Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you approach antidepressant choices for patients with generalized anxiety disorder when the patient reports excessive sedation on low doses of SSRIs?
We forget that bupropion, despite systemic misconceptions, has a very good anxiolytic effect. It is the darling of the centers treating refractory anxiety disorders.
How do you approach the use of buprenorphine/naloxone in pregnant and breastfeeding patients?
If the patient is already on it, many doctors, including myself as an addiction psychiatrist, will simply switch to the same dose without the naloxone component, just to use the minimum necessary meds while pregnant. It’s not a hard and fast rule though. The dose may need titration later in pregnanc...
What are your perspectives on using GLP-1 agonists as a primary or adjunctive treatment in psychiatric care?
It does not appear that that class of medication could be a primary treatment option at the moment. There is a significant new and emerging body of information indicating that the use of these medications could be very useful and therapeutic potential is sizable. Given that the majority of our patie...
How frequently do you recommend EKGs in pediatric patients on antipsychotics, especially in patients taking antipsychotics with more QTc risk?
AACAP recommends baseline EKGs only in patients with a family history of cardiac problems (sudden cardiac death in young/arrhythmia in close relatives), personal or family history of arrhythmia/other cardiac abnormalities, personal history or symptoms including syncopal attacks, and palpitations to ...
What do you do when a patient experiences multiple rounds of antidepressant-related tachyphylaxis?
Our clinic is having remarkable success with TMS for those patients.
When do you decide to use liothyronine (T3) for augmentation in treatment for treatment-resistant depression and how do you implement it?
The starting dose is between 5 and 25 mcg daily, and it escalates every 2-3 weeks but only after lab f/u results. Baseline FT4, T3,TSH and f/u labs. Avoid suppressing TSH excessively, to prevent osteoporosis.
What do you do for patients who have received accidental extra dosages of long-acting injectable antipsychotics?
Close monitoring, any EPS, one repeat EKG in a few days, reporting this to the family so that they are aware of the patient getting an extra dose, and cutting down or stopping any oral anti-psychotics to mitigate risk are some of the things I would do. There is no clear protocol on this, unfortunate...
How do you differentiate postpartum psychosis from postpartum obsessive compulsive disorder?
This is a fantastic question and one that arises frequently in my clinic. There are a couple of cases, but the simplest and most common distinction is awareness of the unreasonable nature of their intrusive thoughts in OCD, while postpartum psychosis is typically paired with a belief in delusional c...
Below what eGFR would you consider discontinuing lithium in a bipolar disorder patient with chronic kidney disease?
It seems nowadays we have other effective therapy besides lithium for the treatment of bipolar disorder. I tend to stop lithium as soon as I get a sense that there is a decline in kidney function as to avoid further damage. Of course, all of this depends on the specific situation and other possible ...
Which interventions have you found effective for managing sensory sensitivities in children with autism spectrum disorder?
Sensory sensitivities are very common in ASD and are listed as one of the four aspects of the core symptoms under the restricted, repetitive behaviours, interests or activities criteria of the DSM-5. Depending on the sensitivity, therapeutic interventions can be designed and implemented by occupatio...