Background: Up to date, evidence based, and best practice psychopharmacologic treatment options for Eating Disorders, Depression, Anxiety disorders including Obsessive Compulsive Disorder and Post Traumatic Stress Disorder, and Substance Abuse. Discussion of the unique considerations in the malnourished patient and proposed strategies for optimizing outcomes.
Content Outline
I. Introduction
II. Psychopharmacologic Treatment of Eating Disorders
A. SSRIs – field updates and best practice
B. Atypical Antipscyhotics – field updates and best practice
C. “Benzos” – field updates and best practice
D. Mood Stabilizers / Anti-epileptic drugs – field updates and best practice
III. How Malnutrition Impacts Body Ability to Respond to Psychotropic Medications
A. Serotonin synthesis
a. Importance of nutritional proteins (building blocks)
b. Rate limiting role of Folic acid
c. “Normal” lab findings vs. optimal lab finding
d. Data supporting folate levels correlate with treatment response
e. Findings so robust that new pharmaceuticals developed
f. Forms of supplementation
B. B12
a. “Normal” lab finding vs. optimal lab finding
b. Data supporting B12 levels correlate with treatment response
c. Findings so robust that new pharmaceuticals developed
d. Forms of supplementation
C. Prevalence data for Folate and B12 deficiencies in eating disordered populations
D. Data correlating serotonin treatment response to body weight/restoration
IV. Treatment Options for Commonly Co-Occurring Psychiatric Conditions
A. Prevalance Data of Commonly Co-Occurring Psychiatric Conditions
B. Depression
a. Treatment Paradigms for initiating and adjusting treatment to optimize outcomes
i. Matching pharmacologic profiles to patient profiles
ii. Are two mechanisms better than one – field updates
iii. Antidepressant combinations and augmentation strategies for difficult cases – field updates
b. Importance of full treatment
i. Relapse and prevention data
ii. What constitutes an adequate trial
iii. APA recommendations for maintenance treatment
C. Anxiety
a. OCD
i. Treatment Paradigms for initiating and adjusting treatment to optimize outcomes
ii. Field updates
b. PTSD
i. Treatment paradigms for initiating and adjusting treatment to optimize outcomes
ii. Field updates
1. Prazosin
a. Data supporting efficacy
b. Special considerations in the eating disordered population
c. Dosing strategies
2. Additional Augmentations strategies
D. Substance Abuse/Dependency
a. Treatment strategies and field updates
i. Antabuse
ii. Naltrexone
iii. Campral
iv. others
b. Off label uses for impulsive/high reward behaviors
V. Concluding comments, acknowledgements and opening for questions.
Persons experiencing eating disorders are a very specific patient population who often have impact from the eating disorder in every aspect of their lives. Unfortunately, those suffering eating disorders are even more likely than general populations to be experiencing one or more psychiatric comorbidities. Those with multiple diagnosies suffer increasingly for the additive impact of each additional disorder and also, unfortunately, the eating disorder's physiologic impact adds special considerations to standard psychiatric treatment.
The goal of this didactic program is to present in clinically relevant terms the physiologic considerations in the malnourished patient, how to optimize the patient's likelihood of responding to treatment, and the most up to date, evidence based and best practice treatment options for comorbidities. We will also discuss what current literature supports specific to the psychopharmacologic treatment of eating disorders.
A secondary goal is to enhance awareness of the importance of treating both the eating disorder and comorbid illness simultaneously to have best outcomes. By increasing provider awareness of considerations and making these complex concepts more easily accessible, we will hopefully see downstream effects of increased patient knowledge of the impact of their illness and the importance of treatment adherence to improve outcome.
8 years of General Adult Psychiatry, 3 years as Medical Director of Outpatient Eating Disorders Program at Laureate, 3 years as Medical Director of the Adult Eating Disorders Program at Laureate.
