Presentation on Setting up a Ketamine Assisted Psychotherapy Practice by Veronika Gold, LMFT and Gregory Wells, PhD at Exploring Psychedelics, Ashland, Oregon, May 34-25, 2018
Presentation on Setting up a Ketamine Assisted Psychotherapy Practice by Veronika Gold, LMFT and Gregory Wells, PhD at Exploring Psychedelics, Ashland, Oregon, May 34-25, 2018
THE ROLE OF PSYCHIATRISTS IN RENAL TRANSPLANT UNITS.pptxAyooluwaOlaniyi
Psychiatrist role in organ transplant unit is central, as the whole structure and functionality of the team is held together by consultation liaison psychiatry team.
Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
AnnMarie O'Brien, Social Worker at The Royal, presented on the signs and symptoms of depression, risk factors for depression in women, and what we can do about it.
Depression is a debilitating mental disorder affecting a great number of individuals. This presentation covers most common causes of depression, its symptoms and most effective treatments. Alcohol, drugs, and risk of suicide are also addressed. Presentation created by Lucia Merino, LCSW for Women in Transition,a weekly support group offered at Kaiser Permanente Adult Psychiatry -Cupertino, CA. 2014
Evidence-Based Treatments and Integrative PsychotherapyKevin Rushton
A comparison of reactions within the mental health treatment community to the "Dodo Bird Verdict", the idea that virtually all treatment modalities are comparable in efficacy.
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
In this community lecture, Summit Medical Group practitioners share insights regarding the warning signs of depression and offer options for treatment, including therapy and medication.
Vortioxetine Brintellix Trintellix Clinical and Pre-clinical DataAmit Vishwakarma
Vortioxetine is indicated for the treatment of Major Depressive Disorder
Vortioxetine has several novel pharmacological properties
Vortioxetine is different from SSRIs/SNRIs due to direct effects at 5-HT receptors
In addition to being a SSRI, vortioxetine has modulating activity of a variety of serotonin receptors
Cognitive improvement is novel in series of antidepressant drugs
THE ROLE OF PSYCHIATRISTS IN RENAL TRANSPLANT UNITS.pptxAyooluwaOlaniyi
Psychiatrist role in organ transplant unit is central, as the whole structure and functionality of the team is held together by consultation liaison psychiatry team.
Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
AnnMarie O'Brien, Social Worker at The Royal, presented on the signs and symptoms of depression, risk factors for depression in women, and what we can do about it.
Depression is a debilitating mental disorder affecting a great number of individuals. This presentation covers most common causes of depression, its symptoms and most effective treatments. Alcohol, drugs, and risk of suicide are also addressed. Presentation created by Lucia Merino, LCSW for Women in Transition,a weekly support group offered at Kaiser Permanente Adult Psychiatry -Cupertino, CA. 2014
Evidence-Based Treatments and Integrative PsychotherapyKevin Rushton
A comparison of reactions within the mental health treatment community to the "Dodo Bird Verdict", the idea that virtually all treatment modalities are comparable in efficacy.
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
In this community lecture, Summit Medical Group practitioners share insights regarding the warning signs of depression and offer options for treatment, including therapy and medication.
Vortioxetine Brintellix Trintellix Clinical and Pre-clinical DataAmit Vishwakarma
Vortioxetine is indicated for the treatment of Major Depressive Disorder
Vortioxetine has several novel pharmacological properties
Vortioxetine is different from SSRIs/SNRIs due to direct effects at 5-HT receptors
In addition to being a SSRI, vortioxetine has modulating activity of a variety of serotonin receptors
Cognitive improvement is novel in series of antidepressant drugs
BEATING THE BLUES: PRACTICAL SOLUTIONS FOR A COMMON HEALTH PROBLEMSummit Health
Lecture on depression, including information about causes, symptoms, and treatment. Learn to distinguish depression from feeling down. Find out how practical techniques can help improve short-term and long-term blue moods, sadness, and depression.
adjustment disorders and distress in Palliative careruparnakhurana
Psychosocial disorders are very common in patients with advanced malignancies with the commonest being anxiety and depression. Early identification and treatment will help in improving the quality of life of patients and their families and increasing compliance towards treatment and self care,
plain for treatment of patient with chronic pain, psychiatry and psychology are two approaches very important to have a proper treatment for pain disorders
We live in an era of medication, but what else can we do to improve mental health? Are we excessively prescribing, can we approach medicine in a more holistic way?
Presentation for our intermediate workshop in Ketamine Assisted Therapy, focusing on Somatic Work, Transpersonal Techniques, Transference, and Counter Transference.
Talk on the Healing Potential of Non Ordinary States of Consciousness, especially states elicited by the use of MDMA and Ketamine in psychedelic assisted therapy.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. Introduction to Ketamine-Assisted Psychotherapy
San Francisco Psychological Association May 30, 2020
COPYRIGHT 2020
POLARIS INSIGHT CENTER – SAN FRANCISCO
Gregory Wells, Ph.D. & Harvey Schwartz, Ph.D.
2. POLARIS INSIGHT CENTER
SAN FRANCISCO
Ketamine-Assisted Psychotherapy, Training & Consultation
4257 18th Street SF, CA 94114
6. BACKGROUND and HISTORICAL PERSPECTIVES
1. History of Ketamine
2. History of Psychedelic-Assisted Psychotherapy and Psychedelic
Medicine
3. Diverse Models: Biological/Medical – Psychological –
Transpersonal/Shamanic
4. MDMA – Psilocybin - Ketamine
5. Influence & Legacy of the War on Drugs
6. Influences on the Development of the KAP protocol/model
7. Treatment Indications
◇ Treatment Resistant Depression
◇ Anxiety Disorders & OCD
◇ PTSD
◇ Addictions
◇ Psycho-spiritual growth process
and existential distress
◇ Pain Disorders
Contraindications
◇ Severe Personality Disorders
with caution
◇ Delusional Disorder
◇ Bipolar with caution
◇ Untreated HTN
◇ Cardiovascular Disease
◇ Kidney disease or impairment
8. Ketamine’s Signature (1)
• Rapid onset, Rapid metabolism & Excellent safety profile
• Dose-related access/flexibility for therapeutic process – Psycholytic &
Psychedelic
• Reduction/Elimination of external stimuli and sensations &
heightening of internal visual experience
• Preservation of the observer-self, observing-ego, witnessing-self
• Outside of bounded time and space – different levels and depth of
altered state experience
9. Ketamine’s Signature (2)
• Spaciousness of mind, Freedom of mind, Sense of movement and
music essential
• Reduction of verbal thinking and processing and connection to
symbolic realm of experience
• Reduction in negative, obsessive, and self-referential thinking
• Experience of surrender, formlessness, love, interconnectedness,
humility, awe, gratitude and union with Divine Love, Divine Mind
• NDE, OBE, Archetypal Experiences/Encounters
• Navigating the range of ecstatic to challenging experiences
12. Neurobiological Mechanisms of Action
• Increased Glutamate: Ketamine is an NMDA (N-methyl-D-aspartate)
glutamate receptor antagonist: transmission –prefrontal cortex
• “Master Switch:” Glutamate - most abundant and important excitatory
neurotransmitter, aka “Workhorse of the Brain”
• Glutamate Roles: Pain, Anxiety, Inflammation, Stress, Fear Conditioning,
Depression, Neurological/Psychological Resilience, Learning, Memory
• Changes in cell signaling, synaptic plasticity and strengthens neural
circuitry
13. Neurobiological Mechanisms of Action
• Reverses Neuronal Atrophy
• Supports Synaptogenesis & dendrite spine morphogenesis
• Strengthens synaptic connections – learning/memory consolidation
• Reduces brain activity in areas involved in rumination and self-monitoring
• Disrupts DNF (default mode network), creates hyper-connectivity
• Regulates downstream to other neurotransmitter systems
14. RISKS and SIDE EFFECTS
• Nausea and Vomiting
• Transient increase in BP and heart rate
• Dizziness, disorientation, blurred vision, headache, dry mouth
• Increase or decrease in energy (fatigue or restlessness) (rare)
• Neurotoxicity- only in chronic and high dose usage
• Potential for tolerance & abuse and dependence
• Urethral cystitis and bladder pain with chronic and long term use
• Non-compliance
16. Intake and Treatment
Planning
• Collaborative - Physician, Therapist, & Patient
• Review medical history, screen for contraindications and
determine candidacy
• Completion of assessment measures
• Treatment plan and dosing strategy is determined
collaboratively
17. Psychotherapeutic Model
• Emphasis on Set, Setting, Music, Interpersonal Connection
• Therapeutic relationship as primary container - physician
and medicine support the psychotherapy
• Preparation and Integration built into treatment plan
• Non-Ordinary States of Consciousness are held as crucial
for healing and seen as meaningful
• 3-hour sessions allow for plenty of time to process material
19. Preventing Medical
Emergencies
• Patient blood pressure taken before sessions, but no
continual monitoring
• Physician or RN stay onsite during IM sessions for
minimum of 1 hour after injection
• Therapists BLS certified
• To date there have been zero medical emergencies
20. Treatment Approaches
Low Dose
◇ Empathogenic Experience - Trance-
like state
◇ Psycholytic Therapy
◇ Allows for ongoing communication
◇ Induces mild dissociation, mildly
anesthetic, yet present and relaxed
state
◇ Generally low-risk; low side effects
Moderate to High Dose
◇ Out of Body Experience (OBE)
◇ Near-Death Experience (NDE)
◇ Ego-Dissolving Transcendental experience
◇ Moderate to profound dissociative sedation,
may be similar to high dose classical
psychedelics
◇ Potential for side effects; not suitable for all
clients
21. Dosing Strategy
• All patients start with low dose. Allows for patient to gently and slowly
experience the ketamine space and allows therapist to monitor response.
Minimizes anxiety.
• Initial sessions:
• SL: 100-200mg
• IM: 0.4-0.8mg/kg
• Subsequent sessions:
• SL: 200-400mg
• IM: 0.8-1.8mg/kg
22. Sublingual Lozenges
• Office relationship with Koshland Compounding Pharmacy
• Introduces patients to KAP while minimizing medical
invasiveness
• Allows for at-home use in some patients
• Empowers patients in their own healing
• Can be used in conjunction with IM administration
23. Treatment Protocol for Lozenge Sessions
◇ Medical and Psychological Assessment and Intake Session
◇ 1-2 in office sessions with low-moderate dose lozenges
◇ Education and guidance to prepare for at-home low dose sessions
◇ 6 at-home low dose sessions over 2-week period
◇ Therapist contact after every at-home session
◇ Patient required to have own therapist for weekly sessions
◇ Maintenance phase: less frequent sessions and/or IM sessions
24. Intramuscular
Injection (IM)
• Dosage is determined via active collaboration between
physician, therapist, and patient
• Better tolerated by some patients
• Allows for more precise dosing and stacked/titrated dosing
25. Safety and Monitoring
• No automatic refills
• Patients are required to communicate with
therapist after every at-home session
• Regular office contact required and cases are
reviewed at monthly case conference
• Planned use of mood monitoring apps in future
• Ongoing use of assessment measures
26. CHALLENGES AND CONTRAINDICATIONS
Medical Contraindications
Psychological Contraindications
Insufficient preparation
Resistance to Integration
Resistance to letting go
Resistance to facing problems
Inadequate collaboration with
other providers
28. Empathogenic
Psycholytic
Out of Body Experience
Trance
Perinatal Matrices
Near Death Experience
Ego Disssolution
Moderate Dose
High Dose
Low Dose
29. Preparation
• Medical and psychological effects of the
medicine are described and questions
addressed
• Encourage trust in inner healing intelligence
• Expectation management - not a magic bullet
• Importance of intention, set, setting, integration
34. “I have died. I now see myself walking out of my body
and now I am seeing a light tunnel in the sky , it is
exquisite, experiences from my life passing by..”
Re-entering her body she said “I never felt so
comfortable and embodied, I feel renewed energy,
motivation, and desire for living my life fully. I cannot
wait to leave the office and start living”.
36. MAJOR GOALS OF KAP INTEGRATION
●Safety/stabilization: Smooth re-entry, prevention, ongoing monitoring
●Attachment: Relationship continuity and repair & deepen collaboration
●Enhanced self-monitoring: Observing ego, neutrality, disentanglement
●Debriefing: Emotional processing, meaning- making, releasing, grieving
●Resolving: Pathogenic beliefs and conflicts among parts of the self
●Durability: Accrual of benefit & consolidation of gains
37. MAJOR GOALS of INTEGRATION
• Dedicated application of new found wisdom; support behavior
changes
• Understanding challenging experiences: psychological & archetypal/
spiritual
• Effective use of transference and countertransference experience
• Coping with changes in identity and worldview and social system
• Process traumatic memories & meanings and navigate spiritual
emergency
• Improved navigation of interpersonal challenges and intimacy
38. AREAS OF RESEARCH
• Depression & Anxiety
• PTSD
• Pain Management
• Substance Abuse Recovery, Relapse Prevention
• Mixed KAP with CBT and Mindfulness based practices
• End of Life Anxiety
• Neurological/Neuropsychological Resilience
• Wellbeing, Spiritual growth and Personality Transformation
39. Recent Research on Ketamine - Depression
Dore et al. (2019) J. Psychoactive Drugs: Clinical Outcome - Three Large Private
Practices Administering Ketamine-Assisted Psychotherapy. Dep, Anx, PTSD
- 235 patients from 3 private practices treating with similar KAP model. Mean
age 42.7 years, 85% college + educ; M/F equal; 1/3 prior experience
psychoactive medicines. #KAP Sessions 1-25. (NO CONTROL GROUP)
RESULTS: BDI and HAM Anx – Clinically significant improvements. Number of
session/treatment duration- correlated positively with greater improvements.
- Greater improvements in patients with severe symptom burden – higher
scores on measures, suicidality at intake and within past year, hx of
hospitalization, higher ACE scores. Increased age correlated with increased
improvement.
Side effects: Nausea office/home 13%/6% nausea; 6%/2% vomit; Agitation
1/3%
40. Recent Research on Ketamine - PTSD
1. O’Brien et al. (2019) Pharmaceuticals. Impact of Childhood Maltreatment on
IV Ketamine Outcomes for Adult Outpatients w TRD
Results: Higher load of clinical symptoms and background trauma associated
with better response to a single as well as repeated infusions compared to
those with lower symptom load and less trauma hx. Higher loads also
associated with higher remission rates.
2. Ross et al. (2019). Annals of Clin. Psychiatry. High-dose ketamine infusion for
the tx of PTSD in combat veterans. N=30; 6 infusions
Results: Sign improvement in scores on PTSD & Depr; no change in substance
use.
41. Proposed & Recent Research on Ketamine:
PTSD & End of Life Anxiety
• Veen et al. (2018): Curr Topics Behav Neurosci – Subcutaneous Dose Ketamine in PTSD-a
role for reconsolidation therapy. Targeting the process of reconsolidation to attenuate
fearful and traumatic memories. Ketamine embedded in a CBT exposure type
psychotherapeutic process. Proposal to use therapeutic window to activate memories,
disrupt and reconsolidate.
• Wolfson and Cole- Multi-site Hospice Study – 2 KAP sessions – end of life anxiety,
depression, and PTSD (Proposed). KTC Foundation
• Martial et al. (2019). Consciousness and Cognition – Of all the drugs evaluated for semantic
similarity, Ketamine ranked the highest in terms of providing a safe and reversible
experimental model for Near Death Experience (NDE) phenomenology; raises possibility
that NMDA antagonists with neuroprotective properties may be released in the proximity of
death.
42. POLARIS INSIGHT CENTER
KAP Day-Long Didactic Trainings
info@polarisinsight.com
6/11/20 or 6/13/20 - Introductory Module
6/20/20 - Intermediate Module
Advanced & Experiential Modules TBA
43. Polaris Insight Center
4257 18th St.
San Francisco, CA 94114
415.800.7083
polarisinsight.com
info@polarisinsight.com
greg@polarisinsight.com
harvey@polarisinsight.com
THANK YOU!!!