PSYCHIATRY RESIDENT/FELLOW INITIATED AND DESIGNED PSYCHIATRY RESIDENT/FELLOW INITIATED AND DESIGNED BIPOLAR MODULE PROJECT AS A PART OF THE PSYCHOPHARMACOLOGY CURRICULUMBIPOLAR MODULE PROJECT AS A PART OF THE PSYCHOPHARMACOLOGY CURRICULUM

Nirupama Natarajan, MD ¹, Shabnam Sood, MD, Ragy R. Girgis, MD, Anna Boriskovskaya, MD, Shiva Srinivasan, MD, Amit Chopra, MD, Chadi Abdallah MD,Nirupama Natarajan, MD ¹, Shabnam Sood, MD, Ragy R. Girgis, MD, Anna Boriskovskaya, MD, Shiva Srinivasan, MD, Amit Chopra, MD, Chadi Abdallah MD,Chadi Abdallah, MD, Arman Danielyan, MD, Mallika Lavakumar, MD, Syed Quadri, MD, Danielle Martin, MD, Brent Wilson, MD, Michael Stanger MD, Anthony Rostain MD, Michael Jibson MD, Sidney Zisook, MDChadi Abdallah, MD, Arman Danielyan, MD, Mallika Lavakumar, MD, Syed Quadri, MD, Danielle Martin, MD, Brent Wilson, MD, Michael Stanger MD, Anthony Rostain MD, Michael Jibson MD, Sidney Zisook, MD

¹Child & Adolescent Psychiatry Fellow, Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA¹Child & Adolescent Psychiatry Fellow, Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA

BACKGROUNDTeaching Psychopharmacology requires the effective transfer of an ever-changing information base to maximize effectiveness, adherence and satisfaction. Portable curricula developed by the American College of Neuropsychopharmacology (ACNP)1 and American Society for Clinical Psychopharmacology (ASCP) 3 in partnership with the American Association of Directors of Psychiatric Residency Training (AADPRT) have begun to address some of the inadequacies in the pedagogy of psychopharmacology in residency training 2,4. In the 2006 AADPRT annual meeting, an ad hoc committee was formed including individuals from the ASCP curriculum committee to help make the ASCP’s Psychopharmacology Curriculum more “resident friendly”. A workshop presented at the 2007 AADPRT meeting introduced the multifaceted schizophrenia module. Resident training in Psychopharmacology may be advanced through improvements in teaching neuroscience and developing up-to-date core curricula.

OBJECTIVESThe primary aim of the ASCP Committee on Residency and Fellowship was to develop novel, multi-modal psychopharmacology curricula in major depression and bipolar disorder to support psychopharmacology education in Adult Psychiatry Residency Training Programs.

METHODSThe general committee divided into depression and bipolar module work groups met monthly by conference call to develop the curriculum from September 2009 – June 2010.The workgroup performed a review of published ABPN, APA, AADPRT, and ACGME core competencies and practice guidelines to delineate the scope of the psychopharmacology curriculum to be developed.

COMMITTEE SELECTIONThe committee received nominations from Psychiatry Residency/Fellowship Training Directors nationwide, selected 15 residents/fellows and formed 2 subgroups to serve over a period of 12 months and work on the development of multi-model training modules for bipolar disorder and depression. This presentation highlights the progress of the bipolar curriculum group.

CURRICULUM DESIGN Twelve mini-modules were chosen to make up the Bipolar teaching Module, each of which could be used as free-standing teaching sessions or collectively as one comprehensive curriculum.The core of each module was a Power Point presentation.Corresponding multi-modal learning activities stemmed from each mini-module.Problem and group-based learning and alternative teaching exercises were developed for each mini module to reinforce didactic learning objectives and extend learning beyond the scope of the slide set.Teaching modalities included Jeopardy®- style psychopharmacology quizzes, multiple-choice question banks, and clinical vignettes/sham scenarios designed to assess the ACGME core competencies.

BIPOLAR CURRICULUM: 12 MINI-MODULES Historical and Epidemiological Highlights Neurobiology of Bipolar Disorder Bipolar Depression and treatment approaches Atypicals for Maintenance Pediatric Bipolar Disorder Bipolar Disorder Vs Borderline Personality DisorderPregnancy & Bipolar Disorder Co-morbid ADHD Co-morbid Substance Use Disorders Psychosocial Aspects of TreatmentPharmacotherapy of Bipolar Disorder Evidence – based medicine: CANMAT & ISBD guidelines for management of Bipolar disorder

APA Guidelines for Mania ManagementSevere mania or mixed episode- lithium or valproate with antipsychotic.Less ill- monotherapy with lithium, valproate or antipsychotic like zyprexa.Short term adjunct treatment with benzos.Mixed episodes- valproate preferred.2nd generation preferred over 1st .Alternatives are carbamazepine or oxcarbamazepine , ziprasidone or quetiapine.

Interpersonal and Social Rhythm TherapyInterpersonal and Social Rhythm TherapyFocuses on patterns of social stimulation and sleep-wake cycle schedule and improving interpersonal relationships.Assesses the contribution of life events and social rhythm disruptions to previous episodes.Identifies core interpersonal difficulties.

CLINICAL VIGNETTES/MULTI-STEM QUESTIONSCA is a 9 year-old boy presenting with his parents who noticed that CA fails

to finish his homework, often loses toys and books, does not seem to listen when spoken to directly, is easily distracted, fidgets with his hands or squirms in his seat, has difficulty playing quietly, often acts as if “driven by a motor”, speaks fast and excessively, often interrupts others, blurts out answers before questions have been completed, and has difficulty awaiting his turn.

What are the common symptoms between ADHD and BPD?Though CA has been having the previously mentioned symptoms for more

than 3 years, his parents brought him to see a psychiatrist today because over the last week these symptoms got worse, he became more irritable and he was not sleeping for more than 4 hours per day. Yesterday, when the teacher asked him to stop interrupting others, he ran out of the classroom, broke the hallway window, and then left the school building entirely.

What is his current diagnosis? And how do we distinguish between ADHD and BPD? Based on our knowledge of CA’s presentation and our literature review: What would be the suggested treatment for CA?

BPD with co-morbid ADHD could possibly be a distinct disorder from both ADHD and BPD

The relationship between these 2 disorders is likely complex and multifactorial.

Bipolar Spectrum Disorders

Bipolar I disorder: history of mania*

Bipolar II disorder: history of hypomania and major depressive episodes*

Cyclothymia*

Hyperthymic temperament

Secondary mania (to other illnesses or drugs)

Antidepressant-induced mania and hypomania

Treatment of Co-morbid Bipolar disorder and Border line personality disorder

Anticonvulsants have efficacy in both bipolar disorder and borderline personality disorder. Preston et. al. reported a 40% reduction in the dimensions of borderline personality disorder in patients with co-morbid bipolar disorder with Lamotrigine. There was a trend for co-morbid bipolar patients to require a second psychoactive medication in addition to lamotrigine during extended treatment.

CONCLUSIONS A psychiatry resident/fellow designed Bipolar Module was designed to

flexibly suit the needs of individual Residency Programs and improve psychopharmacology teaching in residency programs by placing an emphasis on Multi-Modal learning activities.

It is an innovative tool for teaching Psychopharmacology which enables Psychiatric trainees and other Psychiatrists to master a large volume of information.

The Module is scheduled to undergo field testing at Psychiatry Residency Programs later this year to test feasibility and effectiveness..

SELECTED REFERENCES1. Glick, ID, Janowsky, DS, Dalzman C, et al.: A Model Psychopharmacology Curriculum for Psychiatric Residents. Nashville: American College of Neuropsychopharmacology, 1984.2. Glick, ID, Zisook, S: The challenge of teaching psychopharmacology in the new millennium: the role of curricula. Academic Psychiatry 29:134-140, 2005.3. A Model Psychopharmacology Curriculum for Psychiatric Residency Training Programs, Training Directors and Teachers of Psychopharmacology. Glen Oaks, American Society of Clinical Psychopharmacology, 2006.4. Zisook, S, Balon, R, Benjamin, S, et al.: Psychopharmacology curriculum field test. Academic Psychiatry 33:358-363, 2009.

DISCLOSURESDr. Zisook has received grant/research support from ASPECT and honorarium from GlaxoSmithKline in the past year.Dr. Girgis has received research support from Janssen and Lilly through the American Psychiatric Institute for Research and Education and a travel stipend from Lilly, Forest and Elsevier Science through the Society of Biological Psychiatry.Drs. Abdallah, Boriskovskaya, Chopra, Danielyan, Jibson, Lavakumar, Martin, Natarajan, Quadri, Rostain, Sood, Srinivasan, Stanger and Wilson have no disclosures to report.

PowerPoint Presentations

PowerPoint Presentations