The field of neuropsychiatry has seen a significant shift towards telemedicine in recent years, particularly accelerated by the COVID-19 pandemic. As we consider the future of care delivery, it’s important to examine the pros and cons of both telemedicine and traditional in-office visits for neuropsychiatric patients.
Advantages of Telemedicine
Improved Access to Care
Telemedicine has proven to be an effective tool for providing specialized healthcare to patients with neurological and psychiatric conditions, especially those in remote areas or with mobility issues[1]. It eliminates geographical barriers, allowing patients to connect with specialists regardless of their location.
Convenience and Cost-Effectiveness
Patients appreciate the convenience of receiving care from home, saving time and money on travel and reducing the stress associated with clinic visits[6]. This is particularly beneficial for those with chronic conditions requiring frequent follow-ups.
Comfort and Privacy
Many patients, especially those with anxiety disorders or certain phobias, feel more comfortable receiving care in their own environment[4]. This can lead to more open and productive therapy sessions.
Flexible Scheduling
Telemedicine allows for more flexible appointment times, making it easier for patients to fit care into their busy schedules[6].
Advantages of In-Office Care
Comprehensive Physical Examinations
In-person visits allow for more thorough physical examinations, which can be crucial for accurate diagnosis and treatment planning in neuropsychiatry[1].
Non-Verbal Communication
Face-to-face interactions provide clinicians with a full range of non-verbal cues, which can be essential in assessing a patient’s mental state and overall well-being[7].
Technological Barriers
In-office visits eliminate potential technical difficulties that can disrupt telemedicine sessions, ensuring smoother interactions between patients and providers[5].
Medication Management
Some clinicians find it easier to initiate or adjust medications during in-person visits, particularly for complex cases or when starting long-term treatments[7].
Patient Preferences and Outcomes
Research shows that patient preferences for telemedicine vs in-person care are mixed. While many appreciate the convenience of telemedicine, others prefer the personal touch of face-to-face interactions[3]. Importantly, studies have demonstrated that telepsychiatry can be as effective as in-person care for many conditions, with high levels of patient satisfaction[4].
Considerations for Practitioners
Hybrid Models
Many neuropsychiatrists are adopting hybrid models, combining telemedicine and in-person visits to leverage the benefits of both approaches[2]. This allows for flexibility in care delivery while maintaining the option for face-to-face interactions when necessary.
Technology and Training
Successful implementation of telemedicine requires adequate technology infrastructure and training for both providers and patients[5]. Investing in user-friendly platforms and providing ongoing support can significantly improve the telemedicine experience.
Legal and Ethical Considerations
Practitioners must be aware of licensing requirements and ethical guidelines when providing telemedicine services, especially across state or national borders[7].
Conclusion
Both telemedicine and in-office care have their place in modern neuropsychiatry. The choice between the two should be based on individual patient needs, the nature of the condition being treated, and the specific requirements of each clinical encounter. As technology continues to advance and healthcare systems adapt, we can expect to see further integration of telemedicine into neuropsychiatric care, complementing rather than replacing traditional in-office visits.
Ultimately, the goal is to provide high-quality, accessible care that meets the diverse needs of neuropsychiatric patients. By thoughtfully combining telemedicine and in-person services, practitioners can offer a more comprehensive and patient-centered approach to care.
Integrative Approaches to Dementia Treatment: Exploring Ketogenic Diets and Beyond
As the prevalence of dementia continues to rise globally, researchers and clinicians are exploring integrative approaches to prevent cognitive decline and treat dementia symptoms. Among the most promising interventions is the ketogenic diet, which has shown potential benefits for brain health and cognition.
The Ketogenic Diet and Dementia
The ketogenic diet is a high-fat, low-carbohydrate diet that shifts the body’s metabolism towards fat burning and ketone production. Recent studies have highlighted the potential of ketogenic diets in addressing dementia:
– A randomized crossover trial found that a 12-week modified ketogenic diet improved daily function and quality of life in Alzheimer’s patients[3].
– Ketones may serve as an alternative energy source for the brain, potentially compensating for impaired glucose metabolism often seen in Alzheimer’s disease[3].
– The neuroprotective properties of ketones are being investigated for their potential in preserving cognitive abilities[1].
Dr. Maurice Preter’s Perspective
As a psychodynamic psychiatrist, psychopharmacologist and neurologist, Dr. Preter’s protocol emphasizes the importance of lifestyle factors in brain health and dementia prevention. His approach includes:
– Judicious use of ketogenic diets as a potential treatment strategy for Alzheimer’s disease[4].
– Addressing the role of inflammation and oxidative stress in neurodegeneration, including the use of curcumin, the active compound in turmeric, for its anti-inflammatory and antioxidant properties that may benefit brain health.
More generally:
– Nutritional interventions, including ketogenic diets and targeted supplementation.
– Stress reduction techniques and lifestyle modifications, specifically sleep and sexual hygiene.
– Addressing underlying medical conditions and medications that may contribute to cognitive decline.
Additional Integrative Approaches
Beyond ketogenic diets, other integrative strategies for dementia treatment and prevention include:
– Regular physical exercise, particularly resistance training, which may lead to structural brain changes associated with a lower risk of Alzheimer’s dementia[7].
– Maintaining social connections, as frequent social contact has been linked to reduced brain atrophy in older adults[7].
Conclusion
While pharmaceutical treatments for dementia have shown limited success, integrative approaches offer promising avenues for prevention and symptom management. The ketogenic diet, in particular, has emerged as a potential intervention worthy of further research. As we continue to unravel the complex nature of dementia, a multifaceted approach incorporating dietary interventions, lifestyle modifications, and targeted therapies may offer the best hope for those affected by cognitive decline.
It’s important to note that while these approaches show promise, individuals should consult with healthcare professionals before making significant changes to their diet or treatment regimens, especially those with existing health conditions or cognitive impairments.
– Psychodynamic psychiatrists are medical doctors (MDs) who have completed residency training in psychiatry and have an interest and additional expertise in psychoanalysis, psychodynamic theory and technique.
– If indicated, they can prescribe medications in addition to providing psychodynamic therapy.
– Psychodynamic psychiatrists often take a more integrative or holistic view, considering biological, psychological, and social factors in assessment and treatment.
– They may combine medication management with psychodynamic therapy sessions.
– As physicians, psychodynamic psychiatrists tend to have more extensive medical training compared to non-MD therapists.
Psychodynamic Psychotherapists
– Those psychodynamic psychotherapists who aren’t medical doctors by education typically have graduate-level training in psychology, counseling, social work, or a related mental health field. Common degrees include PhD, PsyD, LCSW, or LPC.
– They tend to not have a formal medical background and cannot prescribe medications.
Key Similarities
– Both use psychodynamic techniques like free association, dream analysis, and exploring the unconscious.
– Both aim to help clients gain insight into unconscious patterns and resolve internal conflicts.
– Both focus on early life experiences and how they shape current functioning.
– Both work to strengthen ego functions and adaptive defenses.
– Both emphasize the importance of the therapeutic alliance.
Key Differences
– Psychiatrists are medical doctors by education and can prescribe medication, non-MD psychotherapists cannot.
The choice between a psychodynamic medical psychotherapist/psychiatrist or non-MD therapist often depends on the patient’s specific needs, preferences, and whether medication may be beneficial as part of treatment.
See previous post. Dr Kelsey saved tens of thousands of children in the U.S. and Canada from the greatest ever anti-anxiety medication (until it wasn’t) synthesized in Germany.
PS I remember the time when the surviving amelic/phocomelic children, then in their teenager years were a common sight in Germany. The wikipedia page is informative:
Frances Kathleen Oldham KelseyCM (née Oldham; July 24, 1914 – August 7, 2015) was a Canadian-American[1]pharmacologist and physician. As a reviewer for the U.S. Food and Drug Administration (FDA), she refused to authorize thalidomide for market because she had concerns about the lack of evidence regarding the drug’s safety.[2] Her concerns proved to be justified when it was shown that thalidomide caused serious birth defects. Kelsey’s career intersected with the passage of laws strengthening FDA oversight of pharmaceuticals. Kelsey was the second woman to receive the President’s Award for Distinguished Federal Civilian Service, awarded to her by John F. Kennedy in 1962.
Born in Cobble Hill, British Columbia,[3] Kelsey attended St. Margaret’s School from 1928 to 1931 in the provincial capital, graduating at age 15.[4] From 1930 to 1931, she attended Victoria College (now University of Victoria). She then enrolled at McGill University, where she received both a B.Sc. (1934) and an M.Sc. (1935) in pharmacology.[3] Encouraged by one of her professors, she “wrote to EMK Geiling, M.D., a noted researcher [who] was starting up a new pharmacology department at the University of Chicago, asking for a position doing graduate work”.[4] Geiling, unaware of spelling conventions with respect to Francis and Frances, presumed that Frances was a man and offered her the position, which she accepted, starting work in 1936.[5][6]
Upon completing her Ph.D., Oldham joined the University of Chicago faculty. In 1942, like many other pharmacologists, Oldham was looking for a synthetic cure for malaria. As a result of these studies, Oldham learned that some drugs are able to pass through the placental barrier.[8] During her work, she also met fellow faculty member Fremont Ellis Kelsey, whom she married in 1943.[4]
While on the faculty at the University of Chicago, Kelsey was awarded her M.D. in 1950.[4] She supplemented her teaching with work as an editorial associate for the American Medical AssociationJournal for two years. Kelsey left the University of Chicago in 1954, decided to take a position teaching pharmacology at the University of South Dakota, and moved with her husband and two daughters to Vermillion, South Dakota, where she taught until 1957.[3]
She became a dual citizen of Canada and the United States in the 1950s in order to continue practicing medicine in the U.S., but retained strong ties to Canada where she continued to visit her siblings regularly until late in life.[2]
In 1960, Kelsey was hired by the FDA in Washington, D.C. At that time, she “was one of only seven full-time and four young part-time physicians reviewing drugs”[4] for the FDA. One of her first assignments at the FDA was to review an application by Richardson-Merrell for the drug thalidomide (under the tradename Kevadon) as a tranquilizer and painkiller with specific indications to prescribe the drug to pregnant women for morning sickness. Although it had been previously approved in Canada and more than 20 European and African countries,[9] she withheld approval for the drug and requested further studies.[3] Despite pressure from thalidomide’s manufacturer Grünenthal, Kelsey persisted in requesting additional information to explain observations by Leslie Florence of neurological symptoms published in the British Medical Journal in December 1960.[4][10] She also requested data showing the drug was not harmful to the fetus.[10]
Kelsey’s insistence that the drug should be fully tested prior to approval was vindicated when the births of deformed infants in Europe were linked to thalidomide ingestion by their mothers during pregnancy.[11][12] Researchers discovered that the thalidomide crossed the placental barrier and caused serious birth defects.[8] She was hailed on the front page of The Washington Post as a heroine[13] for averting a similar tragedy in the U.S.[14]Morton Mintz, author of The Washington Post article, said “[Kelsey] prevented … the birth of hundreds or indeed thousands of armless and legless children.”[13] Kelsey insisted that her assistants, Oyama Jiro and Lee Geismar, as well as her FDA superiors who backed her strong stance, deserved credit as well. The narrative of Kelsey’s persistence was used to help pass rigorous drug approval regulation in 1962.[1]
After Mintz broke the story in July 1962, there was a substantial public outcry. The Kefauver Harris Amendment was passed unanimously by Congress in October 1962 to strengthen drug regulation.[11][12] Companies were required to demonstrate the efficacy of new drugs, report adverse reactions to the FDA, and request consent from patients participating in clinical studies.[15] The drug testing reforms required “stricter limits on the testing and distribution of new drugs”[8] to avoid similar problems. The amendments, for the first time, also recognized that “effectiveness [should be] required to be established prior to marketing.”[11][12]
As a result of her blocking American approval of thalidomide, Kelsey was awarded the President’s Award for Distinguished Federal Civilian Service by John F. Kennedy on August 7, 1962,[16] becoming the second woman so honoured.[17] After receiving the award, Kelsey continued her work at the FDA. There, she played a key role in shaping and enforcing the 1962 amendments.[14] She also became responsible for directing the surveillance of drug testing at the FDA.[3]
Kelsey retired from the FDA in 2005, at age 90, after 45 years of service.[9] In 2010, the FDA named the Kelsey Award for her, to be awarded annually to an FDA employee for “Excellence and Courage in Protecting Public Health”.[18]
In 2010, the FDA presented Kelsey with the first Drug Safety Excellence Award and named the annual award after her,[20] announcing that it would be given to one FDA staff member annually.[21] In announcing the awards, Center Director Steven K. Galson said: “I am very pleased to have established the Dr. Frances O. Kelsey Drug Safety Excellence Award and to recognize the first recipients for their outstanding accomplishments in this important aspect of drug regulation.”[22]
Kelsey turned 100 in July 2014,[23] and shortly thereafter, in the fall of 2014, she moved from Washington, D.C., to live with her daughter in London, Ontario.[24] In June 2015, when she was named to the Order of Canada, Mercédes Benegbi, a thalidomide victim and the head of the Thalidomide Victims Association of Canada, praised Kelsey for showing strength and courage by refusing to bend to pressure from drug company officials, and said “To us, she was always our heroine, even if what she did was in another country.”[24]
Kelsey died in London, Ontario, on August 7, 2015, at the age of 101,[25] less than 24 hours after Ontario’s Lieutenant-Governor, Elizabeth Dowdeswell, visited her home to present her with the insignia of Member of the Order of Canada for her role against thalidomide.[26]
^“When Kelsey read Geiling’s letter offering her a research assistantship and scholarship in the PhD program at Chicago, she was delighted. But there was one slight problem — one that ‘tweaked her conscience a bit.’ The letter began ‘Dear Mr. Oldham,’ Oldham being her maiden name. Kelsey asked her professor at McGill if she should wire back and explain that Frances with an ‘e’ is female. ‘Don’t be ridiculous,’ he said. ‘Accept the job, sign your name, put ‘Miss’ in brackets afterwards, and go!'” Bren (2001).
Kelsey, Frances O. (1993), Autobiographical Reflections(PDF). This was drawn from oral history interviews conducted in 1974, 1991, and 1992; presentation, Founder’s Day, St. Margaret’s School, Duncan, B. C., 1987; and presentation, groundbreaking, Frances Kelsey School, Mill Bay, B. C., 1993.
McGovern, James (2020), “Quieter Things: The Tale of Frances Oldham Kelsey”, Boulevard, 35 (2 & 3): 209–219.
Mintz, Morton (1965), The therapeutic nightmare; a report on the roles of the United States Food and Drug Administration, the American Medical Association, pharmaceutical manufacturers, and others in connection with the irrational and massive use of prescription drugs that may be worthless, injurious, or even lethal., Boston: Houghton Mifflin, LCCN65015156. Library of Congress catalog entry.
McFadyen, R. E. (1976), “Thalidomide in America: A Brush With Tragedy”, Clio Medica, 11 (2): 79–93, PMID61093.
Mulliken, J. (August 10, 1962), “A Woman Doctor Who Would Not be Hurried”, Life, vol. 53, pp. 28–9, LCCN37008367.
Maurice Preter, MD is a European and U.S. educated psychiatrist, psychotherapist, psychopharmacologist, neurologist, and medical-legal expert in private practice in Manhattan. He is also the principal of Fifth Avenue Concierge Medicine, PLLC, a medical concierge service and health advisory for select individuals and families.
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