Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
When do you attribute tremors to lamotrigine?
Not a side effect of LTG, but tremors are common and patients love to attribute everything to medications.
How do you approach requests for academic accommodations such as extended test time in college students with ADHD?
I do receive such requests, particularly from kids in college or high school with severe ADHD symptoms. I do write in my letter that due to the diagnosis of ADHD, the patient may be allowed some accommodation in testing and may be given an extra time to complete the tests compared to other peers. I ...
Do you routinely prescribe naloxone at discharge for patients with a known history of opioid use disorder?
Yes. I routinely prescribe naloxone intranasal for patients with OUD. This is also routine in our Emergency Department and our Crisis Response Center. In our locality, patients can obtain naloxone from their pharmacy, free of charge. Naloxone, when available, can be used by bystanders or family memb...
Do you prescribe linezolid to patients who are concomitantly on an SSRI?
Yes, cautiously, especially when LZD is the best or only option. Recent Eur J Clin Pharmacol July 2023 meta-analysis involving 84 publications found an observed rate of < .01%; another study Shi et al., PMID 37301313 found a similar rate (1/1743 persons, 0.06%). Holding an SSRI for a day or two prio...
When is it useful to test for multiple amyloid-related biomarkers for patients undergoing work-up for cognitive impairment?
If a patient has a presentation consistent with MCI or early dementia due to AD (slow progressive decline, STM loss, no hallucinations, no neuro deficits), I will get an MRI and amyloid blood-based biomarkers. If the goal is just a diagnosis, I stop there. If they are interested in “mab” therapy, I ...
When do you consider referring adolescents with major depressive disorder for TMS?
TMS has gained FDA approval to aged 15 for major depressive disorder refractory to medication. That statement alone has many layers. First, often the mood disorders that are difficult to treat do not necessarily meet criteria for MDD, and this is often because of family concerns and environmental st...
Would you be comfortable using isotretinoin in a female teenage patient who has a history of depression that is now stable but with a prior suicide attempt two years ago?
Yes. There is ample evidence that isotretinoin does not cause depression. In the large Canadian study, there was a slightly negative association with suicide. As the good doctors noted above, using appropriate step therapy, with informed consent (especially regarding pregnancy and birth defects), is...
How reliable do you find it to make the diagnosis of bipolar disorder based on a patient report of prior symptoms or questionnaire and not the actual observation of hypo/mania on the exam?
I agree that direct observation is always nice, but we certainly don't want to wait for a manic episode to determine the correct diagnosis. I find that by asking lots of detailed questions, most people who have experienced and manic episode can report enough history to correctly. Identify the episod...
How do you approach the management of mild to moderate tics induced by stimulants in children?
If dose reduction or medication switch is not possible, first-line treatment includes adding an alpha agonist like guanfacine or clonidine. I prefer guanfacine as clonidine is more sedating and less tolerated by kids. CBIT (Comprehensive Behavioral Interventions for Tics) would be great but hard to ...
What is your pharmacologic approach to treating insomnia comorbid with sleep apnea?
I do not usually treat any insomnia, regardless of comorbidities, with any targeted medication for the insomnia itself. If the patient is getting over 5 hours of sleep, then I use CBT-I as this is guideline-recommended (AASM) first-line treatment for insomnia and has efficacy lasting over a year out...