The 6^th Psych Congress Elevate took place in Las Vegas, Nevada, from June 3–5 2022, providing a forum for mental health clinicians to meet, network, and advance both their careers and the field of mental health. This year’s congress delivered a transformative educational experience in which attendees were provided the opportunity to engage in three days of cutting-edge research that translated into clinical application. This article highlights the key scientific sessions of interest.

Selected scientific sessions: tardive dyskinesia 

Citrome L, Matthews D, and Yeiser B – Addressing persistent myths and misconceptions in tardive dyskinesia¹ | Teva- and Neurocrine-sponsored educational symposium

• The presenters: 
  • Emphasized the importance of assessing the impact of tardive dyskinesia (TD), even in patients with a low total Abnormal Involuntary Movement Scale (AIMS) score
  • Reviewed the American Psychiatric Association (APA) guidelines on the frequency of TD screening using structured assessments 
• Although the entire audience indicated familiarity with AIMS, only 75% of attendees confirmed they perform AIMS assessments in practice 
• The presenters highlighted: 
  • AIMS as the gold standard screening tool for TD 
  • The importance of encouraging clinicians to perform AIMS assessments regularly, as many payors require an AIMS assessment to be conducted for approval of treatment with vesicular monoamine transporter 2 (VMAT2) inhibitors 
• Dr Citrome encouraged clinicians to treat TD themselves rather than referring patients to a movement disorder specialist 
• While presenting the number needed to treat and number needed to harm calculations for VMAT2 inhibitors, Dr Citrome highlighted that patients are 20 times more likely to respond to than discontinue this treatment due to an adverse event 
• Bethany Yeiser, president of the CURESZ Foundation and patient advocate, shared her experience of living with schizophrenia (SZ) and TD 

Bahroo L and Hughes J – Tardive dyskinesia: overcoming the challenges of differential diagnosis & treatment in the era of telepsychiatry¹ | Neurocrine-sponsored product theater

• This session focused on: 
  • The differential diagnosis of dopamine receptor blocking agent (DRBA) induced movement disorders 
  • The assessment of TD using telepsychiatry
  • Current guidelines for the treatment of TD
  • Key differences between VMAT2 inhibitors 
• The audience was shown videos of patients with TD, akathisia, dystonia, and drug-induced parkinsonism and asked to identify the DRBA-induced movement disorder
• Jo Hughes remarked that in-person visits are preferred for new patients and when diagnosing and assessing DRBA-induced movement disorders 

Selected scientific sessions: schizophrenia

Mattingly G and Pridgen B – Breaking down the barriers to utilizing long-acting injectable antipsychotics for schizophrenia management¹ | Teva- and Alkermes-sponsored educational symposium

• The presenters discussed some of the barriers to optimal SZ treatment including antipsychotic (AP) nonadherence
• They reviewed both the pathophysiology of SZ and the mechanisms and side effects of APs 
• The presenters also discussed: 
  • Evidence supporting the use of long-acting injectables (LAIs) for the management of SZ 
  • Clinical practice guidelines
  • Common tapering strategies for switching LAIs 
• An overview of commercially available LAIs in the United States (US) was provided, as well as those in late-stage development by Teva, Rovi, and Otsuka/Lundbeck 
• The presenters described correct injection techniques, and suggested working closely with pharmacists and healthcare professionals to help administer LAIs 
• They also highlighted strategies to boost clinicians’ confidence in performing injections, including: 
  • Watching instructional videos 
  • Observing experienced colleagues 
  • Practicing using a training model 
  • Building rapport with the patient 

Alva G and Baldwin L – Empowered decision making: a treatment team approach to long-acting injectables for adult clients with schizophrenia¹ | Janssen-sponsored product theater

This session focused on:

• The importance of adherence in SZ management 
• Factors that affect adherence 
• Patient outcomes associated with non-adherence 
• The benefits of LAIs, including: 
  • Reduced daily pill count 
  • Delayed time to relapse 
  • Assured medication delivery 
  • More consistent plasma levels 
  • Reduced risk of relapse due to non-adherence 
  • Allowing more time to respond to a missed dose 
• Clinical practice guidelines including the National Council for Behavioral Health, Florida Best Practice Psychotherapeutic Medication, and APA guidelines supporting the use of LAIs were reviewed 
• Attendees were encouraged to discuss LAIs early with patients and their caregivers
• Patient-related barriers to LAI use, e.g., lack of awareness of LAIs, loss of control, stigma, fear of needles, and negative past experiences were discussed 
• Clinician-related barriers discussed include:
  • Believing patients will not consider LAIs 
  • Overestimating a patient’s fear
  • Inaccurately viewing LAIs as a last resort 
  • Having limited time available to discuss LAIs 
• It was emphasized that most barriers are ‘pseudo’ barriers and may be overcome with: 
  • Education 
  • Effective communication 
  • Building strong therapeutic alliances 
  • Listening to and respecting the patient’s preferences and past experiences 
  • Providing psychoeducation 
  • Shared decision-making 
  • Starting LAI discussions early 
  • Involving family and caregivers 
  • Using a treatment team approach 
  • Using clear and positive language 
  • Continuing to revisit the conversation regularly 
• The ‘GAIN’ framework was suggested for LAI conversations: Goal setting, Action planning, Initiating treatment, and Nurturing motivation

Summaries of selected posters: tardive dyskinesia

Tardive dyskinesia across the complexity spectrum: from quality-of-life improvement to novel treatments¹ | Teva and Neurocrine de novo poster

Geffner-Smith A, Meyer J, Stewart M, Williams P

Objective: This analysis aimed to assess the learners’ knowledge upon completion of the TD 360 curriculum of educational activities. The purpose of the TD 360 curriculum was to increase the awareness of TD impact on patient outcomes, barriers to care, clinical guideline treatment recommendations, and VMAT2 inhibitors. 

Results: Findings demonstrated a 63% increase in learners’ knowledge following participation in any of the educational programs within the curriculum in 2020 and 2021.

Development of the MIND-TD questionnaire as a screening tool for tardive dyskinesia¹ | Neurocrine encore poster

Lundt L, Jain R, Basin P, Matthews D, Shah C, Roque A, Vanderhoef D, Kelly C

Objective: The aim of this study was to assess the ability of MIND-TD, a questionnaire based on input from a panel of expert clinicians to help healthcare professionals screen for TD, to identify patients requiring further assessments for TD. Part 1 of the questionnaire included a yes/no question for each of the following topics: Movement, Impact, Notice, and Daily Activities. Part 2 of the questionnaire included items related to physical/functional difficulties (Thorough Interview) and checklists of characteristic movements for TD and other drug-induced movement disorders (Differentiate). 

Results: Authors concluded that MIND-TD can be used at routine in-person, virtual, or audio-only visits to identify patients who may require further assessments for TD.

Summaries of selected posters: schizophrenia

Early versus late administration of long-acting injectable antipsychotic agents among patients with newly-diagnosed schizophrenia: an analysis of a commercial claims database¹ | Teva de novo poster

Kane J, Chen A, Lim S, Mychaskiw M, Tian M, Wang Y, Suett M, Rubio J

Objective: The study aimed to evaluate treatment patterns, healthcare resource utilization (HCRU) and costs among patients with newly-diagnosed SZ treated with atypical LAIs within 1 year (early) versus >1 year (late) after diagnosis. 

Results: Overall, SZ-related HCRU and cost were lower for patients who initiated LAIs early versus with those who initiated LAIs late; with a mean difference of $2301.03 between both groups. Hospitalizations were comparable between groups, while costs were lower for the early LAI group. A greater proportion of patients with SZ who initiated a LAI within one year of diagnosis achieved successful LAI implementation (53.9%) versus those who initiated a LAI >1 year after diagnosis (48.0%).

Long-acting injectable antipsychotics: practical considerations and impact on adherence in schizophrenia¹ | Janssen poster

Citrome L, Geffner-Smith A, Stewart M, Williams P

Objective: This analysis assessed an educational curriculum that was designed to meet learning objectives associated with SZ identification and treatment using LAIs. Educational objectives included discerning differences among LAIs, understanding adherence challenges, and implementing patient-centric communication strategies to improve patient acceptance of LAIs. 

Results: Findings demonstrated a 94% increase in learners’ knowledge following participation in any of the educational programs within the curriculum in 2020 and 2021. Prior to engaging in the activities, clinicians displayed low levels of knowledge regarding the pharmacology of current medications and implementation strategies to facilitate patient acceptance of LAIs. Following completion of the activities, clinicians were likely to indicate increased knowledge, and felt more confident in their ability to properly use LAIs in the clinic, potentially indicating educational success.

Reference

1. 6th Annual Psych Congress Elevate; June 3–5, 2022; Las Vegas, NV

NPS-US-NP-01147