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Depression
0.75 CME CREDIT

More than half of all mental health treatment takes place in primary care, a major burden (though also an opportunity) for providers who are expected to do so many things at once. How can psychiatry help given their limited availability across the country? Enter the Collaborative Care Model, with multiple randomized trials showing feasibility and improved outcomes from adding two main ingredients in primary care clinics: an in-house Behavioral Health Consultant who serves as liaison, data-gatherer/recorder and manager of a registry of patients who receive “treat to target” follow-up; and a remote consulting psychiatrist in regular communication with the BHC and the primary care team. This presentation will briefly describe the 5 principles which drive this Collaborative Care Model and will also focus on implementation: what steps need to be taken to incorporate such a program in a primary care practice? And how does setting and geography play a role? General guidelines from experience implementing this model in 12 different clinics will help your planning (from pre-contemplation to preparation to action!)


woman sitting by window looking demure

Depression is a common but complex condition, requiring accurate diagnosis, and targeted stepwise pharmacologic and nonpharmacologic interventions. In this session, learn the DSM-5 diagnostic criteria for major depression, and how changes in DSM-5 affect the diagnosis and characterization of depressive disorders; how to apply simple, quick tools to screen for depression; and how to compare and contrast treatment modalities, including pharmacotherapy and cognitive behavioral therapy (CBT).


Depression

This lecture will provide an overview of recent developments in the treatment of major depressive disorder. The lecture will summarize current antidepressant medication options, and discuss augmentation strategies for patients with difficult-to-treat depression. Safety and efficacy information will be reviewed for several of the new FDA-approved medications for major depressive disorder.


It is commonly difficult to obtain timely mental health referrals in many communities across the country, but many patients seen by primary care practitioners suffer from depression. Hence, primary care clinicians are commonly the first point of contact and treatment for patients with depression. This activity will review procedures to screen for depression, the relative efficacy of different antidepressants, and when to switch or augment antidepressant therapy. In addition, Dr. Smetana will discuss one of the most important factors in drug selection, i.e. how to exploit side effect profiles to advantage of patients.


0.55 CME CREDIT

This activity is part of the ConnectED Learning: Depression curriculum. Primary care providers encounter patients with depression every day in their practices. How can a busy practitioner make the important distinctions among these patients: who will respond, to what treatment; and who needs specialty care such as psychotherapy? This Expert Perspective will answer common questions relevant to the primary care treatment of depression and provide insight into the diagnosis and management of depression and its subtypes.


1 CME CREDIT

This activity is part of the ConnectED Learning: Depression curriculum. Join expert faculty as they address your remaining questions and reinforce key learning points made throughout the ConnectED Learning series of activities on Depression: Resolving Clinical Complexities in Primary Care.


1.25 CME CREDITS

This activity is part of the ConnectED Learning: Depression curriculum. Primary care providers encounter depressed patients every clinic day. How can a busy practitioner make the important distinctions among these patients: who will respond, to what treatment; and who needs specialty care (psychotherapy and/or medication management)? This session will present a model for recognizing subtypes, especially the mixed sub-type, with an emphasis on using this knowledge to direct management in order to improve outcomes and reduce iatrogenic risk.


0.75 CME CREDIT

This lecture will focus on assessment and management of depression and anxiety in primary care. In addition to receiving an overview of screening tools and interview techniques, attendees will learn about challenges and obstacles to treating depression and anxiety. Topics will include recognizing frequent symptom presentations, differential diagnosis, common mistakes in prescribing, and a brief review of new medications. The speaker will discuss a treatment-to-target approach and how to choose medications based on side effect profile and target symptoms. Management of suicidal ideation and deciding when to refer are also highlighted topics for discussion in this session on the urgent need for optimal treatment of depression and anxiety in primary care.


0.6 CME CREDIT

This activity is part of the ConnectED Learning: Depression curriculum. This case explores the history and management of a 35-year-old woman with recurrent depressions and brief phases of elevated mood which had previously been missed by past providers. Several clues are present in this case that suggest bipolarity in addition to episodes of depression. By attending to clues in her history and presentation, her primary care provider recognizes the need for a different treatment approach.


0.6 CME CREDIT

This activity is part of the ConnectED Learning: Depression curriculum. This case presents the history of a 68-year-old male with a distant history of depression who presents to his PCP with an episode of depression. This case will examine the sole use of monoamine agonist antidepressants and their potential to worsen manic-like symptoms of psychomotor excitation. The use of other dopamine blockers and/or lithium for the mixed depressive state and/or suicidality will also be discussed in order to appreciate the risk of suicide among individuals with mixed depression.


1 CME CREDIT

This lecture will address five common but challenging issues in primary care practice including the cause of a patient's red eye, the cause of a patient's pathologic headache, whether a patient is depressed or suicidal, whether a patient has endocarditis, and causes of a patient's back pain.


Dr. Ballard will provide case examples on the presentation, assessment and management of depression and anxiety in adolescents in the general pediatric clinic. She will discuss screening tools and considerations for diagnosing depression and anxiety in youth who present with somatic symptoms. She will also discuss engaging adolescents and their families in discussions about mental health along with the AAP practice parameters for management of depression and anxiety, and a few major studies from the psychiatry literature, including TAOS, TORDIA, and CAMS.