Amazing news this evening! The Neuropsychiatry of Chronic Fatigue Syndrome & #LongCovid - A Practical Guide is accredited for CPD by the RACGP (7.5 hrs) over 3 evenings. Self-accreditation for psychiatrists (7.5 hrs). Coming up in May! #ChronicFatigueSyndrome#LongCovid#meded
Day 1
✅Neuropsychiatry of Chronic Fatigue Syndrome
✅Pathophysiology of Chronic Fatigue Syndrome
✅ Clinical Assessment of Chronic fatigue syndrome
✅Management principles in Chronic fatigue syndrome
✅Clinical Case Study part 1 – Diagnostic aspects
✅ Neuropsychiatry of Long Covid
✅ Pathophysiology of Long Covid
✅ Clinical Assessment of Long Covid
✅ Management principles in Long Covid
✅ Clinical Case Study part 2 – Practical management of Long Covid
✅ Special Comorbidities – Fibromyalgia, POTS, Mast Cell Activation etc
✅Psychopharmacological aspects in management
✅Matching psychopharmacology to symptomatology
✅Advances in Chronic fatigue syndrome & Long Covid
✅Clinical Case Study part 3 – Complex Case Mx
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Weighing into the the ongoing debate on the existence of ADHD. Strange to me. Labels can always be debated and disproven but the underlying neuroscience ( may be incomplete) but not so easily disproved. So let's get back to neuroscience to understand #ADHD. 🧵👇
In order to understand ADHD, we need to look at the three main brain functions 1. Cognition 2. Movement & action and 3. Reward sensitivity. 1/
Cognition, specifically executive dysfunction which is affected in ADHD, is mediated by the DLPFC and D1 and Alpha 2A receptors are key (very relevant to psychopharmacology). D1 receptors not so easily stimulated but are essential for reward learning. 2/
Relevance to GPs & psychiatrists in 🇦🇺 [webinar open for all HPs]. Up to 1/2 of patients w #longCOVID could be described as meeting criteria for CFS. Approximately 10 million Australians have had confirmed SARS-CoV-2 infection with long-term sequelae only now being defined ...1/
"To prepare the next generation of health-care providers and researchers, medical schools must improve their education on infection-initiated illnesses such as long COVID and ME/CFS, and competency evaluations should include these illnesses. [Davis et al, 2023]
"As of 2013, only 6% of medical schools fully cover ME/CFS across the domains of treatment, research and curricula, which has created obstacles to care, accurate diagnosis, research and treatment" [Davis et al, 2023]
The study on escitalopram v placebo in healthy volunteers measuring reinforcement sensitivity has caused a stir as usual with incorrect interpretations of ‘SSRIs blunt emotions’This is incorrect - let us understand reinforcement sensitivity 🧵👇
Keeping it simple -Humans utilise the limbic network (Amygdala-Ventral striatum) & PFC to respond to stimuli & make decisions leading to actions. Reinforcement learning / reward learning helps us solve problems. Reward does not only mean pleasure. Removal of a ‘problem’ =reward
Reinforcement sensitivity consists of 3 dimensions that can be mapped neurobiologically - 1. behavioural inhibition (BI), 2. behavioural activation ( BA) 3. Threat response - FF etc. When individuals are anxious or depressed - the response to stimuli may be dysfunctional
Since 5-HT is all the rage - Here are some antidepressants that do not act via SERT blockade. Antidepressants are not a homogeneous group. Most commonly those that put them under one umbrella have a anti-med agenda. So let's get started 👇
1. Agomelatine - 5 HT2C antagonist & Melatonin R agonist. ⬆️DA&NA in PFC. Melatonergic potentiation - ⬆️SWS psychscenehub.com/psychinsights/…
2. Modafinil & Armodafinil - NAT and DAT inhibitors ⬆️ NA & DA AND activation of Orexin pathways - ⬆️wakefulness. psychscenehub.com/psychinsights/…
With 1-way ideologies (the chemical imbalance) I find one rule useful. As Taleb says (finance) don't ask a person what their opinion or reco is - ask them what's in their portfolio. So @markhoro@joannamoncrieff@HengartnerMP-how do you treat depression? Do u prescribe SSRIs? 1/n
Do you prescribe antidepressants that directly or indirectly act on serotonin receptors. If you prescribe ADs how do you explain this to the patient. @markhoro you in detail explain withdrawal Sx neurobio- how do you Rx dep in your practice? 2/n
And if you prescribe ADs should the media be aware that although your paper debunks the very narrowly studied link between Serotonin & dep - some of you prescribe ADs outlining reasons for that? Wouldn't that be the responsible thing to do?