Ready to Use, Basic Psychopharmacology Didactic Curriculum 2014 Behavioral Sciences in Family Medicine Conference Yvonne Murphy, MD Associate Program Director MacNeal Family Medicine Residency

Educational Objectives Acquire and learn to use teaching materials on pharmacologic management of four common mental health conditions presenting to primary care Acquire and learn to use teaching materials on pharmacologic management of four common mental health conditions presenting to primary care Increase personal knowledge of pharmacologic treatments for common mental health conditions presenting to primary care Increase personal knowledge of pharmacologic treatments for common mental health conditions presenting to primary care Explore additional resources for satisfying the FM-RRC requirements for teaching in behavioral science Explore additional resources for satisfying the FM-RRC requirements for teaching in behavioral science

Introductions What is your professional training and current role? Why did you choose this session and what are you hoping to get out of it?

Why you (as behavioral scientist) should teach medication management You already teach how to identify these patients and other treatments You already teach how to identify these patients and other treatments Many of these patients will not see a psychiatrist despite referral; their only access to care for their mental condition may be their family physician Many of these patients will not see a psychiatrist despite referral; their only access to care for their mental condition may be their family physician Residents and faculty will look to you for information to guide them Residents and faculty will look to you for information to guide them Teaching them will provide more comprehensive care for the patient Teaching them will provide more comprehensive care for the patient

Why you (as behavioral scientist) should teach medication management Insure your program’s accreditation and compliance with RRC requirements: ”Residents must demonstrate competence to independently diagnose, manage, and coordinate care for common mental illness and behavioral issues in patients of all ages” ”Residents must demonstrate proficiency in their ability to use pharmacotherapy” ”There must be a structured curriculum in which residents are educated in the diagnosis and management of common mental illnesses” ”There must be a structured curriculum in which residents are educated in the diagnosis and management of common mental illnesses”

The Teaching Materials 3 complete slideshows 3 complete slideshows Depression, Anxiety, ADHD Depression, Anxiety, ADHD Approximately 1 hour each Approximately 1 hour each Focus on pharmacotherapy Focus on pharmacotherapy We have separate teaching on diagnosis and effective behavioral therapies We have separate teaching on diagnosis and effective behavioral therapies Appropriate for students, residents, faculty Appropriate for students, residents, faculty Large or small group setting Large or small group setting Additional case conference format to use Additional case conference format to use

Bipolar Disorder I recommend downloading 2013 BHS Forum presentation “Identifying and Initiating Treatment for Bipolar Disorder in the Family Medicine Office” Karen Blackman, MD and Amy Romain LMSW, ACSW

Basic Format of Teaching Modules Eight Easy Steps to Treating Depression/Anxiety/ADHD with Medications

8 Easy Steps to Treating Depression with Medications Make the right diagnosis Make the right diagnosis Assess suicide risk Assess suicide risk Decide on medication vs other treatment Decide on medication vs other treatment Patient Education Patient Education Base selection of medication on individual patient factors (gender, co morbid medical conditions and medications, worst symptoms) Base selection of medication on individual patient factors (gender, co morbid medical conditions and medications, worst symptoms) Frequent follow up (1 week after initiation) Frequent follow up (1 week after initiation) Augmentation or switch for non response Augmentation or switch for non response After 5-8 months, assess need maintenance After 5-8 months, assess need maintenance

8 Easy Steps to Treating Anxiety with Medication Make the right diagnosis Make the right diagnosis suspect/screen with medical symptoms suspect/screen with medical symptoms Assess for co-morbid depression Assess for co-morbid depression Decide on medication vs CBT/Exposure or EMRD for PTSD Decide on medication vs CBT/Exposure or EMRD for PTSD Patient Education Patient Education Base selection of medication on individual patient factors (gender, co morbid medical conditions and medications, worst symptoms) Base selection of medication on individual patient factors (gender, co morbid medical conditions and medications, worst symptoms) Frequent follow up (1 week after initiation) Frequent follow up (1 week after initiation) Switch for non response Switch for non response Maintenance Maintenance

8 Easy Steps to Treating ADHD with Medications Make the right diagnosis Make the right diagnosis Assess for co-morbid conditions Assess for co-morbid conditions Decide on medication and/or other treatments Decide on medication and/or other treatments Patient/Parent Education Patient/Parent Education Selection of medication Selection of medication Follow up and reassessment of response Follow up and reassessment of response Titration of dose, if needed or switching Titration of dose, if needed or switching Maintenance Maintenance

Audience to Choose 1 Topic Area to Review DepressionAnxietyADHD

Tips for Teaching Co-teach with faculty physician, psychiatrist, and/or pharmacist Co-teach with faculty physician, psychiatrist, and/or pharmacist Incorporate a case from your own practice Incorporate a case from your own practice

Psychopharmacology Case Conference Initiated after initial didactic presentations are given Initiated after initial didactic presentations are given Slides from those presentations are ed out for review before the conference and reference during Slides from those presentations are ed out for review before the conference and reference during Cases are identified from practice; primary resident provider is present (ideally; no preparation needed) Cases are identified from practice; primary resident provider is present (ideally; no preparation needed) Brief review of principles of treatment Brief review of principles of treatment Small groups discuss each case focusing on the question “What would be the best medication for this patient and why?” Small groups discuss each case focusing on the question “What would be the best medication for this patient and why?” Each group presents back to the larger group their answer and additional questions raised Each group presents back to the larger group their answer and additional questions raised

Resources and References Mayo Clinic Acute Care Psychiatry Clinical Review, October 2012 I highly recommend this conference. Excellent, evidence-based and current information. They also provide you all slides and patient videos on a jump drive. Another upcoming conference: Mayo Clinic Psychiatry in Medical Settings January , 2015 in New Orleans, LA The course will provide up to date reviews of depression, anxiety, delirium, dementia, suicide risk, substance use, and personality factors in medical- surgical patients. Updates also will be provided on chronic fatigue, fibromyalgia, psychiatric problems in pregnancy and the postpartum period, somatic symptom disorders, functional neurologic disorders, and functional gastrointestinal disorders.

Resources Amer Society of Clinical Psychopharmacology Amer Society of Clinical Psychopharmacology Model Psychopharmacology Curriculum for Training Directors and Teachers of Primary Care Physicians, 7 th Edition $500 -includes complete slideshows on anxiety, depression, psychosis, bipolar, somatization, insomnia, dementia, delirium, substance abuse

Group Discussion on Additional Strategies and Formats for Teaching these Topics Questions