Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you handle requests for disability or accommodations in clinical settings with limited administrative support or documentation time?
If you are working in private practice without ancillary support like case managers, I highly recommend having patients make appointments while you complete the forms for them. Clinically, if paperwork is being sprung on you out of nowhere, an evaluation is necessary anyways to determine if it's app...
How do you approach the role of professional home organizers in the treatment of patients with hoarding disorder?
This is a great question on a very rich topic! Here’s a brief summary of my approach. For treating hoarding disorder (HD), professional home organizers can serve as a valuable adjunct to standard care, but their role requires careful clinical framing, appropriate patient selection, and active coordi...
After remission from a first episode of psychosis how long do you continue antipsychotic treatment before attempting taper or discontinuation?
I don't think this is a one-size-fits-all question. This will depend on a number of factors. Probably most important is the client's attitude toward medication and their experience with it. Those who have done well with medication and have had no problems with side effects may be more comfortable co...
What strategies have you found effective for obtaining insurance approval for xanomeline-tropsium (Cobenfy)?
Contacting the company and talk with their representatives and they can help facilitate the process, i.e. , resources to connect the patient with and/or samples until they can get it in a financially responsible manner
Which patients do you think would benefit most from xanomeline-tropsium (Cobenfy) monotherapy?
What we know best about this new drug, Cobenfy, a xanomeline-trospium combination, is that it does not directly affect the dopamine receptor, so it is novel and a new antipsychotic drug. And its antipsychotic efficacy has been demonstrated and accepted by the FDA. But still, we have a rather ‘pure’ ...
How do you identify and respond to possible elder abuse in patients with dementia?
Elder abuse, also known as elder mistreatment, includes psychological, physical, and sexual abuse; neglect, which includes caregiver neglect or self-neglect, and financial exploitation. Physical abuse includes the infliction of physical pain or injury to an older adult, which may result in bruises, ...
Which cardiac comorbidities prompt you to obtain cardiology evaluation before starting stimulant treatment in adults with newly diagnosed ADHD?
Cardiac conduction abnormalities are a concern, as the heart will be working harder with a stimulant on board, which can worsen conduction abnormalities. Also, anyone with cardiomyopathy has to be treated carefully, as the cardiac muscle has to work harder with stimulants on board. In both cases, pa...
Is there sufficient evidence yet to support the use of lithium supplementation or prescription in the management of neurodegenerative diseases?
No.I assume the question was written in response to a recent publication in Nature (Lithium deficiency and the onset of Alzheimer’s disease), highlighting recent research in mouse models where lithium deficiency in the brain led to accelerated amyloid pathology, which could be in part reversed by re...
How do you manage patients with bipolar I disorder who report emotional blunting or numbness while taking lithium?
Adjusting the once-daily bedtime dose to a lower level in the therapeutic range may help. I always tell patients that this is a recognized side effect of lithium. A discussion about the often unavoidable depressive episode following a manic episode may convince patients that avoiding a manic or hypo...
How do you address parental concern about children becoming addicted to stimulants for ADHD treatment?
In the current environment with an epidemic of fatalities from opiates, the question about addiction to stimulants is timely. I present the parents with the data, which shows that controlled dosing leads to a steady level of dopamine and does not produce a high. Further, studies find that treated ki...