Today’s workshop on the “Latest Treatments of Bipolar Depression”,  by Claudia Baldassano, M.D., was advertised to meet three learning objectives.

1.    Identify bipolar depression.
2.    Strategize the newest medications for bipolar depression.
3.    Explore the role of adjunctive psychosocial treatment in bipolar depression

Dr. Baldassano spent a large amount of time during her 3 hour workshop to help identify bipolar depression (manic-depression in the old days), demographics and common misdiagnosis. She discussed the common differential diagnosis issues, including unipolar depression, ADHD, borderline personality disorder, schizoaffective disorder etc. She pointed out that this disorder is commonly under diagnosed due to the clinician failure to obtain a full family history or explore the possibility of manic or hypomanic events. Bipolar disorder is episodic, versus other disorders that may be chronic. Dr. Baldassano  said the clinician should not accept the “snapshot” presented early in the admission interview but should assemble the whole “photo album” by the end of the interview including the family history as corroborated by family members. She emphasized the importance of including family members in diagnosis and treatment.

Dr. Baldassano mentioned a few interesting tidbits about bipolar disorder from the research. The younger the onset, the worse will be the symptoms over a longer period. She reminded the audience that depression is a “syndrome” not a diagnosis. Depression may occur as a result of many physical and mental health disorders over the lifespan. She also clarified the difference between different types of bipolar disorder, and different manifestation of symptoms based on the age of the patient. She also emphasized the high rate of suicides among bipolar patients (25% above the general population).

On a humorous note, Dr. Baldassano presented a slide that suggested that a “soft sign” of bipolar disorder is someone who wears a red necktie, a red belt and has a red car. After checking my own tie and belt, I was amused to note that others around me were doing the same.

Although medications to treat bipolar depression, have not dramatically changed in the past couple of years, Dr. Baldassano presented research on the effectiveness of medical treatment. She said that many antidepressant medications are at best, ineffective in alleviating depressive symptoms in bipolar disorder, and at worst, may trigger an increase in a manic episode cycle. She presented several research studies, using placebo controls to illustrate her point. Dr. Baldassano did a nice job of describing the research on medical treatments that are effective in treating bipolar depression. She helped to explain the use of lithium. She acknowledged the dangers of this medication, but she presented research to demonstrate it’s effectiveness, especially in the reduction of suicides for this population. She also demystified the use of electroconvulsive therapy (ECT) as currently performed, stating that this is an effective treatment, after medication has failed to alleviate symptoms.

Interesting, but sad, Dr. Baldassano presented research suggesting that despite the reduction of symptoms through current medical treatments, functionality of the patient does not improve at the same rate.

Finally, Dr. Baldassano discussed the effectiveness of non-medical treatments such as Cognitive Behavioral Therapy (CBT) etc.

Her workshop accomplished all three objectives to some extent, but fell a little short on number 3 because of time constraints. As do many presenters, Dr. Baldassano allowed questions throughout the presentation. She did ask that the questions be kept short, and said that she would allow time for more questions at the end. After the third lengthy question in the first 15 minutes, it occurred to me that some in the audience did not understand her request.  I knew that she would not be able to complete her material and I suspected that Objective 3 would suffer. I was right. The material for all three Objectives was in her handouts but she ran out of time.

Although Dr. Baldassano answered all questions, some of the questions were very basic or tangential to the topic and did not appear to be well thought-out. These interrupted the flow of the workshop. Other questions were right to the point and demonstrated an intermediate or advanced level of knowledge of the topic. These enhanced the workshop.  Perhaps the presenters in the future should advertise the level of these workshops for Basic, Intermediate, or Advanced audiences. What do you think?

On December 7th from 8:30 to noon, FCP is hosting a workshop at the Health and Wellness Center in Warrington, PA. Please log on to www.fcpartnership.org  to learn more and register for this event.

Latest Treatments of Bipolar Depression

In this informative presentation, participants will learn how to identify bipolar depression and gain an understanding of the latest treatments. The role of traditional antidepressants in bipolar depression and when it is appropriate to use these agents will be discussed. The workshop will also cover the use of mood stabilizers and antipsychotic medications in the treatment of bipolar depression, and present novel treatments, such as Transmagnetic Stiumulation and psychosocial treatments.

Workshop Objectives

At the end of this activity, the learner will:

• Identify bipolar depression.
• Strategize the newest medications for bipolar depression.
• Explore the role of adjunctive psychosocial treatment in bipolar depression.

Presenter: Claudia F. Baldassano, M.D. is Director of the Bipolar Outpatient Resident Teaching Program and Assistant Professor of Psychiatry at the Hospital of the University of Pennsylvania School of Medicine. Formerly the Medical Director of Reserach at Friends Hospital, Dr. Baldassano has spoken at the American Psychiatric Association, American Academy of Clinical Psychiatrists and her research has been published in the American Journal of Psychiatry, Canadian Journal of Psychiatry, Psychiatry Review, and Comprehensive Psychiatry.

Ethics and Record Keeping

Aside from today’s talk on “Ethics and Record Keeping Practices in
Pennsylvania for the Mental Health Professional”, Dr. Allan Tepper put on a great performance in
his Workshop. He reminded me of a cross between Jerry Seinfeld, the comedian,
and Chef Robert from television. I’m sure that you all know Jerry Seinfeld, a little
sarcastic, but a very funny stand-up comedian. Chef Robert is a no nonsense
chef and businessman who visits selected restaurants to tell them what they are
doing wrong and what they can do better. Dr. Tepper presented a reality check,
including risks for noncompliance for record keeping and confidentiality. Just as Chef Robert tells it like it is for restaurant owners, Dr. Tepper told it like it is for licensed Mental Health
Professionals.

Regardless of the profession, few people enjoy hearing what
they might be doing wrong and what they could be doing better. Dr. Tepper asked some pointed questions of the audience on ethical issues regarding their practice. He did a nice job of pointing
out legal and ethical issues to their response without embarrassing anyone. His
sense of humor often saved the day, or at least the moment.

Dr. Tepper is an attorney, and a psychologist. He was
able to switch hats as needed during his workshop. He reminded the audience
that his topic was limited to record keeping and confidentiality. I have
previously heard Dr. Tepper speak on many ethical and legal topics in Mental
Health. Apparently, some of the audience also appreciated his broad expertise,
as the questions were sometimes beyond the scope of this workshop. He briefly
answered the question, and adroitly steered his response back to the topic.

In short, Dr. Tepper’s Workshop met his objectives. His presentation was not “high tech” (He used a flip chart! Thank goodness, he did not allow Power Point to get between him and his audience). The three hours went by very quickly and I learned a few things. Between the humor, his presentation addressed the Therapist –Client relationship (relationship beginning and end documented.), the expected content of the records (handout provided, or contact your licensing Board), Maintenance of
records (e.g. All Boards expect five years after last session but Insurance providers may expect up to 10 years), He also discussed the the recent updates to the “Duty to Warn” obligation. This is a complex issue regarding a client who threatens someone outside of the therapeutic relationship. (Emerich case law decision, PA 1999).

Dr. Tepper advised all licensed MHP’s to frequently check their Board’s Websites for updates on new statutes and regulations.

Adolescent Risk Taking Behavior

This was a great workshop today from Dr. Bradley Connor. His topic, “Risk Taking in Adolescence” included three learning objectives: 1. Demonstrate an etiological model of risky behavior in adolescence. 2. Identify in adolescents, when risky behavior becomes pathological. 3. Evaluate treatment modalities for treating pathological risky behavior for adolescents.

At the beginning of his presentation, Dr. Connor said that he talks fast. Boy, did he ever! My brain was on 78 RPM during his presentation! (that’s a very fast, old record player speed for the youngsters, under 60 years old). The good news for those of us able to keep up with his talk is that he presented a wealth of information in the three hours allotted for his workshop.

Dr. Connor presented research that discussed genetic and environmental etiology for risky behavior in adolescents. Most compelling was his ”Dual Process Model “ of risk taking behavior. He presented research that suggests that the “Mesocorticolimbic Dopamine Pathway” (It feels good!), part of the brain develops before the “Cognitive Control Pathway” (Is the risk worth the cost!). His research suggests that adolescents may take risks to feel excitement, before they are able to make a decision about the consequences. He pointed out that the full cognitive decision making process is typically not fully developed until age 25 for the adolescent.

Dr. Connor did a very nice job of defining the components of risk taking behavior. He discussed impulse control problems, and sensation seeking as separate issues. He described risky behavior related to sensation seeking as a lifelong personality trait that exits throughout the lifespan and across all cultures. Risk taking behavior is higher among boys than girls. His research suggests that this may also be a result of social influence to expect boys to take more risks than girls.

Dr. Connor’s talk showed that genetic and environmental factors play a role in adolescent risk taking behavior. Cerebral hormones such as dopamine, and the ability of the brain to process these chemicals is genetic, If the individual has difficulty metabolizing dopamine (genetics) then they are more sensitive to risk taking behavior. His research also suggests that environmental trauma such as physical, sexual abuse or sustained emotional trauma may contribute to risk taking behavior in adolescence.

Treatment methods that he suggested include: Prevention – Target children who show risky behavior in early years (elementary school), start communication and education. Open child-parent communication, offer alternative thrill seeking.Diversion-Difficult to replace learned habits of the“feel good” response for teenagers. Replace habits with alternative “feel good”activities such as adventure programs, sports programs.Motivation Enhancement Techniques to encourage behavior change, along with Cognitive Behavioral Therapy are effective in helping adolescents to reduce risk taking behavior.

FCP 2011 Fall Workshops!

On Wednesday, November 2, 2011, FCP will begin the 2011-2012 Behavioral Health Workshops .
The FCP Fall 2011 Workshop series will feature three workshops.

November 2, 2011
Morning Workshop - 8:30 - 12:00 a.m. - Risk Taking in Adolescence

As children enter adolescence there is a significant increase in their engagement in risky behavior, such as experimenting with drugs, driving recklessly, and engaging in risky sex. These behaviors often lead to devastating outcomes, including drug dependence, incarceration, serious injury, and contraction of sexually transmitted diseases. This workshop will help participants identify when risky behavior becomes pathological. It will also cover the genetic, psychological, and environmental etiology and the treatment of pathological risky behavior.

Presenter: Bradley T. Conner, Ph.D. is Assistant Professor, Department of Psychology at Temple University. The recipient of many awards and honors, Dr. Conner’s research involves examining impulsivity, sensation seeking, treatment motivation, and risk taking behavior. He helped develop Temple University’s Addictive and Risky Behaviors Laboratory, and he has been published in the Journal of Anxiety Disorders, Clinical Psychology Review, the Journal of Substance Abuse Treatment, and Psychiatry Research. Dr. Conner has presented at the Institute for the Study of Child Development, the American Psychological Association, and the Association for Behavioral and Cognitive Therapies.
At the end of this activity, the learner will be able to:
Articulate an etiological model of risky behavior in adolescents.
Identify, in adolescents, when risky behavior becomes pathological.
Evaluate treatment modalities for treating pathological risky behavior in adolescents.


Afternoon Workshop - 1:00 - 4:00 p.m. - Ethics and Record Keeping Practices in Pennsylvania for the Mental Health Professional

This interactive, practical workshop will focus upon recordkeeping practices and Licensing Board Rules and Regulations that impact mental health professionals in Pennsylvania. Topics include content of records, what constitutes the record, record retention practices, the release of records, response to subpoenas and court orders, child abuse reporting requirements, and the duty to protect by warning. The workshop includes a discussion of case management issues and concerns, and handouts specific to Pennsylvania.

Workshop Objectives

At the end of this activity, the learner will be able to:
Describe Licensing Board record keeping rules and regulations.
Classify specific information that is required to be maintained in a patient's record.
Infer a working understanding of record access and release issues.

Presenter: Alan Tepper, J.D., Psy.D. is a renowned psychologist/attorney specializing in representing mental health and medical professionals in licensing and disciplinary board proceedings. He also serves as an expert witness in forensic matters, with an emphasis in criminal, civil, and professional ethics matters. Dr. Tepper’s dual training, coupled with his trial and clinical experience, helps bring an additional element to the review, analysis, and presentation of ethical issues for mental health professionals.

December 7, 2011

Morning Workshop: 8:30 - 12:00 a.m. - Latest Treatments of Bipolar Depression

In this informative presentation, participants will learn how to identify bipolar depression and gain an understanding of the latest treatments. The role of traditional antidepressants in bipolar depression and when it is appropriate to use these agents will be discussed. The workshop will also cover the use of mood stabilizers and antipsychotic medications in the treatment of bipolar depression, and present novel treatments, such as Transmagnetic Stiumulation and psychosocial treatments.

Workshop Objectives

At the end of this activity, the learner will:
Identify bipolar depression.
Strategize the newest medications for bipolar depression.
Explore the role of adjunctive psychosocial treatment in bipolar depression.

Presenter: Claudia F. Baldassano, M.D. is Director of the Bipolar Outpatient Resident Teaching Program and Assistant Professor of Psychiatry at the Hospital of the University of Pennsylvania School of Medicine. Formerly the Medical Director of Reserach at Friends Hospital, Dr. Baldassano has spoken at the American Psychiatric Association, American Academy of Clinical Psychiatrists and her research has been published in the American Journal of Psychiatry, Canadian Journal of Psychiatry, Psychiatry Review, and Comprehensive Psychiatry.

Thanks Dr. Levy - Greeart Workshop in March, 2011

Dr. Dan said...
Great workshop today! Dr. Suzanne Levy from the Center for Family Intervention Science at the Children’s Hospital of Philadelphia talked about Attachment Based Family Therapy (ABFT). Although her workshops are usually one or two days, she managed to squeeze into three hours, enough information to intrigue me to obtain more education about this topic. Dr. Levy’s presentation was dynamic and she was very knowledgeable. I especially enjoyed her brief explanation of the research and the theory behind this approach to family therapy. As I looked around the room, I noticed several folks whose training began in the 1960’s and early 1970’s, much as mine did. As she spoke, I recalled those early days with Dr. Sal Minuchin at the Child Guidance Clinic and the introduction of “Structured Family Therapy”, with nostalgia. Dr. Levy’s discussion of the research reminded us that family therapy techniques, enhanced with attachment theory etc, have evolved into an “empirically based” treatment approach.

I thought that Dr. Levy did a nice job of presenting the ABFT overview, with both benefits and risks of the family described as factors in the treatment. Although not intending to make the audience experts in ABFT, her presentation of the “Five Tasks” hit the mark to help us appreciate the “guidance” provided by the model, without the “cook-book” approach of other empirically based psychotherapy techniques (Honestly, do you always follow the rules of your “theory” of choice?). Dr. Levy’s emphasis on intentionality at each session to stay focused on the goals, allows use of clinical judgment (and the many years of training) to choose the appropriate strategies to reach the goals. I don’t know about you, but this point helps me feel more like a professional and less like a technician.

Dr. Levy was not trying to “sell” this technique to all. She acknowledged that the research supports success with this approach to a selected, but very large population of families (including single parent, alternate caregivers and other nontraditional families) with adolescents. Research is being conducted with families of younger children. Dr. Levy was quick to acknowledge that this technique is not for everyone. My understanding of her comments excluded adolescents or parents with intellectual disability or other developmental problems, serious mental illness, drug or alcohol addiction, and families where physical abuse is prevalent. In short, this treatment approach appears most effective when both the adolescent and the caregiver are capable of insight. Also, limited to therapists with a tolerance of raw emotions.

I can always tell when the audience is satisfied with a workshop by the quiet attending to the speaker and the appropriateness of questions. The audience was quiet throughout her talk. Questions were relevant and did not detract from her presentation. She responded to all questions thoroughly and checked back with each person to make sure. The audience appeared satisfied with Dr. Levy's Presentation presentation.

March 2, 2011 2:55 PM

Great Pediatric OCD Workshop

This was a great presentation today by Dr. Martin Franklin on Cognitive Behavioral Treatment of Obsessive Compulsive Disorder in children and adolescents. This was his return visit to the Foundations Community Partnership behavioral health lecture series by popular demand. Dr. Franklin presented last fall on “Trichotillomania” in adolescents. Today’s workshop was a full house. He was welcomed back.

Today’s presentation was both enjoyable and informative. This was one of the few times where I’ve seen the audience readily postpone a break in the middle of the three hour workshop, to learn more about the presenters treatment techniques. The 3 hours went by quickly. His workshop included the necessary elements including: Phenomenology and description of the disorder, assessment instruments and strategies, research to support the theory and treatment, and an overview of treatment techniques. He did not simply read his slides, he told humorous but very relevant stories, provided case examples and included research studies. He quickly came back to his point for each item. Overall, I thought that his presentation was well balanced, and all elements were covered. He really knows this stuff!

Sometimes, I attend workshops where the presenter is stilted, defensive, or awkward at handling questions. In some cases, questions from the audience appear as an attempt to “hurry” the presentation, with the presenter saying “I will get to that later.” All questions today appeared relevant and current to the items being presented. Dr. Franklin listened carefully and answered each question fully. He also allowed questions at the end. Questions did not interrupt the flow of his workshop. He was gracious and thorough in response to questions. The audience was satisfied.

As usual, I learned a bunch of things from Dr. Franklin this morning. His focus on the Obsessive Compulsive Cycle (Obsession-Distress-Compulsion-Relief) is important. He reiterated that his treatment will increase obsessive thoughts and distress, while limiting or eliminating compulsive behavior. Tolerating and habituating to the obsessive thoughts and eliminating the compulsion is essential in treatment. He described many creative techniques to increase exposure to the obsessions that need to be challenged without the relief provided by the compulsive behavior. At one point during Dr. Franklins presentation, I almost thought that it would be fun to be a kid with OCD, so I could participate in his treatment (I said almost!). Dr. Franklin pointed out that these techniques also work with children and others who do not have high ability for insight. He said that the clinician must work hard to find creative but concrete opportunities for exposure to obsessions, because the person may not recognize that the obsessions and compulsions are unreasonable. As usual with CBT research, combination of medication (SRI’s) and CBT treatments appear most effective.

Dr. Franklin mentioned that research often explains very complex things in complex ways. He was trying to make it simple in his presentation. As the former college linebacker and current coach, father, Philly sports fan, and everyday guy that he appears, Dr. Franklin did just that. As he stated, his daughter, at age six did better. She described his treatment methods in a couple of sentences.

“Blah, blah blah, do the thing you’re afraid of.
Blah, blah, blah, the more you do it, the easier it gets.”

Any other thoughts?