Alcohol Misuse from Adolescence to Senescence: Consequences to Brain Structure and Function

1.5 CE Credit

 

Presented by:

Edith V. Sullivan, Ph.D.
Professor, Department of Psychiatry & Behavioral Sciences
Stanford University School of Medicine








Alcohol Use Disorder (AUD) is a highly prevalent neuropsychiatric disorder that affects both sexes across the lifespan. Chronic, excessive drinking often results in serious untoward consequences on family, work, and personal well-being. AUD is marked by a characteristic profile of neuropsychological deficits and damage to selective constellations of neurocircuitry. AUD is often heralded by early life alcohol misuse, which can alter normal neurodevelopmental trajectories. With sustained sobriety in adult AUD, brain structural and functional recovery can ensue. This lecture describes acquisition and measurement approaches used in quantitative neuroimaging and neuropsychological studies for tracking alcoholism's dynamic course of relapse and sobriety. Also considered are modulating factors, including age, sex, nutrition, and common comorbidities. Whether alcohol-related functional impairment in older individuals with AUD constitutes dementia will also be considered. The studies reviewed are controlled and provide evidence for human neuroadaptation and neuroplasticity and hope for recovery in alcoholics who maintain sobriety.

After the session, participants will be able to:
1. Define alcoholism and explain how alcohol use disorder disrupts selective brain structures and functions and can cause aberrations in neurodevelopmental trajectories.
2. Describe how alcoholism-related functional brain changes across the ages are a form of neuroadaptation that may underlie dysfunctions, making alcoholism a self-perpetuating disorder.
3. Discuss how sustained sobriety can result in improvement in brain structure and function.
4. Explain how alcoholism-related brain structural and functional damage might alter self-perception and readiness for treatment.

 
 
Target Audience: Research and clinical neuropsychologists, graduate students, and postdoctoral fellows
Instructional Level: introductory, intermediate

Edith V. Sullivan, Ph.D., is a professor in the Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine where she has been mentoring students and conducting research for the past 30 years. Dr. Sullivan’s background as an experimental neuropsychologist and brain imaging scientist led to the development of her program of study in alcoholism, focusing on faulty frontocerebellar circuitry underlying a selective subset of cognitive and motor dysfunctions commonly expressed in alcoholism. Her ongoing work focuses on neural mechanisms of structural and functional connectivity underlying cognitive and motor processes in human alcoholism, animal models of high alcohol exposure in interaction with nutritional deficiencies, and how comorbidities of HIV infection along with normal aging compound the throes of alcoholism on brain structure, function, and neural circuitry.  Dr. Sullivan is also an investigator on the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), which is a prospective multi-site study aimed at determining the developmental trajectories of brain conjunction with the neuropsychological and emotional development of adolescents before and after initiating drinking. Dr. Sullivan is the author of more than 300 peer-reviewed papers, as well as many chapters and reviews and has presented her alcoholism research nationally and internationally. Her scientific honors include National Institute on Alcohol Abuse and Alcoholism MERIT and Senior Scientist Awards, Research Society on Alcoholism Distinguished Researcher Award and Henri Begleiter Award for Excellence in Research, International Neuropsychological Society Distinguished Career Award, and Doctorate Honoris Causa bestowed by the Ecole Pratique des Hautes Etudes of France. She received her B.A., M.A., and Ph.D. in Experimental Psychology at the University of Connecticut.

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An Update on the Neuropsychology of HIV and Other Infectious Diseases

1.5 CE Credits

Presented by:
Steven Paul Woods, Psy.D.
Professor of Psychology
University of Houston

Clinical neuropsychologists are likely to encounter persons infected with HIV and other neurotropic viruses (e.g., hepatitis C), which may be the primary condition for a referral or an incidental risk factor for neurocognitive impairment. In this 90-minute webinar, we will provide an update on the neuropsychological aspects of infectious disease, focusing primarily on HIV. Specifically, we will critically review and discuss recent literature on: 1) changes in the epidemiology of HIV disease, which is increasingly affecting older adults; 2) brain systems involved in HIV infection; 3) the neuropsychological profile of HIV disease and the diagnosis of HIV-associated neurocognitive disorders; 4) the influence of common moderating factors, such as premorbid variables, psychiatric comorbidity, and co-infection with HCV on the expression of HIV-associated neurocognitive disorders; 5) HIV’s impact on health behaviors (e.g., medication adherence) and everyday functioning (e.g., household management); and 6) emergent pharmacological and rehabilitation efforts to manage HIV-associated neurocognitive disorders.

After the webinar, participants will be able to:

  1. Describe the recent changes in the epidemiology of HIV disease and the influence of infection and its comorbidities on brain structure and function.
  2. Explain the practical advantages and limitations of current approaches to diagnosing HIV-associated neurocognitive disorders.
  3. Discuss the effects of HIV-associated neurocognitive disorders on health behaviors (e.g., medication adherence) and everyday functioning (e.g., household management).

Target Audience: Clinical neuropsychologists

Instructional Level: Intermediate

Steven Paul Woods, Psy.D. is a Professor of Psychology at the University of Houston, where he is the Director of the Cognitive Neuropsychology of Daily Life (CNDL) Laboratory. Dr. Woods also holds appointments as an Adjunct Professor at UC San Diego (Psychiatry) and the University of Western Australia (School of Psychological Science). His program of research uses cognitive theory to enhance the clinical detection, prediction, and remediation of real-world health outcomes in various neuropsychological populations, including HIV disease and aging. In particular, he is interested in how people’s ability to “remember to remember” (i.e., prospective memory) affects health-related behaviors such as adhering to medications. Dr. Woods is the Director of Clinical Neuropsychology Training at the University of Houston and is an active teacher, both in the classroom and in the laboratory. He is a licensed psychologist and operates an evidence-based neuropsychology clinic that serves HIV+ persons at the Thomas Street Health Center in Houston. Dr. Woods is a Fellow of the American Psychological Association (Division 40, Society for Clinical Neuropsychology) and the National Academy of Neuropsychology (NAN).

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Effects of Alcohol on Cognitive Functioning 

1.5 CE Credits

Presented by:
Robin C. Hilsabeck, Ph.D., ABPP
Clinical Scientist II at INC Research
Associate Clinical Professor of Psychiatry at University of Texas Health Science Center in San Antonio

Approximately 17 million adults and 855,000 adolescents had an alcohol use disorder (AUD) in 2012.  Deaths related to alcohol are the third leading cause of preventable death in the U.S.  Given these statistics, almost all neuropsychologists will be faced at some point with a patient who has an AUD. Understanding both the acute and chronic effects of alcohol on cognitive functioning is a primary objective of this webinar. Recent advances in neuropathophysiology, as well as common findings on neuroimaging and neuropsychological tests are reviewed.  The evolution from chronic alcohol use to Wernicke’s encephalopathy to Korsakoff’s syndrome is discussed, along with the effects of alcohol use in special populations, including adolescents and elderly. Risk factors, comorbidity, emerging pharmacotherapies, and cognitive rehabilitation strategies are also highlighted.  

After the webinar, participants will be able to:

  1. Explain cognitive abilities affected by acute and chronic alcohol use.
  2. Describe the role of thiamine deficiency in cognitive impairment associated with AUDs.
  3. Differentiate between cognitive profiles of chronic alcohol use and Korsakoff’s syndrome.
  4. Identify risk factors for AUDs in adolescents.  

Target Audience:Neuropsychologists, advanced neuropsychological trainees, physicians, psychologists, and other professionals with specialty training in AUDs

Instructional Level:Intermediate to Advanced (some prior knowledge of neuroanatomy, neurotransmitter systems, and neuropsychological constructs is expected)

About Robin C. Hilsabeck, Ph.D., ABPP
Dr. Hilsabeck is a board certified clinical neuropsychologist who earned her Ph.D. in clinical psychology from Louisiana State University in 1999 with internship training in neuropsychology at University of Oklahoma Health Science Center. She completed a 2-year postdoctoral fellowship in neuropsychology at University of California, San Diego where she worked primarily with patients with chronic liver disease, including those with alcohol dependence and chronic hepatitis C infection.

Dr. Hilsabeck is Clinical Scientist II at INC Research, a contract research organization that assists in running global clinical trials.  She also is Associate Clinical Professor of Psychiatry at University of Texas Health Science Center in San Antonio where she has been on faculty since 2006.  From January 2005 through June 2012, she served in multiple roles at the South Texas Veterans Health Care System in San Antonio, including Director of the Neuropsychology Service and Director of the Neuropsychology Residency Program.  She continues to collaborate in clinical research at the VA in San Antonio. 

Dr. Hilsabeck has obtained grant funding from both private funders, as well as the NIH, and has 50 publications, including a recent book chapter on substance use in the edited book by Shane Bush entitled, “Neuropsychological Practice with Veterans.”  She is Associate Editor of The Clinical Neuropsychologist and serves on the editorial board of the Archives of Clinical Neuropsychology.  She also is Past President of the National Academy of Neuropsychology.

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Marijuana Mindset: Assessing the Impact of Recreational and Medical Use on Cognition

1.5 CE Credit

 

Presented by:
Dr. Staci Gruber 
Director of the Cognitive and Clinical Neuroimaging Core
McLean Hospital’s Brain Imaging Center











During this presentation, Dr. Gruber will discuss the cognitive and clinical impacts associated with cannabis use, and will explain important distinctions between recreational cannabis users and medical cannabis (MC) patients. She will review recent findings from the Marijuana Investigations for Neuroscientific Discovery (MIND) program, including data from the first observational and longitudinal study of medical cannabis (MC) patients. To date, findings indicate that after initiation of MC treatment, patients exhibit notable changes on measures of cognitive function, clinical state, quality of life, conventional medication use, and neuroimaging variables. Dr. Gruber will explain potential reasons for these changes and areas in need of further investigation.

 After the webinar, participants will be able to:

1) Discuss important distinctions between medical cannabis use and recreational cannabis use.
2) Summarize cognitive and neural changes associated with medical versus recreational cannabis use.
3) Explain potential reasons for cognitive and clinical changes observed after initiation of MC treatment.

Target Audience: This webinar is intended for neuropsychologists, clinicians, and other professionals wanting a clearer understanding of the impact of medical and recreational cannabis use on the brain.

Instructional Level: Intermediate

Dr. Staci Gruber is the Director of the Cognitive and Clinical Neuroimaging Core at McLean Hospital’s Brain Imaging Center and an Associate Professor of Psychiatry at Harvard Medical School. She has been studying the impact of recreational cannabis use on the brain for over two decades using neurocognitive, clinical and diagnostic assessments, and multimodal brain imaging techniques. Dr. Gruber’s work has been published in numerous peer reviewed journals and has been the basis for national and international symposia, documentaries, news stories and press conferences. Her ongoing initiative to educate policymakers, judges, attorneys and the general public about the neurobiologic differences between adults and adolescents as well as additional factors that contribute to the impact of cannabis on the brain have had both local and national impact on policy formation. She was recently invited to speak to the US Senate about the need for expanded abilities to conduct medical cannabis research. Given the differences between recreational and medical cannabis use, Dr. Gruber launched Marijuana Investigations for Neuroscientific Discovery (MIND) in 2014, the first ever program of its kind designed to clarify the specific effects of medical cannabis use. MIND utilizes valid, robust research models and supports numerous projects designed to address the impact of medical marijuana on a number of important variables including cognition, brain structure and function, clinical state, quality of life, pain, sleep, and other health-related measures. As the director of MIND, Dr. Gruber has generated major contributions to the field as the first investigator to assess medical cannabis patients longitudinally, first to acquire neuroimaging data in medical cannabis patients, and as Principal Investigator of the first ever clinical trial of a whole plant-derived, high CBD product custom formulated to treat anxiety. 


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Medication & Cognition 

1.5 CE Credits

Presented by:
Joseph E. Comaty, Ph.D., M.P.
Adjunct Assistant Professor in Psychology at Louisiana State University
Emeritus Faculty of the Southern Louisiana Internship Consortium in Psychology at Louisiana State University

This course is designed to provide the audience with the most up-to-date information on those psychotropic medications often misused in older adults. The course will cover identification of the medications in the classes of antipsychotics, antidepressants, benzodiazepines, non-benzodiazepine hypnotics, stimulants, cognitive enhancers, and acetylcholinesterase inhibitors.  The audience will be provided information on the indications for the use of these classes of medications and their most common adverse effects, particularly as experienced by older adults especially those with dementia.  Finally, the course will provide the audience with a summary of the BEERS criteria and other initiatives that have attempted to reduce the use of potentially inappropriate medications in the population of older adults.  

After the webinar, participants will be able to:

  1. Describe the most commonly used psychotropic drugs in the elderly.
  2. Discuss the difference between the current use of psychotropic drugs versus their FDA indications.
  3. Explain the most frequently encountered adverse effects of the currently used psychotropic drugs, especially the impact on cognition.
  4. Discuss the effectiveness of psychotropic medications in treating psychiatric/behavioral disorders of the elderly including risk / benefit ratios.  

Target Audience:This presentation is designed for prescribing psychologists; psychologists who work with older adults in a variety of clinical settings; psychologists who may be conducting research on medication effects in the elderly; or psychologists who are teaching courses on psychopharmacology and/or behavioral health treatment of special populations including the elderly.   Other behavioral health practitioners may also benefit from the information provided in this course.

Instructional Level:Intermediate

About Joseph E. Comaty, Ph.D., M.P.  
Dr. Comaty received his M.S. in experimental psychology from Villanova University; his Ph.D. in psychology with a specialization in clinical neuropsychology from the Rosalind Franklin University of Medicine and Science, in Illinois; and his postdoctoral Masters Degree in clinical psychopharmacology from Alliant University/CSPP of California. He is a licensed psychologist under the Louisiana State Board of Examiners of Psychologists (LSBEP) and a licensed Medical Psychologist (i.e., prescribing psychologist) under the Louisiana State Board of Medical Examiners. He retired from the Louisiana Department of Health and Hospitals, Office of Behavioral Health in 2013 where he was the Chief Psychologist and Medical Psychologist and Director of the Division of Quality Management. He is an adjunct assistant professor in psychology at Louisiana State University (LSU) in Baton Rouge and serves as emeritus faculty of the Southern Louisiana Internship Consortium (SLIC) in psychology at LSU. He is currently serving a second term as member of the LSBEP where he was previously a member and past chair; he has just completed his term as a charter member and most recent chair of the RxP Designation Committee of APA, and is a current site reviewer for APA’s Committee on Accreditation. He is a member of the Model Act and Regulation Revision Committee for the Association of State and Provincial Psychology Boards (ASPPB). His research is in the areas of behavior therapy, pharmacology, and clinical psychopharmacology. He is the author of over 60 articles, book chapters, and presentations. He is a co-author of the psychopharmacology textbook, Julien’s Primer of Drug Action, the most recent edition being published in April 2014. He has served on federal grant review committees and has been a reviewer for Psychiatric Services; The Journal of Gerontology: Psychological Sciences; the Journal of Behavioral Health Services and Research; and the Journal of Psychology & Clinical Psychiatry.

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Positive Neuropsychology: Orienting Toward Brain and Cognitive Health

1.5 CE Credit

Presented by:

John J. Randolph, Ph.D., ABPP-CN
Geisel School of Medicine at Dartmouth
Randolph Neuropsychology Associates, PLLC








 While positive psychology has experienced considerable growth and empirical support over the past 20 years, related principles have been adopted inconsistently by those working in neuropsychology and other clinical neurosciences.  The present seminar will clarify an orientation to neuropsychological practice focused on the study and promotion of brain and cognitive health—positive neuropsychology—that incorporates perspectives from positive psychology.  First, the concept of cognitive health will be examined in the context of developments in positive psychology and the neuropsychological literature.  This will be followed by discussion of an evidence-based model (C.A.P.E. model) that delineates four key domains of brain and cognitive health.  Recent and historical research covering these domains will be discussed as related to healthy and neuropsychiatric populations.  Practical cognitive and lifestyle strategies that can promote executive and other cognitive abilities will be reviewed, including a discussion of ways to incorporate related interventions into one’s professional repertoire.  

 After the webinar, participants will be able to:

1. Describe the emerging field of positive neuropsychology.
2. List four key domains of brain and cognitive health promotion.  
3. Explain lifestyle factors and practical strategies associated with neuropsychological health, and identify ways to incorporate these strategies into clinical practice.  

 

Target Audience: This webinar is intended for neuropsychologists and other professionals interested in learning about foundations and applications of positive neuropsychology.

Instructional Level: Intermediate 

Dr. John Randolph is a board-certified clinical neuropsychologist in independent practice and Adjunct Assistant Professor of Psychiatry at the Geisel School of Medicine at Dartmouth.  He is a Past President of the New Hampshire Psychological Association and a National Academy of Neuropsychology Fellow.  He is editor of the professional reference, Positive Neuropsychology: Evidence-Based Perspectives on Promoting Cognitive Health, and author of the recently released general audience book, The Brain Health Book: Using the Power of Neuroscience to Improve Your Life.  His research has focused on contributors to cognitive health and resilience, metacognition, executive functioning, and cognitive and neuroimaging aspects of multiple sclerosis.  He earned his Ph.D. in clinical psychology (neuropsychology specialization) from Washington State University, and completed clinical and research fellowships in neuropsychology and neuroimaging at the Geisel School of Medicine at Dartmouth.

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Social Cognition: An Important Face of Neuropsychology

1.5 CE Credits

Presented by:
Skye McDonald, Ph.D.
UNSW AUSTRALIA

This course introduces the concept of social cognition as a critical facet of neuropsychological function and a target for assessment and intervention. We discuss the regions of the brain that are implicated in social cognition and the range of clinical conditions that may give rise to social cognitive impairment. We discuss three main tenets of social cognition: (1) emotion perception (i.e., the ability to read emotions in others); (2) theory of mind (i.e., the ability to understand another’s point of view); and (3) empathy (i.e., the ability to engage with another and share their experience). We discuss various ways in which impairments in these attributes manifest and how they can be measured. Common instruments used for their assessment are covered, and we conclude with an overview of relevant interventions to ameliorate these impairments.


After the webinar, participants will be able to:

1. Describe the main aspects of social cognition that may be impaired in clinical conditions.
2. List a range of clinical disorders that are likely to include impairment in social cognition.
3. Identify a range of tests of social cognition that are suitable for clinical use.
4. Discuss possible approaches to remediate social cognitive disorders.

Target Audience: Suitable for experienced neuropsychologists with little to no knowledge of social cognition

Instructional Level: Intermediate

Skye McDonald is a Professor of Clinical Neuropsychology at UNSW Australia.  She has a BSc (Hons) from Monash University, a Masters degree in Clinical Neuropsychology from the University of Melbourne and a PhD from Macquarie University. She worked as a clinician with people with acquired brain disorders for 10 years before taking up her academic post at UNSW where she has been for 25 years. Skye is a world leader in understanding social cognitive disorders after brain injury. She has published 188 peer reviewed journal articles, 19 book chapters, 2 books and 140 conference presentations, most of which focus on social cognition and its disorders, especially following acquired brain injury, as well as ways to remediate such disorders.  In 2018 she was elected President of the International Neuropsychological Society (term: 2019-2021).

 
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The Effects of Marijuana on Cognition

1.5 CE Credits

Presented by:
Joanna Jacobus, Ph.D.
Staff Psychologist, VA San Diego Healthcare System
Project Scientist, UC San Diego

This course will focus on the most current research findings on the neurocognitive correlates of adolescent and young adult marijuana use.  The course will include both neuropsychological findings and neuroimaging investigations focused on markers of neural tissue health. Findings will be presented in the context of both cross-sectional and longitudinal studies, studies that have explored the contribution of pre-existing differences, and studies evaluating both acute and longer-term effects on the developing brain.

After the webinar, participants will be able to:

  1. Describe the current research on the impact of adolescent and young adult marijuana use on neurocognitive functioning and structural brain integrity.
  2. Identify other biology and psychosocial factors (e.g., recency, severity, age of onset) that contribute to poorer neurocognitive outcomes in marijuana users. 

Target Audience: Neuropsychologists, both clinicians and researchers, interested in learning about the most recent research on the impact of marijuana use on adolescent and young adult brain development. 

Instructional Level: Intermediate

AboutJoanna Jacobus, Ph.D.  
Dr. Jacobus is a Project Scientist in the UCSD Department of Psychiatry and licensed Clinical Psychologist in the VA San Diego Healthcare System. Dr. Jacobus completed her predoctoral training in neuropsychology at the SDSU/UCSD Joint Doctoral Program, and her postdoctoral training in the UCSD Department of Psychiatry. Her research interests focus on neurocognitive and structural brain changes related to healthy adolescent neurodevelopment and substance use, particularly cannabis misuse. She is working on projects utilizing multimodal neuroimaging approaches to understand the complex relationships between marijuana and alcohol use, structural and functional brain changes, and neurocognitive functioning measured in late adolescence and early adulthood. Dr. Jacobus has over 30 publications in the area of adolescent and young adult substance use.

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