DSM-5 Field Trial Results a Hot Topic at APA 2012 Meeting

Deborah Brauser

May 03, 2012

May 3, 2012 — Telepsychiatry, neuromodulation, the role of genetics, and updates for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are just some of the hot items on the agenda of this year's American Psychiatric Association's 2012 Annual Meeting in Philadelphia.

"Telepsychiatry is one of many tools we currently have. But in many situations, it may be the only tool where people can get psychiatric services," APA Scientific Program Committee chair Kenneth R. Silk, MD, told Medscape Medical News.

Dr. Kenneth Silk

"So how do we make our resources available to a wide range of patients? How do you connect to individuals who do not have access to needed services? More than just an interesting idea, I think this is our responsibility to figure out," said Dr. Silk, who is also professor in the Department of Psychiatry and director of the Personality Disorders Program at the University of Michigan Medical School in Ann Arbor.

He reported that other important topics include integrated care, which is the theme of this year's meeting; maternal mental health issues; disaster psychiatry; and ways that clinicians can protect themselves against burnout and workplace violence.

He noted that the last-mentioned issue "is terribly important" in light of the recent shootings at the Western Psychiatric Institute and Clinic at the University of Pittsburgh, where 1 person was killed and several others wounded.

"It makes you pause and really think: Do we work in safe environments? Is a mental health facility less safe than another facility? I like to think that it's safer because we're more cognizant of what might go on in these situations. But it's important to be careful and to take precautions," said Dr. Silk.

So far, more than 9000 attendees are registered for the meeting, which will feature 1139 abstracts. In addition to 4 days of new research posters, there will be 475 sessions, including oral scientific presentations, symposia, and educational courses. The full program is posted on the APA's Web site.

DSM-5 Field Trial Results Are In

"I think one of the biggest hot-button issues is going to be the DSM-5, because it is scheduled for publication in 2013. There are certainly going to be some significant changes to the manual, and that always makes people anxious," said Dr. Silk.

Dave Kupfer, MD, and Darrel Regier, MD, chair and vice-chair, respectively, of the DSM-5 Task Force, will present overall updates during a forum scheduled for Saturday morning. Specific topics will be highlighted in other sessions throughout the meeting. These will include reports from the following:

  • The Neurodevelopmental, Child and Adolescent Disorders, ADHD and Disruptive Behavior Disorders, Personality and Personality Disorders, and Neurocognition work groups on Sunday from 8 to 11 am

  • The Psychotic Disorders; Mood Disorders; and Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders work groups on Sunday from 1 to 4 pm

  • The Somatic Symptoms Disorders, Eating Disorders, Sleep-Wake Disorders, Sexual and Gender Identify Disorders, and Substance-Related Disorders work groups on Monday from 9 am to noon

In addition, the DSM-5's field trials have been completed "and the results are in," said Dr. Silk. "This will allow the psychiatric public to take the first peak at some of the findings. And I think that will generate a lot of interest and excitement." This session is scheduled for Saturday from 2 to 5 pm.

"If a member would go to all of these sessions, I think they'd get a better appreciation with respect to how the DSM-5 is developed and where it's going. And the appreciation will be different from what one would read in the newspapers," added Dr. Silk. "It's different if you follow along from the scientific point of view."

Neuromodulation Front and Center

"I think the other topic that's really coming up in psychiatry is the treatment topic of neuromodulation. It's been around for a decade, but I think it's something that's going to become more prominent in psychiatry," said Dr. Silk.

Neuromodulation includes deep brain stimulation (DBS), electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and magnetic seizure therapy.

Dr. Silk noted that "a whole series" of talks and workshops will be given on this subject. A few of his recommendations include a Saturday session by Helen S. Mayberg, MD, on the latest data on the use of DBS for treating depression; a Monday morning symposium by Sarah "Holly" Lisanby, MD, on neuromodulation in clinical practice; and a Tuesday morning workshop on TMS.

When asked about the several new research posters that assess the use of ECT for children, Dr. Silk said that this "is obviously a controversial topic."

"As with anything else in psychiatry, the question is whether or not those treatments can be applicable to children — and under what conditions. Since there are so many opinions attached to ECT even now, when it's proven itself to be a very efficacious treatment, I think we really need more data on it rather than having arguments about it in the field of public opinion," he said.

He stated that most psychiatrists "would agree that ECT today is a pretty safe treatment," and it has been used in the geriatric population "for a long time."

"Do you extend it to children and adolescents? My knowledge of it is it's an effective treatment. But everybody always worries about whether there will be permanent cognitive changes or side effects. And in what age groups will the potential side effects outweigh the potential beneficial effects?"

Genetics, Maternal Mental Health

Genetics is also a topic that attracts a lot of attention, as apparent from the fact that studies and data on it are "growing exponentially," said Dr. Silk.

"I think most people would say that the liability to develop psychiatric disorder is some combination of genetic predisposition and environmental/situational stress. But I don't always think it's necessarily 50-50. It depends on the individual person and on the situation."

Several posters and presentations on maternal mental health and its effects on children will also be presented at the meeting. These include a Sunday morning lecture on 3 decades of perinatal psychiatry, a Monday morning symposium on perinatal psychiatric consultation, a Monday workshop on pregnancy and parenthood, and a Tuesday afternoon symposium on reclaiming the role of motherhood for women with serious mental illness.

"The whole idea of psychiatric treatment in women who are pregnant is still evolving. I had children in the early '80s, when 'no drug shall touch the mother for months before and after' was common," said Dr. Sillk.

"Now, people are thinking about the biological changes that women go through if they're in an episode of psychiatric illness. And some of those biological changes may be as detrimental or even more detrimental to the fetus than some of the medications out there."

Importance of Telepsychiatry

Switching to talk of psychiatric patients living in rural areas, Dr. Silk said that the bulk of those individuals are probably being treated by primary care physicians.

"And that's fine as long as the doc is knowledgeable about psychiatry to some degree and if the patient responds. If a patient doesn't respond to first- or second-line treatment, then there need to be ways for those individuals to consult with people who have more expertise in psychiatry," he said.

"We have several tools for telepsychiatry. And although we need to think about confidentiality issues, I think it is incumbent upon us as experts in the field of mental health to make our services available. I think that's not only essential, it's also very exciting."

He noted that the availability of more and more different types of apps for mobile devices means that there are now many ways to reach patients who feel alone.

"This can apply not only to patients but also to those who are treating them, including psychiatrists or general practitioners or internists or nurse practitioners. I think there are many people with a lot of skills and knowledge, which is a wonderful resource."

Integrated Care

The issue of integrated care has become so important that it is the theme of this year's meeting.

Almost 2 dozen sessions will be offered on its various aspects.

"How do you bring psychiatric services into the general practitioner setting? There are a number of initiatives that the government is putting forth with respect to accountable care organizations, and developing medical homes for patients that will involve physicians from different specialties. So how do you get healthcare providers to coordinate to provide comprehensive care to these patients?" asked Dr. Silk.

"And if you have a patient with a chronic psychiatric illness and you want a coordinating physician, should that physician be a psychiatrist rather than a primary care doc? What are the economics and the financing behind that? How do you make it work?"

He noted that past reports have shown that bringing primary care doctors into a mental health center has resulted in improvements in patients' overall medical conditions, which could then help improve their psychiatric conditions — and vice versa.

"So how do you bring these doctors together? Several of the meeting sessions will deal with these issues, including the skills needed for consulting at a primary care clinic, current models of effective integrative care, and what we can learn from Europe, where collaborative care is more the norm than it's been over here," said Dr. Silk.

"I think there's a terrific opportunity to expose oneself to what will probably be the future of how care will be delivered over the next 15 to 25 years."

Physician, Heal Thyself

Several posters and sessions will also focus on things clinicians can do to help themselves, including steps for protecting against stalking and ways to fight burnout. There will also be a lecture on Sunday afternoon that addresses workplace violence.

"I think we need to realize that the work that we do is difficult. We've learned to adapt to the job, but we need to be able to turn to other people or have some things we can practice so that when the job really does become stressful, we can find ways to release that. I work with a team, and talking together about these things makes it easier to get through the day," said Dr. Silk.

Speaking of making things easier for clinicians, the APA is offering a free app for mobile devices to use at the meeting. The new app can be downloaded from the organization's Web site directly to a smart device and is available for iPad, iPod Touch, iPhone, Blackberry, and Android.

Features of the app include a calendar that allows the building of a customizable schedule with interactive features, alerts that tell of any real-time changes to the meeting program, and an interactive map and listing of the exhibitors.

"It will also be connected to Twitter, for sure," added Dr. Silk. The official Twitter hashtag for the meeting is #APAAM12.

All-Star Speakers

A few last recommendations from Dr. Silk include Sunday's Opening Session with Glenn Gabbard, MD, "who is one of the most popular psychiatrists writing about psychodynamic psychotherapy and psychoanalysis today," and Aaron "Tim" Beck, MD.

"Tim is in his 90s and was a psychoanalyst and really the founder of cognitive behavioral therapy. These two docs are going to have a conversation about cognitive therapy and psychodynamic therapy being more alike than different," explained Dr. Silk.

"This will give people an opportunity to see these 2 masters of psychotherapy. Tim is really a legend in his own time and just as sharp as he ever was. I would say this is one event that should not be missed."

Other lectures he is especially excited about include the following:

  • Steven Hyman, the former director of the National Institute of Mental Health (NIMH), will give a talk on Tuesday morning;

  • Sir Michael Rutter, MD, from the UK, will speak on Sunday morning about resilience;

  • Mayada Akil, MD, from the NIMH, will speak on Monday morning on why psychiatrists should care about neuroscience; and

  • Erik Kandel, MD, "our only psychiatric Nobel prize winner," will be giving the Adolf Meyer Award Lecture on Monday.

"It's like an all-star team of speakers this year," said Dr. Silk.

And for the attendees looking for suggestions of things to do outside the meeting, he noted a Van Gogh exhibit at the Philadelphia Museum of Art that will end on Sunday, and a stop at "any greasy spoon" in the area for a great cheesesteak hoagie. He also reported that the convention center is next to the Reading Terminal Market, "which is a great place to sneak out for lunch." The enclosed market currently houses more than 100 vendors.

Overall, Dr. Silk said that he is extremely proud of the upcoming meeting — and happy with where the field is right now.

"I've been in psychiatry for 40 years and it's still as exciting to me as it was when I started, even though how we think about mental illness is so different now. It's never boring, and there's a chance to just keep learning about people and the way they think," he said.

"After being in the field so long, I really appreciate how strong people are. You study their weaknesses, but I think you come out appreciating their strength as they struggle with illnesses that can be debilitating. And more often than not, they make do and keep on going."

The American Psychiatric Association's 2012 Annual Meeting will run from May 5 through May 9. All events are listed on the association's Web site.

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