Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What is the role of inpatient psychiatric or psychological evaluation in patients who have had acute function change as an inpatient?
This is an important question. An acute change in function is a frequent reason for hospital admission and must be considered as a feature of some underlying medical, neurological, or psychiatric condition. It is important to know what functions have changed, including basic and instrumental activit...
How do you approach treatment-refractory schizophrenia which has not responded to multiple antipsychotic trials including clozapine?
I would also add that there are now case reports and case series of the ketogenic diet having significant benefits for the treatment of refractory schizophrenia, including some cases of those who had not benefitted from clozapine. The mechanisms of action by which a ketogenic diet improves brain hea...
What varying approaches do you take in suicide risk assessments?
I agree with the following from Dr. @Dr. First Last: "Ultimately, no scale or method is going to be perfect. We are unfortunately bad at predicting which individuals with suicidal ideation progress to an attempt. The most we can do is gather as much information as possible about how someone is feeli...
How do you manage nausea side effects in patients on cariprazine?
Have them try taking it every other day. This can offset side effects, given the long half-life.
What pharmacological management do you consider in patients with Autism Spectrum Disorder whose primary behavior is aggression?
As with all of my child patients, my approach is never to medicate behavior but rather to medicate suffering. This means that I view “aggression” of all forms as a kind of communication that something is wrong inside and that other means of effective communicating or managing that discomfort or what...
What is your approach when the child refuses to separate from parents during psychiatric evaluation?
Children sometimes refuse to separate from parents during a psychiatric evaluation. The simple answer to how I respond when this occurs is that I complete the interview with the parent(s) in the room. For preschoolers and many school-age children, a refusal to separate is not necessarily something t...
How do you approach the use of benzodiazepines in patients with chronic medical illnesses that may be susceptible to respiratory compromise (e.g., CHF, COPD, ILD)?
It’s a very good question and answers may vary among different specialty providers. Yes, a slow or gradual weaning of the benzodiazepines would be advisable. When they reach lower doses the taper should be even slower over weeks or longer. There is a risk for not weaning them off benzodiazepines inc...
What considerations do you take regarding using valproic acid in men who are hoping to conceive with a partner?
This recommendation was based on an analysis of one retrospective study, with data being re-analyzed, in addition to case reports and animal studies. It seems to me that it's too soon to be making rash decisions about treatment, but informing patients of the possibility and uncertainty seems reasona...
How do you manage emotional blunting due to SSRIs/SNRIs?
As with other classes of psychotropic medication, I have found that even though two medications may be in the same class, a particular patient may experience different responses to them, both in effectiveness and/or side effects. So, if that occurs, I will often try another medication in the same cl...
What is your next step in management for patients who develop sexual side effects on an SSRI (anorgasmia, low libido, etc.) but are responding well to therapy?
Managing side effects from SSRI medications is a key component of treating patients in the outpatient setting who are suffering from depression and/or anxiety. This is doubly true given the fact that primary care is often the most accessible, and often most trusted, source for patients to make their...