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.
- Psyhiatrist|Trauma Counseling|Psychiatry|Geriatric Psychiatry|Counseling Psychology|Child and Adolescent Psychiatry
Location: Hall D
University of Texas Health Science Center, USA
Sonali Sarkar completed her medical school in India. She pursued a career in public health. She completed her Master’s and Doctoral degrees in Public Health from University of Texas school of Public Health in Houston, TX, USA. He is a young investigator, physician researcher and scientist. She has a track record of publications including her recent publication in the World Journal of Psychiatry (impact factor 12) about the Negative Symptoms of Schizophrenia.
Psychiatric polypharmacy is defined as the use of two or more drugs in the treatment of a psychiatric condition. It is widely prevalent in clinical practice. The rationale for polypharmacy is not clear. Etiologic factors are patient demographics (age, gender, race, low socio-economic status), personality disorder, psychiatric conditions (psychosis, schizophrenia, affective or mood disorders), comorbidities, severity of disease, treatment- refractoriness, prescribing practice, inpatient or outpatient setting, concern for reduction of extra-pyramidal and other side effects. Among children and adolescents’ the polypharmacy correlates are age (13 -15 years), male gender, caucasian race, low socio-economic status, medicaid or public insurance, disability, and foster care or child custody outside of biological family. Pediatric polypharmacy is also associated with a diagnosis of behavioral disorder, autism spectrum disorder, ADHD, conduct disorder/oppositional defiant disorder, personality disorder, violence, tics, psychosis, affective and mood disorder. The concurrent administration of multiple drugs increases the risk of drug interactions and adverse effect including morbidity and mortality. Psychiatric polypharmacy is also associated with cumulative toxicity, poor medication adherence and treatment non-compliance. Thus, psychiatric polypharmacy poses a significant public health problem. However, not all polypharmacy is harmful. Polypharmacy is proven to be beneficial in patients with psychotic, mood or affective disorder having dual diagnosis with substance abuse, personality disorder (obsessive compulsive) and comorbid conditions including thyroid, pain or seizure disorder. Combination therapy with different class of drugs antidepressants or antipsychotics with different mechanism of action have beneficial therapeutic consequences. Therefore, a better understanding of physicians’ rationale for polypharmacy, patient tolerability and effectiveness of prescribing strategy is needed to guide practitioners and to inform the development of evidence based treatment guidelines. Here we review the problem of polypharmacy in psychiatric patients, describe possible etiologic factors, associated consequences and provide recommendations for promoting beneficial polypharmacy and reducing harmful polypharmacy in clinical practice.
Charles University, Czech republic
M Grünerova-Lippertova has her research priorities in rehabilitation after stroke, neurotraumatology, early rehabilitation, experimental neuro-rehabilitation and psychotherapy. She was teaching at the University of Cologne: lectures and seminars in the field of rehabilitation. She is head of the Neurological Rehabilitation Centre ANR Bonn. She is also head of the Clinic of Rehabilitation Medicine in Prague and lecturer at the Charles University in Prague in the field of neuro-rehabilitation. Her innovative attitude helps finding new ways in neuro-rehabilitation care.
Statement of the Problem: For a successful social and occupational reintegration first of all the dimension of neuropsychological disturbances and behavioral disorders after brain damage is of major responsibility. Aim of the study was an analysis of behavioral disorders after stroke. Following questions should be answered: how many patients in sub-acute phase after stroke have deficits in behavior- which kind and degree-, are there any differences between the groups of patients with or without limitations in activities of daily living.
Orientation: Retrospective study, 61 patients 0-6 months after stroke were included. Examination of behavioral disorders was made with Neurobehavioral Rating Scale (NBRS), examination of daily behavior with Marburger Kompetenz Skala (MKS). Additional a second NBRS-scoring was made dividing up the patients in two groups: group 1 with patients with no or minor limitations in ADL vs. group 2 with patients with limitations in ADL. These two distributions were analyzed on significant differences with the non-parametrical U-test.
Findings: First of all, already in early phase of disease a huge spectrum of behavioral deficits can be recognized, mainly – next to well known symptoms of depression and fear - limitations in fatigability and attention. Results of the MKS-score of daily behavior showed most of all limits in recreational activities, physical work and mobility (driving a car, using the public transport) – this as well in self-assessment as well in foreign assessment. The hypothesis of a difference in NBRS, made by examination in the groups of patients with or without limitations in activities of daily living with the non-parametrical U-test, was affirmed by a score of p<0.001.
Conclusion & Significance: Behavioral deficits earn, especially in severely affected patients after stroke, special consideration. Early comprehension of individually neuropsychological and behavioral therapy could be expected as an important factor for improvement of reintegration of these patients.
Syracsue University Counseling Center, USA
Carrie Lynn Brown completed her PhD in Counseling Psychology in 2012 from the University of Kentucky and Predoctoral internship requirments from Pennsylvia State University, Counseling & Psychology Services. She is a Staff Therapist at Syracuse Univeristy’s Counseling Center, and also holds the titles of Group Counseling Coordinator, Sexual and Relationship Violence Advocate, and LGBTQ Liaison. She has published 10 papers in reputed journals and serves as an ad hoc reviewer for a number of peer reviewed journals.
The number of trans* identifed college students has increased dramatically in the past decade (ACHA Guidelines, 2015). Despite this trend, the number of college counseling centers, therapists trained and expereinced to provide services to this population remains lacking. More specially, students who are seeking medical transitions require a referral from a mental health provider for these treatments. However, many students lack the resources to receive counseling services off campus and are unable to obtain the referrals necessary for medical transitions (i.e. hormones and/or surgical procedures). Additionally, many states require letters from mental health providers for legal changes of gender identification markers on legal documents, such as driver’s licenses, birth certificates, passports, and social-security cards. This presentation introduces therapists to get an awarness about the Trans* community as well as the means for providing the proper referrals and documentation for gender transition and legal documentation changes. Review of an assessment tool regarding gender transition, as well as the existing literture regarding needs, personal experiences, and directions for future training will be provided. Additionally, exmaples of referral letters and WPATH (World Professional Association for Transgender Health) standards for composing these letter will be reviewed. Challenges, barriers, and consulation opportunitites will also be discused.
Sejal Mehta, MD MBA has her expertise in evaluation, medication management and passion in improving the health and wellbeing of individuals across the lifespan. Her inquisitive look tele psychiatry has become more focused and intense in recent years. She is invested in creating new pathways for improving healthcare. She is looking at this vastly untouched but much needed service to community at large and elderly in particular. She has weighed positive and not-so-positive aspects of this care model and believes that it has a potential to provide easily accessible services in elderlies needing mental health care addressed.
Statement of the Problem: Entire US population is aging. As we have increased number of aging individuals, need for emotional and mental health support is also rising. Several problems have already been identified regarding access to mental health providers. Social, familial, financial constraints also play major role in availability of mental healthcare. New developing field of tele psychiatry has promising outlook for future. Application is being attempted in several different models throughout the country.
Methodology & Theoretical Orientation: Several recent articles have been published discussing pro-cons of tele-application of psychiatry. Psychiatry is a unique branch of medicine that has a potential for being equally effective as in-person session, if done right. There are some pitfalls like unintended HIPPA breach should be carefully managed.
Findings: Tele psychiatry is still in infantile stage. It has lots of potential to be main stream mental healthcare delivery system. Confidentiality and reimbursement are the two major factors that need to be worked out for smooth seamless care delivery.
Conclusion & Significance: Yes, tele psychiatry is a brilliant option to address issues of mental health in geriatric population. In coming years, there will be a clearer picture and t will be emerging with guidelines and protocols for it to be very high standard of care.
Paulina Fuentes Moad, PsyD, is a Boston-based Doctor in psychology, has spent most of her professional life examining the different methods of communication that can help people speak their truth. In radio, she served as a co-host and presenter for the talk show “NAMI Latino y la Comunidad.” She is the Director and Founder of “Vive Con Vida, A.C.,” which provides mental health education via online tools and media. She has trained in different treatment modalities, such as psychodynamic and behavioral therapy, and completed her internship at Massachusetts General Hospital/Harvard Medical School at the MGH Chelsea Healthcare Center.
Contemporary contexts of psychotherapy highlight the importance of ‘safety’ in the therapeutic relationship. It is imperative to understand what ‘safety’ means to our patients/clients, as well as to us as providers, in order to provide the highest quality of care. While the frame and limitations of the therapeutic context provide certain psychological safety, it is also a set up that is bounded to rules and regulations that can challenge the therapy/counseling relationship in particular situations. In order to protect the wellbeing of the general public, ethical bodies implement guidelines and policies that can force psychotherapists to stop their practices, temporarily or permanently, immediately. The shattered sense of safety and transgression to the self, that such traumatic ruptures can unravel in our patients/clients, regardless of their diagnosis or lack of them, is atrocious; particularly in therapies that acknowledge and work with transference and countertransference. The unpreparedness to deal with traumatic ruptures raises questions and concerns about how we can better think and act when dealing with such situations, whether it happens to us, or by being the subsequent therapist of people who have suffered abuse in therapy or traumatic ruptures. This presentation explores hypothetic and real scenarios of people who are victims of abrupt termination of therapy or supervision due to ethical boundary violations. It describes the horrors that, such patients are exposed to and provides clinical guidelines and advice to subsequent therapists and survivors in order to better understand such a pervasive type of trauma that is often concealed.
Government Medical College, India
Title: Determinants of outcome of conduct disorder among children and adolescents in a tertiary level pediatric care setting
Time : 15:00-15:30
Dr. JAYAPRAKASH. R, Ph.D., M.D, DPM, DCH is qualified in both Pediatrics and Psychiatry. He has Ph. D in Child Psychiatry from University of Kerala, ICMR-Foreign Research fellowship in Child Psychiatry and underwent research training in the Institute of ICAMH, Sydney, Australia, Special training in child and adolescent psychiatry from NIMHANS, Bangalore and Training in educational Science for health professionals from NTTC, JIPMER, and Pondicherry. He is a fellow of Indian Association for Child and Adolescent Mental health, Indian Psychiatric Society, Indian Academy of Pediatrics. He has won various academic awards for his research papers, published many research papers on international and national medical journals and also been invited as resource person for various Governmental and non-governmental agencies. He is also working as a health activist, author of various books on health and child mental health and columnist on child mental health in leading daily in Malayalam.
Background: Children and adolescents with conduct disorder (CD) are heterogeneous population with wide variations in range of symptomatology, severity, age of onset, sub types, prevalence and co-morbidity, functional impairment, response to intervention and outcome. Aim: To describe psychosocial and clinical profile, course and outcome and to identify the risk factors which determine poor outcome of CD among children and adolescents.
Methods: Clinic based prospective follow up study. Consecutive 300 children in age group 6-18 years with CD, attended Behavioral Pediatrics Unit OP was collected, intervened and followed up for one year. Initial and final scores of abnormal psychosocial situation, symptom severity and functional level were assessed. Psychosocial and clinical profile, clinical course, clinically significant outcome were studied by descriptive statistics followed by significant test for hypothesis. Determinants of poor outcome of CD were identified by logistic regression.
Results: There was significant male dominance (4:1). Majority was of childhood onset type (76.7%). Main psycho social problems were single parent family (18%), family history of alcoholism (15%), domestic violence (5.3%), both together (22.4%) and psychiatric illness (8.4%). Most common complaint was ‘often argues with adults’ (99.33%). Important co-morbidities were hyperkinetic disorder (66.7%) and mixed disorders of conduct & emotion (17.3%). Clinically significant improvement (50% or more reduction in RBPC score) was observed among 64.51% of study population at the end of follow up.
Conclusion: Determinants of poor outcome of CD were single parent family, family history of alcoholism, domestic violence and psychiatric illness, conduct symptom namely ‘’has used a weapon that can cause serious harm to others’’, co-morbid hyperkinetic disorder, mixed disorders of conduct and emotion, duration of CD and initial severity of symptoms.
Keywords: Behavioral Pediatrics Unit (BPU); conduct disorder (CD); childhood and adolescent onset type of CD; Abnormal psychosocial situation; symptom severity; functional impairment and determinants of poor outcome
Location: Hall D
The Family Institute at Northwestern University, USA
Statement of the Problem: The traumatized client enters the counseling session suffering from the neurobiological effects of psychological trauma exposure. This exposure can have a detrimental impact on the brain functioning levels as well as the homeostasis of the client’s physical body. Stress causes the body to activate its survival mechanisms, which include immune, neuroendocrine, peripheral, hypothalamic-pituitary, and neurochemical systems. The stress response can alter the brain’s functioning and its structure and may not return to pre-stress homeostasis levels. At this point, the client may demonstrate PTSD symptomology or acute stress responses. The purpose of the study is to find clinically sound approaches to relieving and reducing the long term negative effects of activation of the survival mechanism. The goal serving is to strengthen the client’s emotional core. Building resilience, or the process of adapting well in spite of adversity, can be cultivated or enhanced through this biological process. There are clinical approaches that can change these responses such as neuroplasticity which occur at a neuronal level and can alter the neuronal firings. Within the body, the use of mindfulness is one approach that can lead to more awareness and self-reflective learning. A mindfulness based approach to the experiential process provides a holistic activity that encourages non-judgmental awareness to the current moment in time. Creative mindfulness techniques and training can assist the client in building their levels of resiliency to strengthen their neurobiological response to the trauma.
Conclusion and Significance: To compensate and readjust to this process, creative mindfulness techniques are considered as a method for increasing the resilient levels within the client. Building resiliency through creative means can serve to enhance learning as well as increase mental capacities and promote wellness. Creative approaches can be an appropriate method for encouraging the reconstruction of the neural networks of the brain.
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 merging creativity and mindfulness techniques for increased resiliency in clients with a history of trauma and anxiety based responses.