Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you treat ADHD with short periods of benefit from stimulant medications?
How do you counsel patients regarding using stimulants for attention-deficit/hyperactivity disorder during pregnancy?
There is limited research evaluating the course of ADHD across pregnancy and postpartum. The individual woman’s severity of illness and impairment inform treatment decisions across pregnancy. As with the treatment of all disorders during pregnancy, the risks and benefits of medications need to be ca...
What are your preferred strategies for managing sundowning in patients with moderate Alzheimer’s disease?
It's not a one-size-fits-all as expected. I tend to strongly push for behavioral/environmental adjustments and minimize polypharmacy. On top of my head, behavioral strategies may include: Creating a rigid, predictable, simple schedule for naps, baths, meals, and medication. More stimulation as tole...
How do you approach treatment of depression in Graves' Disease?
Though depression is often associated with hypothyroidism, it has also been found to be associated with hyperthyroid states and depression itself can impact thyroid function levels (1, 2). It is important to normalize thyroid function as psychiatric symptoms physiologically stemming from hyperthyro...
How do you manage fatty liver disease in patients on olanzapine who are reluctant to change meds?
I wonder if there are hepatologists available to consult with?There is a new drug with a novel mechanism of action Rezdiffra (resmetirom) that is specifically studied/designed for MASH (NASH). I haven't seen it used yet in my patients, but I am fascinated by the mechanism of action. Will it have psy...
When do you consider the use of clonidine in gabaergic withdrawal and how do you approach the risk of masking the autonomic signs of withdrawal when it is used?
There is limited and indirect evidence for the use of clonidine in "benzodiazepine-sparing" protocols for gabaergic withdrawal treatment. Generally, an anticonvulsant is used along with clonidine in this context. This "new" data recapitulates old, mainly European, studies combining beta-blockers wit...
How do you differentiate between hyperactive delirium and excited catatonia?
This is a highly complex distinction to make for several reasons, not the least of which is that the two conditions can coexist in the same patient at the same time. This has been demonstrated in some recent studies of mainly intensive care delirious patients, though the reported very high incidence...
What strategies have you found most effective for supporting weight loss in patients with bipolar disorder while minimizing the risk of mood destabilization?
If residual depressive symptoms are present, then the addition of bupropion is helpful. If the weight gain is deemed due to necessary psychiatric medication, then the addition of metformin often works. Of course, for the management of weight, diet and exercise need to be encouraged (in addition to t...
What medications would you consider for severe delusional disorder in a patient with RLS worsened by aripiprazole and quetiapine, who refuses clozapine?
Lyrica - better than gabapentin and will help with anxiety that might be brought on by delusional disorder. No FDA-approved medication for delusional disorder, and it may best be treated with gentle CBT for psychosis.
What alternative ADHD medications would you consider in a child with a complex cardiac history unresponsive to guanfacine?
Choosing another medication to treat ADHD in a child with a complex cardiac history who has already failed guanfacine is not a straightforward task. To make this decision, one would need to understand which symptoms of ADHD are causing the most functional impairment (inattention, hyperactivity, both...