Nonpharmacologic Treatment of Psychiatric Disorders

Pharmacologic therapies often complement nonpharmacologic therapies in the treatment of psychiatric disease. An overview of the theory and practice of psychotherapy and interventions is provided in this chapter. Psychodynamic or psychoanalytic psychotherapy, developed by Sigmund Freud, has influenced many forms of psychotherapy. The underlying framework of psychoanalytic theory holds that a majority of a person’s psychological experiences are unconscious.

P147 Solriamfetol Titration & AdministRaTion (START): Characteristics of patients with obstructive sleep apnoea (OSA) and prescriber rationale for starting treatment with solriamfetol

Introduction Solriamfetol (Sunosi) is a dopamine/norepinephrine reuptake inhibitor approved (EU/US) to treat excessive daytime sleepiness (EDS) in adults with OSA (37.5–150 mg/day) or narcolepsy (75–150 mg/day). This study examined characteristics of patients with OSA initiating solriamfetol and prescribers’ rationales. Methods This descriptive study included a retrospective patient chart review among US-based physicians prescribing solriamfetol for patients with OSA/narcolepsy. Solriamfetol initiation strategies were classified as de novo (no prior EDS medication), transition (switched/switching from existing EDS medications), or add-on (adding to current EDS medication). Results Physicians (n=24) entered data from 50 patients with OSA (mean+/-SD age, 52+/-9.1 years; 62% male). EDS was primarily moderate (56%) or severe (36%). Mean+/-SD Apnea-Hypopnoea Index at OSA diagnosis was 33.1+/-19.7 (n=37). The most common nonpharmacologic treatment was positive airway pressure (n=39, 78%); 36/39 (92%) were considered adherent. Common comorbidities included obesity (BMI>/=30) (n=25, 50%), cardiovascular disorders (n=16, 32%), and type 2 diabetes (n=14, 28%). Twenty-two (44%) patients were de novo, 26 (52%) transitioned (primarily from wake-promoting agents [18/26, 69%]), and 2 (4%) added solriamfetol (to stimulants). The efficacy of solriamfetol prompted most discussions to prescribe de novo (18/22, 82%); a desire for improved efficacy and/or augmentation of other medications prompted most transitioning (15/26, 58%) and add-on (2/2, 100%) therapy. At data collection, 48 (96%) patients were stable on solriamfetol; one each discontinued due to lack of efficacy and side effects. Discussion Efficacy was a key consideration for physicians prescribing solriamfetol for EDS in a real-world sample of patients with OSA. Support Jazz Pharmaceuticals

590 Nonpharmacologic Pain Management in Pediatric Burn Patients: A Systematic Review

Introduction Pain is a universal feature of pediatric burns that is associated with long-term mental health consequences in this population. While pharmacologic therapy can alleviate pain, it does not always provide complete control and carries its own risks. Current literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct in pediatric burn patients. The aim of this systematic review is to summarize the literature of nonpharmacologic pain management in pediatric burn patients. Methods A systematic review was conducted using PubMed, Ovid MEDLINE, Scopus, and Web of Science. Keywords included: analgesia, pain, children, pediatric, paediatric, child, young, adolescent, burn, and scald. Papers were included if they were randomized, controlled, had original data, collected pain scores as a function of nonpharmacologic treatment, and were conducted on pediatric burn patients. Reviews, case reports, and opinion papers were excluded. Data were extracted on pain scale, pain score during and after treatment, and significance of results. Pain reduction was calculated as the percent difference between experimental and control pain scores, and treatments with significant pain reduction were considered effective. Results Sixteen studies were included, with nonpharmacologic treatments categorized as interactive (n=12) or passive (n=4). Interactive treatments required patient activity throughout treatment and included virtual reality (n=6), distraction devices (n=3), child life therapy (n=1), directed play (n=1) and digital tablet games (n=1). Passive treatments included cartoons (n=1), hypnosis (n=1), massage therapy (n=1) and music (n=1). Mean age was 8.39 years and percent total body surface area (%TBSA) burned was 5.95%. Treatment was effective in 9 out of 16 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 24.3% (n=12) and post-procedure pain by 33.6% (n=5). Of the studies reporting mid procedure pain, pain reduction was greater in interactive treatments (32.3% n=10) than in passive treatments (-15.6% n=2) (p=.016). Conclusions Nonpharmacologic therapy can be an effective adjunct in pediatric burn pain management. Significantly greater pain reduction in interactive treatments suggests distraction may lead to greater analgesia; however, the number of passive treatments for comparison was low. This study shows promise in the application of nonpharmacologic therapy, and further research will allow standardized algorithms to integrate nonpharmacologic therapy with medications.

Nonpharmacologic Treatment of Insomnia in Primary Care Settings

Introduction: Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a nonpharmacologic approach should be preferred in most cases. Although generally considered first-line treatment, the nonpharmacologic approach is often underestimated by both patients and physicians. Objective: To provide primary care physicians an up-to-date approach to the nonpharmacologic treatment of insomnia. Methods: PubMed, Web of Science, and Scopus databases were searched for relevant articles about the nonpharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. Main Message: Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and nonpharmacologic approaches, while the latter should be generally considered first-line treatment. A primary care physician may opt to refer the patient to a sleep medicine specialist for refractory cases. Conclusions: This paper provides an overview of current recommendations and up-to-date evidence for the nonpharmacologic treatment of insomnia. This article emphasizes the importance of cognitive-behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered.