Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you manage patients with body dysmorphic disorder who pursue repeated dermatologic or other cosmetic procedures despite reassurance or prior interventions?
I run a monthly psychodermatology clinic, and over the years, I’ve met quite a few patients with body dysmorphic disorder who come in asking for recommendations or referrals for cosmetic or surgical treatments. Many of them are genuinely convinced there’s something seriously wrong with the way they ...
How do you address mental health and online presence with teenage patients?
There are four variables that I talk to parents/teens about: Volume of screen exposure; low vs high. There is some data that pure volume is a risk factor, but not uniformly so. Psychiatric vulnerability; low vs high. Some kids are more vulnerable (e.g., social and generalized anxiety disorder and d...
What is the best way to manage low systolic blood pressures on clozapine when the patient has failed multiple other antipsychotic trials?
Orthostatic hypotension is considered a common side effect during clozapine titration, specifically due to its alpha-1 receptor antagonism. This effect is most commonly seen when initiating clozapine or with dose increases.General initial strategies to address this side effect include reevaluating t...
How do you approach cognitive impairment in the assessment of transplant candidacy?
Three main elements of cognitive impairment in organ transplantation present themselves: Impact on the candidate's ability to qualify for organ listing. Impact on the candidate's future ability to care for themself including adherence to the post-operative immunosuppressant regimen. Ability to cons...
How do you approach transplant psychiatric evaluations when ongoing mental illness raises concerns about adherence to post-transplant treatment?
Mentally ill parents who need a transplant need a very supportive caregiver team. I count on families where available, and I provide very frequent supportive sessions myself. Where possible, Adult Protective Services may help. During my years of practice, I have dealt with three such patients.
How do you handle child/adolescent patients on the inpatient unit who have developed medication-seeking behaviors as a primary way of coping with distress?
This question can be interpreted in several ways, but here it is taken to mean a pediatric inpatient who repeatedly seeks medications for psychological distress instead of engaging in psychotherapeutic work or other coping strategies. And not including chronic pain patients. In this context, the aim...
What approaches have you used to reduce boarding times for patients in the emergency department awaiting inpatient psychiatric admission?
Every emergency room and health system has unique challenges that impact boarding times. One strategy that UCI implemented was to switch from a consultation model to a co-management model. We noted that patients would be boarding on average 70 hours even prior to the COVID-19 pandemic, and boarding ...
What medication management strategies exist for children with neurodevelopmental disorders who respond poorly to stimulants and have intolerable side effects on antipsychotics?
Although neurodevelopmental disorders include ASD, ADHD, communication disorders, intellectual developmental disorders, tic disorders, and motor disorders, I will focus on ASD and ADHD, based on the question. And although the various stimulants and antipsychotic medications have different side effec...
How do you manage acting-out behaviors in children in short-term crisis settings?
Managing behavior is a complex concept and difficult to address in a generic way. In general, it's helpful to conceptualize behaviors using the ABCs of a behavioral analysis. First, what is the antecedent to the behavior? This may take different forms depending on the environment. A general emergenc...
What policies do you take regarding legalized recreational marijuana or medical marijuana use in transplant patients?
The use of THC and CBD is becoming an increasingly important topic in solid organ transplantation. Recent survey data has demonstrated that daily cannabis use is higher than daily alcohol use in the U.S. (Caulkins, PMID 38775461).Certainly, the legalization of THC use in many states has led to consi...