medicine in genera. And I think that's a really good thing," said Dr. Hilty.

"The day-to-day clinician is sometimes a little bit removed from field trials and the development of the DSM. But I think these sessions will help them understand the process and how it will apply to their practice. It'll let them feel more connected."

Although he speaks highly of all the scheduled events at the meeting, Dr. Hilty said that the poster presentations are always his favorite part.

"That's where people present the latest information and you can go by and exchange thoughts on not only the research but also ideas on how to possibly bring it forward to a real-world setting. There's just a wealth of information and tips and thought-provokers there. I highly recommend checking them out," concluded Dr. Hilty.

The APA's 2011 Annual Meeting will run from May 14 through May 18. All events are listed on the association's Web site.


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