Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
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.
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.
How do you differentiate demoralization from depression during cancer treatment?
Certainly a key question in all referrals for "depression" in psycho-oncology. The two syndromes have areas of overlap and are not mutually exclusive. Clinical depression in cancer looks much like it would in any other context, though non-specific physical symptoms that can be caused by the cancer/t...
How do you differentiate Down syndrome disintegrative disorder from Alzheimer’s disease?
The short answer is that it may not be possible. Down syndrome disintegrative disorder, although not fully validated, is a developmental regression in children with Down syndrome and is thought to be characterized by a loss of previously acquired adaptive, cognitive, and social skills in individuals...
Would you consider over-the-counter dextromethorphan (low dose, slow titration) as augmentation in MDD?
Just one comment to clarify what might be a title/question mismatch:Augmentation of bupropion with dextromethorphan makes sense, given the positive results from the bupropion/dextromethorphan polypill. As to results, I'll leave that to others, as I haven't used this strategy very often.Augmentation ...