Saturday, October 24, 2015
What I'm Learning at the MGH Psychopharm Conference, Continued
Moving right alone here, but I'm now many lectures behind. I'll do my best:
Dr. Jenike on Obsessive Compulsive Disorder
"It's almost unheard of to have a patient get all better."
~SSRI's are the usual medication, often at higher doses than used to treat depression.
~Cognitive Behavioral therapy is the best augmenter.
~MAOIs may help with OCD with panic attacks.
~Lots of other stuff has been tried including Dilantin, Neurontin, morphine, Zofran, pindolol, tramadol St. John's Wort, inositol.
~Glutamate may be involved in OCD and medications that effect glutamate have shown some promise, Including Namenda (memantine), riluzole (a medicine used to treat ALS), and N-Acetylcysteine
~In sudden onset of OCD, consider infectious etiologies, including PANDAS (Google it)
Dr. Simon on PTSD
~propranolol doesn't seem to prevent PTSD (sorry, Roy)
~People who get opiates may be less traumatized -- better pain control likely
~steroids may have some some role in preventing PTSD if administered soon after a trauma
~Don't use benzos for PTSD, they interfere with extinction learning and ultimately make PTSD worse.
~Don't use benzos for PTSD.
~Prazosin helps with nightmares. Lunesta may help with insomnia
~SSRIs help, but not a lot. Risperidone and quietiapine may be helpful, there is not enough data to say much about other antipsychotics.
~There's not enough data to support that smoking marijuana is helpful.
~We need more research.
Dr. Zakhary on OCD-related disorders: Body dysmorphic disorder, trichotillomania (hair pulling), skin picking and hoarding
~There are no FDA approved medications to treat these disorders. Check out http://Trich.org
~People with body dysmorphic disorder can spend up to 8 hours/day looking in the mirror.
~SSRIs may help. There is no indication for using an antipsychotic even if the patient is delusional.
~Tricotillophagia is the name for eating the hair after it's been pulled out. You learn something new every day.
~N-acetylcysteine may be helpful (NAC), dose of 1200mg -2400mg/day. Brand names Jarrow or Swanson, and you can get it from Amazon. Swanson is cheaper.
~Also Naltrexone at 50-100mg, or Olanzapine, 10mg/d
~For skin picking: SSRIs may help. Olanzapine 5mg/d, Abilify 5-10mg/d, Lithium, or Milk Thistle. It's all case reports.
~An itch workup should be done.
~Hoarding: medications studies are inconsistent and very limited. CBT!
So, I've gotten you to 5:15 yesterday. I went to sessions on Sleep Disorders (avoid meds, refer for >CBT!, and apparently trazadone doesn't work) and Natural medications for psychiatric disorders at night, and then dinner at a wonderful French restaurant on Newbury Street with a friend. It made for a late night, and it all started over this morning with more to come tonight, and all day tomorrow.
Thanks for listening.
Posted by Dinah on Saturday, October 24, 2015