Clinical Updates Track: Expert Guidance on Deprescribing, Polypharmacy, PTSD, Psychedelics, and More

Managing diagnostic dilemmas is a focus of the Clinical Updates track at the Annual Meeting.

“The intent is to update psychiatrists on the state-of-the-art on clinical issues frequently encountered in the standard office, specifically on conditions for which there is uncertainty about the diagnosis and best treatment,” said Ronald M. Winchel, M.D., assistant clinical professor of psychiatry at Columbia University, who has led the track for four years. “Clinicians need up-to-date information and state-of-the-art science, but they also need help with the anxiety these moments engender. … I like to zero in on topics will help reduce clinicians’ anxiety by giving them the best guidance.”

The meeting’s 12 Clinical Updates sessions will feature some of the leading experts in the field, including Anita Clayton, M.D., Jonathan M. Kane, M.D., Donovan Maust, M.D., Michael Ostacher, M.D., M.P.H., Carolyn Rodriguez, M.D., Ph.D., Tricia Suppes, M.D., Mauricio Tohen, M.D., M.B.A., Rachel Yehuda, Ph.D., and many more.

Winchel reviewed a few of this year’s Clinical Updates offerings for Psychiatric News:

• Mixed Features in Persons with Depressive and Bipolar Disorder: Historical, Conceptual, Nosological, and Clinical Implications: The “mixed features” specifier, added to the DSM-5 in May 2013, may help identify patients at higher risk of developing bipolar disorder or those who may not respond well to standard depression treatments. Yet how to best manage patients with mixed features, Winchel said, “is a conundrum, and it’s a common one.” Renowned mood disorder expert Roger McIntyre, M.D., will walk attendees through the latest research and best guidance.


• Current Perspectives on Treatment-Resistant Depression: “It makes us anxious to have a patient with treatment-resistant depression who’s been through two or three augmentations and is still not getting better. … There are still several choices of treatment. Which one do I go for?” The session, led by preeminent psychopharmacologist Michael E. Thase, M.D., will provide solid guidance.


• Behind the Mask: When Trauma Looks Like Depression, Anxiety, ADHD, or Psychosis: Diagnosing and treating posttraumatic stress disorder can be especially difficult, in part because it frequently presents as depression or an anxiety disorder, Winchel said. Led by an all-star lineup of Rachel Yehuda, Ph.D., Lauren Lepow, M.D., Ph.D., Elizabeth Haase, M.D., and David Mintz, M.D.


• From Tantrums to Triggers: The Diagnostic Challenge of Irritability in Children and Adolescents: Many disorders first present in childhood and adolescence as irritability, including unipolar depression, disruptive mood dysregulation disorder, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder. “Of course, adolescents often have a normative irritability in relation to their parents, so even defining irritability as a symptom rather than a developmental stage can be challenging,” Winchel said. “Determining which diagnosis it may herald, if any, and which treatment is indicated, compounds the difficulty. The last thing you want to do is mistake early bipolar disorder for ADHD and prescribe a stimulant.” Led by physician-scientist Manpreet K. Singh, M.D., M.S.

• Borderline, Bipolar, or Both: The Diagnostic Dilemma: “Certain diagnoses lead to inherently poor reporting on the part of the patient due to lack of insight,” Winchel said. “Patients with hypomania often feel pretty good and may mistake their symptoms as merely ‘feeling better,’ and they are more likely to seek treatment for the depressive phase of the illness, where they spend 80% of their symptomatic time. … Similarly, individuals with borderline personality disorder and poor insight into their emotional dysregulation aren’t going to tell you that they were inappropriately enraged, they’ll tell you that ‘The other person was a [jerk].’” Led by diagnostic specialist Mark Zimmerman, M.D.


• From Promise to Practice: Psychedelic Research for Everyday Psychiatry: Analysts predict that psilocybin will likely be approved by the FDA in 2026 or the very near future. “Patients are coming in and asking about psychedelics left and right, and we need to be able to respond knowledgeably,” Winchel said. Expert Tricia Suppes, M.D., will present what is likely to be a standing-room-only session on recent research findings and potential clinical use of psychedelics.

Other select sessions from the Clinical Updates track include:

• The Much Too Medicated Patient, Rational and Irrational Polypharmacy
• Deprescribing Benzodiazepines and Z-Drugs; Novel Substances of Misuse: Kratom and Derivatives
• Deprescribing Antipsychotics, Antidepressants, and Mood Stabilizers
• Decoding OCD, Diagnostic Dilemmas and Emerging Treatments
• Bipolar Disorders, Treating Comorbid Conditions, Substance Use Disorders
• SSRIs, Efficacy, and Safety, From Childhood to Young Adulthood

For dates, times, and locations of these and other sessions, check the APA Meetings App. ■