Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What role do you think AI-based clinical decision-making aids should play in psychiatric practice today?
Not yet. AI is still in its infancy and may be prone to "hallucinating" answers, as indicated by the legal cases where AI simply manufactured case precedents that don't exist. This is a risk that is probably not necessary in psychiatric diagnosis and treatment at this point in history. Although usin...
How do you approach treatment of obsessive behavior in patients with autism spectrum disorder?
This is such a rich topic, which comes up frequently in my practice, and the diagnostic distinction has real treatment implications. I think it’s helpful to start with some definitions, in which the key is function, not topography. OCD obsessions/compulsions: ego-dystonic, anxiety-driven, patient r...
When, if ever, do you consider prescribing clozapine after only one unsuccessful antipsychotic trial in schizophrenia?
I have read a recent JAMA Psychiatry paper concerning clozapine initiation after 1 antipsychotic trial, which was not successful (Li et al., PMID 41811299). I have not changed my practice, which is to require 2 such trials (which blood level confirmation to eliminate non-compliance) before prescribi...
What non-pharmacologic interventions or resources do you recommend for parents of patients with severe anxiety?
It depends on the type of anxiety, but a few things that I have found helpful over the years... Education about the physiology of anxiety, amygdala info, and the body’s response/cycle to anxiety is key. Help the patient understand that the goal cannot be to “get rid of” all anxiety; trying to contr...
How many of your patients continue medications for ADHD after they turn 18?
I would say the majority of my patients continue ADHD treatment once they reach the age of consent. I generally approach treatment by getting both parental consent and patient assent, and encourage gradual autonomy during visits starting around age 16 (depending on developmental level), so most of m...
When have you found the Nidra TOMAC device to be helpful for refractory restless leg syndrome?
I have one patient who found it helpful with breakthrough symptoms in refractory RLS, but was unable to get enough coverage to continue using it.
What is your approach to REM behavior disorder not adequately treated with melatonin and clonazepam?
Rule out comorbidities like sleep apnea or medications causing RBD. Optimize doses for melatonin and clonazepam, and consider dual therapy with these. Other options are gabapentin or pramipexole. Thanks,Sam Morkous
What medication strategies do you find most effective for treatment-resistant depression with a history of trauma?
If the depression is not responsive to first-line and newer antidepressants, a trial of mood stabilizers such as Lamictal or Lithium or atypical antipsychotics such as Abilify can be tried. If the anxiety is additionally severe, quetiapine can be tried.
Do you recommend lavender oil for the treatment of anxiety in your practice?
As a child and adolescent psychiatrist, I am more conservative when considering treatments for children vs. adults. Lavender oil is approved for use in Germany but has no FDA approval in the US. In the studies on lavender oil, there has been evidence of benefit. The problem in the US is that it is m...
Other than firearms, what dangerous items do you recommend removing or securing as a part of safety planning?
Medications, including over-the-counter (OTC) Sharps, including knives in the kitchen (this will be tough for the family - I have had them remove from drawers and keep one secure for use until the acuity resolves) Cleaners (all bathroom/kitchen cleaners) Alcohol