Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
When do you consider the use of lumateperone to treat schizophrenia spectrum disorders?
It is obscene that these drugs cost $1,400-$1,800/month retail.
How do you approach disposition planning when a patient makes homicidal threats on presentation to the emergency department but later recants?
We are psychiatrists, and we have our area of expertise... the legal system has theirs... the legal system, NOT the medical system, has created Tarasoff or more specifically THE DUTY TO WARN. I have taught residents, medical students, and nurse practitioners for many years, and I present a very simp...
How do you treat depression symptoms in patients with Parkinson's disease?
The management of PD-related depression can be a little complicated, but there are several proposed algorithms out there based on varying degrees of evidence. Personally, I like this reference (Pontone and Mills, PMID 33648830) as a place to start. It makes 3 key points: Distinguishing between PD an...
How do you approach patients who present repeatedly to the ED with suicidal ideation but no clear acute change in risk?
If a young patient presents repeatedly to the ED with SI, even if there is no change in acute risk, it is an indication that whatever is being put in place is not working well enough to support the patient, and/or a communication of the young patient's distress. This warrants a careful assessment of...
When do you consider using benzodiazepines to treat insomnia in patients with acute mania?
In acute mania in younger patients, benzodiazepines can be a very helpful adjunct to mood stabilizers when they are not able to control the hyperactivity and insomnia with mood stabilizers alone. In younger patients, I will go with longer-acting benzodiazepines, and in shorter-acting ones for older ...
How do you approach the role of professional home organizers in the treatment of patients with hoarding disorder?
This is a great question on a very rich topic! Here’s a brief summary of my approach. For treating hoarding disorder (HD), professional home organizers can serve as a valuable adjunct to standard care, but their role requires careful clinical framing, appropriate patient selection, and active coordi...
What strategies have you found effective for obtaining insurance approval for xanomeline-tropsium (Cobenfy)?
Contacting the company and talk with their representatives and they can help facilitate the process, i.e. , resources to connect the patient with and/or samples until they can get it in a financially responsible manner
How do you identify and respond to possible elder abuse in patients with dementia?
Elder abuse, also known as elder mistreatment, includes psychological, physical, and sexual abuse; neglect, which includes caregiver neglect or self-neglect, and financial exploitation. Physical abuse includes the infliction of physical pain or injury to an older adult, which may result in bruises, ...
Which cardiac comorbidities prompt you to obtain cardiology evaluation before starting stimulant treatment in adults with newly diagnosed ADHD?
Cardiac conduction abnormalities are a concern, as the heart will be working harder with a stimulant on board, which can worsen conduction abnormalities. Also, anyone with cardiomyopathy has to be treated carefully, as the cardiac muscle has to work harder with stimulants on board. In both cases, pa...
How do you manage patients with bipolar I disorder who report emotional blunting or numbness while taking lithium?
Adjusting the once-daily bedtime dose to a lower level in the therapeutic range may help. I always tell patients that this is a recognized side effect of lithium. A discussion about the often unavoidable depressive episode following a manic episode may convince patients that avoiding a manic or hypo...