Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you approach tapering electroconvulsive therapy after an acute treatment course leading to successful resolution of symptoms for treatment-resistant depression?
The acute series is three days a week or 12 treatments. If clients reach state of full remission before the 12 treatments in the acute series then the recommendation is to start gradual dose reduction by doing twice a week times one week, if there is ongoing remission, then reduce to once a week, bi...
How do you treat a patient with shared delusional disorder aka folie à deux?
Use open dialogue non-hierarchical family group meeting including relatives of the folie couple.
How do you approach the management of patients on lamotrigine who develop a minor rash?
Lamictal rash can be dangerous but if we stop or switch lamictal for any rash during treatment we can run out of options soon. Get a good history and pictures, if possible. How long have they been on lamictal and was there a recent dose change or did the pharmacy change their generic brand? Have an...
Are there certain sedatives or anti-epileptic meds to avoid in patients with IDD?
They are very interesting questions and I think “do no harm” relates to the issue of using any medication, whether it's an anti-epileptic drug or something for pain, or anything. Any medication can have an impact. When you think about someone with an intellectual or developmental disability (IDD) w...
What work-up do you recommend in patients with early-onset dementia?
After a thorough history (especially drugs, alcohol and Family Hx) - would do: imaging study, TSH, B12 level and consider genetic labs and CSF for early onset dementia.
What are the recommendations for considering deep brain stimulation in a patient with tremors and dementia or mild cognitive impairment?
In PD, studies with the strongest quality of evidence show a slight decline in global cognition in patients undergoing STN-DBS compared to GPi-DBS or medical therapy. However, the majority of controlled clinical trials and observational studies do not find changes in global cognition among these gro...
Do you avoid SSRIs in patients with a history of RCVS?
SSRIs are on a long list of medications associated with RCVS. The condition is relatively rare, and a very low percentage of patients have recurrences. If there is a strong indication for antidepressants, I would treat them with appropriate warnings.
How would you adjust the steroid dose for steroid-induced psychosis in a patient being treated for secondary HLH with the HLH-94 protocol?
If disease status allows weaning, we slowly wean per recommendations in HLH94. If they need steroids because of significant hyperinflammation that is damaging, then we add risperidone, which generally works very well.
How do you evaluate patients with suspected pseudo-dementia?
I am very careful about diagnosing a functional cause for cognitive impairment. I typically get vitamin B12 and TSH levels, and also get a neuropsychological evaluation. They are usually able to pick up underlying behavioral disorders or poor effort. If unrevealing, and there are no obvious risk fac...
Is it possible to develop worsening motor features of Parkinson's disease (PD) when using clozapine (for treatment of PD psychosis) above a certain dose?
Clozapine does not appear to worsen Parkinson's disease at most doses used for patients with PD. Other side effects are dose limiting such as orthostatic hypotension and sedation. The challenge of blood monitoring has limited the use of this drug in the US.There is a wonderful podcast on movementdis...