Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How have you incorporated prescription digital therapeutic treatments for chronic insomnia, such as SleepioRx or Somryst, into your practice?
I have not yet prescribed any of the digital therapeutic treatments, but there are key differences. The US Department of Veteran Affairs developed CBT-i Coach based on the therapy manual CBT for Insomnia in Veterans, and the app is free to use. CBT-i Coach is intended to augment face-to-face care wi...
How do you decide when to initiate medical workup (e.g., thyroid, B12, infection) in a geriatric patient experiencing new onset or worsening low mood?
It is important to distinguish between low mood, which can occur from a host of environmental stressors, and frank depression, and there are 3 ways to look at either in the older patient: Early onset depression in someone now older, and the patient feels the present one is exactly the same as previo...
What is your approach regarding ADHD drug holidays during school breaks?
The wisdom of drug holidays for individuals with ADHD depends on a number of factors. The primary reasons supporting holidays revolve around reducing stimulant side effects. Weekend drug holidays are not usually helpful, but during a summer holiday, growth concerns secondary to stimulant treatment m...
Is there a role for leucovorin in improving verbal communication in children with autism spectrum disorder?
Although leucovorin/folinic acid is not currently recommended as a standard first-line treatment for ASD, the evidence for its use in improving verbal communication and social reciprocity, plus some behavioral improvement in children with ASD and certain genetic variation in folic acid metabolism (M...
How do you handle cases where patients use cannabis to self-manage anxiety, but are hesitant to try SSRIs?
If the patient is anxious, they should be in psychotherapy to figure out what is making them anxious. Use of SSRIs may or may not be sensible, but it is not the first response to treating anxiety. The fact that the patient is distrustful of SSRIs may become an issue, but it is not central here. Expl...
Will you incorporate the use of tirzepatide in the management of patients with OSA?
Yes! However, the best methods to incorporate GLP-1s into the practice of Sleep Medicine have yet to be determined. Hopefully, our professional organizations can provide us with clinical practice guidelines to better direct our practice in this area.For those that have not had a chance to review, SU...
When do you consider the use of zuranolone to treat postpartum depression?
Perhaps fortunately, there have been few cases in my experience where zuranolone, a new, scarce, and expensive treatment, is needed. The latency of response to an antidepressant may not be the same in all circumstances. The symptoms of depression or anxiety that occur during periods of flux in women...
How do you manage polyuria and polydipsia from lithium?
My first step is to confirm that the symptoms, including polydipsia and polyuria, are due to NDI and not other reasons. Other potential causes that should be excluded are: Psychogenic polydipsia other substance-induced, such as caffeine, diuretics primary DM pituitary related CKD Lowering the dose...
What medications do you find helpful to reduce drooling associated with antipsychotics?
Atropine Ophthalmic Solution 1%: 1 GTT SL QHS. The two leading theories explaining the mechanism of sialorrhea are: Potent agonism at muscarinic M4 receptors. Blockade of alpha-2 adrenergic receptors. Both mechanisms increase salivary flow. Atropine Ophthalmic Solution is absorbed locally. It shou...
How do you approach psychopharmacologic treatment of ADHD in correctional settings?
Correctional settings are very specialized in terms of psychopharmacological prescribing. The nature of the criminal or adjudicated actions the patients may have committed, the need for patient and staff safety, the desire not to inadvertently provide medications that could be used to commit a crime...