CME presentation at WSMA annual meeting. Problematic opioid use, questioning the concept of "pseudo-addiction", seeing chemical dependency as somewhere well along the continuum of problematic opioid use.
Ketamine-assisted psychotherapy is an emerging treatment that combines ketamine administration with psychotherapy. It is distinguished from ketamine infusion clinics by its emphasis on set and setting, the therapeutic relationship, and preparation and integration into the treatment plan. Ketamine has rapid onset and metabolism, and produces dissociative states from psycholytic to psychedelic. Its mechanisms of action involve glutamate and neuroplasticity. Risks include nausea, increased blood pressure, and potential for abuse with chronic use. Polaris Insight Center provides ketamine-assisted psychotherapy following screening, dosing, integration processes to maximize benefits and safety.
This document provides an overview of ketamine-assisted psychotherapy (KAP). It discusses ketamine's rapid onset and safety profile, and its ability to access different states of consciousness for therapeutic purposes. Key aspects of the KAP process are outlined, including medical intake and screening, psychological preparation, low to high dosing strategies, and potential experiences during sessions like empathogenic states. Risks and challenges of KAP are addressed. Major goals of the integration process after sessions are described, such as emotional processing and resolving pathogenic beliefs. The document promotes a multidisciplinary treatment approach and lists training opportunities provided by Polaris Insight Center.
This document provides an overview of ketamine-assisted psychotherapy training at Polaris Insight Center. It discusses ethical considerations for ketamine therapy including codes of ethics, the importance of set and setting, preventing misconduct, and ensuring access. It also covers conducting group ketamine sessions, virtual ketamine therapy, integrating spiritual experiences, and future training opportunities.
This document provides information and guidance for starting a ketamine assisted psychotherapy practice. It discusses treatment indications for ketamine therapy including treatment resistant depression, anxiety, PTSD, and addictions. It also lists contraindications. Treatment approaches for ketamine are described, including low and moderate to high dosing. A sample treatment protocol is outlined involving medical and psychological assessment, in-office sessions, at-home sessions, and maintenance phases. Training resources for ketamine therapy are listed. Considerations for a ketamine practice such as vision, education, set and setting, staff training, protocols, partnerships, and adverse events are reviewed.
This document provides information on the management of schizophrenia. It defines schizophrenia and its symptoms. It discusses the phases of treatment including acute, stabilization, and maintenance phases. It covers diagnostic evaluation, pharmacological treatment including antipsychotic medication selection and dosing, and non-pharmacological treatment. It also addresses management of agitation, treatment of relapse, and prevention of recurrence. The goal of treatment is to control symptoms, reduce risk of relapse, and help patients improve functioning.
Ketamine-assisted psychotherapy is an emerging treatment that combines ketamine administration with psychotherapy. It is distinguished from ketamine infusion clinics by its emphasis on set and setting, the therapeutic relationship, and preparation and integration into the treatment plan. Ketamine has rapid onset and metabolism, and produces dissociative states from psycholytic to psychedelic. Its mechanisms of action involve glutamate and neuroplasticity. Risks include nausea, increased blood pressure, and potential for abuse with chronic use. Polaris Insight Center provides ketamine-assisted psychotherapy following screening, dosing, integration processes to maximize benefits and safety.
This document provides an overview of ketamine-assisted psychotherapy (KAP). It discusses ketamine's rapid onset and safety profile, and its ability to access different states of consciousness for therapeutic purposes. Key aspects of the KAP process are outlined, including medical intake and screening, psychological preparation, low to high dosing strategies, and potential experiences during sessions like empathogenic states. Risks and challenges of KAP are addressed. Major goals of the integration process after sessions are described, such as emotional processing and resolving pathogenic beliefs. The document promotes a multidisciplinary treatment approach and lists training opportunities provided by Polaris Insight Center.
This document provides an overview of ketamine-assisted psychotherapy training at Polaris Insight Center. It discusses ethical considerations for ketamine therapy including codes of ethics, the importance of set and setting, preventing misconduct, and ensuring access. It also covers conducting group ketamine sessions, virtual ketamine therapy, integrating spiritual experiences, and future training opportunities.
This document provides information and guidance for starting a ketamine assisted psychotherapy practice. It discusses treatment indications for ketamine therapy including treatment resistant depression, anxiety, PTSD, and addictions. It also lists contraindications. Treatment approaches for ketamine are described, including low and moderate to high dosing. A sample treatment protocol is outlined involving medical and psychological assessment, in-office sessions, at-home sessions, and maintenance phases. Training resources for ketamine therapy are listed. Considerations for a ketamine practice such as vision, education, set and setting, staff training, protocols, partnerships, and adverse events are reviewed.
This document provides information on the management of schizophrenia. It defines schizophrenia and its symptoms. It discusses the phases of treatment including acute, stabilization, and maintenance phases. It covers diagnostic evaluation, pharmacological treatment including antipsychotic medication selection and dosing, and non-pharmacological treatment. It also addresses management of agitation, treatment of relapse, and prevention of recurrence. The goal of treatment is to control symptoms, reduce risk of relapse, and help patients improve functioning.
Cognitive Behaviour therapy for Substance abuseSarah Javed
Cognitive behavioural therapy (CBT) and relapse prevention (RP) techniques are used to treat substance abuse. CBT provides skills to help people initially stop using drugs and sustain abstinence through challenging dysfunctional thoughts and developing new coping behaviors. RP focuses on maintaining abstinence by preventing lapses from escalating into full relapses. Key CBT concepts include identifying triggers, high-risk situations, and cravings. Clinicians use functional analysis to understand a client's drug use patterns and teach strategies like urge surfing and thought stopping to cope with cravings without using. Role plays help clients learn and practice drug refusal and other skills to support lifestyle changes and abstinence.
The document provides an overview of non-pharmacological management in psychiatry including psychotherapies, brain stimulation methods, and neurosurgery/deep brain stimulation. It discusses various types of psychotherapies such as psychoanalysis, cognitive behavioral therapy, rational emotive behavioral therapy, dialectical behavioral therapy, group psychotherapy, family therapy, and couples therapy. It also covers brain stimulation methods like electroconvulsive therapy and transcranial magnetic stimulation.
'Non-pharmacological management in dementia' is really nice article published in British Journal of Psychiatry Advances. It gives basic idea about non pharmacological management in all forms of dementia for Behavioral and psychological symptoms of dementia.
KAP module 4 Trauma and Training of psychedelic-assisted therapistsPolaris Insight Center
This document provides an overview of considerations for ketamine-assisted psychotherapy in treating trauma. It discusses types of trauma, stages of trauma recovery, and categories of working with trauma from a nervous system dysregulation perspective. It outlines pathways of healing trauma and a transpersonal approach. Key aspects of psychedelic-assisted therapy are described, including how trauma may emerge and unique preparation approaches. Ketamine is discussed as a trauma healing support agent, with specific strategies outlined. Long-term integration dimensions are presented. The document concludes with discussing trauma integration and connection to benevolent spirituality.
This document summarizes guidelines for managing schizophrenia through pharmacological and psychosocial treatment. It discusses using antipsychotic medications such as second generation antipsychotics for acute episodes and maintaining treatment. Clozapine is recommended for treatment-resistant cases. Psychosocial interventions like family therapy, cognitive behavioral therapy, social skills training, supported employment, and substance abuse rehabilitation are described. Long-acting injectable antipsychotics can help with treatment adherence. The overall goal of management is achieving remission of symptoms and optimal functioning through a combination of medical and psychosocial support.
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?
The document provides an overview of consultation-liaison psychiatry, including basics, common conditions, and management approaches. It defines consultation-liaison psychiatry and its roles in a general hospital setting. Common conditions addressed include delirium, suicide, depression, agitation, and medical issues like hepatic or renal impairment. Management prioritizes identifying and treating underlying causes, coordinating pharmacological and non-pharmacological approaches, and effective communication with medical teams.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
CBT in Clozapine resistant schizophrenia - Journal reviewEnoch R G
This document summarizes a randomized controlled trial that examined the effectiveness of cognitive behavioral therapy (CBT) for individuals with clozapine-resistant schizophrenia. The trial compared CBT plus treatment as usual to treatment as usual alone over a 21-month period. It was hypothesized that CBT would reduce symptoms of schizophrenia, improve quality of life, and improve user-defined recovery compared to treatment as usual alone. The trial recruited participants through inpatient mental health services in five sites in the UK and was approved by the National Research Ethics Committee.
This document discusses anxiety disorders and their symptoms, classification, epidemiology, and treatment. It defines anxiety as a feeling of tension, worry and physical changes. It describes several types of anxiety disorders including generalized anxiety disorder, panic disorder, phobic disorders, post-traumatic stress disorder, and obsessive-compulsive disorder. It provides information on the symptoms, diagnosis, risk factors, and treatment including pharmacological therapies such as SSRIs, TCAs, benzodiazepines, and non-pharmacological therapies such as cognitive behavioral therapy.
The document outlines the table of contents for the IAHPC Manual of Palliative Care 3rd Edition. The table of contents covers 7 sections: I) Principles and Practice of Palliative Care, II) Ethical Issues in Palliative Care, III) Pain, IV) Symptom Control, V) Psychosocial, VI) Organizational Aspects of Palliative Care, and VII) Resources. Section I defines palliative care and discusses the need, goals, principles, teams, communication, and integration of palliative care.
The document discusses bipolar disorder and provides an agenda for the topics that will be covered, which include the epidemiology, costs, and hidden forms of bipolar disorder. It is presented by several professors of psychiatry and addresses objectives like understanding subtle and special population presentations of bipolar disorder as well as treatment guidelines. Bipolar disorder is a chronic and disabling condition that is often misdiagnosed or diagnosed late. Accurately diagnosing and treating it can be challenging.
This document discusses long-acting injectable (LAI) antipsychotics for the management of schizophrenia. It provides an overview of the biology and outcomes of schizophrenia, including high relapse rates when treatment is discontinued. Relapse is associated with increased dopamine function and may be linked to disease progression. LAI antipsychotics can help improve adherence and reduce relapse rates compared to oral antipsychotics. The document reviews guidelines recommending LAI use and discusses patients' and clinicians' positive attitudes towards LAIs. It also covers the receptor profile and attributes of paliperidone palmitate, an atypical LAI antipsychotic.
Psychiatric Disorders in Chemically Dependent Individuals - October 2012Dawn Farm
This program provides an overview of co-occurring addiction and psychiatric illness, including standard diagnostic criteria, individual considerations for determining the appropriate course of treatment, available treatment interventions, and the perspectives of both the addict and the treatment provider on addiction and psychiatric illness. It is presented by Dr. Patrick Gibbons, LMSW, DO; Adjunct Clinical Instructor in Psychiatry at the University of Michigan; Medical Director of the WCHO Community Crisis Response Team; consultant with Pain Management Solutions in Ann Arbor; Medical Director of the Michigan Health Professionals Recovery Program, and Medical Director of Dawn Farm. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
This document discusses various investigations and psychological tests used in psychiatry. It categorizes investigations into routine tests, electrophysiological tests, brain imaging tests, neuroendocrine tests, and genetic tests. Some key routine tests mentioned include complete blood count, urine analysis, renal and liver function tests, electrolytes, and drug level estimation. Psychological tests are used to assess symptoms, personality, cognitive functioning, environmental stressors, and psychodynamics. Nurses should be familiar with psychological tests to enhance treatment and measure patient progress.
Hanipsych, functional recovery in depressionHani Hamed
This document discusses functional recovery in depression. It begins by providing statistics on the prevalence of depression and other psychiatric disorders worldwide. It then discusses various milestones in the treatment of depression such as response, remission, and relapse. While symptom remission is an important goal, it does not always translate to functional improvement. Factors like residual symptoms, impairment at work or home, and social/emotional functioning are important to patients. The document presents evidence that escitalopram treatment can significantly improve daily living and functional outcomes compared to other antidepressants.
This document provides an overview of obsessive-compulsive disorder (OCD), including its definition, epidemiology, clinical manifestations, diagnosis, differential diagnosis, management, and recommendations. OCD is characterized by recurrent obsessions and compulsions that cause distress or impairment. It has a lifetime prevalence of 2.3% and typically starts in childhood or adolescence. Treatment involves cognitive-behavioral therapy, selective serotonin reuptake inhibitors, or a combination of both.
This document provides an overview of hypnotherapy and mental health. It includes Sha LéWilante's credentials and areas of practice. The document then covers various topics related to mental health including what constitutes mental illness, common types of mental health problems, potential causes, assessment methods, treatments options like hypnotherapy, improving mental health, evidence-based practices, and how to connect with Sha LéWilante via various websites and social media platforms.
Choosing a subspecialty region in psychiatryJankiPatel55
A few psychiatrists concentrate on a particular region, as an example here. Specialists and clinicians of psychiatry pharmaceutical companies frequently work closely to treat emotional wellbeing conditions.
C. Give the patient Tylenol 650mg P.O as ordered and assist the patient with guided imagery.
This patient's pain level is relatively low at a 2/10 and is being well managed with scheduled Tylenol. Guided imagery could help further reduce the patient's perception of pain without unnecessary opioid exposure. Options A, B, and D would likely provide more pain relief than is needed and increase risks of opioid dependence, misuse or overdose.
The conundrum of opioid tapering in long term opioid therapy for chronic pain...Paul Coelho, MD
The document discusses the challenges clinicians face when tapering patients off long-term opioid therapy for chronic pain. It explains that opioid dependence can cause worsening pain, psychiatric symptoms, and functioning during tapering due to neuroplastic changes. While tapering seems logical to address risks of high-dose opioids, it may paradoxically make a patient's issues worse due to protracted abstinence syndrome. The document provides guidance for managing these complex patients focused on both pain and opioid dependence.
Cognitive Behaviour therapy for Substance abuseSarah Javed
Cognitive behavioural therapy (CBT) and relapse prevention (RP) techniques are used to treat substance abuse. CBT provides skills to help people initially stop using drugs and sustain abstinence through challenging dysfunctional thoughts and developing new coping behaviors. RP focuses on maintaining abstinence by preventing lapses from escalating into full relapses. Key CBT concepts include identifying triggers, high-risk situations, and cravings. Clinicians use functional analysis to understand a client's drug use patterns and teach strategies like urge surfing and thought stopping to cope with cravings without using. Role plays help clients learn and practice drug refusal and other skills to support lifestyle changes and abstinence.
The document provides an overview of non-pharmacological management in psychiatry including psychotherapies, brain stimulation methods, and neurosurgery/deep brain stimulation. It discusses various types of psychotherapies such as psychoanalysis, cognitive behavioral therapy, rational emotive behavioral therapy, dialectical behavioral therapy, group psychotherapy, family therapy, and couples therapy. It also covers brain stimulation methods like electroconvulsive therapy and transcranial magnetic stimulation.
'Non-pharmacological management in dementia' is really nice article published in British Journal of Psychiatry Advances. It gives basic idea about non pharmacological management in all forms of dementia for Behavioral and psychological symptoms of dementia.
KAP module 4 Trauma and Training of psychedelic-assisted therapistsPolaris Insight Center
This document provides an overview of considerations for ketamine-assisted psychotherapy in treating trauma. It discusses types of trauma, stages of trauma recovery, and categories of working with trauma from a nervous system dysregulation perspective. It outlines pathways of healing trauma and a transpersonal approach. Key aspects of psychedelic-assisted therapy are described, including how trauma may emerge and unique preparation approaches. Ketamine is discussed as a trauma healing support agent, with specific strategies outlined. Long-term integration dimensions are presented. The document concludes with discussing trauma integration and connection to benevolent spirituality.
This document summarizes guidelines for managing schizophrenia through pharmacological and psychosocial treatment. It discusses using antipsychotic medications such as second generation antipsychotics for acute episodes and maintaining treatment. Clozapine is recommended for treatment-resistant cases. Psychosocial interventions like family therapy, cognitive behavioral therapy, social skills training, supported employment, and substance abuse rehabilitation are described. Long-acting injectable antipsychotics can help with treatment adherence. The overall goal of management is achieving remission of symptoms and optimal functioning through a combination of medical and psychosocial support.
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?
The document provides an overview of consultation-liaison psychiatry, including basics, common conditions, and management approaches. It defines consultation-liaison psychiatry and its roles in a general hospital setting. Common conditions addressed include delirium, suicide, depression, agitation, and medical issues like hepatic or renal impairment. Management prioritizes identifying and treating underlying causes, coordinating pharmacological and non-pharmacological approaches, and effective communication with medical teams.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
CBT in Clozapine resistant schizophrenia - Journal reviewEnoch R G
This document summarizes a randomized controlled trial that examined the effectiveness of cognitive behavioral therapy (CBT) for individuals with clozapine-resistant schizophrenia. The trial compared CBT plus treatment as usual to treatment as usual alone over a 21-month period. It was hypothesized that CBT would reduce symptoms of schizophrenia, improve quality of life, and improve user-defined recovery compared to treatment as usual alone. The trial recruited participants through inpatient mental health services in five sites in the UK and was approved by the National Research Ethics Committee.
This document discusses anxiety disorders and their symptoms, classification, epidemiology, and treatment. It defines anxiety as a feeling of tension, worry and physical changes. It describes several types of anxiety disorders including generalized anxiety disorder, panic disorder, phobic disorders, post-traumatic stress disorder, and obsessive-compulsive disorder. It provides information on the symptoms, diagnosis, risk factors, and treatment including pharmacological therapies such as SSRIs, TCAs, benzodiazepines, and non-pharmacological therapies such as cognitive behavioral therapy.
The document outlines the table of contents for the IAHPC Manual of Palliative Care 3rd Edition. The table of contents covers 7 sections: I) Principles and Practice of Palliative Care, II) Ethical Issues in Palliative Care, III) Pain, IV) Symptom Control, V) Psychosocial, VI) Organizational Aspects of Palliative Care, and VII) Resources. Section I defines palliative care and discusses the need, goals, principles, teams, communication, and integration of palliative care.
The document discusses bipolar disorder and provides an agenda for the topics that will be covered, which include the epidemiology, costs, and hidden forms of bipolar disorder. It is presented by several professors of psychiatry and addresses objectives like understanding subtle and special population presentations of bipolar disorder as well as treatment guidelines. Bipolar disorder is a chronic and disabling condition that is often misdiagnosed or diagnosed late. Accurately diagnosing and treating it can be challenging.
This document discusses long-acting injectable (LAI) antipsychotics for the management of schizophrenia. It provides an overview of the biology and outcomes of schizophrenia, including high relapse rates when treatment is discontinued. Relapse is associated with increased dopamine function and may be linked to disease progression. LAI antipsychotics can help improve adherence and reduce relapse rates compared to oral antipsychotics. The document reviews guidelines recommending LAI use and discusses patients' and clinicians' positive attitudes towards LAIs. It also covers the receptor profile and attributes of paliperidone palmitate, an atypical LAI antipsychotic.
Psychiatric Disorders in Chemically Dependent Individuals - October 2012Dawn Farm
This program provides an overview of co-occurring addiction and psychiatric illness, including standard diagnostic criteria, individual considerations for determining the appropriate course of treatment, available treatment interventions, and the perspectives of both the addict and the treatment provider on addiction and psychiatric illness. It is presented by Dr. Patrick Gibbons, LMSW, DO; Adjunct Clinical Instructor in Psychiatry at the University of Michigan; Medical Director of the WCHO Community Crisis Response Team; consultant with Pain Management Solutions in Ann Arbor; Medical Director of the Michigan Health Professionals Recovery Program, and Medical Director of Dawn Farm. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
This document discusses various investigations and psychological tests used in psychiatry. It categorizes investigations into routine tests, electrophysiological tests, brain imaging tests, neuroendocrine tests, and genetic tests. Some key routine tests mentioned include complete blood count, urine analysis, renal and liver function tests, electrolytes, and drug level estimation. Psychological tests are used to assess symptoms, personality, cognitive functioning, environmental stressors, and psychodynamics. Nurses should be familiar with psychological tests to enhance treatment and measure patient progress.
Hanipsych, functional recovery in depressionHani Hamed
This document discusses functional recovery in depression. It begins by providing statistics on the prevalence of depression and other psychiatric disorders worldwide. It then discusses various milestones in the treatment of depression such as response, remission, and relapse. While symptom remission is an important goal, it does not always translate to functional improvement. Factors like residual symptoms, impairment at work or home, and social/emotional functioning are important to patients. The document presents evidence that escitalopram treatment can significantly improve daily living and functional outcomes compared to other antidepressants.
This document provides an overview of obsessive-compulsive disorder (OCD), including its definition, epidemiology, clinical manifestations, diagnosis, differential diagnosis, management, and recommendations. OCD is characterized by recurrent obsessions and compulsions that cause distress or impairment. It has a lifetime prevalence of 2.3% and typically starts in childhood or adolescence. Treatment involves cognitive-behavioral therapy, selective serotonin reuptake inhibitors, or a combination of both.
This document provides an overview of hypnotherapy and mental health. It includes Sha LéWilante's credentials and areas of practice. The document then covers various topics related to mental health including what constitutes mental illness, common types of mental health problems, potential causes, assessment methods, treatments options like hypnotherapy, improving mental health, evidence-based practices, and how to connect with Sha LéWilante via various websites and social media platforms.
Choosing a subspecialty region in psychiatryJankiPatel55
A few psychiatrists concentrate on a particular region, as an example here. Specialists and clinicians of psychiatry pharmaceutical companies frequently work closely to treat emotional wellbeing conditions.
C. Give the patient Tylenol 650mg P.O as ordered and assist the patient with guided imagery.
This patient's pain level is relatively low at a 2/10 and is being well managed with scheduled Tylenol. Guided imagery could help further reduce the patient's perception of pain without unnecessary opioid exposure. Options A, B, and D would likely provide more pain relief than is needed and increase risks of opioid dependence, misuse or overdose.
The conundrum of opioid tapering in long term opioid therapy for chronic pain...Paul Coelho, MD
The document discusses the challenges clinicians face when tapering patients off long-term opioid therapy for chronic pain. It explains that opioid dependence can cause worsening pain, psychiatric symptoms, and functioning during tapering due to neuroplastic changes. While tapering seems logical to address risks of high-dose opioids, it may paradoxically make a patient's issues worse due to protracted abstinence syndrome. The document provides guidance for managing these complex patients focused on both pain and opioid dependence.
This document discusses the distinction between opioid dependence and addiction. It notes that while tolerance and dependence are physiological adaptations to long-term opioid use, addiction is defined by aberrant drug-seeking behaviors. For patients receiving opioids long-term for pain, dependence may develop but not necessarily addiction if they do not exhibit drug-seeking behaviors. However, abruptly stopping opioids can cause withdrawal and craving, emerging addiction behaviors. The experience in Washington state shows that for some patients, tapering established long-term opioid treatment can destabilize them and complex, persistent dependence may require ongoing treatment similar to addiction maintenance therapy.
This editorial discusses the author's changing views on long-term opioid treatment for non-cancer pain. While the author previously believed opioids were appropriate to treat all types of pain, the author now questions their effectiveness and safety for long-term treatment of non-cancer pain. The author describes commonly encountering patients on dangerously high opioid doses for musculoskeletal pain. The author argues guidelines setting a maximum recommended opioid dose could help address this problem.
Dr liu 12 8-2012 updike-risk management and pt assessment in pmChau Nguyen
This document discusses risk management and patient assessment for chronic pain patients being considered for opioid therapy. It outlines how to evaluate risks of addiction, conduct screening, monitor patients on treatment, and intervene if problems arise. Key points include using screening tools to assess risk, implementing strategies like urine testing and restricted refills to reduce risk, and having treatment plans and taper protocols in place for problematic patients. Resources for treatment of opioid dependence are also provided.
The document discusses pain and addiction as co-morbid disease states. It provides epidemiological data on the prescription drug abuse epidemic, including increased rates of opioid abuse and overdose deaths. It also examines the role of physicians in fueling non-medical prescription drug use through improper prescribing practices or a lack of training in identifying addiction.
This document discusses effective pain management and the challenges of treating chronic pain with opioids. It provides an overview of pain management principles, the risks of addiction, and approaches to assessing patients and monitoring opioid treatment. While opioids can help treat pain in some cases, providers must consider the risks and benefits for each patient due to the potential for abuse, addiction and undertreatment of pain.
This clinical track presentation summarized the diagnosis of addiction and impact of pain. It covered the importance of precise diagnoses for both pain and substance use disorders to develop effective treatment plans. The presenters were Steven Moskowitz, MD and Robert Hall, MD, moderated by Christopher Jones, PharmD. It reviewed challenges around opioid use for chronic pain including physical dependence, addiction risk, and medical side effects impacting multiple body systems. Treatment strategies discussed included risk assessment, monitoring, non-opioid options, and considering both abstinence and medication-assisted treatment approaches.
FIRST DRAFT1FIRST DRAFT9First DraftErica K.docxAKHIL969626
FIRST DRAFT 1
FIRST DRAFT 9
First Draft
Erica K. Fernandez
Argosy University
Pain Management for Patients with Addiction Problems
Thesis Statement
The ability of clinicians to keep patients in check has proven to be a challenge, especially with concerns regarding the legitimacy and physical functions affecting overall pain management in patients with an addiction problem.
Background
The treatment modalities for chronic pain using COT in active drug users or those who are in remission present a significant challenge for clinicians who oversee the effectiveness of the intervention. Moreover, such notions are correlated to the concerns of patients experiencing a relapse to substance abuse during the duration of therapy since analgesics may obscure drug-seeking behaviours that are characteristic of addictive diseases. This results in poor treatment outcomes where patients are likely to be discharged prematurely from pain care treatment (Ballantyne & Mao, 2003). Additionally, there is the widespread misconception that chronic pain patients with an addiction problem often encounter health professionals who possess inadequate training in clinical guidelines that are related to comorbidities of chronic pain and related addiction issues. Moreover, there exists a dilemma for the treatment of abstinent and former heroin addicts as they are at a high risk of relapsing to addiction if they are exposed to opioid drugs. They also face the risk of relapsing if they are not accorded sufficient care. For people who are already on opioid medication such as methadone often experience challenges responding to pain relievers when they are hospitalized. In such as case, the fundamental principle of management denotes the prevention of withdrawals by initiating methadone for heroin users while providing additional analgesia as recommended while confirming whether the pain relief is satisfactory (Chou et al., 2009). Additionally, most physicians have developed a phobia of over prescribing narcotics as pain relievers. Perhaps this may be attributed to the fear of the legal repercussions that may ensue including the divergences in federal guidelines on matters about the use of narcotics as a pain reliever. Thus, it is the responsibility of the individual practitioner to offer pain management using opioids for legitimate standard and by the regulation of medical practice.
Objective
The purpose of this research is to evaluate the challenges that are faced by clinicians in pain treatment for patients with addiction problems. On the other hand, the study focuses on offering a counter-argument to the thesis by providing ideal solutions for pain management for patients with SUDs. Additionally, the research intends to highlight the complex interconnection that exists between pain management and addiction to opioids.
Supporting Points
For clinicians, the hardest challenge is perhaps knowing the right way to handle patients who require pain medication, ...
Why doctors prescribe opioids to known opioid abusersPaul Coelho, MD
- Prescription opioid abuse is a major epidemic in the US, with 60% of abused opioids obtained from physician prescriptions. Some doctors knowingly prescribe opioids to patients who are abusing or diverting the drugs.
- Factors contributing to this issue include a shift in medicine's philosophy to prioritize pain treatment, cultural attitudes that any pain requires treatment, and financial incentives to treat pain but not addiction.
- Short-term solutions proposed include requiring physician education on addiction, implementing prescription drug monitoring programs, and reimbursing physicians for addiction counseling. However, the problem will only be fully addressed when addiction is considered a treatable disease.
This document summarizes the misconceptions around opioid use and addiction. It discusses how opioids work in the brain to produce both analgesia and euphoria through activation of mu-opioid receptors. Repeated use leads to tolerance and physical dependence, but addiction only occurs in a small percentage of patients and involves distinct molecular mechanisms. Common misconceptions include equating addiction, tolerance and physical dependence. The document advocates for strategies to minimize risks of diversion and abuse through abuse-deterrent formulations.
The Highs And Lows Of Opiate Managementguest2e3167
This document summarizes guidelines for prescribing opioids to manage chronic pain. It discusses the high prevalence and economic impact of chronic pain, as well as barriers physicians face in treating it. While opioids can provide pain relief, they carry risks of adverse effects, addiction, and overdose. The guidelines recommend developing a comprehensive treatment plan, trying non-opioid options first, carefully selecting and titrating opioid doses, monitoring patients for signs of misuse, and using treatment agreements to promote safe prescribing. The goal is to improve patients' function and quality of life while minimizing risks from long-term opioid therapy.
This document discusses the challenges of treating chronic pain and opioid dependency. It notes that prior to 2011, addiction rates associated with prescription opioids were believed to be much lower than later studies found them to be. It also discusses the overprescription of pain medications and the high rates of illegal drug use and worse health outcomes among chronic pain patients prescribed opioids. The document advocates for more specialized treatment of chronic pain and opioid dependency as diseases, and notes the medical profession's unwitting role in exacerbating the problems.
The document discusses the issues of polypharmacy and adverse drug reactions (ADRs) in elderly patients. It notes that polypharmacy is associated with reduced quality of life, increased healthcare costs, and preventable hospitalizations and deaths in seniors. The elderly have unique pharmacokinetics that increase their risk of ADRs. The document proposes a CARE approach to reduce polypharmacy and ADRs through caution, compliance, adjusting doses, regular review of medication regimens, and educating patients. It also recommends the use of a personal health record.
1. Mrs. S, a 65-year-old woman on high-dose fentanyl for back pain, is experiencing increased pain and distress. She is converted to methadone but later returns saying the methadone is not working due to vomiting.
2. The document discusses the neurobiology of opioid addiction, changes in the DSM definitions of addiction and dependence, and the difficulty distinguishing dependence from addiction in chronic pain patients on long-term opioid treatment who inevitably develop tolerance and dependence.
3. Dependence in pain patients involves both physical and psychological factors that can drive continued opioid use even in the absence of an addictive disorder. It is an adaptive change that is difficult to reverse.
For this Discussion, review the case Learning Resources and the DustiBuckner14
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 1 En
Three questions to ask the patient and a rationale for asking these questions.
How may I be of assistance today? This question creates a rapport between you and the patients, and it makes her know that the doctor is ready to listen and help her.
What are you doing to cope with grief after losing your husband? This question will help the care ...
The document summarizes the agenda for a palliative care monthly meeting. It includes seminars on responding to requests to "let me die", palliative chemotherapy, depression and anxiety in palliative care, demoralization and its impact, and managing difficult pain. Specific cases are discussed to illustrate approaches to existential distress, balancing benefits and burdens of chemotherapy, and treating physical and psychological suffering.
Intensity of chronic pain — the wrong metric Paul Coelho, MD
The document discusses how pain intensity is an imperfect metric for evaluating chronic pain treatment outcomes. While pain intensity was widely used as the goal of acute and end-of-life pain treatment, it fails as a measure for chronic pain, which has different causes and meanings. For chronic pain patients, factors like suffering, distress, disability, and quality of life may be better indicators of treatment success than pain intensity alone. The document advocates for moving beyond a focus solely on pain intensity and adopting multimodal treatments and a biopsychosocial approach that considers the complex nature of chronic pain.
This document provides an overview of addiction psychiatry including:
- The neurobiology of addiction and how chronic drug use decreases dopamine levels and impacts brain regions responsible for motivation, inhibition and determining importance.
- Dually diagnosed patients often have substance use disorders and psychiatric illnesses which complicate treatment. Integrated treatment is recommended.
- Motivational interviewing and relapse prevention therapy aim to help patients through the stages of change to maintain sobriety.
- Pharmacological interventions for various addictions including opioids, alcohol and cocaine are discussed though more research is still needed on effective medications.
- A case example involves assessing potential prescription opioid misuse or addiction in a chronic pain patient.
The Opioid Crisis – Big Pharma Marketing and the dangers of extrapolation.Aaron Garner
NINTH ANNUAL ANN DAUGHERTY SYMPOSIUM (Tara Treatment Center)
FOR BASIC SCIENCE OF ADDICTION, TREATMENT AND RECOVERY
June 6th 2018 from 8am-4:30pm
Franklin College 101 Branigin Blvd. Franklin, IN 46131
This conference is a forum for professionals, policymakers, educators and the public from diverse disciplines interested in the biochemical, genetic, behavioral, and public health aspects of addiction.
Registar at:
https://crm.bloomerang.co/HostedDonation?ApiKey=pub_83aac092-878e-11e4-b8ac-0a8b51b42b90&WidgetId=1418240
Presentation By:
Jim Ryser, MA, LMHC, LCAC
Director, Chronic Pain and Chemical Dependence IU Health
Similar to Wsam Presentation For Opiate Guidelines (20)
The Opioid Crisis – Big Pharma Marketing and the dangers of extrapolation.
Wsam Presentation For Opiate Guidelines
1. Chronic Non-Cancerous Pain & Problematic Opiate Use Diagnostic and Therapeutic Principles with some Guidelines James K. Rotchford MD MPH Olympic Pain & Addiction Services (OPAS) Port Townsend, WA
2. Disclosure: OPAS is a private medical practice. New patients are seen primarily because of consultation request. Medicare Provider Labor & Industry Provider Kitsap Physician Service Provider
16. Dopamine is the “currency” which determines the response of Nucleus Accumbens: dopamine spikes within the NA occur as below to “cues” and promotes behavior accordingly
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21. Hypothesis regarding pseudoaddiction: Our ideas about pseudoaddiction in pain management stem from “neurotic” patterns particularly prominent in American culture: “ In 1919 , a Federal ruling held that treatment of addiction was “outside the realm of legitimate medical interest”. This created the conundrum that allowed physicians to treat pain but not addiction that sometimes occurs in the context of medical use. (Principles of Addiction Medicine, 2009 p. 1329, Chapter on Opioid Therapy of Pain by Savage SR et al.)
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24. Difference Between a Chronic Pain Patient & an Addict Adapted from: Schnoll SH, Finch J. J Law Med Ethics . 1994;22:252-6. Addiction is a disease; medication compliance is not addiction Yes No Denial about any problems Yes No Use continues in spite of problem No Yes Medications improve quality of life Yes No Out of control with medications Addiction Physical dependence
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31. Problematic Analgesic Opioid Use - a disorder with a clinical continuum? Less than effective Use/Prescribing? Poor Pain Management/education Chemical Coping/Self Medicating Occasional Abuse Regular Abuse 5 C’s of Addiction Complications alone define problematic analgesic opioid use
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Editor's Notes
Many medical students are taught that if opioids are prescribed in high doses or for a prolonged time, the patient will invariably become an addict. Therefore, the common wisdom is to prescribe the lowest possible dose at the longest possible dosing interval. As a result, opioids are frequently prescribed in doses that are inadequate and at time intervals beyond the duration of action of the drug, resulting in poor analgesia. 1 The term pseudoaddiction was first introduced by Weissman and Haddox in 1989 to describe the iatrogenic syndrome of abnormal behavior developing in direct consequence of inadequate pain management. 2 They described the natural history of pseudoaddiction as a progression through 3 characteristic phases including: (1) inadequate prescription of analgesics to meet the primary pain stimulus; (2) escalation of analgesic demands by the patient associated with behavioral changes to convince others of the pain's severity; and (3) a crisis of mistrust between the patient and the health care team. Treatment strategies include establishing trust between the patient and the health care team and providing appropriate and timely analgesics to control the patient's level of pain. 2,3 1. Schnoll SH, Finch J. Medical education for pain and addiction: making progress toward answering a need. J Law Med Ethics. 1994;22:252-6. 2. Weissman DE, Haddox JD. Opioid pseudoaddiction—an iatrogenic syndrome. Pain . 1989;36:363-6. 3. A consensus document from the American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine. Definitions Related to the Use of Opioids for the Treatment of Pain . 2001.
There is a distinction between the patient who is physically dependent, but not out of control with medication, and the addict who is. The physically dependent person’s quality of life is improved through use of the medication, whereas the addict’s quality of life is severely impaired. Use of medication continues or increases despite adverse consequences to the addict; however, the physically dependent patients will complain or seek to deal with negative consequences, such as side effects, by trying to cut down on the medication. The addict is unaware or in denial about the problems caused by the medication; the physically dependent patient is concerned about these problems. 1 1. Schnoll SH, Finch J. Medical education for pain and addiction: making progress toward answering a need. J Law Med Ethics . 1994;22:252-6.