Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
At what point would you recommend initiating psychotherapy or psychotropic medications to manage mood and anxiety symptoms following a new oncology diagnosis in pediatric patients?
Perhaps the most important piece to this question is missing, and that is that more history is required to determine what to do with a recently diagnosed cancer patient. What was the patient’s psychiatric status pre-cancer? If the patient had undiagnosed mental health problems–anxiety or depressio...
What interventions do you recommend for preschool-aged children exposed to severe trauma (ex. sexual assault) but not displaying any observable signs of PTSD?
I would be curious as to when the "assault" occurred in relation to the child being evaluated? When one says that there are no PTSD symptoms, are they using the under-6 criteria? PTSD symptoms are not the only response to an assault; children are more likely to demonstrate distress behaviorally, su...
Do you find consumer grade wrist actigraphy useful in measuring sleep quality and duration?
Consumer wearables are advancing quickly, and there is a lot of variation in their performance, particularly in those with sleep disorders. Unfortunately, there is a wide variation in the performance of devices, even ones using the same signals to calculate sleep/wake. Additionally, orthosomnia is a...
What are your preferred non-benzodiazepine therapies for the hyperactive/agitated phase of methamphetamine withdrawal, both in the hospital and in the office?
In our outpatient substance use disorder practice, we tend to use lisdexamphetamine (Vyvanse) at fairly high doses off-label for patients with meth withdrawal. We establish a buddy system preferably with someone who lives with them, provide Suicide hotline phone number, describe reasons to transport...
What strategies have you found most effective for obtaining prior authorization for newer antipsychotics and antidepressants?
My EMR has an integrated PAR feature. It is clunky; the other resource is CoverMyMeds. You have to enter basic demographics of the patient, but the interface will send the information to the insurance company. Many times, the approval is automatic. If not, there is a "further information" which is a...
How do you approach a case of apparent worsening catatonia despite high-dose benzodiazepines and ongoing ECT?
In my experience, this may reflect an incorrect or incomplete diagnosis, comorbid medical problems, or side effects of medications. ECT is a great treatment for catatonia, and I start to have doubts about everything, but ECT, if ECT doesn't work. I think re-evaluating diagnosis, ensuring that we kno...
How do you determine when ongoing outpatient treatment is no longer beneficial, and it may be appropriate to transition a patient to another provider?
To answer this question, I’d want to first set aside the issue of patient abandonment by taking it for granted that any transition would occur in a manner consistent with ethical and legal guidelines (for example, but not exclusively, those set out by the AMA, the literature, and in murky or content...
What is your approach to GLP-1 agonists as a psychiatrist in patients who are overweight or have eating-related disorders?
More and more of my patients have been asking for these medications in the past 12 months. For context, my niche is psychotic and bipolar disorders. Most (if not all) of my patients are on a combination of mood stabilizers and antipsychotics that are notorious for causing significant weight gain. Co...
What approaches have you found most helpful for concurrent severe major depressive disorder and alcohol use disorder?
I'm a strong believer in AA for alcoholics, to address the addiction and also the depression, as the social support offered there can be very helpful. A person agreeing to "work the steps" with a sponsor has more in-depth character restructuring and available support than most therapists can provide...
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...