Atypicals in Practice: Case Studies on Dosing
neuroscienceCME TV
Premiere Date: Wednesday, March 5, 2008This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Nurses (CNE)
- Pharmacists (ACPE)
- Psychologists (APA)
- Social Workers (NASW)
All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™
Credit Expiration Date:
Thursday, March 5, 2009
Note: Credit Is No Longer Available
 | Charles B. Nemeroff, MD, PhD Professor and Chair Department of Psychiatry Mulva Clinic for the Neurosciences Director, Institute of Early Life Adversity Research Dell Medical School The University of Texas at Austin Austin, TX |
 | Stephen R. Marder, MD Daniel X. Freedman Professor of Psychiatry Vice Chair for Education Semel Institute for Neuroscience at UCLA Director Desert Pacific Mental Illness Research, Education, and Clinical Center Los Angeles, CA |
 | Sheldon H. Preskorn, MD President and Chief Executive Officer Clinical Research Institute Professor, Department of Psychiatry and Behavioral Sciences University of Kansas School of Medicine-Wichita Wichita, KS |
The selection of an appropriate antipsychotic drug and dosing regimen is critical to maximizing clinical
benefit and improving functional outcome in patients with schizophrenia. The selection of a medication
regimen requires consideration of the comparative pharmacodynamic profiles of available agents in terms
of efficacy and tolerability.(1) Treatment optimization also requires careful evaluation of pharmacokinetic
factors that may impact the specific dosing regimen.(2) By remaining up-to-date on the evidence base
regarding the psychopharmacology of atypical antipsychotics, clinicians can make rational treatment
decisions that will improve the outcome of their patients. In this interactive, case-based neuroscienceCME
TV activity, faculty will review the pharmacologic profiles of atypical antipsychotic drugs, and through
patient case examples, will discuss evidence-based strategies for optimizing dosing and maximizing
symptom remission and functional outcome in patients with schizophrenia.
- Mauri MC, Volonteri LS, Colasanti A, Fiorentini A, De Gaspari IF, Bareggi SR. Clinical pharmacokinetics of atypical antipsychotics. A critical review of the relationship between plasma concentrations and clinical response. Clin Pharmacokinet 2007;46:359-388.
- Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics. Differential risk and clinical implications. CNS Drugs 2007;21:911-936.
To apply concepts related to the pharmacokinetics and pharmacodynamics of atypical antipsychotics to patient cases and to review current evidence on dosing strategies.
At the end of this CE activity, participants should be able to:
- Compare and contrast atypical antipsychotics with respect to receptor binding and clinical pharmacology.
- Evaluate atypical antipsychotics in terms of pharmacokinetic considerations related to dosing.
- Apply techniques from patient case vignettes to optimize outcomes with appropriate dose selection regimen.
Physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers, case managers, pharmacists, and other clinicians interested in learning state-of-the-art strategies for dosing atypical antispsychotics.
CME Credit (Physicians):
CME Outfitters, LLC, is accredited
by the Accreditation Council for Continuing
Medical Education to provide continuing
medical education for physicians.
CME Outfitters, LLC, designates this educational activity for
a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians
should only claim credit commensurate with the extent of
their participation in the activity.
CNE Credit (Nurses):
CME Outfitters, LLC, is an approved
provider of continuing nursing education by the New York
State Nurses Association, an accredited approver by the
American Nurses Credentialing Center’s Commission on
Accreditation.
It has been assigned code 6WASUP-PRV-0628. 1.0 contact
hours will be awarded upon successful completion.
Note to Nurse Practitioners: The content of this CNE activity pertains to Pharmacology.
CEP Credit (Psychologists):
CME Outfitters is approved
by the American Psychological Association to sponsor
continuing education for psychologists. CME Outfitters
maintains responsibility for this program and its content.
(1.0 CE credits)
NASW Credit (Social Workers):
This program was approved
by the National Association of Social Workers (provider
#886407722) for 1 continuing education contact hour.
CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
Universal Program Number: 376-000-08-004-L01-P (live presentation) 376-000-08-004-H01-P (recorded programs)
Post-tests, credit request forms, and activity evaluations can be completed online at www.neuroscienceCME.com (click on the Testing/Certification link under the Activities tab - requires free account activation), and participants can print their certificate or statement of credit immediately (70% pass rate required). Otherwise, participants should fully complete and return both the credit request form and activity evaluation located within the course guide for this activity. A certificate or statement of credit will be mailed within 4-6 weeks to all who successfully complete these requirements.
Stephen R. Marder, MD
Dr. Marder received his AB from the University of Pennsylvania and his MD from the State University of New York at Buffalo. After
an internship at Denver General Hospital, he completed a residency at the University of Southern California. From 1975 to 1977
he was a Clinical Associate in the Biological Psychiatry Branch at the National Institute of Mental Health. In 1977 he joined the
staff at the Brentwood VA Medical Center and the faculty at UCLA.
Dr. Marder’s research has focused on the drug treatment of schizophrenia and the pharmacology of antipsychotic drugs. He has
authored or co-authored more than 200 journal articles and chapters based on research. He is currently the Director of the VISN
22 Mental Illness Research, Education Clinical Center (MIRECC) for the Department of Veterans Affairs and the Director of the
Section on Psychosis at the UCLA Semel Institute for Neuroscience and Human Behavior. He is the leader of the NIMH MATRICS
program for facilitating the development of drugs for improving neurocognition in schizophrenia and the Principal Investigator
of the NIMH Treatment Units for Research on Neurocognition in Schizophrenia.
Dr. Marder has received the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill, the Stanley Dean
Research Award of the American College of Psychiatry, the Alexander Gralnick Award from the American Psychiatric Association,
and the Kempf Award from the American Psychiatric Association. He is listed in The Best Doctors in America and America’s Top
Doctors.
Sheldon H. Preskorn, MD
Dr. Preskorn is Professor for the Department of Psychiatry at the University of Kansas School of Medicine-Wichita (KUSM-W) and
President and Chief Executive Officer for the Clinical Research Institute.
Dr. Preskorn has extensive experience in clinical trials methodology including the application of clinical trials methodology to
clinical practice sites. This experience includes studies evaluating the risk of seizures on bupropion and phase IV introduction
studies of several antidepressants to clinical practitioners. In these studies, several hundred clinical practitioners as opposed to
effectiveness, safety, and tolerability of psychiatric medications in the usual world of clinical practices.
Most recently, Dr. Preskorn was one of 14 regional directors for the largest National Institute of Mental Health (NIMH)
antidepressant study ever conducted, the Sequence Treatment with Antidepressant to Relieve Depression (STAR*D) trial. This
study was conducted in primary care and psychiatric clinical practice sites as opposed to professional clinical trials site in 14
regional sites around the country. It involved over 4,000 patients.
Dr. Preskorn was also a principal investigator on the NIMH Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) which is
the largest effectiveness trial ever conducted in patients with schizophrenia.
Both the STAR*D and CATIE trials were studies which examined the effectiveness of psychiatric medications in patients seen in
routine clinical practice as opposed to carefully selected patients seen in professional clinical trials sites. For this reason, these
studies had more minimum data set collections compared to registration efficacy trials. The designs of these studies had to be
compatible with clinical practice and had to address issues of standardizing data collection and ensuring that it was informative
while simultaneously not overly burdensome to practitioners.
Dr. Preskorn has also done large scale pharmacoepidemiology studies in the Veterans Administration Medical System. In these
studies, Dr. Preskorn, used claims data as well as pharmacy data to explore potential differences amongst three serotonin
selective reuptake inhibitors: fluoxetine, paroxetine, and sertraline.
In conducting and participating in these trials, Dr. Preskorn has gained considerable practical experience in how to design and
execute such naturalistic studies being mindful of what is level of data collection optimally represents the appropriate balance
between completeness and practicality/do-ability. That includes knowing how to design and structure assessments so that they
do not adversely impact on the efficiency of clinical practice.
In addition to the above, Dr. Preskorn, has extensive experience in more involved registration clinical trial in psychiatry having
been a principal investigator on over 250 such studies and also has extensive experience in translating the results of both
naturalistic as well as more formal clinical studies to publications to aid clinicians in applying the information gained from such
studies to their day-to-day clinical care.
Charles B. Nemeroff, MD, PhD, Moderator
Dr. Nemeroff was born in New York City in 1949 and educated in the New York City Public School System. After graduating from
the City College of New York in 1970, he enrolled in graduate school at Northeastern University and received a Master’s degree
in Biology in 1973. He received his MD and PhD (Neurobiology) from the University of North Carolina at Chapel Hill. His residency
training in psychiatry was conducted at both the University of North Carolina and at Duke University, after which he joined the
faculty of Duke University. At Duke he was Professor of Psychiatry and Pharmacology and Chief of the Division of Biological
Psychiatry before relocating in 1991 to Emory University School of Medicine in Atlanta, Georgia, where he is the Reunette
W. Harris Professor and Chairman of the Department of Psychiatry and Behavioral Sciences. His research has concentrated
on the biological basis of the major neuropsychiatric disorders, including affective disorders, schizophrenia, and anxiety
disorders. His clinical research is focused on the use of genetic, neuroendocrine, neuroimaging and neurochemical methods
to comprehensively understand the pathophysiology of depression. In recent years he has uncovered the neurobiological
mechanisms that mediate the increased risk for depression in victims of child abuse. He has also contributed to other seminal
findings such as the burgeoning area of research concerning the relationship of depression to cardiovascular disease, as well as to
identifying predictors of specific antidepressant treatment responses.
Dr. Nemeroff has received numerous honors during his career, including the A.E. Bennett Award from the Society of Biological
Psychiatry (1979), the Judith Silver Memorial Young Scientist Award from the National Alliance for the Mentally Ill (1989), both
the Kempf Award in Psychobiology (1989) and the Samuel Hibbs Award (1990) from the American Psychiatric Association (APA),
and the Gold Medal Award and the Research Prize (1996) from the Society of Biological Psychiatry. In 1993 he was awarded the
Edward J. Sachar Award from Columbia University and the Edward A. Strecker Award from The Institute of Pennsylvania Hospital.
In 1997, he was the recipient of the Gerald Klerman Award from the National Depressive and Manic-Depressive Disorders
Association and the Selo Prize from the National Alliance for Research in Schizophrenia and Depression. In 1998 he was the
recipient of the Research Award in Mood Disorders from the American College of Psychiatrists and in 1999 he received the Bowis Award from the same organization. He was awarded the Menninger Prize in 2000 from the American College of Physicians, the
Research Award from the American Foundation for Suicide Prevention in 2001, and the Burlingame Prize from the Institute of
Living in 2002. In 2006 he received the American Psychiatric Association Research Mentoring Award and Vestermark Award. Dr.
Nemeroff served as the Editor-in-Chief of Neuropsychopharmacology (2001-2006). With Alan F. Schatzberg, MD, he is co-Editor of
the Textbook of Psychopharmacology, soon to be in its Fourth Edition, published by the American Psychiatric Association Press.
He has served on the Mental Health Advisory Council of the National Institutes of Mental Health and the Biomedical Research
Council for NASA. He is past President of the American College of Neuropsychopharmacology and the American College of
Psychiatrists. He is currently a member of the Board of Directors of the American Foundation for Suicide Prevention and President
of its Scientific Council. He is chair of the APA Committee on Research Training. In 2002 he was elected as a member of the
Institute of Medicine of the National Academy of Sciences.
He is currently the recipient of several research grants from the NIH, including a Conte Center for the Neurobiology of Major
Mental Disorders, and has published more than 850 research reports and reviews.
Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all its CE
activities. Faculty must disclose to the participants any significant relationships with commercial companies whose products or
devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has
evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure,
use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant
information only. It is not assumed that these relationships will have a negative impact on the presentations.
Dr. Marder has disclosed that he receives grants/research support from Merck & Co., Inc., and Allon Therapeutics. He serves as a
consultant to Bristol-Myers Squibb Company, GlaxoSmithKline, Hoffmann La-Roche, Memory Pharmaceuticals, Otsuka America
Pharmaceuticals, Pfizer Inc., Solvay Pharmaceuticals, and Wyeth Pharmaceuticals.
Dr. Preskorn has served or is serving as a principal investigator, a member of the speakers bureau, and/or as a consultant for the
following companies: Abbott Laboratories, AstraZeneca, Aventis, Biovail, Boehringer-Ingleheim, Bristol-Myers Squibb, E. Merck,
Eisai, Eli Lilly, GlaxoSmithKline, Hoffman LaRoche, Janssen, Johnson & Johnson, Lundbeck, Merck, Neurosearch, Novartis, Organon,
Otsuka, Pfizer Inc., Solvay, Sommerset, Sumitomo, Wyeth, and Yamanouchi.
Dr. Nemeroff consulted to, served on the speakers bureaus and/or Board of Directors of, has been a grant recipient from, and/or
owned equity in one or more of the following: Abbott Laboratories, Acadia Pharmaceuticals, American Foundation for Suicide
Prevention (AFSP), American Psychiatric Institute for Research and Educations (APIRE), AstraZeneca, BMC-JR LLC, Bristol-Myers
Squibb, CeNeRx, Corcept, Cypress Biosciences, Cyberonics, Eli Lilly, Entrepreneur’s Fund, Forest Laboratories, George West Mental
Health Foundation, GlaxoSmithKline, i3 DLN, Janssen Pharmaceutica, Lundbeck, National Alliance for Research on Schizophrenia
and Depression (NARSAD), Neuronetics, NIMH, NFMH, NovaDel Pharma, Otsuka, Pfizer Pharmaceuticals, Quintiles, Reevax, UCB
Pharma, Wyeth-Ayerst. Currently, Dr. Nemeroff serves on the Scientific Advisory Board for AstraZeneca, Johnson & Johnson,
Pharma Neuroboost, Forest Laboratories , Quintiles, and NARSAD. He is a grant recipient from NIH, NARSAD and AFSP. He
serves on the Board of Directors of AFSP, NovaDel Pharmaceuticals, Mt. Cook Pharma, Inc., and the George West Mental Health
Foundation. He owns equity in CeNeRx and Reevax. He owns stock or stock options in Corcept and NovaDel.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The
faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational
uses (any uses not approved by the FDA) of products or devices.
CME Outfitters, LLC, the faculty, and Pfizer Inc. do not endorse the use of any product outside of the FDA labeled indications.
Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without
evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
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