Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you weigh the risks of antipsychotic induced metabolic side effects when treating behavioral symptoms of dementia in a patient with diabetes?
This is an excellent question and is a difficult clinical metabolic risk concern in a poorly characterized population. Most of what we know about antipsychotic-induced metabolic syndrome, such as weight gain, dyslipidemia, insulin resistance, and hyperglycemia, comes from younger patients with schiz...
When do you order brain imaging in young adults presenting with first-episode psychosis in the absence of clear neurologic red flags?
You should always consider brain imaging, at least at CT, in the first episode of psychosis. While this will be negative almost 99% of the time, it's always good to rule out that population that may have something else going on in the brain that we can actually attribute the psychosis to. Also, chec...
What pharmacological management do you consider for self-injurious behavior in patients with autism spectrum disorder?
This is a great question but requires a nuanced answer. It all depends. In short, what I think the clinician needs to know is whether the patient with ASD and self-injury has a treatable condition that is driving self-injury. Perhaps the most critical is whether the patient has a medical problem tha...
Do you consider using buspirone for the management of anxiety in older patients?
While buspirone has been FDA-approved for the treatment of generalized anxiety disorder (GAD) and for short-term relief of anxiety symptoms in general since the 1970s, it is not generally considered a first-line treatment, despite its low misuse potential as a non-benzodiazepine. There are no large ...
Is there sufficient evidence yet to support the use of lithium supplementation or prescription in the management of neurodegenerative diseases?
No.I assume the question was written in response to a recent publication in Nature (Aron et al., PMID 40770094), highlighting recent research in mouse models where lithium deficiency in the brain led to accelerated amyloid pathology, which could be in part reversed by replacement.I want to remind th...
How do you decide whether to hold chronic medications with sedation potential in patients presenting with acute encephalopathy?
As soon as the patient comes, I recommend medication levels where possible to decide if essential medications with sedation potential should be stopped. Also, basic labs to get to the cause of the mental status change, including the scans and an EEG. In case all that is not possible, then depending ...
When do you suspect an autoimmune encephalitis in a child or adolescent with new-onset psychosis?
Given the rarity of true childhood schizophrenia, autoimmune encephalitis, and other medical etiologies should be considered in any patient presenting with new-onset psychosis prior to age 13. In adolescents, sudden onset of symptoms, absence of family history, lack of prodrome, and other atypical p...
How do you discuss sexual and gender identity-related anxiety with teens when family dynamics are rigid or culturally conservative?
First and foremost is safety. Never put children or teens in danger by hostile family or neighbors. In other words, don’t out them or encourage them to out themselves if they don’t feel safe doing so. You never know how people around them might react. That means be careful with your documentation, t...
Do you recommend GLP-1s for antispychotic induced weight gain?
When antipsychotic induced weight gain causes obesity (BMI>30), I recommend a trial of tirzepatide or semaglutide. I have observed the typical benefits in my patients, including decreases in lipids, lower HgbA1c, lower BPs, improved mobility, and loss of 10-20% of body weight over 6 months. Expense ...
How do you address sleep disturbance related to cessation of daily cannabis use?
First of all, I think challenges with sleep and daily cannabis use are underappreciated. We often hear that individuals use cannabis to help them relax and fall asleep. I'm going to highlight findings from a recent review by Kaul et al., PMID 33580483. Similar to what our patients report, acute or s...