Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What do you recommend to patients when they are having an acute flare of fibromyalgia symptoms?
Great, this is a really important area and unmet need in the field of fibromyalgia management. Unlike other nociplastic disease states (e.g., migraine), there are no rigorously studied abortive therapies to rapidly treat a flare of centralized pain. Indeed, all the therapies we use for FM are intend...
How do you manage lamotrigine or lithium-induced acne?
For Lithium, I have referred patients to dermatology but it seems the interventions suggested such as Doxycycline, Spironolactone, or Bactrim do not fully help. I try to reduce the dose if possible or switch to another mood stabilizer if the acne is severe and bothersome that it is making the patien...
When do you consider using dextromethorphan–bupropion for the treatment of depression?
The data support a rapid antidepressant effect given the NMDA activity that is different than monoamine activity of all other antidepressants. Within a week, many patients I treat notice a benefit and this continues to improve for several weeks. The general guidelines would suggest Auvelity be a sec...
How do you approach the psychiatric evaluation and disposition of adolescents presenting after an overdose that was not a suicide attempt?
There is much to learn. If previous history of SIB, OD-likely admit. Known psychiatric disorder - perhaps IOP/PHP. What triggered the OD? For instance, breakup, argument - perhaps IOP/PHP. Recent traumatic event - perhaps IOP/PHP Family functioning: Is the family supportive, dismissive, chaotic, or...
How do you approach prescribing stimulants for ADHD in patients who are concurrently using cannabis?
Cannabis use can confound the assessment and management of ADHD symptoms. I believe the only way to differentiate ADHD symptoms vs. symptoms related to cannabis use is to discontinue the cannabis use and monitor. Also, keeping track of the amount and frequency of cannabis consumed will give us some ...
How should psychotherapy techniques for patients with autism spectrum disorder be adjusted, if at all?
The answer depends, at least in part, on the level of ASD with which the patient presents. Psychotherapy can be very useful for patients with Level 1 ASD, but some individuals with Level 1 ASD are more capable of benefiting from therapy than others. In general, using a more structured approach, allo...
What are your go-to options for managing ICU delirium in patients with contraindications to antipsychotics?
Evidence for Ramelteon (Yu et al., PMID 36726202)Delirium with behavioral disturbances Depakote Clonidine Propranolol, especially with TBI Non pharmacological Make sure they're closer to the nursing station. Constant re-orientation. Shades open during the day and close at night. Bring anything they ...
How do you counsel patients with depression about the role exercise may play in alleviating depressive symptoms?
I’m a big fan of exercise for all of my patients, to the point where I have my 5th-degree black belt diploma on the wall of my office next to my undergrad, PhD, and MD diplomas. I tell patients, “That’s up there to say to try and fit in exercise as realistically as your schedule allows, in a way you...
How do you treat disruptive mood dysregulation disorder?
DMDD is quite an enigma. The whole concept of irritability, which transcends many diagnoses, is also interesting. DMDD was meant to avoid overdiagnosis of moody disruptive behavior as bipolar. Since many of those kids are not suffering from bipolar disorder, I thought it was a great move. Unfortunat...
What doses of lithium have you found effective in reducing suicidal ideation?
For depression augmentation in patients who have non-bipolar states, I generally use 150-450 mg (low-dose lithium). The blood levels usually range below therapeutic for bipolar, but the low-dose lithium can help reduce SI without too many side effects. I still watch for issues of thyroid and kidney ...