LOUISVILLE When Ali Farooqui, MD, told me he wanted to expand psychiatry beyond its traditional boundaries, he meant it.
He organized the 2024 KPMA conference, to expand psychiatry into “a whole-person approach to mental health that includes brain health, body health, family health, and nutritional health.”Here are some key takeaways from the conference:
Nutraceuticals and Phytoceuticals in Psychiatric Practice: G. Randolph Schrodt, MD
If you took a vitamin this morning or one of your patients took a supplement last night, pay attention.
They’re not backed by hard science or regulated like psychiatric prescription drugs, but over-the-counter supplements and herbal products are big business, widely advertised, and used by patients for psychiatric symptoms.
What makes it complicated is that: a) some of these products live up to their claims (when not misused); b) doctors don’t get much formal training about how to navigate the hype and safely integrate the effective products into clinical practice. Some of the OTC treatments who have earned a place in psychiatric settings include:
- St. John’s wort: Studies show that the psychoactive compounds in St. John’s Wort are superior to a placebo for treating mild to moderate depression and not significantly different from comparative SSRIs.
- Omega-3 fatty acids: As an anti neuroinflammatory, Omega-3 fatty acids enhance neural and synaptic plasticity and have an anti-depressive effect.
- Vitamin D: Low Vitamin D is associated with depression, anxiety, and seasonal affective disorder (SAD).
- Magnesium: Magnesium is associated with significant reductions in depression scores.
- N-acetylcysteine (NAC): By regulating glutamate levels in the brain, NAC appears to be effective in treating depression, bipolar disorder, and moderate to severe OCD and may relieve seasonal affective disorder. NAC may also have applications in treating substance use disorders. Preliminary studies show that NAC may decrease cannabis and nicotine use and cravings.
Endocrinology and Mental Health: Omalara Fakunle, MD
Dr. Fakunle shed light on the complex interface of common endocrine issues and mental health. Thyroid disease can manifest with personality changes, dementia, and aggressive behavior. Patients with subclinical hypothyroidism often experience depression. “Screen for thyroid disease, but also look for other potential causes. It’s easy to misdiagnose when patients report nonspecific symptoms like fatigue.”
Dr. Fakunle described GLP-1 potential to reverse psychotropic-induced obesity and hyperphagia associated with antipsychotic medications. In addition, GLP-1 may address cognitive deficits that are not alleviated by antipsychotics.
Nutrition and Mental Health Implications: Vanessa Oliver, RD, LD
“People walk in to see the dietician and expect me to be this no-nonsense, white coat-wearing ‘step on the scale’ person who says, ‘Stop eating sugar and go lose 25 pounds.’ I am not that person,” Dr. Oliver said.
You’re always going to see the top 10 list of foods that you should absolutely eat to be healthy or that you should never let pass your lips. But it’s not an “Eat this, don’t eat that” scenario, which is how it’s often presented. These are black-and-white thinking traps. It’s more about consistent behavior, focusing on your overall diet.
Substance Use Disorders Treatment Update: James Hawthorne, MD
Suboxone and buprenorphine disorder treatment is shifting from stigmatization to acceptance in Kentucky.
“These treatments have been shown to be life-saving, yet they are still stigmatized in some circles. It’s important to make them more accessible.”
Dr. Hawthorne discussed regulatory issues related to buprenorphine prescribing and shared various strategies for buprenorphine initiation, including standard in-office induction, at-home induction, and low-dose initiation. He also discussed the use of long-acting injectable buprenorphine in the treatment of OUD.
Treatment of Methamphetamine Use Disorder: Jonathan Martin, MD
You can never write anyone off or assume anything.
“I think the most surprising thing I’ve learned about working in the field of addiction medicine is who you end up seeing using substances. It’s not what you expect. I’ve had grandmas, CEOs, lawyers, doctors, and then the people you would normally expect.
Dr. Martin discussed the expected time course of methamphetamine-induced psychosis and explored treatment options and efficacy.
Psychopharmacology Update – Promising New Treatments for Depression: Brian Casey, MD
“After several years, we’re finally seeing some breakthrough treatments for depression beyond SSRIs.”
Dr. Casey highlighted the standout features of new antidepressants:
- Gepirone: An antidepressant that doesn’t cause sexual dysfunction.
- Ketamine: An antidepressant that works faster and offers more than SSRIs. It triggers the formation of new, healthier neural connections in the brain and may repair damage to the brain’s proteins caused by stress hormones
- Esketamine: An antidepressant that shows promise for treatment-resistant depression unresponsive to SSRIs.
- Zuranolone: The first pill for postpartum depression (PPD). It works quickly and stabilizes hormones rather than serotonin levels.
An Alarming Increase in NonSuicidal Self-Injury in Adults: Chelsea Atwater, DO
“We’ve seen a very large and sudden increase in the prevalence of nonsuicidal self-injury (NSSI) since the pandemic, especially in adults…. I don’t know that we have much training in how to treat it.”
Dr. Atwater emphasized the strong correlation between NSSI and suicide completion rates and discussed the current best practices for NSSI, including prescription, complementary, and alternative interventions.
Criminalizing Patients with Schizophrenia Can Lead to a Cycle of Noncompliance and Reoffending: Kelsee Crawford, PharmD
“It’s one of the disease states that often gets criminalized when they’re just extremely sick patients. We know that patients with any disease type are not going to take medicine the way they should. … It’s important to find a medication that they’re willing to continue taking so they can live a normal life, have stable relationships, and stay out of the justice system.”
Exploring the Intersection of AI, Psychiatry, and EHR: Rian Kabir, MD and Nathan Aquino, MD
Dr. Kabir provided a big-picture perspective of AI’s remarkable potential to transform healthcare and its hair-raising risks.
Dr. Aquino homed in on AI integration as a game-changer for EHR systems to enhance documentation accuracy, coding, and clinical decision support and unlock the power of predictive analytics to improve patient outcomes and streamline care.
KPMA Leadership: Forging the Future. A Lifetime Achievement Award for Rif El-Mallakh, MD
“Dr. Rif El-Mallakh is a triple threat,” according to colleague Kathy Vincent, MD. “He is an education expert, he has extraordinary teaching skills, and he also has a real passion for research.”
A Focus on Advocacy: Ruchita Agrawal, MD
“I want to focus on advocacy. We are not very good lobbyists, and our patients need so many medications that Medicaid and insurance providers do not cover.”
A Focus on the Deadliest Mental Disorder – Eating Disorders: Zubi Suleman, MD
“We don’t ask those questions, and people are not willing to tell us what’s going on with them. Ask about past body dysmorphia behaviors. Ask about restrictive eating behaviors. Offer patients a blind weight where they’re not facing the scale.”