Cognitive Disturbances in Major Depression: What Are We Missing?

Program Overview
Faculty
Presentation
Quiz
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Program Overview

Cognitive Disturbances in Major Depression: What Are We Missing?

On-Demand Webcast

This CME activity is based on the slides and lectures presented by the faculty at the symposium, Cognitive Disturbances in Major Depression: What Are We Missing?, on Sunday, September 21, 2014 at the 27th Annual U.S. Psychiatric and Mental Health Congress in Orlando, Florida.

Faculty
Richard Keefe, PhD
Professor of Psychiatry and Behavioral Sciences
Duke University Medical Center
Durham, North Carolina

Prakash Masand, MD
Chairman and CEO, Global Medical Education
New York, New York

For faculty bios, please call 609-371-1137.

Intended Learners

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

Learning Objectives

After completing this activity, participants should be able to:

• Identify cognitive dysfunction in patients with untreated and treated major depressive disorder (MDD) by the use of screening questions and scales

• Identify the factors contributing to poor prognosis in MDD patients including residual cognitive symptoms

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

Activity Overview

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

To be eligible for documentation of credit, participants must complete the educational activity, complete the 16-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: October 31, 2014
Expiration Date: October 31, 2015
Estimated time to complete: 1.5 hours

There is no fee associated with this activity.

For questions regarding this educational activity, please call 609-371-1137.

Hardware/Software Requirements
All educational activities 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. Windows Media Player or compatible alternative, sound card, and speakers are required for streamed audio. The latest version of the Adobe Flash Player is suggested (please download here(http://get.adobe.com/flashplayer/)) for video programs. A PDF reader is required for print publications. Please direct technical questions to [email protected]

Accreditation
This activity has been planned and implemented by North American Center for Continuing Medical Education (NACCME) and Global Medical Education (GME). 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 1.5 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 1.5 contact hours.

Provider approved by the California Board of Registered Nursing, Provider #13255 for 1.5 contact hours.

Pharmacology credits: 1.5 hours

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 Science, University of Louisville School of Medicine, Louisville, Kentucky

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

Planning Committee

The planning committee comprises Allan Tasman, MD, Prakash Masand, MD, Richard Keefe, PhD, Andrew Penn, RN, MS, NP, CNS, APRN-BC; Stephen Chavez, Raquel Gaerlan, Ed Jackson, MD, Mike Kearney, Tanya Kenevich, 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 has reported the following:

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

Dr. Keefe: Consultant/ad board/service provider—Abbvie, Akebia, Amgen, Asubio, AviNeuro/ChemRar, BiolineRx, Biomarin, Boehringer-Ingelheim, EnVivo, GW Pharmaceuticals, Lundbeck, Merck, Minerva Neurosciences Inc., Mitsubishi, Novartis, Otsuka, Roche, Shire, Takeda, Targacept; Research funding—Department of Veteran’s Affairs, NIMH, Singapore National Medical Research Council, Research Foundation for Mental Hygiene, PsychoGenics, Novartis, Brain Plasticity Institute; Investment—Founder of NeuroCog Trials, Inc., which provides rater training, data quality assurance, and consultation to several pharmaceutical companies and other consortia. Investor in Sengenix, Inc. but do not do any work related to this company; Royalties—Brief Assessment of Cognition in Schizophrenia (BACS) testing battery, MATRICS Consensus Cognitive Battery (MCCB), Virtual Reality Functional Capacity Assessment Tool (VRFCAT)

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

Mr. Chavez, Ms. Gaerlan, Dr. Jackson, Mr. Kearney, Ms. Kenevich, 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, psychostimulants, acetylcholinesterase inhibitors, memantine, antipsychotics in the treatment of MDD.

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. 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 North American Center for Continuing Medical Education. 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.

Grant Support

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

Richard Keefe, PhD, Professor of Psychiatry,Duke University Medical Center

Richard Keefe, Ph.D., is Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, North Carolina. He received his BA from Princeton University and his Ph.D. in clinical psychology from New York University.

Dr. Keefe’s research is primarily devoted to understanding cognitive dysfunction and its treatment in patients with schizophrenia and related disorders, including those at high risk for schizophrenia. He has had a leadership role for cognitive methods in several large National Institute of Mental Health studies, including the CATIE, MATRICS, TURNS, CRSTN and TENETS projects. He has published more than 200 scientific papers and two books.

Dr. Keefe is Associate Editor of Psychological Medicine and serves on the editorial boards of Schizophrenia Research, Schizophrenia Bulletin, Psychiatry and Clinical Neurosciences, and Innovations in Clinical Neuroscience. He was the 2012‐2014 President of the International Society for CNS Clinical Trials and Methodology. He is on the Scientific Board of the Brain and Behavioral Research Foundation.

Prakash Masand, MD, Chairman and CEO, Global Medical Education, Adjunct Professor, Duke-National University of Singapore Medical School

Prakash Masand, M.D.
Chairman and CEO, Global Medical Education (GME), New York, NY
Adjunct Professor, Academic Medicine Education Institute, Duke-National University of Singapore Medical School

Dr. Masand is Founder, Chairman, and CEO of Global Medical Education (GME) and also serves as Adjunct Professor at the Academic Medicine Education Institute, Duke-National University of Singapore Medical School (Duke-NUS). He is also Co-founder, Chaiman and CEO of Centers of Psychaitric Excellence (COPE). He was formerly Consulting Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center and Director of Therapeutic Area Development/Neurosciences Medicine at the Duke Clinical Research Institute in Durham, NC.

Dr. Masand received his medical degree from the Topiwala National Medical College at the University of Bombay in India. He completed his residency training in psychiatry at S.U.N.Y. Upstate Medical University in Syracuse, New York, and a fellowship in Consultation-Liaison Psychiatry at Massachusetts General Hospital, Harvard Medical School, in Boston, MA.

Dr. Masand’s clinical research interests include psychopharmacology, novel antipsychotics, psychiatric disorders in the medically ill, treatment-resistant depression, irritable bowel syndrome and its relationship to psychiatric illness, and the use of psychostimulants in the medically ill.

The author of more than 400 abstracts, articles, reviews, and book chapters, Dr. Masand’s work has been published in peer-reviewed journals including The New England Journal of Medicine, American Journal of Psychiatry, Journal of Clinical Psychiatry, and Journal of Clinical Psychopharmacology. Dr. Masand serves on the editorial boards of the Primary Care Companion to the Journal of Clinical Psychiatry, Annals of Clinical Psychiatry, Current Clinical Pharmacology, and The Open Pharmacology Journal. He is also a reviewer for several journals and a frequent speaker at national and international medical meetings.

Dr. Masand was the Founder of psychCME, Inc., a leading program for continuing medical education in the United States, which was acquired by OPTUMHealth , a division of United Health Group, in 2006. Dr. Masand has been named a Distinguished Fellow of the American Psychiatric Association and the Academy of Psychosomatic Medicine.

Cognitive Disturbances in Major Depression: What Are We Missing?

You must answer 11 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 mood
Dependent
Not dependent

Which of the following pharmacologic options have been shown to be effective for cognition in MDD?
Atypical antipsychotics
Cholinesterase inhibitors
Intra-nasal insulin
None of the above

There is a paucity of studies that have aimed to establish the procognitive benefits of aerobic exercise in adults with MDD
True
False

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

Cognitive impairment is a part of the DSM 5 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

According to meta-analysis of data, monotherapy with most antidepressants improves what aspect of cognition in MDD?
Visual memory
Executive function
Processing speed
Attention
Verbal memory

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

The most important weakness of interview-based assessments of cognition in MDD patients is:
reporting bias by patients
cost of test materials
additional time required to ask questions about cognition

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

Which clinical factors do not affect cognitive performance:
age
education
height
comorbid disorders

Since cognitive performance has substantial diurnal variation, when attempting to track cognition over time it is very important to assess patients at the same time of day.
True
False

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 depressive disorder (MMD) does your practice see in a week?

<3
3 - 6
7 - 10
>10

Did this activity meet your needs?

Yes
No

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

1 2 3 4 5

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 depressive disorder (MDD) by the use of screening questions and scales.

1 2 3 4 5

Identify the factors contributing to poor prognosis in MDD patients including residual cognitive symptoms.

1 2 3 4 5

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

1 2 3 4 5

Please rate the faculty on the following: Richard Keefe, PhD (1 = poor; 5 = excellent)

Knowledge and expertise

1 2 3 4 5

Teaching ability

1 2 3 4 5

Please rate the faculty on the following: Prakash Masand, MD (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 or 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

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 this conference.

I would rate my knowledge of validated tools for assessing cognitive disturbances in patients with MDD

PRIOR to attending this activity as: