Day 1 :
East Tennessee State University, USA
Time : 09:50-10:35
Dr. Karl Goodkin is currently working as a Professor and chairman of Psychiatry and Behavioral Sciences at East Tennessee State University of USA. He holds his Ph.D. in Clinical Psychology from University of Miami in Florida. He also holds his MD degree from the University of Miami as well as having been trained in psychiatry at Stanford University, where He also did a psychiatry research fellowship. He did many scientific presentations at national & international meetings. He received many honors and awards. He is a member of Editorial Board. He has been a member of the Committee on HIV Psychiatry of the American Psychiatric Association since 1992. He was the chief editor of books. He has conducted clinical trials of HIV-associated neurocognitive impairment, bereavement and chronic pain.
HIV-associated neurocognitive disorders (HAND) are most commonly seen in the late symptomatic stage of HIV disease, i.e., “full-blown” AIDS. The Frascati Conference revision of the American Academy of Neurology criteria recognizes two clinical neurocognitive disorders: mild neurocognitive disorder (MND) and HIV-associated dementia (HAD). For a diagnosis of MND, there must be mild neurocognitive impairment in at least two domains of cognitive performance and, at most, a minor functional impairment in daily living, insufficient severity for a diagnosis of HAD, and no other known etiology for the symptoms. For a diagnosis of HAD, there must be severe cognitive impairment in two or more domains, at least a moderate level of functional status impairment due to the cognitive symptoms, a lack of clouding of consciousness (i.e., delirium), and no support for another etiology accounting for these symptoms. Cognitive deficits are expected to be established by formal neuropsychological testing. However, broad screening tests are frequently used in practice. HAD is an AIDS-defining diagnosis and may be the first symptom of infection in as many as 25% of patients. Both MND and HAD have been reported to have declined in incidence by as much as 50% since the introduction of effective antiretroviral therapy (ART). Yet, the frequency of HAND has remained similar to the eras prior to effective ART due to inclusion of the condition known as “asymptomatic neurocognitive impairment” (ANI) (or “sub-clinical” neurocognitive impairment). ANI occurs when there is significant cognitive decline in two or more domains of neuropsychological performance but no significant decline in functional status. It is estimated that ANI, as opposed to MND and HAD, has not significantly declined in prevalence in the HAART era. In fact, ANI may constitute the substrate for an eventual recrudescence of HAND in the future, should resistance to antiretroviral medications become widespread. Screening tests for HANDS include the HIV Dementia Scale (HDS), the International HIV Dementia Scale (IHDS), and the Montreal Cognitive Assessment (MoCA). The diagnosis of a neurocognitive disorder due to HIV presumes that results of a workup for other disorders are negative. Such a workup should include a CT scan or MRI of the head, a lumbar puncture, a screening for metabolic causes, and a review for psychoneurotoxicity of prescribed medications as well as psychoactive substance use. Regarding treatment, HAD has been better studied than either MND or ANI. The CSF-penetrating antiretroviral medications have received the greatest attention; yet to date results to support specific agents are limited. Maraviroc and dolutegravir are of current special interest. Neurotransmitter manipulation is also of treatment relevance. Agents that increase dopaminergic transmission, including the psychostimulants and dopaminergic agonists have been supported. Recent evidence also suggests potential efficacy of the serotonin-active agents, although those effects may be mediated by anti-inflammatory effects and neurotrophic effects rather than alterations in serotonergic transmission.
The Family Institute at Northwestern University, USA
Keynote: Mindfulness: Exploring efficacious methods for constructing protective and resilient factors into the Neurophysiology of the Brain
Time : 10:35-11:15
Cori Costello PhD, LCPC, ATR-BC is a clinical lecturer and a core faculty for the Family Institute of Northwestern University’s online counseling program out of Evanston, Illinois. She has 20 years of experience as a licensed counselor and is a registered and board certified art therapist. Her clinical research explores the integration creativity and mindfulness techniques for increased resiliency in clients with a history of trauma and anxiety based responses.
Statement of the Problem: Mindfulness is a Buddhist concept that is described by Kabat-Zinn as waking up and “living in harmony with oneself and with the world.” It is a term that has been discussed with great frequency in various fields of study including, well-being, mental wellness, and positive psychology. More research is indicating the effectiveness of the mindfulness approach or mindful techniques. But how can the manner in which one thinks impact the neurophysiological aspects of the brain? How can mindfulness be efficaciously utilized within the mental health context with stressed or even traumatized clients? Mindfulness provides for alterations in the neuronal activities of various regions of the brain. Through neuroplasticity, the stressed or traumatized individual can increase growth through enhanced learning and shrink emotional illness and disease of the brain. By the process of incorporating mindful techniques, alterations in the brain can lead to resiliency. Resiliency is defined as the process of adapting well despite adversity, trauma, or tragedy. It means bouncing back from those difficult situations and growing emotionally stronger. Being able to be resilient can produce long-lasting hormonal, neurotransmitters, and central nervous system changes. This presentation seeks to explore effective methods for constructing and internalizing protective factors and resilient behaviors.
Conclusion & Significance: The results of such a mindful approach can be observed in the stressed clients’ body responses to stressful situations. The integration of conscious, non-judgmental attention with focused and controlled breath work has a calming effect on other parts of the central nervous system. There is a reduction in activation of the vagal nerve which carries information from the body into the brain. Once in the brain, the neurons begin firing and wiring, based on the perceived level of energy, such as stress, calmness, or anxiety. Being able to be resilient can produce long-lasting hormonal, neurotransmitters, and central nervous system changes.