Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What strategies do you have for obtaining collateral information about ADHD symptoms when a child is homeschooled or in virtual school?
This is definitely a challenge that I've encountered more frequently since 2020! I first found out more about the virtual school program. Some programs do have students meet with a teacher virtually on a regular basis, or have a hybrid component where students go in person for some classes. Basicall...
How do you approach early interventions to reduce the risk of developing post-traumatic stress disorder following a traumatic event?
When I was at the Yale Child Study Center, we developed an early intervention (secondary prevention) called the Child and Family Traumatic Stress Intervention (CFTSI), which decreased PTSD by 63% in the RCT. You can search for it and request training. On the pharmacologic side, it has been shown tha...
How do you approach patients using off-label GLP-1 agonists for alcohol or opioid cravings?
More often than not, the use of GLP-1 agonist treatment for alcohol or opiate cravings is started by patients themselves. They may resort to a boutique-type medical practice to get the medications. Our approach in that situation is to advise them that there is very limited data for use with 1 study ...
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...