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Mixed Features in Depressive Episodes Managing Patients Across the Disease Spectrum

Joseph R. Calabrese, MD; Gary Sachs, MD; Michael E. Thase, MD

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

This activity is supported by an educational grant from Sunovion Pharmaceuticals, Inc.

 

Faculty

Joseph R. Calabrese, MD
Bipolar Disorders Research Chair
Professor, Department of Psychiatry
Director, Mood Disorders Program
University Hospitals Case Medical Center
Case Western Reserve University School of Medicine
Cleveland, Ohio

Gary Sachs, MD
Associate Clinical Professor of Psychiatry
Harvard Medical School
Founding Director, Bipolar Clinic and Research Program
Massachusetts General Hospital
Boston, Massachusetts

Michael E. Thase, MD
Professor of Psychiatry
Director, Mood and Anxiety Disorders Treatment and Research Program
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania

Intended Learners

This activity is designed for psychiatrists, primary care physicians, psychologists, nurse practitioners, physician assistants, psychiatric nurses, and other healthcare professionals involved in treating patients with depressive presentations.

Learning Objectives

Upon completion of the activity, participants should be able to:

  1. Differentially diagnose depressive mental illnesses, focusing on new DSM-5 specifiers and various patient presentations along the disease continuum
  2. Treat depressive episodes based on all presenting symptoms, overall health status, and evidence for medication efficacy and safety
  3. Tailor therapy to patients with depressive episodes and complicating factors, such as mixed features, comorbid Axis I disorders, and other aspects of overall patient health
  4. Educate patients and caregivers on treatment options, self-management strategies, and treatment adherence

Accreditation Information

This activity has been planned and implemented by North American Center for Continuing Medical Education (NACCME) and Integritas Communications. 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 activity for a maximum of 1.0 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 hours. Provider approved by the California Board of Registered Nursing, Provider #13255 for 1.0 contact hours.

Nursing Pharmacology Credits

This continuing nursing educational activity awards up to 0.5 pharmacology 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

Method of Participation

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 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 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.

There is no fee associated with this activity. For questions regarding this educational activity, please call 609-371-1137.

Independent Clinical Reviewer: William C. Torrey, MD, Professor of Psychiatry, Vice Chair for Clinical Services, Department of Psychiatry, Grisel School of Medicine at Dartmouth, Lebanon, New Hampshire

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

Planning Committee

The planning committee comprises faculty members Joseph Calabrese, MD; Gary Sachs, MD; Michael Thase, MD; Nurse Planner Andrew Penn, RN, MS, NP, CNS, APRN-BC; William C. Torrey, MD; Educational Partner Rose O’Connor, PhD; and Raquel Gaerlan, Mike Kearney, Meaghan O’Brien, Randy Robbin, and John Savage, 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.

Dr. Calabrese is a consultant to Dainippon Sumitomo Pharma Co.; Ltd, Forest Laboratories, Inc.; GlaxoSmithKline plc; Janssen Pharmaceuticals, Inc.; Medscape; Sunovion Pharmaceuticals Inc.; and Takeda Pharmaceutical Company Ltd. 

Dr. Sachs is the owner and part-time employee of Collaborative Care Initiative and full-time employee of Bracket. Dr. Sachs is a consultant and advisory board member for Sunovion Pharmaceuticals Inc. and Takeda Pharmaceutical Company Ltd. Dr. Sachs is a shareholder of athenahealth, Inc. and Express Scripts.

Dr. Thase receives grant/research support from the Agency for Healthcare Research and Quality; Alkermes plc; AssureRx; Avanir Pharmaceuticals, Inc.; Forest Laboratoriess, Inc., Janssen Pharmaceuticals, Inc ., National Institute of Mental Health (NIMH), Otsuka Pharmaceutical Co., Ltd. Dr. Thase is an adviser/consultant forAlkermes; Allergan; AstraZeneca; Bristol-Myers Squibb Company; Cerecor Inc.; Eli Lilly and Company; Fabre-Kramer Pharmaceuticals, Inc.; Forest Laboratories, Inc.; Gerson Lehrman Group, Inc.; GlaxoSmithKline plc; Guidepoint Global, LLC; H. Lundbeck A/S, MedAvante, Inc.; Merck & Co., Inc. (formerly Schering Plough and Organon); moksha8 Pharmaceuticals Inc.; Naurex Inc.,  Neuronetics, Inc.; Novartis AG; Ortho-McNeil Pharmaceuticals (Johnson & Johnson; Janssen); Otsuka Pharmaceutical Co., Ltd.; Pamlab, Inc. (Nestle); Pfizer Inc.; Shire US Inc; Sunovion Pharmaceuticals Inc.; Trius Therapeutics, Inc.;Takeda Pharmaceutical Company Ltd. He has equity holdings in MedAvante, Inc; royalties from American Psychiatric Foundation, Guildford Publications, Inc.; Herald Publishing House, and W.W. Norton & Company, Inc; and Spouse’s Employment is with Peloton Advantage, LLC. 

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

Ms. Gaerlan, Mr. Kearney, Ms. O’Brien, Mr. Robbin, Mr. Savage; Dr. O’Connor 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 off-label or investigational use of Lurasidone and Lamotrigine for the treatment of depression with mixed features will be discussed.

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.

Click "Begin Activity" to acknowledge that you have reviewed the preamble information for this activity.

Begin Activity

expiration 12/30/2016

type Webcast


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5 0.001829 0.000366 0.000315 0.000537
SHOW COLUMNS FROM `events`
1 0.001602 0.001602 0.001602 0.001602
SHOW COLUMNS FROM `activities`
1 0.001557 0.001557 0.001557 0.001557
SHOW COLUMNS FROM `users`
1 0.001336 0.001336 0.001336 0.001336
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001197 0.000599 0.000267 0.000930
SHOW COLUMNS FROM `resources`
1 0.001126 0.001126 0.001126 0.001126
SHOW COLUMNS FROM `user_activitiesstatus`
1 0.001115 0.001115 0.001115 0.001115
SHOW COLUMNS FROM `view_log`
1 0.001081 0.001081 0.001081 0.001081
SHOW COLUMNS FROM `questionnaires`
1 0.001028 0.001028 0.001028 0.001028
SHOW COLUMNS FROM `interactions`
1 0.000999 0.000999 0.000999 0.000999
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.000941 0.000471 0.000457 0.000484
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=35)
1 0.000611 0.000611 0.000611 0.000611
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=35) GROUP BY `activity_id`
1 0.000587 0.000587 0.000587 0.000587
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
1 0.000464 0.000464 0.000464 0.000464
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
1 0.000431 0.000431 0.000431 0.000431
SHOW CREATE TABLE `activities`
1 0.000354 0.000354 0.000354 0.000354
SHOW CREATE TABLE `events`
1 0.000336 0.000336 0.000336 0.000336
SHOW CREATE TABLE `users`
1 0.000329 0.000329 0.000329 0.000329
SHOW CREATE TABLE `view_log`
1 0.000316 0.000316 0.000316 0.000316
SHOW CREATE TABLE `resources`
1 0.000311 0.000311 0.000311 0.000311
SHOW CREATE TABLE `user_activitiesstatus`
1 0.000302 0.000302 0.000302 0.000302
SHOW CREATE TABLE `questionnaires`
1 0.000302 0.000302 0.000302 0.000302
SHOW CREATE TABLE `interactions`
1 0.000293 0.000293 0.000293 0.000293
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000930
1
SHOW COLUMNS FROM `activities`
0.001557
2
SHOW CREATE TABLE `activities`
0.000354
3
SHOW COLUMNS FROM `users`
0.001336
4
SHOW CREATE TABLE `users`
0.000329
5
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000484
6
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003915
7
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000457
8
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491949
0.003418
9
SELECT * FROM `activities` `t` WHERE `t`.`id`=35 LIMIT 1
0.000537
10
SHOW COLUMNS FROM `events`
0.001602
11
SHOW CREATE TABLE `events`
0.000336
12
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.001887
13
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000267
14
SELECT * FROM `activities` `t` WHERE `t`.`id`=35 LIMIT 1
0.000323
15
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000270
16
SELECT * FROM `activities` `t` WHERE `t`.`id`=35 LIMIT 1
0.000336
17
UPDATE activities SET archived=1 WHERE finishDate<now();
0.006110
18
SHOW COLUMNS FROM `view_log`
0.001081
19
SHOW CREATE TABLE `view_log`
0.000316
20
INSERT INTO `view_log` (`source`, `unique_id`, `resource_id`, `type`) VALUES (:yp0, :yp1, :yp2, :yp3)
0.003831
21
SHOW COLUMNS FROM `user_activitiesstatus`
0.001115
22
SHOW CREATE TABLE `user_activitiesstatus`
0.000302
23
SHOW COLUMNS FROM `interactions`
0.000999
24
SHOW CREATE TABLE `interactions`
0.000293
25
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=35)
0.000611
26
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=35) GROUP BY `activity_id`
0.000587
27
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000285
28
SELECT * FROM `activities` `t` WHERE `t`.`id`=35 LIMIT 1
0.000318
29
SELECT * FROM `activities` `t` WHERE `t`.`id`=35 LIMIT 1
0.000315
30
SHOW COLUMNS FROM `questionnaires`
0.001028
31
SHOW CREATE TABLE `questionnaires`
0.000302
32
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
0.000431
33
SHOW COLUMNS FROM `resources`
0.001126
34
SHOW CREATE TABLE `resources`
0.000311
35
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
0.000464
Log Messages
Message (details) Level Category Time