Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
Other than firearms, what dangerous items do you recommend removing or securing as a part of safety planning?
Medications, including over-the-counter (OTC) Sharps, including knives in the kitchen (this will be tough for the family - I have had them remove from drawers and keep one secure for use until the acuity resolves) Cleaners (all bathroom/kitchen cleaners) Alcohol
What opportunities do you see for combining xanomeline-tropsium (Cobenfy) with other anti-psychotic agents?
The opportunities of combining Cobenfy with any of our other antipsychotic treatments, in my opinion, are unlimited. This is one of the most important aspects of its drug use that has NOT been systematically tested. One might think first of combining Cobenfy with a widely used drug, like risperidone...
When do you consider writing an Emotional Support Animal (ESA) letter for patients with psychiatric illness?
After much soul searching, I decided that I cannot write these letters. The hard part for me is that I'm an animal lover and a pet owner, and I really do appreciate the happiness and comfort that a good animal companion can provide. But the letters are complicated, because for FHA benefits, you are ...
What pharmacologic and non-pharmacologic strategies have you found helpful in managing brain fog following COVID-19 infection?
In general, a systematic approach should be taken to evaluate COVID-19-related brain fog, which can then guide treatment. Additionally, brain fog following COVID infection can often be multifactorial, and the treatment accordingly often needs to be multi-pronged and comprehensive. The recommendation...
When do you consider pharmacogenetic testing to assist in the selection of antipsychotic medications?
I don't usually consider it, as the evidence of clinical use isn't warranted unless the patient is on heroic dosing or has side effects to every medication. I usually will get plasma levels, and you can get plasma levels for pretty much any antipsychotic - it's a cheaper GeneSight. For example, if I...
How do you counsel patients/give data on long-term use of second generation antipsychotics and risk of involuntary movement disorders?
I never try to use SGA as an adjunct for MDD augmentation - if anything, it might be Caplyta (recently FDA approved and lower side effect profile). I have seen tardive dyskinesia from 1 year of Abilify with Zoloft from a PCP. So I am very hesitant to start an antipsychotic as an adjunct. But at the ...
Is there a role for use of GLP-1/GIP receptor agonists in the management of substance use disorders, whether or not they meet other inclusion criteria for their use?
Currently, we lack the RCTs to understand the full impact of GLP-1s on SUD outcomes. Most evidence is pre-clinical, observational, suggesting potential reductions in cravings and alcohol use. A recent RCT, lab study of semaglutide in non-treatment-seeking adults with AUD showed decreased alcohol con...
What strategies have you found effective in improving acceptance of long-acting injectable antipsychotics in patients with serious mental illness who are ambivalent about treatment?
Good question. I think it's important to understand the patient's perspective, because everyone can have a unique fear regarding LAIs. It could be that they have a fear of needles, are concerned about a lack of autonomy, or are worried about the mechanism of action and potential adverse events. You ...
What is your approach to using newer atypical antipsychotics in the treatment of schizophrenia?
Latuda - great for mood stabilization and bipolar depression. A lot of people like it for borderline personality disorder, but it’s not FDA-approved for that. In my experience, not that great for psychosis or mania, but it also doesn’t really cause weight gain or QTc prolongation. Out of all the se...
How have you incorporated prescription digital therapeutic treatments for chronic insomnia, such as SleepioRx or Somryst, into your practice?
I have not yet prescribed any of the digital therapeutic treatments, but there are key differences. The US Department of Veteran Affairs developed CBT-i Coach based on the therapy manual CBT for Insomnia in Veterans, and the app is free to use. CBT-i Coach is intended to augment face-to-face care wi...