Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you approach anxiety management for patients who have been on long-term (years or more) daily benzodiazepines?
For patients that I have been seeing for several years, and who have been taking a benzodiazepine for several years, every 1-2 years I inquire as to their thoughts about their medication. After they (almost always) say they want to continue, when they get up in age I advise them of the risks of cont...
What behavioral interventions have you found most effective for managing self-injurious behavior in autism?
I think you'll find some good information in this related post: https://www.themednet.org/question/21993
What is your approach to addressing dementia-related agitation for patients living at home with family?
There is absolutely no simple way to answer that question. Even when the family is providing a very calm and nonconfrontational environment, avoiding any possible way of causing the agitation, it is virtually impossible to predict when and why a person with dementia would become agitated, angry, unp...
How do you treat postpartum obsessive-compulsive disorder?
The ideal treatment for women who are breastfeeding is transcranial magnetic stimulation. TMS has a 50% response rate for OCD, higher if treatment is extended past the typical course of 30-36 treatments. This is similar to the response rates reported for SSRI treatment of OCD. Most women with post-p...
What would prompt you to consider a sleep study for narcolepsy in a child or adolescent with new-onset hallucinations?
It would depend on other elements of the history. The age of the child, the timing of the hallucinations, particularly if they are associated with sleep, onset or awakening, other hypersomnia disorder symptoms, and the child's psychiatric history. Generally, I have a very low threshold for an in-lab...
How do you distinguish between borderline personality disorder and complex PTSD in patients with chronic relational trauma?
In my experience, the best differentiating factor is what occurs in the transference and the degree of distortion that occurs in the therapeutic relationship. Patients with complex PTSD may have issues with trust, fear of abandonment, and feelings of victimization, but this generally does not exhibi...
How do you counsel patients who want to use vaping to quit smoking cigarettes?
My patient population is largely persons with severe opioid use disorder. Most use tobacco/ nicotine in some form - typically cigarettes and/or vaping. I have seen people minimize their use of cigarettes with vaping and feel very happy with their results. I don't see, however, a lot of patients stop...
What is the best approach to treatment for cenestopathies (sensation of electric current in patient's brain) accompanied by anxiety and inability to sleep?
Thank you for your question. Cenestopathies (referring to the feeling of being ill and this feeling not localized to one region of the body) may not be the correct term for this interesting phenomenon, commonly called "brain zaps". Brain zaps are a poorly understood symptom of antidepressant withdra...
When do you consider using valproate to manage behavioral disturbances in patients with delirium?
Multiple studies have identified valproate as a potential option for the management of agitation in hyperactive delirium. This has particularly been investigated for patients in ICU settings with some studies finding positive outcomes such as reduction of the total number of concomitant psychoactive...
How do you treat a patient with moderate dementia who experiences a recurrence of depression?
When I get a patient with moderate dementia and depression, I make sure the basic potential reversible medical contributors have been looked into and corrected (i.e., B12/D3 deficiency, OSA, etc). If the patient is on medications that could contribute to depression, I discuss with PCP and family if ...