Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you manage emotional blunting due to SSRIs/SNRIs?
As with other classes of psychotropic medication, I have found that even though two medications may be in the same class, a particular patient may experience different responses to them, both in effectiveness and/or side effects. So, if that occurs, I will often try another medication in the same cl...
What is your next step in management for patients who develop sexual side effects on an SSRI (anorgasmia, low libido, etc.) but are responding well to therapy?
Managing side effects from SSRI medications is a key component of treating patients in the outpatient setting who are suffering from depression and/or anxiety. This is doubly true given the fact that primary care is often the most accessible, and often most trusted, source for patients to make their...
When do you consider lithium for early intervention in those identified to be at risk for bipolar disorder?
Lithium is the preferred first-line agent for bipolar disorder. It offers patients the potential for as close to a cure (restituo ad integrum) as you can get in psychiatry. For this case, I would initiate a 150 mg dose, and potentially build to a low-moderate dose (300-450 qhs) and watch and wait ov...
Other than clozapine, what antipsychotics do you use in a manic or psychotic patient with TD?
Lumateperone is quite all right with minimal D2 involvement. But don't forget the blocking of VMT.
How do you counsel patients who are interested in dietary approaches for managing major depressive disorder?
In integrative medicine literature, there is some evidence that following an anti-inflammatory diet can improve mood symptoms, including MDD. I imagine this would be a good place to start, and certainly, keto diets are considerably less inflammatory than sugar-based diets with high levels of simple ...
How do you address non-adherence to medical treatment in adolescent and young adult oncology patients due to mental illness such as depression?
The best answer, I think, is to obtain a thorough child psychiatric evaluation. Noncompliance may arise from a number of different issues, some of which may relate to major mental illnesses such as major depression or anxiety disorders, or more cognitively based concerns such as ADHD or executive fu...
How do you approach patients with substance use disorders who require chemotherapy for their cancer?
This is, unfortunately, a common, challenging situation that requires addressing multiple facets of care.The first is having enough mental health support for the patient and having a non-judgmental approach. We're lucky to have embedded clinical psychologists in our oncology clinic at my institution...
How do you approach the use of stimulants in patients with ADHD with previous or current substance use disorders?
I agree with Dr. @Dr. First Last about the use of non stimulants as an important intervention with these patients with the added caveat that Wellbutrin XL is highly abused by crushing it up and snorting it. Even this strategy has its limitations in addressing the issue of ADHD and Substance Use Diso...
What precautions should be taken when discharging a patient from the medical setting on new medication assisted therapy for alcohol use disorder?
Great question. This article absolutely adds to the argument for using medications for alcohol use disorder. The precautions would mostly explain side effects, just as you would for any new medication. A few specific considerations depend on the medication (I'll restrict this to four more common cho...
How do you engage and approach a patient presenting with psychotic symptoms who has demonstrated a pattern of malingering and also has polysubstance use disorder?
This is a nice general summary of some basics, non-judgemental, supportive approach, quiet/low stimulation environment: Mental Health First Aid Guidelines. With regards to malingering and how to approach it, try to determine the real want/need (housing or food insecurity?) and if it is something tha...