This course will describe the resources needed to set up office-based treatment with buprenorphine for patients with opioid use disorder (OUD) and review:

1. DSM-5 criteria for opioid use disorder and the commonly accepted criteria for patients appropriate for office-based treatment of OUD;
2. confidentiality rules related to treatment of substance use disorders;
3. Drug Enforcement Administration requirements for record-keeping;
4. billing and common office procedures;
5. the epidemiology, symptoms, and current treatment of anxiety, common depressive disorders, and ADHD and how to distinguish independent disorders from substance-induced psychiatric disorders; and
6. common clinical events associated with addictive behavior.

Special treatment populations, including adolescents; pregnant addicts; and geriatric, HIV-positive, and chronic pain patients, will be addressed, and small-group case discussions will be used to reinforce learning.

After a relative dearth of new drug and device development for treatment of psychiatric disorders, considerable progress is being made in the field. This symposium will review recent advances in drug and device treatment, much of which can already be used in clinical practice. The program will include 6 talks, each with Q&A, as well as breakout sessions to allow for case discussion. The program will be about 8 hours in duration.  Presentations (and speakers) will include the following: Brain stimulatory devices and psychedelics for major depression (DeBattista); maximizing outcome in refractory depression (Schatzberg); managing bipolar disorder (Ostacher); treating children and adolescents with major psychiatric syndromes (Singh); innovations in managing the anxious patient (Nemeroff); advances in the treatment of schizophrenia (Hu). A practical approach will be taken throughout the program.

Addressing suicidality is one of the most daunting challenges that psychiatric clinicians face in daily practice. This master class will introduce an innovative approach to the assessment, treatment and case management of suicidal patients. After examining the various forms of suicidal and self-destructive behaviors, as well as their prevalence and impact in clinical practice, we will engage in a self-examination process designed to highlight the moral, ethical and hot button legal issues associated with treating suicidal patients. We will examine the clinical implications of the prediction and control dilemma, namely, that suicide cannot be predicted or prevented on a case by case basis. Thus, there is a significant likelihood that conventional "risk management" strategies designed to protect clients from self-harm, may actually promote self-stigma and increase the likelihood of suicidal behavior. Participants will learn an approach to suicidal behavior based in Acceptance and Commitment Therapy (ACT; Hayes, Strosahl and Wilson, 2011). ACT views suicidality as a problem-solving behavior designed to eliminate or control distressing, unwanted inner experiences, rather than as a sign of underlying psychiatric illness per se. ACT intervention strategies for suicidality will be examined in detail, with role play demonstrations of key clinical principles, and opportunities for participants to practice core strategies in role play simulations. Along the way, we will address some issues unique to psychiatric assessment and treatment of suicidal patients, namely, the benefits and limitations of medications, and the use of in-patient hospitalization. Participants will also have an opportunity to practice ACT consistent responses to high risk, emotionally challenging communications that can occur in therapy with chronically suicidal patients.

Early recognition and intervention for young people with early psychosis has become a national priority. Landmark studies in first episode psychosis (FEP; RA1SE) and Clinical High Risk for Psychosis (CHRp; NAPLS) have provided a solid base for program development. A key finding from this work being that shortening the duration of untreated psychosis (DUP) is crucial to improving overall outcomes. Following these research findings, over the last several years the federal and many state governments have and continue to make financial commitments to support expanded funding for early psychosis programs in each state. The number of US early psychosis clinical programs has thus exploded over that time frame. There is a consensus that such treatment requires an interdisciplinary approach, but with different proposed models, how does one conceive of and set up a new program or improve existing offerings to be in concert with best practices? Psychiatrists are key team members as part of the coordinated specialty care (CSC) team supporting those with CHRp and FEP. Many psychiatrists, however, have not been specifically trained in the current models of assessment and treatment that have been found to be most effective in supporting young people at-risk for or with early psychosis. This course will provide critical training for the general psychiatrist in the key aspects of assessment, work-up, and intervention models for the young person at risk for or facing a first episode of psychosis. Throughout this course, opportunities will be made available for small group practice, role playing, case discussions, and other opportunities to enhance your practice. The course components will include didactics and interactive training components. Key topics include an initial focus on the role of the psychiatrist as part of the CSC team, as well as skill development in the shared decision-making model of care. Furthermore, diagnostic and assessment issues in the approach to CHR intervention and early psychosis will be discussed. This training will include clarification of differential diagnosis issues, including key components of an appropriate assessment for early psychosis, including interview focus, screens, bloodwork, and consideration of neurological assessment. Intervention components will focus on the continuum of care including CBT for psychosis, family intervention, medication and medical support, supported education/employment, and peer support. Furthermore, specific guidance for psychiatrists on appropriate engagement strategies and collaboration from the perspective of the individual with lived experience with psychosis will also be highlighted. Complexities of addressing co-morbid substance use issues, trauma, and the role of wellness and physical activity in intervention will also be discussed. An additional focus will include special considerations in working with the adolescent with early psychosis and their family, school, and community environment.

Motivational Interviewing (MI) a directional conversation style focused on change grounded in humanistic psychology. William R. Miller and Stephen Rollnick propose that change is a natural and ubiquitous process that is intrinsic to each person, and may occur without any outside intervention. MI seeks to hasten this natural change process by creating an interpersonal situation, wherein the clinician engages the patient in a collaborative dialogue that evokes and supports behavioral change from the patient’s perspective. MI is something that is done with someone, such that it increases the likelihood they will consider and become more committed to change. Clinicians adopt a style or “spirit” of interacting and communicating with patients such that they honor the patient’s experiences and perspective, affirm the patient’s right and capacity for self-direction, and draw out the patient’s goals, values, and perceptions that support change. By creating a therapeutic context grounded in this spirit, clinicians help patients feel more open to exploring their ambivalence about change and empowered by the self-direction afforded to them. This course will review the basic concepts and skills of Motivational Interviewing (MI) and involve participants in exercises to practice skills and tools, to illustrate the practical applicability of these tools in clinical practice with their patients. An MI approach positions clinicians and patients as mutually collaborative experts, and participants adhering to MI can improve the efficiency of the limited clinical time we have with patients. Its introduction in the 1980’s, the effectiveness of MI has been demonstrated across a wide variety of disciplines and issues. Despite this evidence, MI adherent practice has relatively limited penetrance into psychiatry, even in the field of addiction psychiatry. There is a tremendous potential benefit of employing MI to improve psychiatric care, particularly in addressing common problems such as medication non-adherence, increasing healthy behaviors such as diet and exercise, and reducing substance use. The session will introduce or refresh participants to the fundamentals of motivational interviewing emphasizing core ideas such as the ‘righting reflex’, the spirit of MI, the four processes of MI, and the skills in MI. Participants will practice these skills to enhance clinician effectiveness with structuring conversations using MI processes to evoke the patient’s making arguments for change. The session will include discussion and exercises that demonstrate strategies for doing so, along with some of the other basic techniques of MI, with a focus on reflective listening. At the conclusion of this course, clinicians will have more competence using motivational interviewing, will have greater knowledge of the concepts and terminology, and will be able to improve their performance working with patients to change behaviors.