Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you navigate C-2 refills in patients who are stable in their treatment and do not otherwise need to be clinically seen monthly?
This practice is routine in child psychiatry. We fill stimulant prescriptions electronically at the phone request of the family as long as they are keeping quarterly appointments. We do not charge for that service. We do document it in the medical record. Your question begs another question, however...
How do you assess for trauma-related symptoms in children and adolescents who have experienced chronic bullying?
Assessment for trauma-related symptoms in youth who have been victims of bullying is similar to assessment for trauma-related symptoms due to other factors, with special attention paid to symptoms such as school avoidance, being a perpetrator of bullying themselves, threats of harm to self or others...
What antidepressant medications do you usually use alongside ketamine or esketamine treatment in patients with difficult-to-treat depression?
Hello--ketamine clinic psych here. In our clinic's experience, quite a few ketamine-responders can drop the number of medications or lower the doses of medications once ketamine is part of the treatment plan. We don't see a lot of difference between which medication works best since that is so varia...
How do you approach prescribing oxcarbazepine when the patient is on an oral contraceptive?
I first would want to ask what the reason is for oxcarbazepine and if there is a safer alternative for pregnancy. If it's for epilepsy, then I would go with lamotrigine. However, if the patient is stable on oxcarbazepine, then I would lower the dosage. I would strongly encourage an IUD, which is loc...
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...