Rational and Irrational Psychopharmacology for Complex Trauma and Dissociative Disorders
This Webinar, based on the presenter’s 35 years experience with medication management of severely traumatized dissociative individuals, will address the role of psychopharmacology and somatic treatments such as electroconvulsive therapy (ECT) in the treatment of patients with complex trauma (CT) and dissociative disorders. (DD), in particular dissociative identity disorder (DID).
There are 3 basic goals of this workshop. The first is an overview of psychological factors in prescribing medications in general, and, more specifically in psychiatric patients. This includes discussion of what is meant by “target symptoms” in medication management in psychiatry.
Next, the presenter will address conceptualization of symptoms that are legitimate targets for somatic treatments in CT/DD patients, and those that are more amenable to psychotherapy. This includes discussion of medication for mood disorders, fear and anxiety symptoms, PTSD symptoms, and sleep problems, among others. The presenter will discuss typical responses to medications in these patients, using the model of “shock absorber” effects of somatic treatments. Other areas for discussion will include medication classes that have utility in medication management of this patient population; apparent differential responses to medications of dissociative identity disorder self-states; state-dependent medication response; and placebo effects.
The third area is a discussion of specific psychological issues that may arise in prescription of medications to CT/DD patients. This includes issues of informed consent for highly dissociative individuals; patients who are phobic of medications, and those who rely too extensively on medications, and/or seek medications preferentially for solutions to their difficulties. In addition, the presenter will addrss specific issues in the psychopharmacological management of DID patients. Also, the presenter will discuss collaboration between the psychopharmacologist and the non-medical psychotherapist, as well as the interface with the patient’s medical providers.
At the conclusion of this session participants will be able to:
- Describe psychopharmacological and somatic interventions in severely traumatized patients in terms of the "shock absorber" model.
- Assess whether medications work or not in severely traumatized patients who often state that "my meds don't work".
- Identify and address concerns about medications of the person with DID, and those of the self states.
- Describe the use of Prazosin (Minipress) in the treatment of PTSD symptoms.
- Provide a more rational informed consent process for medication treatment in severely dissociative patients.
Presenter: Richard J. Loewenstein, MD
Presenter Bio: Richard J. Loewenstein MD is the founder and Medical Director of The Trauma Disorders Program at Sheppard Pratt Health Systems, Baltimore, MD and Clinical Professor of Psychiatry at the University of Maryland School of Medicine. The Trauma Disorders Program includes a 22-bed inpatient unit, an outpatient program, a fellowship program, and research, consultation and teaching components. He did a research fellowship at the National Institute of Mental Health in Bethesda, MD. He is the author of over 75 papers and chapters on sleep disorders, consultation-liaison psychiatry, dissociation, dissociative disorders, and trauma disorders. He is a fellow of the International Society for the Study of Dissociation and Distinguished Life Fellow of the American Psychiatric Association. He has received numerous awards including the Lifetime Achievement Award of the International Society for the Study of Trauma and Dissociation (the organizations highest award). He is an advisor to the longitudinal Treatment of Patients with Dissociative Disorders (TOPDD) Study headed by Bethany Brand, PhD of Towson University. He has over 30 years experience in the diagnosis and treatment of thousands of adults with severe complex trauma and dissociative disorders (CT/DD), particularly those with dissociative identity disorder (DID). Since 1992, he has been attending psychiatrist and team leader on the inpatient Trauma Disorders Unit at Sheppard Pratt Health System. Here he gained extensive experience in the medication management and provision of electroconvulsive therapy (ECT) for complex trauma and dissociative disorder patients. In addition, since the early 1980s, he has worked with CT/DD/DID outpatients, either as individual therapist, or as medication manager in collaboration with non-medical therapists. Also, he has extensive experience in the differential diagnosis and management of somatic symptoms and conversion disorders in this patient population, to assess the contribution of medical and/or psychological factors in the somatic symptoms in these patients.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program.
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