Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you use lithium levels to adjust treatment during mania?
If someone is getting manic, the mania in itself reduces lithium levels. You need for a period of about 6 weeks maintain a level close to 1 in contrast to a maintenance level of 0.75. I would, of course, use the appropriate antipsychotic to help during this period. If the patient has been Li respons...
How do you counsel patients who are interested in dietary approaches for managing major depressive disorder?
In integrative medicine literature, there is some evidence that following an anti-inflammatory diet can improve mood symptoms, including MDD. I imagine this would be a good place to start, and certainly, keto diets are considerably less inflammatory than sugar-based diets with high levels of simple ...
When is the best time to get a valproate level if a patient is taking Depakote DR once daily?
Levels should be obtained at steady state - which is 5 half lives. For ER formulation, figure about 5 days and it should be a trough level (immediately before the next dose).
How do you address non-adherence to medical treatment in adolescent and young adult oncology patients due to mental illness such as depression?
The best answer, I think, is to obtain a thorough child psychiatric evaluation. Noncompliance may arise from a number of different issues, some of which may relate to major mental illnesses such as major depression or anxiety disorders, or more cognitively based concerns such as ADHD or executive fu...
How do you approach patients with substance use disorders who require chemotherapy for their cancer?
This is, unfortunately, a common, challenging situation that requires addressing multiple facets of care.The first is having enough mental health support for the patient and having a non-judgmental approach. We're lucky to have embedded clinical psychologists in our oncology clinic at my institution...
How do you approach the use of stimulants in patients with ADHD with previous or current substance use disorders?
I agree with Dr. @Dr. First Last about the use of non stimulants as an important intervention with these patients with the added caveat that Wellbutrin XL is highly abused by crushing it up and snorting it. Even this strategy has its limitations in addressing the issue of ADHD and Substance Use Diso...
What precautions should be taken when discharging a patient from the medical setting on new medication assisted therapy for alcohol use disorder?
Great question. This article absolutely adds to the argument for using medications for alcohol use disorder. The precautions would mostly explain side effects, just as you would for any new medication. A few specific considerations depend on the medication (I'll restrict this to four more common cho...
How do you engage and approach a patient presenting with psychotic symptoms who has demonstrated a pattern of malingering and also has polysubstance use disorder?
This is a nice general summary of some basics, non-judgemental, supportive approach, quiet/low stimulation environment: Mental Health First Aid Guidelines. With regards to malingering and how to approach it, try to determine the real want/need (housing or food insecurity?) and if it is something tha...
What recommendations do you have regarding the use of dronabinol to prevent cannabis withdrawal in an inpatient medical or psychiatric setting?
I routinely use dronabinol in patients who are heavy/daily cannabis users and are having a hard time as inpatients with any degree of withdrawal and cravings. It can be a good anxiolytic as well as antiemetic and orexigenic in this situation. Depending on their preferences, it can be scheduled with ...
How do you manage patients with alcohol use disorder who express interest in moderation rather than full abstinence?
In the past, I would try to engage these patients in complete recovery—AA, etc. Today, having read the literature on harm reduction and perhaps being more experienced and tolerant with age, I engage the patient in healthcare activities like exercise, sleep, and diet, and discuss recovery from alcoho...