Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you approach NSAID use in patients on SSRIs?
This is a good question, the combined RR for NSAID+SSRI/GI complications is ~12. I generally avoid the combination and utilize topical NSAIDs if possible. I also discuss the possibility of switching patients from a 'traditional' SSRI to duloxetine, which is FDA approved for the treatment of primary ...
Do you use pimavanserin to treat psychotic symptoms in Lewy body dementia?
Yes, if insurance allows. However, it is my medication of last resort after trying cholinesterase inhibitor and SSRI. It can be used in the place of quetiepine. Note that this is an off-label use of the medication.
How do you manage patients with dementia who require but cannot tolerate an aquaplast mask for radiation therapy?
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Would you avoid the use of keppra in patients with TBI due to concerns for worsening agitation?
I suspect that this practice of prophylactic antiepileptic medications for TBI patients will go away over time. History has shown us time and time again that we over-medicate patients.
What is the best way to manage severe claustrophobia and anxiety for Thermoplastic masks?
I’ve found that P.O. uptake of benzodiazepines is notoriously unreliable, and often the severity of patients’ anxiety isn’t apparent until after the process has begun. Because of this, I stock IM hydroxyzine (a.k.a. Atarax or Vistaril), which is a great non-narcotic old-school anxiolytic with a reli...
Is there a role for medications, beyond treatment for concomitant psychiatric disorders, in the management of pediatric amplified musculoskeletal pain syndrome?
Having been trained by Dr. David Dan Sherry, my answer would be, "no". Using medicines might make the clinician or the patient/family feel better, but they do not work. Medicinal therapy also takes the focus off the 2 required pathways for optimal treatment, namely aerobic exercise (lots of it) and ...