Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What unique factors do you take into consideration for geriatric patients with a first lifetime episode depression?
I agree with the suggestions to check for vascular and early dementia, but a very neglected cause is hypothyroidism. This is a very common cause of depression in all ages. The internists are relatively clueless. It should be a clinical diagnosis, with labs used to guide treatment. In Europe, a TSH >...
What is your approach to assessing traumatic exposure in children?
Ask explicitly with a child, adolescent, or adult: “Have you ever been hurt or abused by adults or other people, physically or sexually?” (Be prepared to elaborate). What we are getting at to some degree here is PTSD-like events. Sadly, people frequently experience death, tornadoes, car accidents, ...
Do you observe worsening irritability, mood symptoms, or increased rates of suicidal ideation in patients with Bipolar Disorder who are using hormone birth control including hormone-releasing IUD?
Actually, my experience is the opposite. Many of my patients use OCs or some form of HRT to keep affective lability low. This is true, especially in the perimenopause.
How do you counsel patients with bipolar disorder who want to breastfeed?
This is a great question! Many women desire to breastfeed their babies, and providers often encourage the initiation of breastfeeding in the immediate postpartum period. For women with underlying bipolar disorder, this decision can be more nuanced. Nursing a young infant requires multiple feedings ...
Is there a benefit to augmenting treatment for schizophrenia by adding aripiprazole (a partial D2 agonist) to a full D2 antagonist such as haloperidol?
I do not see the slightest benefit from that approach. We have gotten quite an impressive number of second-generation medications and absolutely could avoid polypharmacy with two antipsychotic medications adding up the risk of quite significant side effects and affecting patients negatively when the...
What is your approach to managing a patient with egodystonic pedophilia thoughts?
Management of egodystonic pedophilic thoughts should be managed similarly to other intrusive disturbing thoughts, with some specific important nuances. First, it is important to outline the limits of confidentially and the clinicians duty to report danger to others. The clinician must be aware of th...
How do you treat behavioral disturbances in patients with dementia with Lewy bodies?
The best medication for behavioral symptoms and Lewy body disease is a cholinesterase inhibitor. It reduces hallucinations and dream-like delirium. When more is needed, a small dose of quetiapine at night may be helpful. SSRIs reduce anxiety and can reduce aggression.
How do you manage nicotine withdrawal and smoking cessation in teens?
Managing nicotine withdrawal and promoting smoking cessation in adolescents is a multifaceted approach that includes behavioral interventions, pharmacotherapy, and support. Behavioral Interventions Cognitive Behavioral Therapy (CBT): CBT is effective in helping adolescents recognize and change the...
When do you consider lamotrigine in bipolar depression?
Lamotrigine can be initiated and maintained in bipolar II since hypomanic episodes would be unusual. As mentioned before, it is not for an acute situation but can be introduced anytime. Dosing though is recommended as no less than 200 mg and can be taken to above 400 mg. Please check levels 8 to 12....
What is your experience with metformin for improving cognitive impairment in schizophrenia?
I have not found that it does much. But there was a recent promising study for using TMS on a particular brain region that is hopeful.