Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
Which cognitive screening tools do you use when evaluating older adults with suspected dementia?
In keeping with Alexander Luria's (paraphrased) maxim that knowing what a patient gets wrong on cognitive screening is incomplete until you know why/how they erred, I'd say the tool used is less important than interpreting it. So, I don't worry too much about MMSE vs MoCA vs SLUMS (as long as the MM...
How do you manage atomoxetine-related fatigue?
Fatigue is a common side effect of atomoxetine, especially during the early part of treatment. Fatigue associated with usage wanes over time for many users (one to three weeks usually; if it still persists for up to six weeks, fatigue is less likely to resolve on its own), but if not addressed, it c...
Do you recommend lavender oil for the treatment of anxiety in your practice?
As a child and adolescent psychiatrist, I am more conservative when considering treatments for children vs. adults. Lavender oil is approved for use in Germany but has no FDA approval in the US. In the studies on lavender oil, there has been evidence of benefit. The problem in the US is that it is m...
What has your experience been with using SSRIs to treat negative symptoms of schizophrenia?
Thirty years ago, I tried various SSRIs for negative symptoms, with no improvement according to the patient and caregivers.
What is your approach to using prazosin to treat day-time symptoms in PTSD?
I use doxazosin, which has a very similar mechanism of action (it hits different subunits on the alpha receptor), but it does not have as much of an effect on blood pressure, which can limit the dosing of prazosin. It also does not have as many other side effects documented, such as palpitations. Th...
How do you distinguish between antidepressants losing effectiveness vs. not being effective in the first place?
This is a common conundrum in antidepressant therapy. An antidepressant is prescribed, and the patient improves beginning 2-5 weeks later (perhaps after a dose increase), with remission following in the next few weeks. While continuing to take that antidepressant at the same dose (perhaps after seve...
What is the best approach to treatment for cenestopathies (sensation of electric current in patient's brain) accompanied by anxiety and inability to sleep?
Thank you for your question. Cenestopathies (referring to the feeling of being ill and this feeling not localized to one region of the body) may not be the correct term for this interesting phenomenon, commonly called "brain zaps". Brain zaps are a poorly understood symptom of antidepressant withdra...
How do you evaluate and manage acute alcohol withdrawal when symptom-driven protocols are confounded/unreliable?
I developed a structured, objective approach centered on PAWSS risk stratification and standardized mMINDS plus RASS monitoring rather than relying solely on symptom-driven tools like CIWA. At intake, patients with suspected alcohol use disorder undergo PAWSS assessment, baseline mMINDS scoring, RAS...
How do you discuss lithium with patients who are hesitant due to concerns about side effects or monitoring requirements?
I inform patients that lithium is one of the oldest and most studied mood stabilizers. Many people do well on it for years with no or minimal side effects. Patients report that after years of suffering, it provides a sense of calm and helps with sleep. There is some evidence that it reduces suicide ...
What is your approach to managing hallucinations in dementia?
Hallucinations in dementia can be categorized in many ways. To begin to conceptualize a management approach, it is useful to distinguish between various types of clinical presentation: pre-existing psychosis in a patient who then develops dementia; new onset psychosis in a patient with dementia; pre...