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The recording of this webinar will be available later as video-on-demand only for ESTD members.
Free Webinar November 20, 7-8.30pm
Rational and Irrational Psychopharmacology for Dissociative Identity Disorder
Richard J. Loewenstein, M.D.
Adjunct Professor, Department of Psychiatry University of Maryland School of Medicine Baltimore, MD
Abstract
This lecture addresses the role of psychopharmacologic and somatic treatments in treatment of patients dissociative identity disorder (DID). This discussion is also relevant to other severely dissociative patients, including those who meet diagnostic criteria for severe forms of the PTSD Dissociative Subtype (PTSD-DS) and those with complex PTSD with significant dissociative comorbidity. First, I will overview psychological factors in prescribing medications in general. This includes discussion of appropriate “target symptoms” in psychiatric medication management. Next is a discussion of specific psychological issues that may arise in prescription of medications to patients. This includes issues of informed consent for highly dissociative individuals. Also, I address specific issues in the psychopharmacological management of DID patients. I will address conceptualization of symptoms that are legitimate targets for somatic treatments in these patients, and those that are more amenable to psychotherapy. This includes discussion of medication for mood disorders, fear symptoms, PTSD symptoms, and sleep problems, among others. I will discuss typical responses to medications in these patients, using the model of “shock absorber” effects of somatic treatments. Other areas for discussion will include apparent differential responses to medications of DID self-states; state-dependent medication response; and conversion and placebo responses. I will discuss collaboration between the psychopharmacologist and the non-medical psychotherapist, as well as the interface with the patient’s medical providers.
Learning Objectives:
• Describe psychopharmacological and somatic interventions in severely traumatized patients in terms of the “shock absorber” model.
• Assess whether medications are helpful or not in severely traumatized patients who often state that “my meds don’t work”.
• Identify and address psychological issues and traumatic transference responses about medications of the person with DID
• Provide a rational informed consent process for medication treatment in DID treatment
Richard J. Loewenstein M.D. is Adjunct Professor in the Department of Psychiatry at the University of Maryland School of Medicine, Baltimore, MD. He is the founder of, and from 1987-2020 was the Medical Director of The Trauma Disorders Program at Sheppard Pratt, Baltimore, MD, a national referral center for severely traumatized patients. He has been rated by U.S. News and World Report as among America’s top 1 % of psychiatrists. He graduated from Yale University School of Medicine, New Haven, CT in 1975. From 1975-79 he did a psychiatric residency/postdoctoral fellowship, also at Yale University. From 1980-82, he did a research fellowship at the National Institute of Mental Health in Bethesda, MD. He is the author of over 100 papers and book chapters on dissociation, dissociative disorders, trauma disorders, dementia, delirium, somatic symptom disorders, and consultation-liaison psychiatry. He is the Section Editor, Dissociative Disorders, of the American Psychiatric Association (APA), DSM-5 Text Revision (DSM-5-TR). He is co-editor of the 4th Revision (in preparation) of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for Treatment of Dissociative Identity Disorder in Adults. Since 2000, he has primarily been the lead author of the Dissociative Disorders chapter in Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (CTP), with the 11th edition chapter just published. Since 2001, he has authored/co- authored chapters on treatment of dissociative disorders in all editions of the APA’s Treatment of Psychiatric Disorders. He is a distinguished life fellow of the APA and has received the Lifetime Achievement Award of the ISSTD. He is co-investigator and senior advisor to the longitudinal Treatment of Patients with Dissociative Disorders (TOP DD) Study.