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Transcranial Magnetic Stimulation for Major Depressive Disorder: A Pragmatic Approach to Implementing TMS in a Clinical Practice
More than 4 million patients need a new option because do not receive adequate benefit from antidepressants medications for their major depressive illness. NeuroStar Transcranial Magnetic Stimulation Therapy is a non systemic depression option available for outpatient treatment in a psychiatrist’s office. Transcranial magnetic stimulation (TMS) uses a pulsed magnet field to modulate brain cortical activity in the region of the brain associated with mood and NeuroStar TMS has been shown in clinical trials to be an effective antidepressant without the systemic side effects associated with medication antidepressants. NeuroStar TMS is the only TMS device cleared by the FDA for the treatment of adult patients with major depressive disorder (MDD) who have not benefitted from prior antidepressant medication. For this supplement a panel of psychiatrists who are experts in the field of TMS was convened, and they discuss the role for TMS in the treatment of MDD and their experiences with the use of TMS in their clinical practices.
This supplement was submitted and supported by an educational grant from Neuronetics, Inc. It was peer reviewed by Current Psychiatry and Annals of Clinical Psychiatry.
Bipolar Disorder: Differential Diagnosis and Evidence-Based Treatment Strategies
Bipolar disorder (BD) ranks high among the most prevalent and frequently underdiagnosed and undertreated affective disorders in the United States. Despite the growth in research in recent years, an estimated 69% of people with BD have been misdiagnosed; most notably, patients with BD receive a mean of 3.5 other diagnoses and consult 4 physicians before being accurately diagnosed. BD increases the risk for suicide and is associated with several psychiatric and medical comorbidities, including substance misuse, anxiety disorders, cardiovascular disease, metabolic syndrome, and hyperten¬sion. An increasing body of evidence suggests that when appropriate pharmacotherapeutic interventions are initiated early in the course of the disorder, the ultimate prognosis is substantially improved. Longitudinal data on the management of patients with BD, including monitoring for efficacy, safety, adherence, and comorbidities, are available to provide practical, clinically applicable information.
This multimedia resource compendium is designed to educate healthcare professionals about recent developments in the differential diagnosis and medical management of BD, with a focus on a patient-centered, individualized approach to treatment. Psychiatrists and neurologists, as well as pharma¬cists, primary care physicians, and other multidisciplinary team members, may find this compendium of particular value as a clinical reference tool to help improve care and outcomes of their patients with BD.
This supplement was submitted by Albert Einstein College of Medicine, Montefiore Medical Center, the College of Psychiatric and Neurologic Pharmacists (CPNP), and Asante Communications, LLC, and supported by educational grants from Eli Lilly and Company and Janssen, Division of Ortho-McNeil Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs.
MDD is a serious chronic illness that affects the lives of millions of patients and their families, and poses challenges for psychiatrists caring for these individuals. Despite the availability of effective treatments, many patients with MDD fail to achieve remission, the primary goal of therapy. More than half of patients either do not respond or only partially respond to first-line antidepressants. In addition, comorbid chronic medical conditions complicate the clinical presentation and treatment decisions, and require special consideration. A number of effective pharmacologic treatment strategies have been studied for patients in these challenging situations, including switching to another approved antidepressant, combining treatment with an approved antidepressant agent, and augmenting with an agent of a different class.
This supplement was This supplement was submitted by SciMed and supported by an educational grant from AstraZeneca. It was peer reviewed by Current Psychiatry and Annals of Clinical Psychiatry.
Patients with schizoaffective disorder (SAD) meet criteria for schizophrenia, while also meeting criteria for major depressive disorder or mania, and will have periods of psychosis without mood disorder symptoms. SAD remains underdiagnosed, in part because it is frequently confused with other psychiatric disorders with overlapping diagnostic criteria—chiefly schizophrenia, bipolar disorder, and major depressive disorder. Understanding collaborative management of patients with SAD is an important educational imperative for psychiatrists and other health care professionals. Considerable gaps in level-1 evidence mirror the need for psychiatrists to exchange insights into this heterogeneous clinical construct and its clinical management.
This activity is jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications, LLC, and is supported by an educational grant from Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc, administered by Ortho-McNeil-Janssen Scientific Affairs, LLC.
Bipolar disorder (BD) is challenging to diagnose because it is often comorbid with other psychiatric illnesses, drug and alcohol abuse, and physical illness. Since BD is a chronic disorder, long-term treatment with both pharmacologic and psychosocial therapies is needed.
This activity will help clinicians develop an evidence-based approach to therapy, integrate nonpharmacologic management strategies into treatment programs, and create long-term treatment strategies designed to optimize patient outcomes while minimizing medication-related adverse events.
This supplement was submitted by SciMed and supported by an educational grant from AstraZeneca. It was peer reviewed by Current Psychiatry and Annals of Clinical Psychiatry.
The diagnosis and management of psychotic and mood disorders is an evolving process and an important topic for continuing medical education. To facilitate a dialogue on the identification and treatment of psychotic and mood disorders, we have invited 4 expert faculty members to present actual patient cases. The learning objectives of this CME program are: (1) to achieve early and accurate diagnosis of patients with psychotic and mood disorders, using effective screening tools as needed; (2) to determine the most appropriate monotherapy or combination therapy for short- and long-term treatment; and (3) to review the mechanisms of action and metabolism of medications used for these conditions.
Bipolar disorder (BD) is a chronic psychological illness of substantial morbidity and mortality characterized by frequent episodes of mania and depression. This disorder is of particular importance to health care professionals given that it affects up to 3% of the general population and causes a significant impact on the patient's quality of life, as well as a considerable economic burden on both the individual and society.
In November 2009, an expert panel of 7 nationally recognized psychiatric experts convened at the Bipolar Summit. Summit members presented clinical data about six statements that broadly addressed recent advances in the understanding of Bipolar Disorder. The experts voted on the validity of each statement in light of the strength of the available evidence; the results of the experts' ratings were then compared with clinical psychiatrists in the community using a national survey, and recommendations were made for future research. This activity will provide an evidence-based evaluation surrounding the treatment of patients with BD using pharmacologic and psychosocial therapies. The six areas of clinical focus that are explored in this supplement include brain alterations in bipolar patients, bipolar NOS (not otherwise specified) diagnosis and treatment, residual bipolar-related symptoms, use of antidepressants in the treatment of bipolar disorder, treating substance-abuse disorders in bipolar patients, and use of second-generation antipsychotics as mood stabilizers.
This activity is hosted by the University of Minnesota and Consensus Medical Communications. This activity was funded through an educational grant from Janssen, L.P. This grant is administered by Ortho-McNeil Janssen Scientific Affairs, LLC.
MaryAnne—Visit 1: A middle-aged woman going through a troublesome divorce
"I have been active my whole life but this divorce is causing me so much stress, I can’t do anything anymore."
MaryAnne is a 50-year-old Caucasian woman who was referred by her primary care doctor to a psychiatrist for evaluation and management of depressive symptoms. She is currently going through a prolonged and stressful divorce, has become increasingly depressed, and has gained weight over the preceding year.
MaryAnne—Visit 2: A middle-aged woman with persistent pain and depression
"I'm feeling a lot better but I still have pain."
MaryAnne was referred by her primary care doctor 6 months ago for psychiatric evaluation of depressive symptoms. She had complaints of widespread pain, and was experiencing difficulty with sleeping, fatigue, and concentration.