Psychopharmacological Management Research Articles

Safety and Efficacy of Paliperidone Palmitate in Pediatric Patients with Autism and Intellectual Disability.

This retrospective chart review examines the safety, tolerability and effectiveness of long acting injectable paliperidone palmitate (P-LAI) targeting irritability in twenty-six youth and transition-aged individuals with autism spectrum disorder (ASD) and/or intellectual disability (ID) over a 3-year window. Clinical response was evaluated via prospectively assigned Clinical Global Impressions Severity (CGI-S) and Improvement (CGI-I) scales as well as number of hospital presentations. P-LAI was well tolerated with only 3 patients stopping P-LAI due to side effects. The average duration of P-LAI treatment was 21.1months. Difficulty with medication compliance was the most common reason for initiating P-LAI. There was a statistically significant improvement in CGI-I, CGI-S and hospital visits and no change in BMI noted. Given the potential difficulty of medication administration in this population, this evidence of safety, tolerability as well as preliminary data supporting effectiveness is an important addition to the literature regarding psychopharmacologic management of irritability in youth with ASD and ID.

Psychopharmacological management of avoidant/restrictive food intake disorder in children and adolescents: findings from a national surveillance study

Psychopharmacological management of avoidant/restrictive food intake disorder in children and adolescents: findings from a national surveillance study

Psychopharmacological treatments in Down syndrome and autism spectrum disorder: State of the research and practical considerations.

Individuals with Down syndrome (DS) or Autism Spectrum Disorder (ASD), and especially those with both DS and co-occurring ASD (DS + ASD) commonly display behavioral and psychiatric symptoms that can impact quality of life and places increased burden on caregivers. While the mainstay of treatment in DS and ASD is focused on educational and behavioral therapies, pharmacological treatments can be used to reduce symptom burden. There is a paucity of evidence and limited clinical trials in DS and DS + ASD. Some scientific evidence is available, primarily in open label studies and case series that can guide treatment choices. Additionally, clinical decisions are often extrapolated from evidence and experience from those with ASD, or intellectual disability in those without DS. This article reviews current research in pharmacological treatment in DS, ASD, and DS + ASD, reviews co-occurring neurodevelopmental and mental health diagnoses in individuals with DS + ASD across the lifespan, and describes practical approaches to psychopharmacological management.

33.2 Clinical Psychopharmacology Management of Emotional Dysregulation and Impulsive Aggression in ASD

33.2 Clinical Psychopharmacology Management of Emotional Dysregulation and Impulsive Aggression in ASD

Clozapine use in drug induced psychosis in Parkinson´s disease: a case report and review of literature.

IntroductionThe occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential.ObjectivesThe purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.MethodsDescriptive case study and review of literatureResultsWe present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa.He was brought to the emergency department by his family due to the presence of behavioural alterations at home.The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed.Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.ConclusionsDespite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease.Disclosure of InterestNone Declared

14.3 Psychopharmacology Management: Mood Instability and Impulsive Aggression in Youth With ASD

Children and adolescents with ASD are frequently referred for treatment of maladaptive behaviors, including aggression, self-injury, mood dysregulation, and irritability. Concern about the potential for harm to themselves and others in addition to the failure of behavioral interventions creates a need for evidence-based pharmacotherapy. Participants will review: 1) evidence-based pharmacological interventions that reduce the frequency and intensity of acute agitation, self-injurious behaviors, irritability, and impulsive aggression in youth with ASD; 2) safety strategies for outpatient visits; and 3) treatment options for patients with ASD and co-occurring conditions such as ADHD and bipolar disorder, which may be challenging due to side effects.

5.4 Integrating Pharmacogenomic Results Into Clinical Care: Now What?

The role of pharmacogenetic (PGx) guidance in psychopharmacologic management of mental health disorders in children remains unclear for many providers. There continues to be debate in the literature, and a recent pediatric study reflected negative findings when combinatorial PGx findings were applied to clinical care. However, multiple FDA-approved medications have PGx-related dosing guidance. Among the limitations of PGx testing has been the concern that providers are highly influenced by the combinatorial results from commercial labs that drive the selection of medication and at times may cause the practitioner to deviate from evidence-based guidelines.

8.1 ASD and ADHD: Diagnosis and Treatment

The objectives are to offer an up-to-date review of the prevalence and clinical characteristics of ASD and co-occurring ADHD in youth and to offer strategies for the rapid assessment of ASD in a clinic setting and psychopharmacological management of ADHD in ASD populations.

Impressive Response with Brexpiprazole in Ekbom’s syndrome

IntroductionAntipsychotics are the mainstream treatment of delusional disorder. However, limited therapeutic effect was recognized due to side effect and lack of insight.ObjectivesThis article presents a case with Ekbom’s syndrome, also known as delusional parasitosis, who has significant response with Brexpiprazole.MethodsA 58-year-old female developed her very first episode of psychosis 3 weeks before she visited our emergency department. Delusion of spiders laying eggs and bitsy spiders crawling over her body was claimed, followed by depressed mood and insomnia. The patient denied any substance use in recent months. Examination including biochemical studies, complete blood count, vitamin, and endocrine during admission were all normal. Brain image revealed senile cortical atrophy without apparent acute infarction. Cognitive abilities screening instrument (CASI) revealed total score 75, indicating borderline cognitive function. Ophthalmologist and dermatologist were consulted, and no specific abnormality was found.ResultsBrexpiprazole 2mg was prescribed. After 3 weeks of treatment, the delusion improved with less parasitosis content. We discharged the patient, and kept following her at outpatient department with Brexpiprazole 2mg for 2 months. We tried to taper Brexpiprazole to 1mg at clinic, but her delusional parasitosis relapsed within 1 month. Therefore, we titrated the medication back to 2mg, and kept some dosage for 4 months. No more relapse of psychosis or significant movement dysfunction was observed. The total treatment course was 7 months.Conclusions Brexpiprazole, with its D2 partial agonism, shows impressive antipsychotic effect to Ekbom’s syndrome. Little side effect was observed in clinical practice, making Brexpiprazole a worth-trying psychopharmacological management of delusional parasitosis.DisclosureNo significant relationships.

Proposal of a therapeutic algorithm for the psychopharmacological management of treatment-resistant depression

IntroductionThe lack of a standardised definition for the concept of TRD and an adequate criteria for therapeutic response make difficult the management of patients with MDD who do not achieve remission with one or more courses of treatment. All classifications suggested to define TRD are arbitrary, partially evidence-based, subordinated to the pharmacological findings of the time in which they are written and with serious inconsistencies, making it difficult to construct a universal and enduring diagnostic system.ObjectivesConsidering that the most important goal in treating a patient with Major Depressive Disorder (MDD) should be remission and return to previous functionality, the search for a standardised, evidence-based classification system will allow timely and effective interventions leading to the reduction of this devastating condition.MethodsBibliographic reviewResultsThe proposed therapeutic algorithm arises from the combination of several fundamental principles for the management of treatment-resistant depression: the different classification systems of the concept, as well as the concepts of response, relapse, recurrence and remission; the scientific evidence found in the current literature, routine clinical practice, knowledge of switching and augmentation strategies, the new pharmacological targets and neurobiological hypothesis discovered, without forgetting finally the different clinical profiles of depressive symptomatology and the specific indications of each antidepressant.ConclusionsResistant depression is difficult to treat successfully and is not a uniform entity. Recently there has been a move to characterise treatment-resistant depression as ‘difficult-to-treat’ depression on the basis that the former description implies that depression treatments are normally effective and that non-response is therefore somehow abnormal.DisclosureNo significant relationships.

Psychopharmacologic Management of Eating Disorders.

Identifying medications that may be used as therapeutic agents for eating disorders is a longstanding focus of research, with varying degrees of success. The present review consolidates the most recent findings on pharmacological treatment of three eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Recent research suggests that olanzapine demonstrates positive effects on weight gain among outpatients with AN. There are fewer recent advances in psychopharmacological treatment for BN and BED, likely due to the relative success of prior medication trials. Olanzapine is the first medication to safely promote weight gain among individuals with AN. Fluoxetine is FDA-approved for BN treatment, and lisdexamfetamine is FDA-approved for BED treatment. BN and BED also generally respond well to SSRIs prescribed off-label. Research on psychopharmacological treatments for other eating disorders, such as avoidant-restrictive food intake disorder and other specified feeding and eating disorders, are sorely needed.

Pharmacological Treatment of Acute Psychiatric Symptoms in COVID-19 Patients: A Systematic Review and a Case Series.

Delirium and psychomotor agitation are relevant clinical conditions that may develop during COVID-19 infection, especially in intensive care unit (ICU) settings. The psychopharmacological management of these conditions is receiving increasing interest in psychiatry, considering hyperkinetic delirium as one of the most common neuropsychiatries acute consequences in COVID-19 recovery patients. However, there are no actual internationally validated guidelines about this topic, due to the relatively newly introduced clinical condition; in addition, a standardized psychopharmacologic treatment of these cases is a complex goal to achieve due to the risk of both drug–drug interactions and the vulnerable conditions of those patients. The aim of this systematic review and case series is to evaluate and gather the scientific evidence on pharmacologic handling during delirium in COVID-19 patients to provide practical recommendations on the optimal management of psychotropic medication in these kinds of patients. The electronic databases PubMed, Embase and Web of Science were reviewed to identify studies, in accordance with the PRISMA guidelines. At the end of the selection process, a total of 21 studies (n = 2063) were included. We also collected a case series of acute psychomotor agitation in COVID-19 patients hospitalized in ICU. Our results showed how the symptom-based choice of the psychotropic medication is crucial, and even most of the psychotropic drug classes showed good safety, one must not underestimate the possible drug interactions and also the possible decrease in vital functions which need to be strictly monitored especially during treatment with some kinds of molecules. We believe that the evidence-based recommendations highlighted in the present research will enhance the current knowledge and could provide better management of these patients.

Socio-demographic and Clinical Characteristics of Older Patients Transferred from a Consultation Psychiatry Service to Geriatric Psychiatry Inpatient Units

<h3>Introduction</h3> Consultation Psychiatry Services in general hospitals regularly encounter medical-surgical inpatients whose psychiatric co-morbidities necessitate transfer to psychiatric inpatient settings. To our knowledge, limited data exist on such transfers, with even less known about <i>geriatric psychiatry</i> transfers. <h3>Methods</h3> Billing record review determined the proportion of older (≥ 65 years) patients seen by Consultation Psychiatry from 1/1/21 - 8/30/21. Number of such patients transferred to a geropsychiatry inpatient unit were identified through the referral field in our EHR. Chart reviews abstracted sociodemographic and clinical characteristics of transfers. Patients were excluded if they had been transferred <i>from</i> psychiatry inpatient to medical-surgical inpatient and then back to psychiatry; or if they had been transferred from medical-surgical inpatient to psychiatry and then back to medical-surgical because of medical decompensation. Only patients who completed their geriatric psychiatry inpatient stay were included. A consensus assessment between two geropsychiatry evaluators (AV, BG) rated "active" versus "inactive" psychiatric treatment by consultation psychiatrists based on psychopharmacological management, efforts to facilitate ECT treatment where indicated, and re-evaluation prior to transfer. Relationships between key variables and geriatric psychiatry inpatient median lengths of stay (LOS) were evaluated by Mann-Whitney U tests with p-values determined. <h3>Results</h3> From 1/1/21 – 8/30/21, the Consultation Psychiatry service evaluated 1517 individuals, of whom 46% were over age 65 years. Sixty-seven (8.7%) of these patients were transferred to geriatric psychiatry units, which represented 32% of all admissions during that period. Descriptive analyses excluded patients meeting back-and-forth transfer criteria sequentially described above (n = 17 and n=12). Remaining patients (n = 38) comprised the final sample. Mean age of the transferred sample was 75.6 years (SD = 6.79; range = 65-92). 68.4% were women and 31.6% men. Two-thirds of the sample identified as White (68.4%), while 7.9% were Black, 10.5% Hispanic, and 10.5% Asian. 42.1% were married, 18.4% single, 18.4% divorced, and 13.2% widowed. Most patients (81.6%) had at least one child. Over two-thirds (71.1%) lived in a private home with a family member, 13.2% lived at home alone, and 13.2% resided in a nursing home or assisted living facility. The majority of patients (78.9%) were discharged to a private residence, with the remaining group (21.1%) discharged to a structured living facility. Of primary psychiatric diagnoses, 26.8% had a psychotic disorder, 41.8% had a major depressive disorder, 13.4% had bipolar disorder, and 17.9 % had a neurocognitive disorder with concomitant behavioral disturbances. "Active" psychiatric treatment (as defined above) by consultation psychiatrists during medical-surgical hospital stay occurred in approximately two-thirds (68.4%) of patients destined for transfer to geriatric psychiatry. Median length of stay (LOS) in geriatric psychiatry for the entire group was 22.0 (+/- SD 21.4) days. Relationships between median LOS and sociodemographic/clinical variables revealed the following statistically significant findings. Women had a median LOS of 25 (+/- 24.3) days whereas men had a median LOS of 16 (+/- 10.4) days (p < 0.0001). Patients living at home prior to medical-surgical admission had a median geriatric psychiatry unit LOS of 21.0 (+/- 20.1) days as compared to patients who were living in a nursing home or assisted living facility who had a median LOS of 35.0 (+/- 20.9) days (p < 0.0005). Patients discharged home had a median LOS of 20.0 (+/-11.1) days while patients discharged to any structured living facility for seniors had a median LOS of 38.0 (+/- 32.7) days (p < 0.0001). <h3>Conclusions</h3> Nearly half of consultation psychiatry patients were over age 65 years, suggesting geropsychiatric training/expertise in general hospital psychiatry is critical, especially since less than 10% of patients ended up transferred for specialty geropsychiatric inpatient care. Furthermore, that nearly a third of geropsychiatry inpatients emanated from consultation psychiatry and that a third of patients destined for transfer had ‘inactive' treatment during medical-surgical stays further supports closer interactions of consultation and geriatric psychiatry services. The diagnostic breakdown of transfers appeared representative of geropsychiatry inpatients not referred from medicine, however validation awaits comparisons. Gender differences in LOS may be explained by additional analysis of psychosocial/clinical profiles of men and women in this sample. The significantly longer LOS in patients coming from and being discharged to nursing homes or assisted living facilities suggests clinical complexity that should catalyze early disposition planning for such patients. <h3>This research was funded by</h3> N/A

Medication Patterns in a Geriatric Psychiatry Outpatient Clinic

<h3>Introduction</h3> To date, little has been published about the specific pharmacological prescribing patterns in a geriatric psychiatry outpatient clinic. This retrospective chart review was conducted as part of a QI/PI project intended to examine prescribing patterns and more granular details of psychotropic drug initiation and discontinuation among geriatric psychiatry outpatients. The study intended to identify clinical patterns, unmet patient needs, trends, and opportunities to optimize clinical care and improve patient outcomes. The poster is a preliminary summary of identified trends. <h3>Methods</h3> As part of a quality improvement chart review project examining pharmacological treatments and clinical outcomes at two teaching geriatric psychiatry clinics, we set out to review the electronic medical records of one hundred patients seen in a geriatric psychiatry teaching service. Patients were selected if they were 65 years of age or older and had a minimum of six documented outpatient visits or visits spanning a minimum of six months. Data was collected for a maximum duration of twelve months. Data from any inpatient stays was excluded. Our dataset included basic demographic data such as age, sex, and marital status, as well as diagnoses, MMSE scores, and medications extracted from chart documentation at each clinic visit. <h3>Results</h3> At the point of this interim analysis, our population was 75.1 years old (+/- 8.6 years SD), 69% female, 41% widowed, 31% married, 28% single, 90% Caucasian, and had 14.1 ys of education (+/- 2.9 yrs SD). Common medical comorbidities included hypertension (72%), hyperlipidemia (62%), arrhythmias (24%), and 38% were being treated with an anticoagulant. The top three most commonly prescribed medication classes at baseline were: 1) Antidepressants (43%), followed by 2) Benzodiazepines (16%), 3) shared by two classes Antiepileptics/Lithium and Antipsychotics (13% each). The top three most commonly prescribed medications at baseline were: 1) mirtazapine (10%), 2) shared by two drugs, bupropion and quetiapine (7% each), and 3) escitalopram (6%). The reviewed patients had an average of 9 visits over an average 9 month long review period. When first seen at the clinic, patients were already taking an average of 2.6 psychotropic drugs. That number was 2.9 at the end of the followup period. Over the course of the review period, patients on average discontinued 1 drug and started 2 new ones, generating an average of 7.4 orders for medication initiation, discontinuation, or dose adjustments. <h3>Conclusions</h3> These preliminary chart review results reflect the challenges posed by the psychopharmacological management of elderly patients. Patients frequently arrive at our clinic following treatment failures or complications, and often on psychotropic polypharmacy. Due to fluctuations in patients' conditions and the need to titrate medications slowly, patients require numerous medications changes and dose adjustments, necessitating frequent visits. The clinic advises to minimize benzodiazepine use. Our data suggests that a significant proportion of patients (15%) come to our clinic while being treated with benzodiazepines, and our review suggests that in the short term efforts to wean them off their benzodiazepines are not successful. <h3>Secondary Rationale</h3> N/A <h3>This research was funded by</h3> No funding was obtained for this study.

The Association between Modifiable Lifestyle Behaviors and Depression among Asian Americans with Chronic Hepatitis B by Medication Status.

Asian Americans are disproportionately affected by chronic hepatitis B (CHB), with incidence and mortality rates well above those experienced by non-Hispanic white populations. The goal of this study was to examine the association between depression and modifiable lifestyle behaviors among Asian Americans with CHB, with a comparison between those on hepatitis medication and those not on medication. In total, 313 Asian Americans with CHB were recruited through outpatient clinics and community-based organizations to participate in an in-person baseline assessment. We collected data on participants’ sociodemographic characteristics, health-related behaviors, depression symptoms, and modifiable lifestyle behaviors. Bivariate analyses (two sample t-test and chi-square test of independence) and multivariable logistic regression were conducted. We found a high prevalence of depression among individuals living with CHB (41.81% among those not on antiviral medication and 39.71% among those on medication). Multivariate logistic regression results showed that Chinese ethnicity (vs. Vietnamese) and lack of physical activity were significantly associated with a higher risk of mild/severe depression, regardless of medication status. However, the protective effect of physical activity was strong for those on antiviral medication. Furthermore, being employed was significantly associated with a lower risk for depression among Asian Americans on medication, while younger age and being currently married were significantly associated with lower risk of depression among those not on medication. Our findings highlight the significance of physical activity among Asian Americans with CHB, especially for those on antiviral medication. Future prospective research efforts are needed to better identify the potential behavioral mechanisms of depression and provide insights for the psychopharmacological management in this vulnerable population.

Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression.

Approximately 60% of patients with bipolar disorder who present with depression are misdiagnosed as having recurrent unipolar depression, which may lead to inappropriate treatment and potential worsening of symptoms. Bipolar depression in youth has a negative effect on numerous domains of life. Early treatment is crucial, yet diagnosis is difficult. The standard of treatment often requires life-long psychopharmacologic management, and treatments have various adverse effects that should be considered when the clinician tailors the regimen for each patient. By facilitating effective communication with patients, referring to diagnostic criteria, and using assessment tools before diagnosis and as treatment continues, clinicians can identify indicators of the disorder, recommend individualized treatment, and help patients work toward greater success in relationships, at home, and at school or work.

72.3 THE NUTS AND BOLTS OF RESIDENTIAL TREATMENT

This presentation will describe how residential treatment differs from other levels of care and provides a necessary service for those children and adolescents with severe and complex mental health needs. V. Susan Villani, MD, will describe the nuts and bolts of residential treatment beginning with the admission process, followed by the 7 components of care and the phases of treatment. She will compare and contrast how a residential treatment center operates to inpatient, day hospital, and outpatient settings. She will explain the everyday workings of a residential treatment center emphasizing the need for attention to milieu treatment, individual treatment, family engagement and treatment, as well as the provision of educational services adapted to the needs of the resident. The importance of psychopharmacologic management of residents thoughtfully integrated with the other components of care will be described utilizing brief clinical examples. The presentation will conclude by emphasizing the role of the child and adolescent psychiatrist as leader of the multidisciplinary team, while also operating from a holistic approach to care, in order to assure successful treatment. The clinical examples will demonstrate how the holistic approach combined with the phases of treatment over time resulted in successful treatment and return home. Children and adolescents with severe mental health needs require the comprehensive services of residential treatment centers in order to successfully return to their families and community.

Caring for the Mental Health of Youth and Families: What is the Role of the Psychiatric Mental Health Advanced Practice Nurse?

Children in our nation are experiencing the social, emotional, and physical impacts of an unprecedented time in history. Advanced practice nurses prepared as psychiatric clinical nurse specialists and nurse practitioners bring therapeutic interventions, psychopharmacologic management, and systems thinking to clinical environments of care. Insight into the mental health of youth and families and how clinical nurse specialists may provide solutions for forthcoming challenges is discussed. Barriers to mental healthcare such as the invisibility of nurses at state and federal levels must be eradicated to mitigate the mental health challenges that youth, families, and communities endure. Contemporary issues such as effects of social media, stigma, and suicide present burdens that can be moderated through nursing interventions. The psychiatric clinical nurse specialist provides evidence and community-based nursing interventions that, through early identification and advocacy, contribute to positive mental health outcomes for youth and families. The need for well-educated advanced practice nurses has never been greater for our vulnerable populations of children, adolescents, and families with mental health challenges. Nurse-delivered programs demonstrate that interventions are necessary for communication, psychoeducation, and prevention of consequences from unacknowledged social media, stigma, and suicide problems.

Diagnosis and Pharmacotherapy of Bipolar Depression in Pediatric Patients.

Bipolar depression in youth has a negative effect on numerous domains, including physical and emotional well-being, school and family functioning, friendships, and academic success. Early treatment is crucial, yet diagnosis is difficult. The standard of treatment often requires life-long psychopharmacological management, and most treatments increase risk of adverse effects. Pediatric patients who have at least 1 parent with bipolar disorder are considered to be at higher risk for also developing bipolar depression, although there is currently no clear evidence of efficacious pharmacotherapy for these patients.

Addiction Psychiatry and Addiction Medicine: The Evolution of Addiction Physician Specialists.

Addiction Psychiatry and Addiction Medicine are two physician subspecialities recognized by the American Board of Medical Specialties (ABMS) that focus on providing care for patients with substance use disorders. Their shared and distinct historical roots are reviewed, and their respective ABMS board examination content areas and Accreditation Council on Graduate Medical Education (ACGME) fellowship training program requirements are compared. Addiction Psychiatry, a subspecialty under the American Board of Psychiatry and Neurology, began certifying diplomates in 1993, currently has 1202 active diplomates, and certifies around 150 diplomates every 2 years through 50 ACGME-accredited fellowships. Addiction Medicine, a subspecialty under the American Board of Preventive Medicine, began certifying diplomates in 2018, has 2604 diplomates with more expected before the practice pathway closes (anticipated in 2021), after which a fellowship training becomes required. Currently there are 78 accredited Addiction Medicine fellowships and more under development. The fields display substantial overlap between their respective examination content areas and fellowship training requirements, covering similar knowledge and skills for evaluation and treatment of substance use disorders and psychiatric and medical comorbidities across the full range of clinical settings, from general medical to addiction specialty settings. Key differences include that Addiction Psychiatry is open only to Board-certified psychiatrists and places extra emphasis on psychotherapeutic and psychopharmacological management strategies. Addiction Medicine is open to any ABMS primary specialty, including psychiatry. Opportunities for collaboration are discussed as both fields pursue the common goal of providing a well-trained workforce of physicians to meet the public health challenge presented by addiction. (Am J Addict 2020;00:00-00).