Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What’s your approach when a parent declines mental health services for their child due to cultural stigma or fear of CPS involvement?
This is always challenging, but the most important part is establishing a relationship of trust with the family, exploring their concerns and reservations regarding the recommended treatment, and also emphasizing the rationale and risks associated with not following treatment recommendations. CPS ca...
How do you manage stroke-related abulia?
There is surprisingly little recent evidence-based guidance on this front. Most therapeutic options focus on agonism or potentiation of dopamine in the frontal-subcortical circuits. Depending on the center and provider, options include psychostimulants. Any type might do but I prefer methylphenidate...
How do you counsel patients and caregivers on dietary interventions for autism?
Whole foods diet, e.g., Whole30.com. All the information on that website is free. I will remove common food allergens. Remove all synthetic food dyes. 100% organic to protect the microbiome. Consider a spore-based probiotic for a few months.
When would you consider transdermal treatments for ADHD?
Agree with the above, plus if I have a kiddo having a really difficult time in the mornings with tardiness at school and tantrums in the AM because of ADHD, patch can do wonders if applied 2 hours prior to wake-up time. So I have parents apply the patch when they are still asleep, and then the morni...
What has been your experience using mindfulness-based interventions for patients with somatic anxiety symptoms?
Excellent. Here's why. Somatization with anxiety The science All emotions, positive or negative, are felt as physical sensations in the body because the limbic system has no direct conscious pathways to the cortex. Pathways from the limbic system first go to serotonin receptors in the body such as ...
How do you most effectively dose melatonin for children with insomnia?
As is the answer for most questions - it depends on the variables. First, I trial "chronobiologic dosing" (0.3-0.5 mg) about 3-4 hours before bedtime. I find this most helpful for delayed sleep phase, but not so much for maintenance. If they need a little more help with falling asleep, I will add ...
How do you approach stimulant prescribing for ADHD in a patient with auditory hallucinations, that can be command in nature (suicide), who will not take an antipsychotic medication?
Without knowing more history, I would never prescribe stimulants for such a patient. I respectfully disagree with Dr. Gill. Stimulants can cause and do exacerbate psychosis. And I’m not sure what Dr. Gill means when he says Wellbutrin is the culprit? A patient with Chronic Schizophrenia with Acute E...
How do you approach the use of antipsychotics, such as Seroquel/Zyprexa, for insomnia in patients unresponsive to standard treatments?
I still avoid sedating antipsychotics, including quetiapine, unless there is a compelling comorbid indication. I prefer advancing to eszopiclone, higher dose pregabalin, and/or an orexin antagonist at the higher end of the dose range, given that the lower doses were not as dramatically effective ove...
Are the laws regarding prescribing C-2 medications different for mail order pharmacies?
This is an important question and very timely considering the increase in mail order pharmacies. As a practitioner, you can prescribe medications to patients within your state through legitimate mail-order pharmacies located in different states because these pharmacies are licensed to operate acros...
How do you adjust antipsychotic treatment during pregnancy?
Thank you for the question. In general, I try to make as few medication changes during pregnancy as possible, and try to ensure that patients are relatively stable from a psychiatric perspective for several months before conception. Obviously, this is not always feasible. If a patient needs introduc...