Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
When do you choose to switch to antidepressants vs augmentation in treatment-resistant depression?
When I approach depression that has been resistant to many antidepressant trials, I consider the following: First, I reassess the diagnosis. This includes considering comorbidities such as menopause symptoms, ED symptoms, exacerbation of chronic medical issues, and onset of MNCD. I ensure I have con...
What is your approach in counseling a patient with delusions of parasitosis?
Delusions of parasitosis (DOP) or delusions of infestation (DOI) are among the most challenging conditions we treat as dermatologists. I am not sure there is one approach to treating these patients and it can often feel very frustrating and unsatisfying. Nonetheless, we all will encounter these pati...
What is the best treatment option for a patient with bipolar disorder, who stopped her medication at the start of pregnancy and is now at the end of 2nd trimester?
This is a great question. Restarting medication would be a top priority, as we know that the risk of relapse for bipolar disorder mood episodes in women is at least as common during pregnancy as in the non-pregnant state, and that discontinuation of medications increases the risk of relapse during p...
Would you recommend CRRT instead of intermittent hemodialysis to prevent lithium rebound in a patient with lithium toxicity after an initial intermittent hemodialysis session?
I think the best way to approach any "overdose" of a drug that is dialyzable and may have a rebound is to start with hemodialysis and run it until you have achieved your desired response (drug level, improvement in some other parameter) and follow that with CRRT to manage any rebound. This is well s...
How do you approach deprescribing psychiatric medications in elderly patients with polypharmacy concerns?
Briefly, I take 6 steps in my mind to tackle this carefully. Is prescribing really necessary? Can they try non-pharmacological management first? Carefully review the medical, surgical, and social history to avoid possible complications. Thorough medication reconciliation (including OTCs, herbals, ...
When do you consider attributing isolated psychosis to an acute ischemic stroke?
Though relatively rare, systematic reviews have found post-stroke psychosis to occur in just under 5% of patients. When considering attributing psychosis to an acute stroke, there are several things it can be helpful to consider: Differential diagnosis: Making sure to rule out more common etio...
How do you treat ADHD with short periods of benefit from stimulant medications?
How do you counsel patients regarding using stimulants for attention-deficit/hyperactivity disorder during pregnancy?
There is limited research evaluating the course of ADHD across pregnancy and postpartum. The individual woman’s severity of illness and impairment inform treatment decisions across pregnancy. As with the treatment of all disorders during pregnancy, the risks and benefits of medications need to be ca...
What are your preferred strategies for managing sundowning in patients with moderate Alzheimer’s disease?
It's not a one-size-fits-all as expected. I tend to strongly push for behavioral/environmental adjustments and minimize polypharmacy. On top of my head, behavioral strategies may include: Creating a rigid, predictable, simple schedule for naps, baths, meals, and medication. More stimulation as tole...
How do you approach treatment of depression in Graves' Disease?
Though depression is often associated with hypothyroidism, it has also been found to be associated with hyperthyroid states and depression itself can impact thyroid function levels (1, 2). It is important to normalize thyroid function as psychiatric symptoms physiologically stemming from hyperthyro...