2014 – 2015 Psychoanalytic Grand Rounds at Stanford
|Title:||Less is More: Improving Treatment Outcome in Traumatized Youth by Reducing Medication|
|Date:||Friday, October 31, 2014|
|Time:||12:15pm - 01:30pm|
|Presenter:||Edmund C. Levin, MD|
|Chair:||Jeffrey Yost, MFT|
Stanford's Psychiatry and Behavioral Sciences Building, Room 1211
401 Quarry Road
Stanford, CA 94304
|CME/CE:||1.25 CME/CE Credits available for $ 12.50 or $ 15.00|
In recent years the task of psychiatrists serving youth in residential programs has largely shifted to rendering diagnostic evaluations and prescribing medications. Children in residential facilities are often misdiagnosed and treated with high doses of multiple medications drawn from several different classes of psychopharmaceuticals. The more accurate diagnosis for many of these children, Developmental Trauma Disorder (DTD), reconceptualizes the treatment approach and leads to substantial clinical benefit. Initiating treatment through application of milieu and dynamic psychotherapy and the tapering of medication very likely will encounter the challenges of staff resistance and the need to modify the agency’s institutional culture.
The number of children receiving medication, the amount and number of medications used, and the number of aggressive incident reports fell dramatically over a 2-year period. Regarding mood and conduct disorders as manifestations of past trauma, rather than as biochemical imbalances, is the dominant focus of an analytically-informed treatment of DTD.
Edmund C. Levin, MD, a graduate of the adult and child programs at LPPI, is in the practice of general and child and adolescent psychiatry in Berkeley. He works there with patients of all ages and provides consultation to colleagues of all disciplines.
A Life Fellow in the American Academy of Child and Adolescent Psychiatry and a Distinguished Life Fellow in the American Psychiatric Association, he has long been interested in the impact of trauma on child development. He sees his concern with trauma as having become increasingly significant in the past 15 years, as our field has experienced an explosion of “biologic” diagnoses, such as Pediatric Bipolar Disorder often with comorbid ADHD. He believes that this in turn has led to our seeing patients in an overly narrow way, which results all too often in the over use of medications.
He has spoken locally, nationally and internationally and writes frequently on the hazards of over diagnosing and over medicating patients and how that has led medical and non-medical clinicians alike to overlook the significance of environmental, developmental and psychodynamic factors in the treatment of youth.
Participants will be able to:
- explain why trauma is so relatively under diagnosed while “biologic” psychiatric disorders tend to be overdiagnosed and over-medicated.
- describe life long consequences of Developmental Trauma Disorder and Adverse Childhood Experiences.
- explain the need for an extensive evaluation before coming to a working diagnosis and developing a treatment plan.
- explain the need for and describe the ways to change institutional culture of an agency if one is to successfully decrease the over-use of medication for patients.
The San Francisco Center for Psychoanalysis is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians. The San Francisco Center for Psychoanalysis takes responsibility for the content, quality and scientific integrity of this CME activity.
PHYSICIANS: The San Francisco Center for Psychoanalysis designates this educational activity for a maximum of 1.25 credits as listed for each individual program, AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.
LCSWs/MFTs: The San Francisco Center for Psychoanalysis is a provider approved by the Board of Behavioral Sciences, Provider Number PCE623, for 1.25 CE credits on an hour for hour basis.
PSYCHOLOGISTS: Psychologists attending SFCP events approved for CME credits may report AMA PRA Category 1Credit(s)™ toward their CE requirements. Psychologists self-certify the number of hours they have completed on their renewal form (whether online or paper). The San Francisco Center for Psychoanalysis is approved by the American Psychological Association to sponsor continuing education for psychologists. The San Francisco Center for Psychoanalysis maintains responsibility for this program and its content.
REGISTERED NURSES: The San Francisco Center for Psychoanalysis is a provider approved by the California Board of Registered Nursing, Provider Number 02677, on an hour for hour basis.
SFCP is approved by the American Psychological Association to sponsor continuing education for psychologists. SFCP maintains responsibility for this program and its contents.
Commercial Support: None
Faculty Disclosure: The following moderators and planning committee members have disclosed NO financial interest/arrangement or affiliation with commercial companies who have provided products or services, relating presentation(s) or commercial support for this continuing medical education activity: Jeffrey Yost, MFT and Edmund C. Levin, MD. All conflicts of interest have been resolved in accordance with the ACCME Updated Standards for Commercial Support.