Until very recently the fields of Neuropsychiatry and Behavioral Neurology have not had a standardized formal training program. Each institution‘s curriculum varied according to the interests and availability of faculty and staff. The ANPA is attempting to fill this gap in education by utilizing a newly established core curriculum developed for fellowship training in behavioral neurology & neuropsychiatry. The ANPA annual meeting content is anchored to this curriculum which will require a multi-year rotation in order to cover the core concepts and clinical problems in neuropsychiatry. It is also a goal to cover topics that are relevant to the multidisciplinary audience of clinicians, educators, and scientists that attend the meeting.
There are three core subjects for this symposium -- autism, attention deficit hyperactivity disorder (ADHD), and Gilles de la Tourette syndrome
With regard to autism, data from the 2011 Pathways to Diagnosis and Services project identified the unmet needs of individuals with autism spectrum disorders. More than half of the subjects in this study used psychotropic medication when access to psychiatrists and psychologists was identified as a need in this population. Kamio et al. (2012) also identified aggressive behavior as a predictor of (reduced) quality of life among adults with autism spectrum disorders, and Siegel et al. (2012) identified obtaining adequate post-discharge services as the greatest challenge to the care of persons with autism spectrum disorders whose behaviors necessitated at least on inpatient psychiatric hospitalization. These data identify important gaps in practice among the types of specialists who attend the annual ANPA meeting, namely knowledge about autism spectrum disorders, skill in the evaluation and treatment of this condition and its neuropsychiatric sequelae (including aggressive and other behavioral disturbances), and the ability to provide not only inpatient but also outpatient services to individuals with autism spectrum disorders and their families.
With regard to attention-deficity hyperactivity disorder (ADHD), Mitchell et al. (2012) used data from the 2007 Special Review of Attention Deficit Hyperactivity Disorder in Children and Adolescents in New South Wales to evaluate the diagnostic and management practices of physicians, and identified significant differences in these practices by medical specialty. Brown et al. (2011) assessed competencies and practices of a large group of healthcare providers in ADHD and identified barriers to improving care. Of the 2,103 participants completing their assessments, 20% were “not at all confident” and only 44% were “somewhat confident” in being up-to-date in the diagnosis and management of ADHD. When responses of these participants were compared to the American Board of Psychiatry and Neurology’s Child and Adolescent Core Competencies and the American Academy of Child and Adolescent Psychiatry Practice parameters, participants selected appropriate responses only 60% of the time (57% for items on diagnosis and 62% for items on treatment). These studies clearly identify major practice gaps in the area of ADHD, including the diagnosis and treatment of children and adults with this condition.
With regard to GTS, the European Society for the Study of Tourette Syndrome recently developed a set of four reports describing guidelines for the assessment and management of persons and families affected by this condition (Cath et al. 2011; Roessner et al. 2011; Verdellen et al. 2011; Müller-Vahl et al. 2011). The efforts of this international consortium were driven by multiple gaps in this area of practice, including the absence of guidelines describing screening methods for GTS, including cognitive abilities, emotional functions, and motor skills, as well as guidelines on the pharmacotherapy, behavioral and psychological interventions, and neurostimulation interventions used to treat this condition. The products of their efforts can be used to address these practice gaps, and their dissemination (in part or in total) is an important step toward that end.
This educational activity is designed to change participants' knowledge of scientific findings, clinical assessment methods, and neurotherapeutics relevant to the care of persons with specified neuropsychiatric conditions. Reviews of the evaluations of past annual meetings of ANPA indicate clearly that the participants in the meeting favor live sessions, designed as didactic presentations followed by question/answer sessions and/or panel discussions. As the goal of educational formatting is to match the design of an activity to the learning style of its participants, we believe that the format and design of the activity is appropriate and will address usefully the professional practice gaps identified above.
A web-based survey anchored to the sessions (including individual lectures) presented at this meeting with be used to guide participants through a self-assessment of change in knowledge regarding new scientific findings, clinical assessment methods, and neurotherapeutics relevant to care of persons with the neuropsychiatric conditions discussed at this meeting.
Upon completion of this activity, learner will be able to:
1. Integrate into practice the anatomical organization and neuropsychiatric relevance of the prefrontal cortex and its connections with subcortical circuits.
2. Recall the clinical manifestations of disruptions of frontal lobe white matter tracts and connections with subcortical areas including thalamus, basal ganglia, and cerebellum.
3 Utilize the contemporary brain imaging methods to explore the role of these subcortical areas in neuropsychiatric disorders.
NEUROBEHAVIORAL ISSUES IN SLEEP: MOOD, MEMORY, AND OTHER MISCHIEF
1. Recall case examples of how sleep alterations affect cognition and behavior in neurobehavioral disorders.
2. Relate how functional neuroanatomical imaging correlates of sleep states in selected neuropsychiatric disorders.
3. Explain the neurobiological basis of sleep in relation to cognition and behavior.
SOCIAL COGNITION AND THE FRONTAL LOBES: A 35 YEAR ODYSSEY
1. Define and describe the complexities of frontal lobe functions in social cognition and mental state attributions
2. Name the model of brain organization of different types of self-awareness/consciousness
1. To describe the epidemiology, phenomenology and pathophysiology of autism as well as presentation and treatment
2. Construct the language phenotypes, their neural bases and developmental risk factors in autism
3. Restate the excitation-inhibition imbalance theory of autism, its evidence and implications for treatment
4. Review the emerging genetics of autism, new animal models of autism and emerging treatments for autism based on our understanding of the molecular mechanisms of the disorder
CLINICAL PLATFORM PRESENTATIONS
1. Discriminate the differential diagnosis of neuropsychiatric conditions
2. List practical ideas for diagnosis and treatment from oral case presentations
RESEARCH PLATFORM PRESENTATIONS
THE NEUROPSYCHIATRY OF REWARD SYSTEMS
2. Construct the clinical manifestations of disruptions of the reward system
3. Recall novel methods to better understand function and dysfunction of the reward system
ATTENTION DEFICIT HYPERACTIVITY DISORDER
1. Identify the phenomenology and epidemiology of ADHD across the lifespan ( childhood, adolescence, adulthood)
2. Defend the evidence (mainly from neuroimaging) for the developmental neuropathophysiology of ADHD
3. Employ the clinical evaluations (appropriate and optimal) of the child, adolescent and adult referred for probable ADHD diagnosis
4. List the treatment options for each developmental stage, childhood, adolescence and adulthood, of ADHD
1. Utilize explanatory neurobiological models of conversion disorder.
2. Prepare evidence in support of proposed models of conversion disorder.
GILLES DE LA TOURETTE SYNDROME
1. Interpret the epidemiology and clinical phenomenology of Gilles de la Tourette Syndrome
2. Recognize comorbidities of Gilles de la Tourette Syndrome and the biological interactions
3. Translate the neurobiology of movement in normal and pathalogical situations. What does the latter teach us about the former?
NEUROPSYCHIATRIC VALUES AND THE VALUE OF NEUROPSYCHIATRY
1. Recall the traditional neuropsychiatric values using a famous neuropsychiatrist and the disease with which he is associated
2. Classify how traditional values will increase the value of neuropsychiatry in the era of the ACO
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