Chris Aiken, MD

Deepen your empathy in part III of our Wounded Healers podcast: https://lnkd.in/eJbEfEyr Special appearance by the archetypal Carl Jung (who made the art below) #psychiatry #psychotherapy #psychology #psychoanalysis #therapy #mentalhealth #stigma

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Dysphagia has significant impact on patients AND on caregivers. Remember that caregivers spend much time with patients (and their problems) than do clinicians! A good dysphagia rehabilitation program should incorporate caregiver input and activities. MDTP does just that. Home program components (more specifically out of therapy program components) are included in MDTP and involve caregivers working with patients. This does not increase treatment burden but accelerates positive outcomes! Want better outcomes (and support)? MDTP www.fdi2.com New courses being added monthly.

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For consideration in geriatric care.

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Accelerated iTBS is a rapid-acting TMS that stacks 10 sessions/day over a week. It has powerful effects for treatment resistant #depression (FDA approved as SAINT). Here is its first sham-controlled trial in treatment-resistant #bipolar depression: https://lnkd.in/evCqAusf Benefits were large, but trial was small (24)

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What is sensorimotor psychotherapy? “Unlike conventional psychotherapy which focuses largely on verbal cognitive processes, the focus of (somatic psychotherapies) is on the functioning of the deeper, regulatory, levels of the nervous system, in particular the autonomic nervous system; the emotional motor system ; the reticular arousal system and the limbic system” (Payne, Levine and Crane-Godreau) Although this article is focused on somatic experiencing rather than sensorimotor psychotherapy, the approach shares a lot in common with sensorimotor psychotherapy and explains many of the principles underlying these approaches illustrated with a composite case example. https://lnkd.in/e2UTZaup “When a person is exposed to overwhelming stress, threat or injury, they develop a fixed and maladaptive procedural memory that interferes with the capacity of the nervous system to respond flexibly and appropriately. Trauma occurs when these implicit memories are not neutralised.  The failure to restore flexible responsiveness is the basis for many of the dysfunctional and debilitating symptoms of trauma”.  “In somatic psychotherapies, biological completion and autonomic discharge occur in controlled and manageable steps” https://lnkd.in/e7iYMwq7

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Cariprazine (Vraylar) favored for negative symptoms of #schizophrenia in this new unfunded review: https://lnkd.in/eU7ufzwD 1. Superior to risperidone in negative symptoms 2. For positive symptoms, similar efficacy to other antipsychotics, but lower risk of metabolic extrapyramidal (EPS) side effects 3. #Akathisia is its most common EPS effect, though less than aripiprazole's More on how to treat negative symptoms: https://lnkd.in/e2eb35HC #psychiatry #mentalhealth

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In our latest video, Dr. Malik sheds light on a crucial fact about Transcranial Magnetic Stimulation (TMS) therapy: Did you know that TMS has been FDA-approved for the treatment of depression since 2008? 🌟 Join Dr. Malik as she explores the journey of TMS from its approval to its current status as a leading treatment option for depression. 👉Learn about the benefits, effectiveness, and why TMS is a game-changer for mental health. WE ARE HERE FOR YOU! 🌿 📲 847.783.0307 https://lnkd.in/gYX3qje

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Individuals, who are at clinical high risk of developing psychosis CHR-P while they expose to early psychological interventions, which include, not limited to, cognitive-behavioral therapy, reduction high risk family and social stressful atmospheres, social skills training, humanistic and interpersonal psychotherapies, early signs and CHR-P will be improved, preventing real episodes of diagnosed psychosis, therefore early psychological interventions EPI need to be on clinical area as a first line treatment for CHR-P research and clinical guidelines say, though antipsychotic medications could be used, but unwanted side effects occured, thus they are not recommended as a first line treatment, research also says, however clinicians need to be well trained to handle early psychological modalities of interventions for CHR, based on clinical case conceptualization, many thanks for the American Psychiatric Association for elaborating such a clinical essential matter.

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Psychiatry is at a confusing juncture. Its practitioners focus mainly on biological remedies, leaving psychotherapy to others. Roughly half of psychiatrists have left the healthcare system and accept no insurance reimbursement. Their training and experience surpass others in the behavioral field, but many have abandoned leadership roles for the comforts of private practice. A few eminent psychiatrists (e.g., Tom Insel) are grappling with a broader focus and acknowledging the limitations of the medical model for solving behavioral problems.  One critical limitation involves severe mental illnesses. Medications can reduce symptoms, the main goal in a medical framework, but patients also need psychosocial goals like recovery and resilience. The underlying dilemma is conceptual. Psychiatry embraced being a medical specialty during the 1980s, and biological psychiatry makes a biopsychosocial orientation less of a priority. The behavioral field suffers from this. It needs psychiatry to revisit a biopsychosocial orientation, help shape all types of care, and represent the field’s needs within the larger healthcare industry. This last point is critical. Healthcare is a medically dominated industry, and the behavioral field needs its physicians to step up as leaders. Our field will accomplish more if each discipline works together. https://lnkd.in/gUKqqCH2

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We focus on fully formed problems in healthcare, partly due to the medical model’s grounding in diagnosis. Treating a disorder differs from addressing its progression. This is relevant for substance use disorders (SUDs), highly stigmatized conditions that receive little specialized treatment. We should shift focus upstream to intervene earlier. Given a modicum of success, this effort pays for itself. SAMHSA’s annual survey reveals that while over 46 million adults have SUDs, fewer than 10% get treatment. Moreover, SUDs complicate every other illness and raise the total cost of care. Consider one strategy for intervening early in a low-stigma healthcare setting:  using motivational interviewing (MI) in primary care to plant seeds for behavior change. This approach is potent because primary care fosters long-term relationships, and a series of MI conversations over time could boost results. Skilled therapists should lead this work. Therapists use MI to address ambivalence about change. PCPs can learn to utilize these skills as well. Yet, the problem is more structural than clinical. Significant results will accrue only when behavioral staffing in primary care increases substantially—we should aim to have all behavioral care begin there. See more 200-word essays on my website: https://lnkd.in/gF-UnVWS

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The burden of measurement is real, and it affects more than just clinicians’ workload. Learn more about practical strategies for alleviating the measurement burden on clinicians across healthcare roles while improving patient care delivery in our upcoming Member-exclusive webinar! Register ▶️ https://bit.ly/3KVw0Cw

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Elizabeth Wassenaar, MS MD, our Regional Medical Director, was recently featured in this Psychiatric Times article examining the comorbidity of eating disorders and addiction and the potential impact of complexity using GLP-1 agonist medications in treatment. "GLP-1 receptor agonists work in the brain to suppress appetite and increase feelings of fullness, which is how they act for individuals who take them to manage their type 2 diabetes. We are beginning to notice patients who are vulnerable to disordered eating and/or relapse of their eating disorder following the initiation of GLP-1 receptor agonist medications." Read more of her insights here: https://bit.ly/3zufW84

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Last year, methylphenidate (20 mg/day) improved apathy but not other neuropsych symptoms in the 6-mth Apathy in #Dementia Methylphenidate Trial (ADMET2) (n=199) Now comes an analysis of side effects: https://lnkd.in/dEgv2hcd 1. Weight loss (3 lb) 2. Falls (10% vs. 6%) 3. No insomnia, hypertension, or cardiac events #neurology #psychiatry

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Rapid Metabolism of Non-Clozapine Antipsychotics and Its Impact on Treatment Before Clozapine Initiation 🚨 Implications for Diagnosis and Treament of Treatment Resistant Schizophrenia ✅ Retrospective Analysis 📚 👉272 patients using non-clozapine antipsychotics (aripiprazole, risperidone, olanzapine, or quetiapine) 👉Dose-adjusted serum concentration (CD) measured 👉Patients were assigned into low CD (LCD) and normal CD (NCD) subgroups Key Findings:👇 👉40.4% of patients exhibited low dose-adjusted serum concentrations (CD) of their antipsychotic drugs. 👉Metabolic Ratios: LCD patients had significantly higher metabolic ratios compared to normal CD (NCD) patients, particularly for olanzapine (1.5-fold), quetiapine (3.0-fold), and risperidone (6.0-fold). * Metabolic ratio was estimated by the ratio of the metabolite (nmol/L) and parent drug concentration (nmol/L) 👉Impact of Smoking and Genetics: Metabolic differences for olanzapine and risperidone were independent of smoking habits and CYP2D6 genotype. 👉Despite higher doses, LCD patients frequently had subtherapeutic drug levels, especially notable for olanzapine and quetiapine. “Antipsychotic therapeutic drug monitoring with metabolite analyses may be valuable for clinical decision making of treatment-resistant schizophrenia and initiating clozapine treatment.” Paper 👉 Lenk et al , Rapid Metabolism Underlying Subtherapeutic Serum Levels of Atypical Antipsychotics Preceding Clozapine Treatment: A Retrospective Analysis of Real-World Data. CNS Drugs. 2024 #clozapine #olanzapine #antipsychotics #schizophrenia

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Not sure how to approach Lupus in your practice? While estheticians can't diagnose or treat lupus, it's crucial to recognize when to refer clients to healthcare professionals. Lupus is an autoimmune disorder with many systemic symptoms, but there are external signs to watch for. Stay informed and provide the best care! #lupus #esthetician #txesthetician #integrativeesthetics #txskincare https://lnkd.in/gn5b3H8u

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