Course Description

Course Fee: $255
CME Credits: 4.0
(Scroll for CME details.)

This 3-module course, presented by Dr. James Greenblatt, introduces a functional medicine model for AN treatment and recovery, in which the concept of AN is the result of a complex and biologically-mediated interplay between environmental, psychosocial, and metabolic factors is explored. Research supporting associations between metabolic abnormalities, dyslipidemia, micronutrient imbalances, and systemic inflammation will be objectively reviewed, illuminating critical treatment targets for today’s functional psychiatry practice and providing an empirically validated blueprint for personalized interventions. Upon completion, students will be able to substantiate the clinical utility of a functional medicine approach for AN, and safely incorporate evidence-based treatment strategies into existing therapeutic models to maximize patient outcomes.

Learning Objectives

Upon completion of Module 1, students will be able to:

  • Describe the interaction of genetics and environmental factors as they interact to establish individual AN susceptibility / risk
  • Illustrate the cycle of pathologic fear conditioning and its relevance to AN etiology / symptom persistence
  • Identify common psychiatric comorbidities of AN

Course Modules

Module 1

  1. Exploring Current Models for Anorexia Nervosa (AN) Treatment
    1. The psychopharmacology model
    2. AN epidemiology, prevalence, relapse rates, global trends
    3. Suicidality in AN
    4. Genetics and AN
    5. Who’s to blame? Sociocultural influences
    6. Current DSM classifications, criteria, and guidelines
  2. Etiology of eating disorders
    1. Pathologic fear conditioning and chronicity
    2. Dieting: contributor…or not?</li
    3. Psychiatric comorbidities
    4. Adolescent neurodevelopment – implications
    5. Dyslipidemia in AN
  3. Shifting Paradigms: Psychosocial models – alone – are not enough
    1. Not just “E” (environment) and not just “G” (genetics / biochemistry)…but rather [GxE]
    2. EDs involve external, psychosocial factors and internal, biologic vulnerabilities / susceptibilities; a complete therapeutic model must account for both
    3. Nutrition first, psychotherapeutic insight later

Module 2

  1. A Review of AN Etiology, Pathogenesis
  2. Celiac Disease and AN
    1. What is celiac?
    2. Epidemiology, prevalence
    3. Characterization, classification
    4. Celiac and AN comorbidity
  3. Eating Disorders and Dietary Patterns
    1. Veganism, vegetarianism
  4. The Link to Zinc
    1. Meat avoidance and zinc status
    2. A comparison of symptoms: AN vs. zinc deficiency
    3. Zinc deficiency and dysgeusia
    4. Zinc and digestive enzymes
    5. Pathophysiologic and psychopathologic sequelae of zinc deficiency
    6. Zinc and veganism / vegetarianism
    7. Zinc for depression: research evidence
    8. Sleep disturbances and eating disorders=
    9. Zinc for AN: research evidence
    10. Causes of zinc deficiency
    11. Zinc absorption: special considerations
    12. Zinc mechanisms relevant to A
    13. Optimizing zinc intake
  5. A New Model, Based on Measurement: Functional Psychiatry
    1. Old vs. new paradigms
    2. Lab testing to inform and guide personalized interventions

Module 3

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  1. B Vitamins, Psychiatric Health, and AN
    1. Vitamin B3 (niacin)
    2. Vitamin B12
    3. Vitamin B9 (folate)
    4. Vitamin B1 (thiamine)
    5. Vitamin B8 (inositol)
  2.  Vitamin D
    1. Overview: classification, roles in general physiologic and neurologic health
    2. Vitamin D and Neurologic health
    3. Vitamin D status and AN: research evidence
    4. Vitamin D testing and supplementation
  3. The Gut-Brain Axis and Anorexia
    1. Exploring the human microbiota
    2. What does the gut microbiota DO for us?
    3. Factors that negatively impact the gut microbiota
    4. Probiotics and psychiatric symptoms: research evidence
    5. Gut bacteria and eating disorders
    6. Probiotics for AN support and recovery
    7. Small steps, significant implications
  4. Conclusion
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A Glimpse into Anorexia Nervosa

Anorexia nervosa (AN) is a vastly complex mental illness marked by etiologic contributions of genetic, psychological, and metabolic origin. With a relapse rate upwards of 50% within the first year after treatment, as well as the highest mortality rate of any psychiatric disorder, AN presents today’s clinicians with a significant and daunting challenge.

Scientific research is illuminating with increasing focus a stark reality – that being that the majority of current AN treatment models often fail to comprehensively address etiologic factors. Therapeutic paradigms that focus solely on psychological contributors do so to the exclusion of potentially significant biologic factors that studies have revealed to be robustly correlated with metabolism, satiety signaling, neurotransmission, and affective regulation, all of which can influence mood and behavior. Lacking etiologic considerations, many of today’s AN models are incomplete.

CME Details

DURATION OF ACTIVITY
April 4, 2022 through April 3, 2024

ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of MedicusCME and Comprehensive Psychiatric Resources, Inc.  MedicusCME is accredited by the ACCME to provide continuing medical education for physicians.

DESIGNATION STATEMENT
MedicusCME designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

OVERVIEW
This 3-module course, presented by Dr. James Greenblatt, introduces a functional medicine model for AN treatment and recovery, in which the concept of AN as the result of a complex and biologically-mediated interplay between environmental, psychosocial, and metabolic factors is explored. Research supporting associations between metabolic abnormalities, dyslipidemia, micronutrient imbalances, and systemic inflammation will be objectively reviewed, illuminating critical treatment targets for today’s functional psychiatry practice and providing an empirically validated blueprint for personalized interventions. Upon completion, students will be able to substantiate the clinical utility of a functional medicine approach for AN, and safely incorporate evidence-based treatment strategies into existing therapeutic models to maximize patient outcomes.

LEARNING OBJECTIVES

  • Describe the interaction of genetics and environmental factors as they interact to establish individual AN susceptibility / risk
  • Illustrate the cycle of pathologic fear conditioning and its relevance to AN etiology / symptom persistence
  • Identify common psychiatric comorbidities of AN

HOW TO CLAIM CREDIT
In order to receive AMA PRA Category 1 credit™, participants must do the following:

  • Read the learning objectives and faculty disclosures

  • Participate in the activity, review course content and learning strategies, resources and support materials provided

  • Complete the post-test and activity evaluation

  • Achieve a score of 80% or higher on the post-test

PLANNER
Mariela Podolski, MD
Podolski Psychiatry
Adult/Child and Adolescent Psychiatry
West Hartford, Connecticut

Walden Behavioral Care
Director of Child and Adolescent Psychiatry

Eating Disorder Consultant
Department of Corrections, Connecticut

Eating Disorder Consultant
DHMAS/Connecticut Valley Hospital, Connecticut

FACULTY
James Greenblatt, MD
Chief Medical Officer and Vice President of Medical Services
Walden Behavioral Care, Waltham, Massachusetts

Assistant Clinical Professor of Psychiatry
Tufts University School of Medicine
Boston, Massachusetts

DISCLOSURE OF FINANCIAL RELATIONSHIPS
MedicusCME requires instructors, planners, managers, and others in control of educational content to disclose all their financial relationships with ineligible companies over the previous 24 months. All identified financial relationships are thoroughly vetted and mitigated according to MedicusCME policy.

The faculty reported the following relevant financial relationships with Accreditation Council for Continuing Medical Education (ACCME)-defined ineligible entities related to the educational content of this CE activity.

James Greenblatt, MD has disclosed financial relationships with Fullscripts for an affiliate relationship and with Atrium Health/Pure Encapsulations and Jaymac Pharmaceuticals for participating on their Speakers Boards.

Any relevant financial relationships listed for planners or content contributors have been mitigated according to MedicusCME policies. MedicusCME planners and managers have no relevant financial relationships with ineligible companies to disclose.

ACKNOWLEDGEMENTS
This activity is not supported by funds from an ACCME-defined ineligible company.

HIPPA COMPLIANCE ATTESTATION
In accordance with the Health Insurance Portability and Accountability Act (HIPAA), this educational activity, especially when utilizing patient cases for learning demonstration, will not include individually identifiable health information.

DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration (FDA). The planners of this activity do not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

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