An Energizing Symposium: Stimulants in the CL Setting and Beyond

Thursday, November 7, 2024

4:40 PM – 5:55 PM EST

Location: Monroe

Speaker(s)

Jose R. Maldonado, MD, FACLP, FACFE (he/him/his)

Chief, Division of Medical Psychiatry Associate Chair for Hospital & Medical Psychiatry Department of Psychiatry & Behavioral Sciences
Stanford University
Menlo Park, California

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Matthew Gunther, MD, MA (he/him/his)

Clinical Assistant Professor
Stanford University
Stanford, California
Shixie Jiang, M.D.

Assistant Professor
University of Florida College of Medicine
Gainesville, Florida

Lead Speaker(s)

Benjamin Hoover, MD

Clinical Assistant Professor
Stanford Health Care
Palo Alto, California

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Abstract: Background

Consultation-liaison psychiatrists employ neurostimulants across a range of situations, yet the practice is highly variable and not without controversy. We have a range of pharmacologic options, including modafinil, amantadine, and the amphetamine-like medications, which each have distinct mechanisms. Stimulants are used to treat clinical presentations managed by a variety of specialists. In the intensive care unit (ICU), they are considered to assist with ventilator weaning and speech and swallow trials; on medical floors they often serve as a rapid acting treatment for depression and apathy; and in rehabilitation facilities they are used to improve engagement and functional outcomes. Nonetheless, the outcomes in the controlled trials remain controversial and strongly held differences exist, varying dramatically between different specialties and medical settings.

This session is endorsed by the Critical Care Psychiatry SIG.

Learning Objectives:

Understand the mechanisms and benefits of the use of stimulant agents in cases of hypoactive delirium, as well as the differences between available agents.
Understand pathophysiology of disorders of diminished motivation including apathy, abulia, and akinetic mutism and the potential role of stimulants in the management of these symptoms.
Describe use cases for amantadine prescription in cases of traumatic brain injury, including potential for accelerated recovery and improved functioning.