Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What strategies have you found effective in reducing intake no-show rates among patients with severe and persistent mental illness?
Reducing no-shows for community-based intakes depends on how people are initially engaged. Relationship building is always an important factor. Maintaining contact with the referral source and providing several prompts for the appointment to the client begins the process. Providing incentives to att...
What considerations do you take in starting stimulant medications for the management of adult ADHD?
Adult stimulant prescriptions for ADHD and The Journal of the American College of Cardiology in particular have published several articles in the last few years investigating the cardiovascular risk of long-term use of these medications. There have been three already in 2024 and data remains mixed.I...
How do you monitor patients who are symptomatically well-managed on clozapine with supratherapeutic drug levels?
I generally adhered to the published NIH guidelines (Correll et al., PMID 35759211). It also looks like we will be changing everything pretty soon as these recommendations will change.I still plan to do regular neutrophil and WBC counts, definitely not as frequently as previously recommended, but I ...
Do you believe that buspirone is ineffective in patients who are previously treated with benzodiazepines?
I've found buspirone helpful for patients who don't want to taper their benzo unless they have another medication on board. I wait until the buspirone is at a stable dose (typically at least 15 mg BID) before tapering the benzo. I specifically avoid cross-tapering/titration as I worry they will asso...
Do you routinely prescribe an anticholinergic agent for EPS prophylaxis when starting or continuing antipsychotics or do you prefer to use it only as needed (PRN) if/when symptoms develop?
In the setting of starting long-term treatment with antipsychotics, anticholinergics should not be started automatically for prophylaxis of EPS. Anticholinergics have numerous significant side effects and often are continued indefinitely without ever clarifying if patients actually have EPS.Antichol...
What is your approach to using stimulants in treating children with both ADHD and autism?
I think the most important thing to understand is that stimulants can be helpful but perhaps less frequently helpful and often with more side effects than in children with ADHD only. So low expectations with awareness of and preparation for the potential of significant worsening is key. A few other ...
What strategies have you used to facilitate insurance approval of off-label psychiatric medications for children and adolescents?
Off-label (i.e., non-FDA-approved) medications are frequently used to treat psychiatric disorders in children and adolescents. One reason for this is that even FDA-approved medications that have been shown to be effective for child and adolescent psychiatric issues don't always work with every patie...
What is your treatment algorithm for excoriation disorder?
Neurotic excoriation, also known as skin-picking disorder or excoriation disorder, is part of the obsessive–compulsive spectrum. There is no FDA-approved pharmacological treatment. The gold standard, evidence-based therapy is Habit Reversal Therapy (HRT), a form of cognitive behavioral therapy that ...
Are there any potentially successful pharmacologic interventions (instead of CBT or behavioral interventions alone) for Schizoid personality disorder?
This is a tricky question to answer in part because people with schizoid personality disorder do not typically present for treatment. If they do, it is often due to co-morbid symptoms such as mood or anxiety symptoms. Therefore, these symptoms are often what are targeted pharmacologically. People wi...
What antidepressants are recommended for management of depression or anxiety in patients with spinal cord injuries?
Some general considerations first: Acute or chronic injury? Associated TBI? Is uncomplicated depression/anxiety the main feature or significant anger and agitation? Is some cognitive rehabilitation needed? Is some motor system rehabilitation needed? On a vent? Difficult to wean? Acute? Think about a...