EVPS & treatment innovations in behavioral health for posting 2 26 15

Evidenced Based Practices & Treatment Innovations in Behavioral Health

Daniel Castellanos, MD Medical Director, South Florida Behavioral Health Network

Disclosures

Dr Castellanos is Professor & Founding Chair, Department of Psychiatry & Behavioral Health, The Herbert Wertheim College of Medicine, Florida International University

No relevant financial disclosures

Recognize different mental health treatments used throughout history

Identify the levels of scientific evidence that determine what

constitutes evidenced based care

Recognize Evidence Based Practices (EVPs) for common behavioral

health disorders

Identify types of newer and innovative behavioral health treatments for

common behavioral health disorders

Objectives

Castellanos 2014

Castellanos 2014

Although hydrotherapeutic treatment for mental illness had ancient roots, it received increased attention in the 19th century, when the water cure craze spread throughout the western world

Developed and popularized by Vincenz Priessnitz it promised relief from the common ills of the day. Gout, rheumatism, tuberculosis, melancholy, indigestion were all treatable with water

Castellanos 2014

Use of hydrotherapy in American psychiatric hospitals grew rapidly in the first two decades of the 20th century

It was an era with few successful treatments for mental disorders, so in many instances prolonged baths and wet packs replaced physical restraints for agitated patients

Continuous bath, Bloomingdale Hospital. Photo courtesy of Weill Cornell Medical Archives Castellanos 2014

Between 1917 and 1935, four methods for producing physiological shock were discovered, tested and used in the psychiatric practice in Europe: Malaria-induced fever to treat neurosyphillitic paresis (Julius

Wagner-Jauregg, 1917) Insulin-induced coma and seizures to treat schizophrenia,

(Manfred J. Sakel, 1927) Metrazol (Pentylenetetrazol )-induced seizures to treat

schizophrenia and affective psychoses (Ladislaus J. von Meduna, 1934)

Electroconvulsive shock therapy (Ugo Cerletti and Lucio Bini, 1937)

Castellanos 2014

Patients were given regular insulin injections to produce five or six diabetic comas a week for weeks at a time

Insulin therapy continued until the patient improved, or until 50 to 60 comas had been induced

Commonly used in psychiatric institutions in the 1940s and 1950s to treat schizophrenia and other mental illness

Insulin shock therapy was regarded as the treatment of choice for schizophrenia for about twenty years

Castellanos 2014

Castellanos 2014

Ugo Cerletti was convinced that metrazol-induced seizures were useful for the treatment of schizophrenia, but far too dangerous and uncontrollable to be applied (there was no antidote to stop the convulsions at the time, as it happened with insulin). Furthermore, they were highly feared by the patients

Castellanos 2014

Dr. Walter Freeman of George Washington University and Dr. James Watts of Yale brought Monizs leucotomy to the US

They kept encountering problems like the knife breaking off in peoples brains, unexplained seizures, and total disorientation

Castellanos 2014

Prefrontal Leucotomy: Holes drilled in the skull. Surgeon would sever the nerves using a pencil-sized tool called a leucotome. It had a slide mechanism on the side that would deploy a wire loop(s) from the tip. The surgeon could sever the nerves by removing cores of brain tissue, slide the loop back in, and the operation was complete

Prefrontal Lobotomy: Also utilized drilled holes, but in the upper forehead instead of the top of the skull. It was also different in that the surgeon used a blade instead of a leucotome

Transorbital lobotomy

Castellanos 2014

Psychotherapy

Castellanos 2014

Early 1900s Sigmund Freud

1905-1950 Adolf Meyer 1900s-1950s

Carl Jung

1930s-1970s BF Skinner

Today - EVPs

Evolution of Psychotherapy

Castellanos 2014

Evidence Based Practices

Castellanos 2014

Levels of Scientific Evidence

Castellanos 2014

Randomized

controlled trials

Non-randomized controlled trials; large meta-analysis

Observational studies with controls

Observational studies without controls; case series

Case reports; anecdotal reports; clinical consensus

Source: Adapted from US Dept of Health and Human Services; http://www.ahrq.gov/

Highest

Lowest

Evidence Based Practices (EBPs)

Castellanos 2014

Definition:

Applying the best available research results (evidence) when making decisions about health care.

Health care professionals who perform evidence-based practice use research evidence along with clinical expertise and patient preferences.

Source: US Dept of HHS, Agency for HealthCare Research & Quality


Castellanos 2014

Example:

A behavioral health care provider recommends cognitive behavioral

treatment (CBT) for a person with severe generalized anxiety disorder.

The behavioral health care provider makes this recommendation because

RCTs shows that CBT is effective in treating anxiety.


Castellanos 2014

Promising practices:

Certain practices supported by current clinical wisdom, theories, and professional and expert consensus

These practices may lack support from studies that are scientifically rigorous in research design and statistical analysis or

Available studies may be limited in number or sample size or

They may not be applicable to the current setting or population.

Source: www.SAMHSA.gov

Treatment Guidelines

Castellanos 2014

Treatment guidelines incorporate EBPs - PTSD example:

Recommended for Practice

Psychosocial: cognitive behavioral therapy to teach distraction and other

techniques; individual or group counseling and psychotherapy sessions; support

group meetings

Likely To Be Effective

Medications:

Benzodiazepines (lorazepam, diazepam, alprazolam) Azapirones (buspirone) Antihistamines (hydroxyzine) Antidepressants (paroxetine, sertraline, escitalopram, venlafaxine,

mirtazapine)

Atypical neuroleptics (olanzapine, risperidone)

Treatment Guidelines

Castellanos 2014

Treatment guidelines incorporate EBPs - PTSD example:

Effectiveness Not Established

Art therapy

Exercise

Meditation

Massage therapy

Progressive muscle relaxation

Therapeutic touch

Reiki

Foot reflexology

Homeopathy

Castellanos 2014

Insert FMHI Guidelines

Florida Best Practice Medication Guideline for Schizophrenia

Trauma Informed Care

According to SAMHSAs concept of a trauma-informed approach,

A program, organization, or system that is trauma-informed:

Realizes the widespread impact of trauma and understands potential paths for

recovery;

Recognizes the signs and symptoms of trauma in clients, families, staff, and

others involved with the system;

Responds by fully integrating knowledge about trauma into policies, procedures,

and practices; and

Seeks to actively resist re-traumatization.

Castellanos 2014


A trauma-informed approach can be implemented in any type of service setting

or organization and is distinct from trauma-specific interventions or treatments

that are designed specifically to address the consequences of trauma and to

facilitate healing.

From SAMHSAs perspective, it is critical to promote the linkage to recovery

and resilience for those individuals and families impacted by trauma. Consistent

with SAMHSAs definition of recovery, services and supports that are trauma-

informed build on the best evidence available and consumer and family

engagement, empowerment, and collaboration.

Castellanos 2014


A trauma-informed approach reflects adherence to six key principles rather than a

prescribed set of practices or procedures. These principles may be generalizable

across multiple types of settings, although terminology and application may be

setting- or sector-specific:

Safety

Trustworthiness and Transparency

Peer support

Collaboration and mutuality

Empowerment, voice and choice

Cultural, Historical, and Gender Issues

Castellanos 2014


Examples

Castellanos 2014

EBPs for Depression Acceptance and Commitment Therapy (ACT):

ACT is a contextually focused form of cognitive behavioral

psychotherapy that uses mindfulness and behavioral activation to increase

clients' psychological flexibility--their ability to engage in values-based,

positive behaviors while experiencing difficult thoughts, emotions, or

sensations.

Adolescent Coping With Depression (CWD-A):

The CWD-A course is a cognitive behavioral group intervention that

targets specific problems typically experienced by depressed adolescents.

These problems include discomfort and anxiety, irrational/negative

thoughts, poor social skills, and limited experiences of pleasant activities.

Castellanos 2014

EBPs for Depression Attachment-Based Family Therapy (ABFT):

ABFT is a treatment for adols that is designed to treat clinically diagnosed

major depressive disorder, eliminate suicidal ideation, and reduce

dispositional anxiety.

Cognitive Behavioral Therapy for Late-Life Depression :

CBT for Late-Life Depression is an active, directive, time-limited, and

structured problem-solving approach program that follows the conceptual

model of CBT.

Computer-Based Cognitive Behavioral Therapy, Beating the Blues:

Computer-Based CBT, Beating the Blues (BtB), is a computer-delivered

series of CBT sessions for adults with mild to moderate depression and/or

anxiety.

Castellanos 2014

EBPs for Depression Dialectical Behavior Therapy(DBT):

DBT is a cognitive-behavioral treatment approach with two key

characteristics: a behavioral, problem-solving focus blended with acceptance-

based strategies, and an emphasis on dialectical processes.

IMPACT (Improving Mood--Promoting Access to Collaborative

Treatment):

IMPACT is an intervention for adult pts who have a diagnosis of major

depression or dysthymia, often in conjunction with another major health prob.

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A):

IPT for Depressed Adols is a short-term, manual-driven outpatient treatment

intervention that focuses on the current interpersonal problems of adols with

mild to moderate depression severity. Castellanos 2014

EBPs for Depression Cognitive Behavioral Therapy for Adolescent Depression (CBT):

CBT for Adolescent Depression is a developmental adaptation of the classic

cognitive therapy model. CBT emphasizes collaborative empiricism, the

importance of socializing patients to the cognitive therapy model, and the

monitoring and modification of automatic thoughts, assumptions, and

beliefs.

Mindfulness-Based Cognitive Therapy (MBCT):

MBCT is a program for adults with recurrent major depressive disorder.

MBCT represents an integration of components from two interventions:

Mindfulness-Based Stress Reduction, which is based on the core principle of

"mindfulness" and CBT for depression.

Castellanos 2014

EBPs for Anxiety Acceptance-Based Behavioral Therapy for Generalized Anxiety Disorder:

ABBT for Generalized Anxiety Disorder (GAD) is a form of psychotherapy

for adults who have a principal diagnosis of GAD. The treatment is designed

to decrease symptoms of worry and stress, so clients experience a reduction in

GAD symptoms and comorbid depression or mood-related symptoms.

Coping Cat:

Coping Cat is a cognitive behavioral treatment that assists school-age children

in (1) recognizing anxious feelings and physical reactions to anxiety; (2)

clarifying cognition in anxiety-provoking situations (i.e., unrealistic

expectations); (3) developing a plan to help cope with the situation (i.e.,

determining what coping actions might be effective); and (4) evaluating

performance and administering self-reinforcement as appropriate.

Castellanos 2014

EBPs for Anxiety

Dialectical Behavior Therapy(DBT):


characteristics: a behavioral, problem-solving focus blended with acceptance-

based strategies, and an emphasis on dialectical processes.

Eye Movement Desensitization and Reprocessing Eye Movement (EMDR):

Desensitization and Reprocessing is a one-on-one form of psychotherapy that

is designed to reduce trauma-related stress, anxiety, and depression symptoms

associated with PTSD and to improve overall mental health functioning.

Castellanos 2014

EBPs for Trauma/PTSD Child-Parent Psychotherapy (CPP):

CPP is an intervention for children 0 - 5 who have experienced at least one

traumatic event and, as a result, are experiencing behavior, attachment, and/or

mental health problems, including PTSD.

Trauma Recovery and Empowerment Model (TREM):

TREM a fully manualized group-based intervention designed to facilitate

trauma recovery among women with histories of exposure to sexual and

physical abuse.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT):

TF-CBT is a psychosocial treatment model designed to treat posttraumatic

stress and related emotional and behavioral problems in children and

adolescents.

Castellanos 2014

EBPs for Trauma/PTSD Cognitive Behavioral Intervention for Trauma in Schools (CBITS):

The CBITS program is a school-based group and individual intervention

designed to reduce symptoms of posttraumatic stress disorder (PTSD),

depression, and behavioral problems; improve peer and parent support; and

enhance coping skills among students exposed to traumatic life events, such

as community and school violence, physical abuse, domestic violence,

accidents, and natural disasters.

Eye Movement Desensitization and Reprocessing Eye Movement (EMDR):

Desensitization and Reprocessing is a one-on-one form of psychotherapy

that is designed to reduce trauma-related stress, anxiety, and depression

symptoms associated with posttraumatic stress disorder (PTSD) and to

improve overall mental health functioning. Castellanos 2014

EBPs for Behavioral Disorders

Multisystemic Therapy (MST) for Juvenile Offenders:

MST for Juvenile Offenders addresses the multidimensional nature of

behavior problems in troubled youth. Treatment focuses on those factors

in each youth's social network that are contributing to his or her antisocial

behavior.

Multisystemic Therapy With Psychiatric Supports (MST-Psychiatric):

MST-Psychiatric is designed to treat youth who are at risk for out-of-

home placement (in some cases, psychiatric hospitalization) due to serious

behavioral problems and co-occurring mental health symptoms such as

thought disorder, bipolar affective disorder, depression, anxiety, and

impulsivity.

Castellanos 2014

EBPs for Behavioral Disorders

Brief Strategic Family Therapy (BSFT):

Brief Strategic Family Therapy is designed to (1) prevent, reduce, and/or

treat adolescent behavior problems such as drug use, conduct problems,

delinquency, sexually risky behavior, aggressive/violent behavior, and

association with antisocial peers; (2) improve prosocial behaviors such as

school attendance and performance; and (3) improve family functioning,

including effective parental leadership and management, positive

parenting, and parental involvement with the child and his or her peers

and school.

Castellanos 2014

EBPs for Substance Use Disorders

Family Behavior Therapy:

Family Behavior Therapy is an outpatient behavioral treatment aimed at

reducing drug and alcohol use in adults and youth along with common co-

occurring problem behaviors such as depression, family discord, school

and work attendance, and conduct problems in youth.

Brief Strategic Family Therapy (BSFT):

BSFT is designed to address adolescent behavior problems (such as,

substance use); improve prosocial behaviors; and improve family

functioning.

Castellanos 2014

EBPs for Substance Use Disorders

Multidimensional Family Therapy (MDFT):

MDFT is a comprehensive and multisystemic family-based outpatient or

partial hospitalization (day treatment) program for substance-abusing

adolescents, adolescents with co-occurring substance use and mental

disorders, and those at high risk for continued substance abuse and other

problem behaviors such as conduct disorder and delinquency.

Castellanos 2014

EBPs for SMI

International Center for Clubhouse Development (ICCD) Clubhouse

Model:

The ICCD Clubhouse Model is a day treatment program for rehabilitating

adults diagnosed with a mental health problem. The goal is to contribute to

the recovery of individuals through use of a therapeutic environment that

includes responsibilities within the Clubhouse (e.g., clerical duties, food

service, transportation, financial services), as well as through outside

employment, education, meaningful relationships, housing, and an overall

improved quality of life.

Castellanos 2014

EBPs for SMI

Psychiatric Rehabilitation Process Model:

The Psychiatric Rehabilitation Process Model is a process guiding the

interaction between a practitioner and an individual with severe mental

illness. Manual driven, the model is a client-centered, strengths-based

intervention designed to build clients' positive social relationships,

encourage self-determination of goals, connect clients to needed human

service supports, and provide direct skills training to maximize

independence.

Castellanos 2014

EBPs for Co-Occurring Disorders

Multidimensional Family Therapy (MDFT):

MDFT is a comprehensive and multisystemic family-based outpatient or

day treatment program for substance-abusing adolescents, adolescents with

co-occurring substance use and mental disorders, and those at high risk for

continued substance abuse and other problem behaviors such as conduct

disorder and delinquency.

Family Behavior Therapy:

Family Behavior Therapy is an outpatient behavioral treatment aimed at

reducing drug and alcohol use in adults and youth along with common co-

occurring problem behaviors such as depression, family discord, school and

work attendance, and conduct problems in youth.

Castellanos 2014

EBPs for Personality Disorders

Dialectical Behavior Therapy(DBT):


characteristics: a behavioral, problem-solving focus blended with

acceptance-based strategies, and an emphasis on dialectical processes.

Castellanos 2014


Dialectical Behavior Therapy

(DBT) One example in detail

Castellanos 2014

Dialectical Behavior Therapy (DBT)

Why DBT Is an Evidence-Based Program?

Theoretically based

Scientifically evaluated through rigorous research

Found effective in achieving positive results as intended

Evaluation results have been subjected to peer review

Recognized by Federal or other types of organizations as an evidence-based

program

As of this date, eighteen randomized controlled trials published on DBT

demonstrate its utility across client groups with severe and complex disorders.

Castellanos 2014


As of this date, eighteen randomized controlled trials published on DBT

demonstrate its utility across client groups with severe and complex disorders.

Since 1987, DBT evaluation studies conducted by Dr. Linehan and her

colleagues have been published in dozens of scientific journals, including 29

randomized clinical trials conducted across 21 independent research teams.

Castellanos 2014

DBT-Comparative Effectiveness Research & Systematic

Reviews

In addition to outcome trials, DBT has been systematically reviewed and

compared to other psychotherapeutic approaches in comparative effectiveness

research (CER) studies, which compare the benefits and harms of different

interventions and strategies to prevent, diagnose, treat, and monitor community

health and the nations health care system.

Notably, the vast majority of DBT outcome studies have been CER trials since

the evaluations took place in settings where clients were already receiving

treatment.

The superiority of DBT over other commonly used approaches, such as CBT,

psychotherapy, and group therapy, have been found in several studies.

Castellanos 2014


DBT is a cognitive-behavioral treatment approach with two key characteristics:

A behavioral, problem-solving focus blended with acceptance-based strategies

An emphasis on dialectical processes. "Dialectical" refers to the issues

involved in treating patients with multiple disorders and to the type of thought

processes and behavioral styles used in the treatment strategies.

DBT emphasizes balancing behavioral change, problem-solving, and emotional

regulation with validation, mindfulness, and acceptance of patients.

Therapists follow a detailed procedural manual.

Castellanos 2014


DBT has five components:

(1) capability enhancement (skills training);

(2) motivational enhancement (individual behavioral treatment plans)

(3) generalization (access to therapist outside clinical setting, homework, and

inclusion of family in treatment)

(4) structuring of the environment (programmatic emphasis on reinforcement of

adaptive behaviors)

(5) capability and motivational enhancement of therapists (therapist team

consultation group).

Castellanos 2014


Adaptations of DBT have been developed for:

Suicidal adolescents

Individuals with substance use disorders

Individuals with eating disorders

Individuals with comorbid HIV and substance use disorders

Developmentally delayed individuals

Older adults with depression and one or more personality disorders

Individuals with schizophrenia

Families of patients

Women experiencing domestic violence

Violent intimate partners

Individuals who stalk

Inpatient and partial hospitalization settings for adolescents and adults

Forensic settings for juveniles and adults

Castellanos 2014

DBT involves four components:

Individual: The therapist and consumer discuss issues that come up during the week (recorded on

diary cards) and follow a treatment target hierarchy. Self-injurious and suicidal

behaviors take first priority.

Second in priority are behaviors which, while not directly harmful to self or others,

interfere with the course of treatment. These behaviors are known as therapy-interfering

behaviors.

Third in priority are quality of life issues and working towards improving ones life

generally. During the individual therapy, the therapist and patient work towards

improving skill use. Often, a skills group is discussed and obstacles to acting skillfully

are addressed.

Castellanos 2014


Group:

A group ordinarily meets once weekly for two to two-and-a-half hours and learns to use

specific skills that are broken down into four skill modules:

core mindfulness

Interpersonal effectiveness

Emotion regulation

Distress tolerance.

Castellanos 2014


Phone Coaching:

As needed, consumers may contact their therapists for additional support between

sessions.

This support is generally available 24/7, but DBT places certain restrictions to curtail

abuse or overuse of the therapists availability, such as letting consumers know that after

a suicide attempt they will not have immediate contact with their therapist.

Castellanos 2014


Consultation Groups:

Therapists meet weekly to provide support, discuss cases, and practice DBT skills

themselves.

These groups increase motivation, improve therapist skills,provide support, and keep

therapists in fidelity to the model.

Linehan asserts that any therapist acting in isolation is not doing DBT.

Castellanos 2014

DBTs Four Modules

DBT basic skills are taught in four separate modules.

Module One: Mindfulness

Module Two: Distress Tolerance

Module Three: Emotional Regulation

Module Four: Interpersonal Effectiveness

Castellanos 2014


Adaptations of DBT have been developed for:

Suicidal adolescents

Individuals with substance use disorders

Individuals with eating disorders

Individuals with comorbid HIV and substance use disorders

Developmentally delayed individuals

Older adults with depression and one or more personality disorders

Individuals with schizophrenia

Families of patients

Women experiencing domestic violence

Violent intimate partners

Individuals who stalk

Inpatient and partial hospitalization settings for adolescents and adults

Forensic settings for juveniles and adults

Castellanos 2014

Psychopharmacolgy

Castellanos 2014

1950s-Present

Psychopharmacolgy Revolution

1944: Stimulants (1960 marketed as Ritonic)

1948: Lithium:

1817 -first discovered as an element

John Cade, MD first used as treatment for mania

1951: Chlorpromazine (Thorazine): Discovered in France

1952- became available for clinical use

1950s: Clozapine (Clozaril): Discovered 1970s - introduced into clinical practice

Castellanos 2014

Psychotropic Medications II

1958: Imipramine (Tofranil): Synthesized -1898. 1954- studied in the treatment of schizophrenia. 1958- became available for clinical use.

1950s: Haloperidal (Haldol): Discovered. 1959 - First approved for clinical use.

1974: Fluoxetine (Prozac): First described in scientific journal. 1987-Approved by FDA.

1993: Risperidone (Risperdal): FDA Approved.

Castellanos 2014

Psychotropic Medications III

2013: 2 new antidepressants approved:

Vortioxetine (Brintellix)

Levomilnacipran CR (Fetzima)

Castellanos 2014

Promising new medication treatments Ketamine (Ketalar):

An anesthetic

Treatment Resistant Depression (TRD) & OCD

Works very quickly

Potential for abuse (Special K)

Agolmelatine (Valdoxan):

Approved in Europe since 2009 for depression

Works on melatonin

Riluzole (Rilutek):

Approved for ALS (Lou Gehrigs Dis)

Promising results in TRD

Castellanos 2014

Promising new medication treatments

GLYX-13:

In current FDA trials with Fast Track designation

Rapid-acting antidepressant activity with excellent safety

Psychobiotics:

Live organisms (probiotics)

Certain probiotics when ingested may produce mental health benefits

Castellanos 2014

Castellanos 2014

Other Newer, Emerging Treatments

2005 Vagus-Nerve Stimulation (VNS)

Indicated for Treatment Resistant Depression:

Depression has lasted two years or more

If it is severe or recurrent

Treatment failure at least four other treatments

Castellanos 2014

2008 Transcranial Magnetic Stimulation (rTMS)

Indication: Adults with MDD who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode

Castellanos 2014

2013 Deep Brain Stimulation (DBS)

Not FDA approved

Optimal location appears to be ventral capsule/ventral striatum stimulation at the junction of the anterior commissure, anterior capsule, and posterior

ventral striatum

Castellanos 2014

Other Innovations

in

Behavioral HealthCare

Technology

Castellanos 2014

E-Therapy Example

Margaret Sibley, PhD Assistant Professor, Department of Psychiatry &

Behavioral Health, FIU

Title: Increasing Behavioral Treatment Utilization in Adolescents with

ADHD: The Role of ETherapy

Outpatient treatment for families of adolescents with ADHD through

video conferencing

All aspects of treatment and assessment process are conducted without

the family having to set foot in the clinic

Castellanos 2014

Innovations in Behavioral HealthCare Technology

Use of computerized applications

Smart Phone APPs develop for various daily uses by the consumer

Can involve specific treatment interventions (eg, cognitive behavior therapy sessions)

Castellanos 2014

Digital medicine

Managing consumer health by the use of : Ingestible sensors Wearable and implantable physiological sensors Mobile communication technology Web-based patient communities

Represents a new and rapidly evolving paradigm in healthcare

Eg; Proteus Digital Health

Castellanos 2014

Digital medicine

Digital medications:

Contain the same medications available today

In addition, each pill also contains a tiny ingestible sensor which communicates about medication-taking behaviors in real time

Utilizes digital health feedback system

Castellanos 2014

Digital medicine

Digital medications II:

First application of the ingestion sensor is to measure a consumers adherence to oral medication therapy regimens (medication levels)

Other uses include how the body is responding (eg, blood pressure, pulse, etc) and many others

Will allow consumers, families & physicians to take appropriate action in response to a consumers adherence pattern and specific health metrics

Castellanos 2014

Digital medicine

Stretchable electronics (patches):

Contain sophisticated, integrated sensing systems

Possible functions: Transdermal delivery of medication Monitor therapeutic levels of medication Monitor various health functions: pulse; blood pressure; stress;

activity (including movements), etc Detect street drug levels Others

Castellanos 2014

Digital medicine Stretchable electronics (patches):

Castellanos 2014

Optogenetics

&

Pharmacogenomics

Castellanos 2014

Optogenetics

Neuroscientists target a single neuron in the brain of a mouse merely by turning on a light

This is done by using a light activated gene and inserting it into the genome of a mouse to be able to easily identify when the particular neuron is firing in the brain

The purpose is to control a brains activity with light

Castellanos 2014

Optogenetics

Optogenetics is a hot and controversial topic

This could have far reaching benefits with humans to help better understand the complex network of neurons that make up the brain

Identifying these neurons may sometime help people detect flaws or deformities in the various neurons in the brain that cause disorders like schizophrenia

Time will tell as to whether this approach is effective

Castellanos 2014

Pharmacogenomics

Pharmacogenomics:

The study of how genes affect a persons response to medications

Addresses the human variability in medication response

If it were not for the great variability among individuals, medicine might as well be a science and not an art

Sir William Osler, 1892

Castellanos 2014

Pharmacogenomics

Castellanos 2014

Take Home Points

Current emphasis on:

Standardized assessments (eg, validated rating scales) and interventions

The use of EVPs

New technologies are assisting in provision of psychosocial interventions

Emerging treatments involve:

Digital medicine (digital medications & stretchable electronics)

Pharmacogenomics

Castellanos 2014

Parting Thoughts

Real knowledge is to know the extent of one's ignorance. Confucius

EVPS & treatment innovations in behavioral health for posting 2 26 15

Documents

patients castellanos

water castellanos

years castellanos

treatment of schizophrenia

metrazolinduced seizures

insulininduced coma

mental disorders

time insulin therapy