Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What do you consider when selecting an antipsychotic medication for acute agitation?
There are several factors to consider when choosing an antipsychotic (or any) medication for the treatment of agitation. These factors include availability (can I get it at my hospital?), route of administration (do I want/need to give a medication PO vs. IM vs. IV?), onset of action (do I need this...
How do you counsel patients on vaping cessation as compared to smoking cessation?
Presently, evidence-based approaches to vaping cessation are not well-developed. Thus, one should approach nicotine vaping cessation in a similar way to tobacco smoking cessation using a stepped care approach. Motivation to quit (versus reduce) use should be assessed and motivational counselling tec...
How do you manage antipsychotic-induced prolactinemia?
Most patients treated with standard doses of risperidone and paliperidone will develop hyperprolactinemia, typically below 100 ng/ml. However, not all individuals with elevated prolactin levels will exhibit clinical symptoms such as erectile dysfunction, galactorrhea, or irregular/absent menstrual c...
What do you use for treatment-refractory anxiety where trials of antidepressants have not worked either from ability to tolerate or inadequate effect?
I find gabapentin to be very helpful for anxiety. Other agents I've found helpful include the alpha-2 agonists clonidine and guanfacine, which I've found particularly helpful for people with trauma-related anxiety and anxiety with somatic symptoms. Both are also helpful for nightmares. Regarding ga...
What is the best treatment for treatment resistant restless leg syndrome?
In general, when a condition is considered “treatment resistant”, it is useful to reconsider the diagnosis, assess the quality of the patient-doctor relationship, identify potential sources of treatment resistance, and identify multiple non-pharmacological approaches to addressing symptoms.
What medications are safe to use to treat major depression and/or anxiety in a patient with closed-angle glaucoma?
I would recommend that the patient be treated by ophthalmologists for closed-angle glaucoma before starting treatment with an antidepressant.
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...