American Psychiatric Association, May 16-21, 2009Last Updated: May 26, 2009.
The American Psychiatric Association's 162nd Annual Meeting took place May 16 to 21 in San Francisco and attracted more than 15,000 attendees from the United States and over 50 other countries. The meeting presented more than 500 scientific sessions, and featured topics included conflict of interest, the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), borderline personality disorder, alcoholism, and the association between depression and heart disease.
"Dr. Paul Appelbaum, an internationally known ethicist, drafted new guidelines for interactions between psychiatrists, the pharmaceutical industry, and other industries, and chaired a superb presidential symposium," said APA president, Nada Stotland, M.D., of the Illinois Masonic Medical Center in Chicago.
Similar to guidelines published by the Institute of Medicine, the new guidelines caution that conflicts of interest can arise when clinicians are offered significant financial incentives by industries to develop, study, and distribute new medications. They also advise clinicians against using only industry-provided slides and materials during talks to colleagues and instead adhere to criteria established by the Accreditation Council on Continuing Medical Education.
"A lot of people are earning sums of money from talks that don't meet those criteria, a practice which until recently was considered perfectly acceptable," Stotland said. "So people will have to do a lot of thinking over the next few months in order to digest and absorb these new draft guidelines. It's a big deal."
Attendees had multiple opportunities to meet with experts who are developing the revised DSM-V, which is scheduled for publication in 2012. "One very interesting session was basically a town hall meeting where anybody could express their concerns, questions, or complaints," Stotland said. "By and large, that went very well. Although there will be significant changes, people felt that there won't be any big secrets or surprises sneaking up on them."
One of the most widely anticipated changes is a move away from a categorical model that classifies patients as either having or not having a mental disorder, toward a dimensional model that classifies patients across a spectrum ranging from mild to severe.
"Experts are beginning to test new models to see if they better predict future psychopathology, behavior problems, and response to treatment," said program committee member, Kenneth Silk, M.D., of the University of Michigan in Ann Arbor.
As an example, Silk cited the Severity Indices of Personality Problems, a clinical instrument developed by researchers in the Netherlands to assess the severity of personality disorders. The self-report questionnaire includes 16 subscales clustered into five higher order domains -- self-control, identity, integration, relational capacities, social concordance, and responsibility -- which collectively represent the core components of adaptive or maladaptive personality functioning.
"The researchers have a rich data base on four different personality disorders that might help inform DSM-V about which model is better if DSM-V goes dimensional," Silk said.
The track on borderline personality disorder included a symposium on the role of neurobiology and genes. "For the first time, research was presented on the role of opioid receptors and oxytocin genotypes in the emotion dysregulation of borderline personality disorder," Silk said.
Jon-Kar Zubieta, M.D., of the University of Michigan in Ann Arbor, presented a study showing that regional activation of the opioid neurotransmitter system during an emotion challenge was significantly greater among 20 women with borderline personality disorder than in 18 healthy matched controls. "These data demonstrate the involvement of the endogenous opioid system in traits relevant to impulse and emotion dysregulation, as well as in borderline personality disorder, where both these traits form a prominent part of the clinical presentation," Zubieta and colleagues write.
"Some studies show that blocking opioid receptors can decrease patients' tendency to cut themselves because they don't get relief from harming themselves," Silk said. "But treatment with opioid antagonists such as naltrexone hasn't yet gone forward because we don't want patients to engage in other destructive behaviors to relieve stress."
Other meeting highlights included a track on alcoholism, during which Finnish researchers presented a meta-analysis of 58 studies showing that about one-fifth of patients with schizophrenia have an alcohol-use disorder. They also found that the prevalence of alcohol-use disorders in this population has declined since 1995, possibly because of changes in diagnostic systems and possibly because patients in some countries are switching to other drugs such as cannabis.
Multiple sessions also addressed the links between mental health, depression, and heart disease. During one presentation, Alexander Glassman, M.D., of New York City said that a single measure of depression after a coronary event is associated with a doubled risk of death over the next seven years, and that new post-event depression is associated with at least as great a risk of death as recurrent major depression.
"There is strong evidence that selective serotonin reuptake inhibitors are safe in post-acute coronary syndrome patients and there is suggestive, although not definitive, evidence that they can reduce medical risks while they are being administered, but there is no evidence that they induce sustained medical benefit," Glassman writes.
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APA: Sessions Address Issues Affecting Gays and Lesbians
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