Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
In addition to a therapist, what are your favorite resources for tackling perfectionism?
Perfectionism is a pattern of thinking and behaving characterized by rigid, unrealistic, harsh judgments about the performance of the self and others. For a perfectionist, the outcome of their actions is almost never sufficient. Even the measurement itself of each outcome is distorted by their perf...
How do you manage patients with body dysmorphic disorder who pursue repeated dermatologic or other cosmetic procedures despite reassurance or prior interventions?
I run a monthly psychodermatology clinic, and over the years, I’ve met quite a few patients with body dysmorphic disorder who come in asking for recommendations or referrals for cosmetic or surgical treatments. Many of them are genuinely convinced there’s something seriously wrong with the way they ...
How do you address mental health and online presence with teenage patients?
There are four variables that I talk to parents/teens about: Volume of screen exposure; low vs high. There is some data that pure volume is a risk factor, but not uniformly so. Psychiatric vulnerability; low vs high. Some kids are more vulnerable (e.g., social and generalized anxiety disorder and d...
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
What is the best way to manage low systolic blood pressures on clozapine when the patient has failed multiple other antipsychotic trials?
Orthostatic hypotension is considered a common side effect during clozapine titration, specifically due to its alpha-1 receptor antagonism. This effect is most commonly seen when initiating clozapine or with dose increases.General initial strategies to address this side effect include reevaluating t...
What clinical factors guide your decision about if and when to restart antipsychotic medications in patients with primary psychotic disorders recovering from catatonia after stabilization with benzodiazepines or ECT?
The American Psychiatric Association's catatonia workgroup recently published an excellent Resource Document for Catatonia.In this document, they discuss some relevant points on pages 25 - 27: There is a longstanding history of using antipsychotics in catatonia, with available reports on the use of ...
What is your approach to determining eligibility for hospice in persons with Alzheimer's disease?
We strongly recommend early hospice enrollment for patients with dementia as soon as they meet eligibility criteria. In our approach, we carefully evaluate both functional and cognitive decline. One area that is often overlooked, however, is nutrition. When a patient with Alzheimer’s disease begins ...
How do you treat disruptive mood dysregulation disorder?
DMDD is quite an enigma. The whole concept of irritability, which transcends many diagnoses, is also interesting. DMDD was meant to avoid overdiagnosis of moody disruptive behavior as bipolar. Since many of those kids are not suffering from bipolar disorder, I thought it was a great move. Unfortunat...
How does comorbid epilepsy influence your decision on antipsychotic medications?
In general, epilepsy is not a contraindication to the use of antipsychotic medications if they are needed despite the known risk of lowering the seizure threshold. In general, the risk of seizures for most antipsychotics is low, though some antipsychotics, such as clozapine, olanzapine, and quetiapi...
How do you approach cognitive impairment in the assessment of transplant candidacy?
Three main elements of cognitive impairment in organ transplantation present themselves: Impact on the candidate's ability to qualify for organ listing. Impact on the candidate's future ability to care for themself including adherence to the post-operative immunosuppressant regimen. Ability to cons...