Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you approach patients who present repeatedly to the ED with suicidal ideation but no clear acute change in risk?
If a young patient presents repeatedly to the ED with SI, even if there is no change in acute risk, it is an indication that whatever is being put in place is not working well enough to support the patient, and/or a communication of the young patient's distress. This warrants a careful assessment of...
When do you consider using benzodiazepines to treat insomnia in patients with acute mania?
In acute mania in younger patients, benzodiazepines can be a very helpful adjunct to mood stabilizers when they are not able to control the hyperactivity and insomnia with mood stabilizers alone. In younger patients, I will go with longer-acting benzodiazepines, and in shorter-acting ones for older ...
At what lab values (ferritin, TSAT%) would you offer IV iron therapy to patients with restless leg syndrome?
1. I am hopeful that practitioners will start understanding that ferritin alone is not enough to assess iron because of its acute phase reactivity. I like to order iron parameters after a 5-9 hour fast so the serum iron is not speciously elevated and get a ferritin and TSAT. If the ferritin is <30 a...
How do you approach the role of professional home organizers in the treatment of patients with hoarding disorder?
This is a great question on a very rich topic! Here’s a brief summary of my approach. For treating hoarding disorder (HD), professional home organizers can serve as a valuable adjunct to standard care, but their role requires careful clinical framing, appropriate patient selection, and active coordi...
What strategies have you found effective for obtaining insurance approval for xanomeline-tropsium (Cobenfy)?
Contacting the company and talk with their representatives and they can help facilitate the process, i.e. , resources to connect the patient with and/or samples until they can get it in a financially responsible manner
Which patients do you think would benefit most from xanomeline-tropsium (Cobenfy) monotherapy?
What we know best about this new drug, Cobenfy, a xanomeline-trospium combination, is that it does not directly affect the dopamine receptor, so it is novel and a new antipsychotic drug. And its antipsychotic efficacy has been demonstrated and accepted by the FDA. But still, we have a rather ‘pure’ ...
How do you identify and respond to possible elder abuse in patients with dementia?
Elder abuse, also known as elder mistreatment, includes psychological, physical, and sexual abuse; neglect, which includes caregiver neglect or self-neglect, and financial exploitation. Physical abuse includes the infliction of physical pain or injury to an older adult, which may result in bruises, ...
Which cardiac comorbidities prompt you to obtain cardiology evaluation before starting stimulant treatment in adults with newly diagnosed ADHD?
Cardiac conduction abnormalities are a concern, as the heart will be working harder with a stimulant on board, which can worsen conduction abnormalities. Also, anyone with cardiomyopathy has to be treated carefully, as the cardiac muscle has to work harder with stimulants on board. In both cases, pa...
How do you manage patients with bipolar I disorder who report emotional blunting or numbness while taking lithium?
Adjusting the once-daily bedtime dose to a lower level in the therapeutic range may help. I always tell patients that this is a recognized side effect of lithium. A discussion about the often unavoidable depressive episode following a manic episode may convince patients that avoiding a manic or hypo...
How do you address parental concern about children becoming addicted to stimulants for ADHD treatment?
In the current environment with an epidemic of fatalities from opiates, the question about addiction to stimulants is timely. I present the parents with the data, which shows that controlled dosing leads to a steady level of dopamine and does not produce a high. Further, studies find that treated ki...