Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you use lithium levels to adjust treatment during mania?
If someone is getting manic, the mania in itself reduces lithium levels. You need for a period of about 6 weeks maintain a level close to 1 in contrast to a maintenance level of 0.75. I would, of course, use the appropriate antipsychotic to help during this period. If the patient has been Li respons...
How do you counsel patients regarding using stimulants for attention-deficit/hyperactivity disorder during pregnancy?
There is limited research evaluating the course of ADHD across pregnancy and postpartum. The individual woman’s severity of illness and impairment inform treatment decisions across pregnancy. As with the treatment of all disorders during pregnancy, the risks and benefits of medications need to be ca...
What is your approach when evaluating a child brought in by parents who suspect PANS/PANDAS as the cause of the child's psychiatric symptoms?
I encourage reading of the recent comprehensive review of all aspects of PANS in Pediatrics, This is a policy statement by the American Academy of Pediatrics. It is comprehensive and balanced, acknowledging key controversies in diagnostic and treatment approaches. In my clinical practice, the greate...
How do you approach the psychiatric evaluation and disposition of adolescents presenting after an overdose that was not a suicide attempt?
There is much to learn. If previous history of SIB, OD-likely admit. Known psychiatric disorder - perhaps IOP/PHP. What triggered the OD? For instance, breakup, argument - perhaps IOP/PHP. Recent traumatic event - perhaps IOP/PHP Family functioning: Is the family supportive, dismissive, chaotic, or...
In the psychiatric ER, how do you address the issue of child/adolescent patients being left there by caregivers and becoming extended stay patients?
Unfortunately, then it becomes a matter of contacting the Department of Children's Services for intervention. However, that is often a slow and arduous road.
How do you weigh risks/benefits when referring child and adolescent patients for ECT?
I want to begin with a disclosure: I do not personally treat children with ECT in my practice. However, in a prior academic setting where ECT was performed for adults, I was occasionally asked to evaluate adolescents being considered for treatment by the adult ECT service. When thinking about referr...
How do you respond to early refill requests for stimulants in stable patients who report lost or stolen medication?
I do not refill stimulants when they are reported lost or stolen. When starting a treatment course of stimulants with a patient, I review a brief list of instructions and expectations. For stimulants, this includes that it is their responsibility to store and protect their medication from theft or l...
How do you manage ARFID in children encountered in your practice?
ARFID is a fairly new disorder, having been added to the DSM in 2013. Treatment somewhat depends on the type of ARFID with which the patient presents, although there are shared treatment elements regardless of type. Variants include Avoidant type, which usually revolves around sensory issues related...
What role do you think AI-based clinical decision-making aids should play in psychiatric practice today?
Not yet. AI is still in its infancy and may be prone to "hallucinating" answers, as indicated by the legal cases where AI simply manufactured case precedents that don't exist. This is a risk that is probably not necessary in psychiatric diagnosis and treatment at this point in history. Although usin...
When have you found the Nidra TOMAC device to be helpful for refractory restless leg syndrome?
I have one patient who found it helpful with breakthrough symptoms in refractory RLS, but was unable to get enough coverage to continue using it.