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Clinical Implications of Cognitive Disturbances in Major Depression


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Program Overview


Clinical Implications of Cognitive Disturbances in Major Depression

 

On-Demand Webcast

This CE activity is based on the slides and lectures presented by the faculty at the Psych Congress 1-Day Regional meeting in Anaheim, California on Saturday, November 8, 2014.

 

Faculty

Michael J. Ostacher, MD, MPH, MMSc

Professor of Psychiatry and Behavioral Sciences

Stanford University School of Medicine

Stanford, California

 

To access Dr. Ostacher’s bio, please click here

 

Intended Learners

This activity is intended for psychiatrists, primary care physicians, psychologists, nurse practitioners, physician assistants, psychiatric nurses, and other healthcare professionals who seek to improve the care of patients with mental health disorders.

 

Learning Objectives

After completing this activity, participants should be able to:

• Identify cognitive dysfunction in patients with untreated and treated major depression by the use of screening questions and scales

• Identify the factors contributing to poor prognosis in major depressive disorder (MDD) patients, including residual symptoms

• Implement strategies to treat MDD to remission of all symptom domains

 

Activity Overview

This on-demand webcast is available with synchronized slides and audio.

 

To be eligible for documentation of credit, participants must complete the educational activity, complete the 10-question online post-test with a score of 70% or better, and complete the evaluation form.

 

After successful completion of the post-test and evaluation form online, participants may immediately print their documentation of credit.

Participants who have successfully completed the live version of this activity are not eligible to receive credit for this enduring material.

 

Release Date: December 9, 2014

Expiration Date: December 9, 2015

Estimated time to complete: 1.0 hour

 

There is no fee associated with this activity.

 

Hardware/Software Requirements

The evaluations are accessible via a PC (Windows 2000/XP/Vista/7) or Mac (Mac OS 10.x or later) computer with current versions of the following browsers: Internet Explorer, Mozilla Firefox, Google Chrome, or Safari. A PDF reader is required for print publications. Please direct technical questions to [email protected]

 

Accreditation Information 

This activity has been planned and implemented by North American Center for Continuing Medical Education (NACCME) and Global Medical Education. NACCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

 

CME

NACCME designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

CNE

This continuing nursing education activity awards 1.0 contact hour.

 

Provider approved by the California Board of Registered Nursing, Provider #13255 for 1.0 contact hour.

 

APA

North American Center for Continuing Medical Education, LLC (NACCME) is approved by the American Psychological Association to sponsor continuing education for psychologists. NACCME maintains responsibility for this program and its content.

 

Instructional Level: Advanced

 

Independent Clinical Reviewer: Allan Tasman, MD, Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Schwab Endowed Chair in Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky

 

Nurse Planner: Andrew Penn, RN, MS, NP, CNS, Psychiatric Nurse Practitioner, Kaiser Permanente, Redwood City, California; Assistant Clinical Professor, University of California, San Francisco, California

 

Contact Information

For questions regarding this educational activity, please call 609-630-6252.

 

Planning Committee

The planning committee compromises Rakesh Jain, MD, MPH, Roger S. McIntyre, MD, FRCPC, Michael Ostacher, MD, MPH, MMSc, Andrew Penn, RN, MS, NP, CNS, MD, Allan Tasman, MD; Prakash Masand, MD, Global Medical Education; Raquel Gaerlan, Meaghan O’Brien, Randy Robbin, John Savage, and Jessica Steuerman, NACCME.

 

Financial Disclosure and Conflicts of Interest

According to the disclosure policy of NACCME, faculty, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant financial relationships with relevant commercial companies related to this activity. All relevant conflicts of interest that are identified are reviewed for potential conflicts of interest. If a conflict is identified, it is the responsibility of NACCME to initiate a mechanism to resolve the conflict(s). The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation.

 

All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

 

The faculty have reported the following:

 

Dr. Jain: Consultant—Addrenex, Forest, Lilly (and spouse), Merck, Pamlab (and spouse), Pfizer, Shionogi, Shire, Sunovion; Promotional speakers bureau—Addrenex, Forest, Lilly, Merck, Pamlab, Pfizer, Shionogi, Shire, Sunovion; Grant/Research support—AstraZeneca, Forest, Lilly, Pfizer, Shire; Scientific advisor—Addrenex, Lilly, Merck, Pamlab, Pfizer, Shionogi, Shire, Sunovion

Dr. McIntyre: Advisory board—AstraZeneca, Bristol-Myers Squibb, Eli Lilly, France Foundation, GlaxoSmithKline, Janssen-Ortho, Lundbeck, Merck, Organon, Pfizer, Shire; Promotional speakers bureau—AstraZeneca, Eli Lilly, Janssen-Ortho, Lundbeck, Merck, Pfizer; CME activities—AstraZeneca, Bristol Myers-Squibb, CME Outfitters, France Foundation, Eli Lilly, I3CME, Merck, Optum Health, Pfizer, Physicians’ Postgraduate Press; Grant/Research support—AstraZeneca, Eli Lilly, Janssen-Ortho, Lundbeck, Pfizer, Shire

Dr. Masand: Consultant—Forest, Lundbeck, Merck, Pamlab, Pfizer, Sunovion, Takeda; Research support—Forest, Takeda; Promotional speakers bureau—Forest, GlaxoSmithKline, Lundbeck, Merck, Pamlab, Pfizer, Sunovion, Takeda; Stock ownership—Global Medical Education.

Dr. Ostacher: Consultant—Alexza Pharmaceuticals, Eli Lilly, Janssen, Otsuka America Pharmaceutical

 Dr. Tasman and Mr. Penn have disclosed no relevant financial relationships with any commercial interests.

 

Ms. Gaerlan, Ms. O’Brien, Mr. Robbin, Mr. Savage, and Ms. Steuerman have disclosed no relevant financial relationships with any commercial interests.

 

NACCME requires faculty to inform participants whenever off-label/unapproved uses of drugs and/or devices are discussed in their presentations.

 

The faculty have disclosed that the following off-label/unapproved uses of drugs and/or devices and investigational agents will be discussed in the presentations: antidepressants in the treatment of cognitive disturbances in major depression.

 

Privacy Policy

NACCME protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. NACCME and our joint sponsors will not release personally identifiable information to a third party without the individual’s consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

 

NACCME maintains physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

 

Copyright © 2014 by North American Center for Continuing Medical Education, LLC (NACCME)

All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from NACCME. The opinions expressed in this educational activity are those of the faculty and are not attributable to NACCME. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this activity are not necessarily the same as indicated in the package insert for each product, may reflect the clinical experience of the presenters, and may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

 

Jointly provided by North American Center for Continuing Medical Education, LLC, an HMP Communications Holdings Company, and Global Medical Education.

Content for this session was developed by Global Medical Education.

Supported by an educational grant from Takeda Pharmaceuticals International, Inc., U.S. Region and Lundbeck Pharmaceutical Services, LLC

 

Michael Ostacher, MD, MPH, Associate Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

Dr. Ostacher is Associate Professor of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, and at the VA Palo Alto Health Care System, where he is the Associate Director of the Bipolar and Depression Research Program. After graduating with Honors in the College of Letters at Wesleyan University in Connecticut, Dr. Ostacher received his medical degree from the Vanderbilt University School of Medicine in Nashville, Tennessee. He trained in Adult Psychiatry at Harvard Medical School at The Cambridge Hospital.. He has a Masters in Public Health in Health Care Management from the Harvard University School of Public Health, and received a Masters in Medical Sciences as part of the Scholars in Clinic Science Program at Harvard Medical School.  

 

Dr. Ostacher's major research interest is bipolar disorder and comorbid substance abuse, and received a Career Development Award from the National Institute on Alcoholism and Alcohol Abuse (NIAAA) to study substance abuse and mood while the Associate Medical Director of the Bipolar Clinic and Research Program at Massachusetts General Hospital. Dr. Ostacher won National Association for Research in Schizophrenia and Depression (NARSAD) Young Investigator Awards in 2005 and 2009 to study cognition in patients with bipolar disorder and substance abuse, and received a New Investigator Award in 2004 from the National Institute of Mental Health (NIMH), and is faculty for the University of Pittsburgh/NIMH Bipolar Career Development Institute.  He was the principal investigator at MGH for BALANCE, a multinational study of maintenance treatments for bipolar disorder at Oxford University in the United Kingdom, and was the Site PI for the NIMH Bipolar Trials Network at MGH.  He is an Associate Editor of Evidence-Based Mental Health and is on the editorial boards of Bipolar Disorders and the Journal of Clinical Psychiatry.

 

Clinical Implications of Cognitive Disturbances in Major Depression

Michael Ostacher, MD, MPH

Associate Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine







You must answer 7 questions correctly to continue.

While duloxetine demonstrated improvement in a composite cognitive score composed of 4 individual tests compared with placebo, a statistically significant benefit in favor of duloxetine was seen in only which one of the following individual tests?
2-Digit Cancellation Test
Verbal Learning and Recall Test
Letter-Number Sequencing Test
Digit Symbol Substitution Test

In elderly patients with MDD, the multimodal antidepressant vortioxetine demonstrated statistically significant improvements in acquisition and delayed recall (as measured by the Rey Auditory Verbal Learning Test [RAVLT]),as well as information-processing
True
False

A study of vortioxetine in adults showed that the improvement in cognitive performance was _____________ on the improvement in depressive symptoms (as measured by the Montgomery–Åsberg Depression Rating Scale).
Dependent
Not dependent

Cognitive-training interventions may be effective for which of the following?
Anxiety
Recurrence of depression
MDD
A and B

True or False: Cognitive impairment is a part of the diagnostic criteria for MDD.
True
False

In general, patients with MDD demonstrate cognitive impairment at what phase of illness:
during periods of severely depressed mood
during any periods that mood is depressed
even during periods of euthymia

True or False: Cognitive impairment is important, but it is not related to clinically important aspects of the illness such as social functioning and quality of life.
True
False

The most important weakness of brief performance-based assessments of cognition in MDD patients is:
low reliability of change scores
cost of test materials
performance-based tests are not meaningful

What is the greatest strength of clinician-based assessments of cognition?
doctors always know what is best for their patients
questions can be tailored to what aspect of cognitive impairment is most important to the patient
no additional time is required to interview informants

In your clinical practice, how do you assess cognitive disturbances in MDD patients?
Assess their attention span
Assess their decision making process
Assess their memory for words
Assess their processing speed
Use neuropsychological testing
All of the above

GME and PIM are committed to excellence in continuing education, and your opinions are critical to us in this effort. To assist us in evaluating the effectiveness of this activity and to make recommendations for future educational offerings, please take a few minutes to complete this evaluation form. You must complete this evaluation form to receive acknowledgment for completing this activity.



Please complete the following evaluation questions to receive your certificate.


What is your practice type?
MD / DO PA / Nurse Practitioner RN PhD Other


What is your area of specialization?
Psychiatry Psychology General Practitioner Family Practice Internal Medicine Neurology Other, please specify:


Approximately how many patients do you see each week?
Less than 50
50-99
100-149
150-199
200+
I do not directly provide care


Approximately how many patients with major depression does your practice see in a week?
<3
3 - 6
7 - 10
>10


Did this activity meet your educational needs?
Yes No


Did this activity increase your knowledge?
Yes No


Did this activity increase your competence?
Yes No


Did this activity increase your confidence?
Yes No


To what extent were you able to achieve each of the following learning objectives? (1 = very little; 5 = great deal)


Identify cognitive dysfunction in patients with untreated and treated major depression by the use of screening questions and scales.
1 2 3 4 5


Identify the factors contributing to poor prognosis in major depressive disorder (MDD) patients, including residual symptoms.
1 2 3 4 5


Implement strategies to treat MDD to remission of all symptom domains.
1 2 3 4 5


How much did you learn as a result of this CE program (1 = very little; 5 = great deal)?
1 2 3 4 5


Please rate the faculty on the following: Michael Ostacher, MD, MPH, MMSc (1 = poor; 5 = excellent)


Knowledge and expertise
1 2 3 4 5


Teaching ability
1 2 3 4 5


Please rate the following components relating to this activity: (1 = poor; 5 = excellent)


Content
1 2 3 4 5


Relevance to your organization
1 2 3 4 5


Educational format
1 2 3 4 5


Audience-participation portions (eg, Q&A, pre/post-testing)
1 2 3 4 5


Handouts and/or other materials supporting the activity
1 2 3 4 5


Overall
1 2 3 4 5


The therapeutic recommendations presented in this activity did not encourage inappropriate or excessive use of products/devices. (Multiple Choice - Single Selection)
Agree Disagree


The information presented in this activity did not serve to advance a proprietary interest of any commercial entity. (Multiple Choice - Single Selection)
Agree Disagree


Of the patients you see on a weekly basis, how many will benefit from the information you learned today?
10 or fewer 20 30 40 50 or more


Please use the following scale to respond to each of the statements as they relate to your knowledge / skill level prior to and after attending the conference.


I would rate my knowledge of the lack of efficacy of SSRIs and SSNIs for treatment of cognitive dysfunction in patients with MDD:


PRIOR to attending this activity as:
Excellent Very good Good Fair Poor


AFTER attending this activity as:
Excellent Very good Good Fair Poor


I would rate my ability/likelihood to incorporate multitargeted agents into treatment for patients with MDD:


PRIOR to attending this activity as:
Excellent Very good Good Fair Poor


AFTER attending this activity as:
Excellent Very good Good Fair Poor


I would rate my ability/likelihood to assess cognitive symptoms in patients with MDD:


PRIOR to attending this activity as:
Excellent Very good Good Fair Poor


AFTER attending this activity as:
Excellent Very good Good Fair Poor


Do you intend to make any changes to your practice?
Yes
No


If you plan to change your practice behavior, how confident are you that you will be able to make your intended changes?


Incorporate multitargeted agents into treatment for patients with MDD.
Very confident
Somewhat confident
Unsure
Not very confident


Assess cognitive symptoms in patients with MDD.
Very confident Somewhat confident Unsure Not very confident


Other change (please specify)
Very confident Somewhat confident Unsure Not very confident


What barriers outside your control prevent you from changing your practice?
Insurance / cost Institutional policy Lack of patient education Lack of patient adherence Affordability Formulary placement Lack of available guidelines Lack of influence over treatment decisions Tolerability / adverse effects Lack of time / resources Lack of knowledge of optimal management strategies Other: (please speciffy)


How might future activities help you address these barriers?


How did you learn about this webcast?
Mailed invitation Colleague Email Psych Congress Network website Global Medical Education website Other:


Would you be interested in additional educational activities within this therapeutic area? (Multiple Choice - Single Selection)
Yes No


If yes, what topics would you like to learn more about?



Certificate Type:
Physician Psychologist Non Physician Nurse

I certify my actual time spent to complete this educational activity to be
hour(s).


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