Course Description:

This four-module course provides clinicians of all specialties with a comprehensive introduction to Dr. Greenblatt’s integrative model for the treatment of anxiety disorders.  Following an empirically substantiated rationale for the de-prioritization of symptom classification, and a step away from pharmaceutical approaches that overlook causality, the viability of a functional medicine approach will be elucidated through objective reviews of recent studies that show anxiety to be associated with nutritional deficiencies, neurotransmitter dysfunction, systemic inflammation, and other endogenous factors.  The mechanisms through which these factors affect changes in cognition and behavior will be explored, with an emphasis on the practical ramifications of biochemical individuality.  Guidelines for testing will be offered alongside specific nutritional interventions to address anxiogenic physiology, and complementary strategies to support integrative treatments – such as exercise, yoga, and herbal supplements – will be reviewed.  Upon completion, registrants will be able to implement evidence-based integrative methods into clinical protocols and maximize therapeutic outcomes for patients in need.

CME Accreditation (AAFP)
This Enduring Material activity, Integrative Medicine for Anxiety, has been reviewed and is acceptable for up to 5.00 Prescribed credit(s) by the American Academy of Family Physicians.  AAFP certification begins 09/01/2019.  Term of approval is for one year from this date.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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1. Anxiety Redefined

Module 1 will begin with an examination of the anxiety crisis: its scope, prevalence, and escalation in recent years.  Current DSM classifications will be reviewed, and a rationale for de-emphasizing formal diagnostic criteria in integrative approaches will be discussed.  Standard pharmacologic interventions will also be objectively reviewed:  their benefits and shortcomings, benzodiazepine overuse and abuse, and the limitations inherent in treatment approaches that do not account for biochemical individuality.   The presentation will then shift to an in-depth introduction to Dr. Greenblatt’s functional medicine approach to the treatment of psychiatric illness: THE ZEEBRA.  The final component of Module 1 will be devoted to key nutrients associated with anxious pathophysiology – magnesium, vitamin B3, and vitamin B12 – and the elucidation of biologic mechanisms through which they influence cognition and behavior.  Guidelines for lab testing and recommendations for the establishment of personalized supplementation protocols will be discussed.

2. Exploring Etiology in Anxiety and OCD

In Module 2, one of the fastest-growing areas of research in functional psychiatry will be explored and related to the pathophysiology and treatment of anxiety disorders: the gut-brain axis.  Fact will be separated from fad as the very latest in gut microbiota research is objectively reviewed, illuminating mechanisms through which commensal microbes influence neuroendocrine systems, cognition, and behavior.  The implications of gut dysbiosis and Clostridia overgrowth will be discussed as they pertain to anxious pathophysiology, and the applications of probiotic therapies substantiated in light of promising empirical evidence.  Next, obsessive-compulsive disorder will be examined from a functional medicine perspective, and research revealing compelling evidence for a biologic model of OCD will be presented.  Discussions will segue into an introduction to PANS/PANDAS, two often-misdiagnosed disorders of infectious origin which can trigger acute-onset psychiatric manifestations inclusive of OCD-type symptoms.  The module will conclude with an immersive look at the role that amino acids play in neurotransmitter synthesis, and how amino acid depletion fits into an orthomolecular model of anxiety disorder etiology.  Factors capable of inducing amino acid deficiencies will be reviewed, and strategies for augmenting neurotransmitter synthesis through free-form amino acid and 5-HTP supplementation will be outlined.

3. Enhancing Neurotransmission, Eliminating Inflammation

Module 3 will begin with an examination of the many chemical forms and biologic functions of folate. The elucidation of folate’s role in neurotransmitter metabolism and DNA synthesis will highlight the pathologic ramifications of folate deficiency, and dietary, genetic, and metabolic factors capable of hindering folate absorption or conversion will be reviewed as they pertain to the etiology of anxiety disorders.  Next, a closer look at serotonergic signaling will lead to an in-depth discussion of inositol, and the analysis of research evidence supporting the use of inositol in integrative treatment protocols.  The lecture will then shift to a topic at once familiar and under-explored: the association linking diet and mental health, and opioid peptides derived from dairy and wheat that can contribute significantly to psychiatric presentations. Systemic inflammation, intrinsic and exogenous variables that can precipitate inflammation, and the role of inflammation in ‘depressogenic’ and anxiogenic processes will then be discussed, as well as biomarkers that can be quantified through lab testing to hone treatment approaches.  Finally, the mechanisms through which a deficiency of vitamin D can impact neurologic health will be explored.  Recommendations for testing and supplementation in order to achieve vitamin D repletion – a critical prerequisite for the success of integrative anxiety treatment – will be provided.

4. Expanding the Therapeutic Arsenal

In this module, integrative and complementary therapies that research has demonstrated to be effective for the treatment of anxiety will be explored through a functional medicine lens, with an emphasis on biologic mechanisms and supporting scientific evidence.  N-acetyl-cysteine (NAC), precursor to the antioxidant glutathione, has emerged as one of the most promising treatments for anxiety and the related body-focused repetitive behaviors.  It’s antioxidant and anti-inflammatory properties will be examined, and case studies supporting its efficacy across a range of anxious disorders will be reviewed.   Guidelines for NAC supplementation will be discussed, as will potential modifiers of NAC response.  Next, the anxiolytic properties and biologic mechanisms of nutritional lithium, l-theanine, GABA, ashwagandha, and cannabidiol will be explored, widening the range of therapeutic options available to today’s integrative practitioners.  The module will conclude with an analysis of “vitamin E” (exercise) and “vitamin Y” (yoga): their long history of use in traditional systems of medicine, their documented effects on neurotrophic factor production and HPA axis stabilization, and strong research support for their efficacy in improving sleep, attenuating stress biomarkers, and reducing anxiety.

Learning Objectives:

Upon completion of this course, registrants will be able to:

  • Identify key nutritional deficiencies associated with anxiety disorders, and elucidate biologic mechanisms through which these deficiencies precipitate neurologic dysfunction
  • Describe the primary functions of the gut microbiota, the neural and biochemical mechanisms through which the gut communicates with the brain, the ways in which gut microbial activity influences brain function, and the behavioral implications of dysbiosis
  • Elucidate the acute and long-term ramifications of amino acid deficiency as they pertain to anxious manifestations, the mechanisms through which diet, medication, and zinc deficiency can contribute to low amino acid levels, and the clinical utility of supplementation with free-form amino acids
  • Support and substantiate the rationale for a biologic model of Obsessive-Compulsive Disorder
  • Elucidate the clinical utility of a neuropeptides test as part of an integrative, functional medicine assessment for anxiety, and the neurocognitive ramifications of high casomorphin and/or gliadorphin levels
  • Elucidate the mechanisms underlying the anxiolytic properties of nutritional lithium, l-theanine, ashwagandha, GABA, and CBD
  • Describe the biologic effects of exercise and yoga as they pertain to anxious pathophysiology
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