Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What strategies have you found helpful for balancing telehealth and in-person appointments to reduce bottlenecks?
I don't have any bottlenecks. I have an office close to home, so I can come and go at will. I also have a small practice, and I am no longer open to new patients.
In your experience how does the dose of Remeron (mirtazapine) influence side effects like hunger and weight gain?
Mirtazapine will have a more severe occupancy on histamine receptors at the lower doses. That is why we use 7.5 mg as a hypnotic. As you increase the dose, there is also more norepinephrine being produced.
How do you manage clozapine related sedation for patients who have treatment resistant Schizophrenia and otherwise had good response to clozapine?
I have colleagues who use modafinil to address the daytime sedation. I've only tried this once, and the patient had intolerable headaches from the lowest dose of modafinil, so I can't say that I've used this successfully. Strategies I've used with other sedating meds include taking the medication e...
What is your approach to assessing traumatic exposure in children?
Ask explicitly with a child, adolescent, or adult: “Have you ever been hurt or abused by adults or other people, physically or sexually?” (Be prepared to elaborate). What we are getting at to some degree here is PTSD-like events. Sadly, people frequently experience death, tornadoes, car accidents, ...
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....