Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you advise families about the risks and benefits of long-term SSRI use for children who being treated at a very early age (e.g., early elementary school)?
Sorry, but I usually reframe this question when I get it. There is no good data as there is no way to study patients long-term. So to get an idea of what would be required, it would be to randomize a clinical population (anxiety, depression, OCD) to drug and placebo for an extended period to be abl...
When would you consider transdermal treatments for ADHD?
Agree with the above, plus if I have a kiddo having a really difficult time in the mornings with tardiness at school and tantrums in the AM because of ADHD, patch can do wonders if applied 2 hours prior to wake-up time. So I have parents apply the patch when they are still asleep, and then the morni...
What has been your experience using mindfulness-based interventions for patients with somatic anxiety symptoms?
Excellent. Here's why. Somatization with anxiety The science All emotions, positive or negative, are felt as physical sensations in the body because the limbic system has no direct conscious pathways to the cortex. Pathways from the limbic system first go to serotonin receptors in the body such as ...
How do you most effectively dose melatonin for children with insomnia?
As is the answer for most questions - it depends on the variables. First, I trial "chronobiologic dosing" (0.3-0.5 mg) about 3-4 hours before bedtime. I find this most helpful for delayed sleep phase, but not so much for maintenance. If they need a little more help with falling asleep, I will add ...
How do you approach stimulant prescribing for ADHD when a patient has previously reported palpitations with stimulants but has a normal EKG off medication?
Get a cardiology consult and get a certificate about stimulant safety before initiating stimulants.
How do you approach stimulant prescribing for ADHD in a patient with auditory hallucinations, that can be command in nature (suicide), who will not take an antipsychotic medication?
Without knowing more history, I would never prescribe stimulants for such a patient. I respectfully disagree with Dr. Gill. Stimulants can cause and do exacerbate psychosis. And I’m not sure what Dr. Gill means when he says Wellbutrin is the culprit? A patient with Chronic Schizophrenia with Acute E...
How do you treat extrapyramidal symptoms secondary to anti-psychotic use in patients who have not benefited from cogentin or benadryl?
In general, when addressing motor symptoms from antipsychotics (or any dopamine-blocking agents including dopamine-blocking antiemetics), I find it useful to break things down more specifically than just EPS. This often will determine the agent that will be most beneficial. First Category: Hypokinet...
What medications do you prioritize or avoid in Parkinson’s Disease-related psychosis and behavioral disturbance?
From an evidence-based perspective, clozapine continues to have the most solid support for its efficacy in Parkinson's disease-related psychosis. Pimavanserin has FDA approval (albeit with some mixed data) specifically for this indication. Quetiapine and olanzapine are perhaps the most frequently us...
How do you approach the use of antipsychotics, such as Seroquel/Zyprexa, for insomnia in patients unresponsive to standard treatments?
I still avoid sedating antipsychotics, including quetiapine, unless there is a compelling comorbid indication. I prefer advancing to eszopiclone, higher dose pregabalin, and/or an orexin antagonist at the higher end of the dose range, given that the lower doses were not as dramatically effective ove...
Are the laws regarding prescribing C-2 medications different for mail order pharmacies?
This is an important question and very timely considering the increase in mail order pharmacies. As a practitioner, you can prescribe medications to patients within your state through legitimate mail-order pharmacies located in different states because these pharmacies are licensed to operate acros...