Attendees introduced themselves with a brief description of their private practice specialty areas and described practices that serve those with psychosis, depression, anxiety, PTSD/Trauma, ADHD, Autism, and Psychotherapy. Some providers are mid-credentialling and some providers are licensed to practice in both RI and MA.
Many had attended the MAAPPN “Pearls of Practice” Conference on 9/27/24 and expressed appreciation for the valuable information shared on that day. One provider has just started with a Functional & Integrative Psychiatry Fellowship!
Clinical issues of concern were discussed:
Medication Indications:
Vraylar verses Rexulti: preferences, uses, indications?
Both have different mechanism of action:
Rexulti: A partial agonist at serotonin 5-HT1A receptors and dopamine D2 receptors, and an antagonist at serotonin 5-HT2A receptors. It helps modulate dopamine and serotonin levels, contributing to mood and thought regulation.
Vraylar: Also, a partial agonist at dopamine D2/D3 receptors, but it has stronger affinity for D3 receptors, which may make it particularly beneficial in treating cognitive and negative symptoms of schizophrenia.
Psychotherapy:
Discussion of transference and countertransference as extremely useful concepts to explore in Psych APRN practice. Here is a useful site for examples
Boundary Management
Discussion of how to therapeutically communicate boundaries with Axis II patients who idealize and devalue in the therapeutic relationship and how to transition patients to a new team when they repeatedly attempt to re-connect with providers
Insomnia:
Encourage the CBT-I Coach app especially for college age students
Unique uses for Provigil and stimulants
Options: mirtazapine, eszopiclone, (Lunesta), Belsomra
Restless Legs Syndrome
Discussion of RLS and insomnia medication options such as Dopamine agonists: Mirapex (pramipexole); Requip (ropinirole), Neupro Patch (rotigotine); Dopamine mimics: gabapentin, pregabalin (Lyrica) and
Iron supplementation; benzodiazepines (clonazepam or diazepam) for short term use; review medical plan of care as medications can plateau in benefit, suggest lifestyle changes such as regular exercise, avoiding alcohol caffeine and nicotine
Integrative Psychiatry:
Lots of interest in nutritional lithium (Lithium orotate)
Conferences: