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In this CME episode, Dr. Andrew Cutler interviews Dr. Stephen Stahl and Dr. Sarah Vinson about the ethicality and morality of involuntary treatment for serious mental illness (SMI), the relationship between SMI and the criminal justice system, and community-based changes that are being pursued to improve treatment and reduce the criminalization of SMI. Optional CME/CE Credits and Certificate Instructions: After listening to the podcast, to take the optional posttest and receive CME/CE credit, click: https://nei.global/POD23-SMI Learning Objectives: After completing this educational activity, you should be better able to: Recognize the neuroethics involved in involuntary treatment of serious mental illness Identify methods to prevent patients with serious mental illness from entering the criminal justice system, including the utility of diversion programs Institute community-based changes that have the potential to reduce the criminalization of serious mental illness, both on the individual and the policy level Accreditation: In support of improving patient care, Neuroscience Education Institute (NEI) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NEI designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change. A posttest score of 70% or higher is required to receive CME/CE credit. The content in this activity does not pertain to pharmacology and is worth 0.0 continuing education hour of pharmacotherapeutics. Credit Types: The following are being offered for this activity: Nurse Practitioner: ANCC contact hours Pharmacy: ACPE application-based contact hours Physician: ACCME AMA PRA Category 1 Credits ™ Physician Associate: AAPA Category 1 CME credits Psychology: APA CE credits Social Work: ASWB-ACE CE credits Non-Physician Member of the Healthcare Team: Certificate of Participation stating the program is designated for AMA PRA Category 1 Credits™ Interprofessional Continuing Education: IPCE credit for learning and change Peer Review: The content was peer-reviewed by an MD specializing in forensic psychiatry to ensure the scientific accuracy and medical relevance of information presented and its independence from commercial bias. NEI takes responsibility for the content, quality, and scientific integrity of this CME/CE activity. Disclosures: All individuals in a position to influence or control content are required to disclose any relevant financial relationships. Potential conflicts of interest are identified and mitigated prior to the activity being planned, developed, or presented. Interviewer Andrew J. Cutler, MD Clinical Associate Professor, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY Chief Medical Officer, Neuroscience Education Institute, Carlsbad, CA Consultant/Advisor: AbbVie, Acadia, Alfasigma, Alkermes, Axsome, Biogen, BioXcel, Boehringer Ingelheim, Cerevel, Corium, Intra-Cellular, Ironshore, Janssen, Jazz, Karuna, Neumora, Neurocrine, Noven, Otsuka, Relmada, Sage Therapeutics, Sunovion, Supernus, Teva, Tris Pharma, VistaGen Therapeutics Speakers Bureau: AbbVie, Acadia, Alkermes, Axsome, BioXcel, Corium, Intra-Cellular, Ironshore, Janssen, Jazz, Lundbeck, Neurocrine, Noven, Otsuka, Sunovion, Supernus, Takeda, Teva, Tris Pharma Interviewees Stephen M. Stahl, MD, PhD, DSc (Hon.) Clinical Professor, Department of Psychiatry and Neuroscience, University of California, Riverside School of Medicine, Riverside, CA Adjunct Professor, Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, CA Honorary Visiting Senior Fellow, University of Cambridge, Cambridge, UK Editor-in-Chief, CNS Spectrums Director of Psychopharmacology Services, California Department of State Hospitals Grant/Research: Acadia, Alkermes, Allergan/AbbVie, Arbor, AssureX, AstraZeneca, Avanir, Axovant, Biogen, Boehringer Ingelheim Braeburn, BristolMyer Squibb, Celgene, CeNeRex, Cephalon, Daiichi Sankyo-Brazil, Dey, Eisai, Forest, Genomind, Glaxo Smith Kline, Harmony Biosciences, Indivior, Intra-Cellular, Ironshore, Janssen, JayMac, Jazz, Lilly, Lundbeck, Merck, Neurocrine, Neuronetics, Novartis, Otsuka, Pear, Pfizer, Reviva, Roche, Sage, Servier, Shire, Sprout, Sunovion, Supernus, Takeda, Teva, Tonix, Torrent, Vanda Consultant/Advisor: Acadia, Adamas, Alkermes, Allergan/AbbVie, Altus, Arbor, AstraZeneca, Avanir, Axovant, Axsome, Biogen, Biomarin, Biopharma, Celgene, Cerevel, ClearView, Clexio, Concert, DepotMed, Done, EMD Serono, Eisai, Enveric, Eurolink, Fabre-Kramer, Ferring, Forest, Gedeon Richter, Genetica, Genomind, Innovative Science Solutions, Impel, Intra-Cellular, Ironshore, Janssen, Jazz, Karuna, Libbs, Lilly, Lipidio, Longboard, Lundbeck, Merck, Neos, NeuraWell, Neurocrine, NeuroPharma, Novartis, Noveida, Otsuka, Perrigo, Pfizer, Pierre Fabre, Proxymm, Recordati, Relmada, Reviva, Sage, Saniona, Servier, Shire, Sprout, Sunovion, Supernus, Takeda, Taliaz, Teva, Tonix, Tris, Trius, Vanda, Vertex, Viforpharma Speakers Bureau: Acadia, Allergan/AbbVie, Genentech, Janssen, Lundbeck, Merck, Neurocrine, Otsuka, Servier, Sunovion, Takeda, Teva Options Holdings: Delix, Genomind, Lipidio, NeuraWell Sarah Y. Vinson, MD, FAPA Interim Department Chair; Clinical Associate Professor; Director, Child and Adolescent Psychiatry Fellowship Program; Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta, GA Medical Director, Substance Abuse and Mental Health Services Administration (SAMHSA) African American Behavioral Health Center of Excellence, Atlanta, GA No financial relationships to disclose. Pre-Interview Author Sabrina K. Bradbury-Segal, PhD Senior Medical Writer, Neuroscience Education Institute, Carlsbad, CA No financial relationships to disclose. The Planning Committee, Content Editor, and Peer Reviewer have no financial relationships to disclose. Disclosure of Off-Label Use: This educational activity may include discussion of unlabeled and/or investigational uses of agents that are not currently labeled for such use by the FDA. Please consult the product prescribing information for full disclosure of labeled uses. Cultural Linguistic Competencies and Implicit Bias: A variety of resources addressing cultural and linguistic competencies and strategies for understanding and reducing implicit bias can be found in this handout—download me. Support: This activity is supported by an unrestricted educational grant from Alkermes. Released: July 25, 2023 CME/CE credit expires: July 24, 2026
In this episode, Dr. Andrew Cutler interviews Dr. Stephen Stahl on best practices for switching antipsychotics. Optional CME/CE Credits and Certificate Instructions: After listening to the podcast, to take the optional posttest and receive CME/CE credit, click: https://nei.global/POD22-Switch Learning Objectives: After completing this educational activity, you should be better able to: Understand the relevance of receptor binding properties and pharmacokinetic profiles when switching antipsychotics Follow evidence-based guidelines when switching antipsychotics Accreditation: In support of improving patient care, Neuroscience Education Institute (NEI) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NEI designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. A posttest score of 70% or higher is required to receive CME/CE credit. The content in this activity pertains to pharmacology and is worth 1.0 continuing education hour of pharmacotherapeutics. Credit Types. The following are being offered for this activity: Nurse Practitioner (ANCC): contact hours Pharmacy (ACPE): knowledge-based contact hours Physician (ACCME): AMA PRA Category 1 Credits ™ Physician Assistant (AAPA): Category 1 CME credits Psychology (APA): CE credits Social Work (ASWB-ACE): ACE CE credits Non-Physician Member of the Healthcare Team: Certificate of Participation stating the program is designated for AMA PRA Category 1 Credits ™ Peer Review: The content was peer-reviewed by an MD specializing in psychiatry to ensure the scientific accuracy and medical relevance of information presented and its independence from bias. NEI takes responsibility for the content, quality, and scientific integrity of this CME/CE activity. Disclosures: All individuals in a position to influence or control content are required to disclose all relevant financial relationships, which were then mitigated prior to the activity being presented. Interviewer Andrew J. Cutler, MD Clinical Associate Professor, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY Chief Medical Officer, Neuroscience Education Institute, Carlsbad, CA Consultant/Advisor: AbbVie, Acadia, AiCure, Alfasigma, Alkermes, Allergan, Atentiv, Cognitive Research, Intra-Cellular, Ironshore, Janssen, Lundbeck, Neurocrine, Noven, Otsuka, Sage, Sunovion, Supernus, Takeda, Teva Speakers Bureau: AbbVie, Acadia, Alkermes, Allergan, Intra-Cellular, Ironshore, Janssen, Lundbeck, Neurocrine, Noven, Otsuka, Sunovion, Supernus, Takeda, Teva, Tris Interviewee Stephen M. Stahl, MD, PhD, DSc (Hon.) Clinical Professor, Department of Psychiatry and Neuroscience, University of California, Riverside School of Medicine, Riverside, CA Adjunct Professor, Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, CA Honorary Visiting Senior Fellow, University of Cambridge, Cambridge, UK Director of Psychopharmacology Services, California Department of State Hospitals, Sacramento, CA Grant/Research: Acadia, Avanir, Braeburn, Intra-Cellular, Ironshore, Lilly, Neurocrine, Otsuka, Shire, Sunovion Consultant/Advisor: AbbVie, Acadia, Alkermes, Allergan, Arbor, Axovant, Axsome, Celgene, ClearView, Concert, EMD Serono, Eisai, Ferring, Impel, Intra-Cellular, Ironshore, Janssen, Karuna, Lilly, Lundbeck, Merck, Otsuka, Pfizer, Relmada, Sage, Servier, Shire, Sunovion, Takeda, Taliaz, Teva, Tonix, Tris, Vifor Speakers Bureau: Acadia, Lundbeck, Otsuka, Perrigo, Servier, Sunovion, Takeda, Teva, Vertex Board Member: Genomind Pre-Interview Author Sabrina K. Bradbury-Segal, PhD Medical Writer, Neuroscience Education Institute, Carlsbad, CA No financial relationships to disclose. The Planning Committee and Peer Reviewer have no financial relationships to disclose. Disclosure of Off-Label Use: This educational activity may include discussion of unlabeled and/or investigational uses of agents that are not currently labeled for such use by the FDA. Please consult the product prescribing information for full disclosure of labeled uses. Cultural Linguistic Competencies and Implicit Bias: A variety of resources addressing cultural and linguistic competencies and implicit bias can be found in this downloadable handout. Support: This activity is supported by an unrestricted educational grant from Intra-Cellular Therapies. Released: January 26, 2022 CE credit expires: January 26, 2025
George T. Grossberg, MD, conducts a Masterclass examining emerging treatment options for Alzheimer’s disease that are tied to the new research on the microbiome. Dr. Grossberg is the Samuel W. Fordyce professor and director of geriatric psychiatry in the department of psychiatry and behavioral neuroscience at Saint Louis University. He disclosed that he is a consultant for Acadia, Alkahest, Avanir, Axovant, Axsome Therapeutics, Biogen, BioXcel, Genentech, Karuna, Lundbeck, Novartis, Otsuka, Roche, and Takeda; receives research support from the National Institute on Aging, Janssen, and Genentech/Roche; performs safety monitoring for ANAVEX, EryDel, Intra-Cellular Therapies, Merck, and Newron; and serves on the data monitoring committee of ITI Therapeutics. Dr. Grossberg also serves on the speakers’ bureau of Acadia. Take-home points Dr. Grossberg discusses burgeoning research about treatment of Alzheimer’s disease (AD) by altering the microbiota using diet and medications. The microbiome refers to the entirety of microorganisms that live throughout the body. Microbiota are those organisms that live within the gut. Dysbiosis refers to a microbial imbalance, which has been linked to numerous disorders, including inflammatory diseases, psychiatric illness, obesity, diabetes, and more recently, AD. The gut-brain axis describes the impact of microbiota and GI tract health on the brain. Periodontal disease, as a marker of inflammation and as part of the microbiome, is linked to AD. Increasing research into the role of the microbiome, inflammation, and AD has revealed promising treatments. Sodium oligomannate, a drug approved for mild to moderate AD in China, has been shown to slow the progression of AD by remodeling the microbiota and suppressing the production of specific amino acids that promote neuroinflammation. Summary The microbiota has many purposes, including digestion, communication with the immune system, generation of signaling peptides, refining vitamins, and producing antioxidants. Many factors influence the microbiome, including diet, use of antibiotics, exposure to breast milk as an infant, stress, and old age. The gut microbiota can be altered by consuming “prebiotics,” which are food sources that influence the composition of the microbiota. These foods include fermented foods such as yogurt, kombucha, sauerkraut, and kimchi. The Mediterranean diet also has good sources of prebiotics. Birthing method (C-section versus vaginal birth) also influences the microbiota; a recent study shows that an infant’s microbiota after C-section can be altered by giving them an early fecal transplantation from the mother. As further proof of the link between periodontal disease and AD, a recent study identified the presence of Porphyromonas gingivalis, a bacteria that causes gum disease, in the brain in close proximity to the tau tangles of AD. Gingipain, the toxin secreted by this bacteria, is found in high concentrations in brains of individuals with AD. Dr. Grossberg reviewed his “recipe” for AD prevention and treatment: Recommend adequate activity in four spheres: Physical, mental, social, and spiritual. Treat and control all cardiovascular risk factors, including smoking, obesity, diabetes, hypertension, and hyperlipidemia. Recommend good oral hygiene based on the increasing research about the link of periodontal disease and AD. Recommend dietary changes, including a prebiotic or probiotic, and the Mediterranean diet. Dietary changes may also include supplements such as curcumin, B-complex multivitamin, and vitamin E. Control exposure to air pollution as possible. Use a combination pharmacotherapy of an N-methyl-D-aspartate antagonist and a cholinesterase inhibitor for individuals with AD. References Jones ML et al. Gut Microbes. 2014 Jul 1;5(4):446-57. Askarova S et al. Front Cell Infect Microbiol. 2020;10:104. Beydoun MA et al. J Alzheimers Dis. 2020;75(1):157-72. Wang X et al. Cell Res. 2019 Oct;29(10):787-803. Korpela K et al. Cell. 2020 Oct 15;183(2):324-34. * * * Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com
Today in FirstWord:
This week, the team discuss the U.S. Centres for Medicare & Medicaid Services withdrawing support for a novel payment model for Novartis' Kymriah; Pfizer rolling back drug price rise in the U.S. and Axovant's deal with Benitec Biopharma. Presenter: Joanna Fernandes Contributor: Aparna Krishnan
Why is Twitter so mean to Axovant? Adam teaches a crash course on biostatistics. And will sci-fi gene and cell therapies ever go mainstream.
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On this Alzheimer’s Talks we heard from Dr. Lawrence Friedhoff from Axovant Sciences about the new MINDSET trial, a Phase III clinical trial to determine if a new drug in combination with donepezil (commonly known as Aricept) will help with cognition and ability to perform daily living tasks in those with Alzheimer’s disease. Support the show (https://www.usagainstalzheimers.org/ways-donate)
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