Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What is the best treatment for treatment resistant restless leg syndrome?
In general, when a condition is considered “treatment resistant”, it is useful to reconsider the diagnosis, assess the quality of the patient-doctor relationship, identify potential sources of treatment resistance, and identify multiple non-pharmacological approaches to addressing symptoms.
How do you address/manage the recreational use of dextromethorphan (sometimes called "robo-tripping") that has risen to the level of use disorder?
This problem of "robo-tripping" has become an increasingly observed clinical issue, namely the misuse of dextromethorphan with cough medication (Robitussin). This is often in conjunction with alcohol misuse. We recently published a case report in The American Journal of Drug and Alcohol Abuse (Ledwo...
What medications are safe to use to treat major depression and/or anxiety in a patient with closed-angle glaucoma?
I would recommend that the patient be treated by ophthalmologists for closed-angle glaucoma before starting treatment with an antidepressant.
How do you approach tapering electroconvulsive therapy after an acute treatment course leading to successful resolution of symptoms for treatment-resistant depression?
The acute series is three days a week or 12 treatments. If clients reach state of full remission before the 12 treatments in the acute series then the recommendation is to start gradual dose reduction by doing twice a week times one week, if there is ongoing remission, then reduce to once a week, bi...
How do you treat a patient with shared delusional disorder aka folie à deux?
Use open dialogue non-hierarchical family group meeting including relatives of the folie couple.
How do you approach the management of patients on lamotrigine who develop a minor rash?
Lamictal rash can be dangerous but if we stop or switch lamictal for any rash during treatment we can run out of options soon. Get a good history and pictures, if possible. How long have they been on lamictal and was there a recent dose change or did the pharmacy change their generic brand? Have an...
Are there certain sedatives or anti-epileptic meds to avoid in patients with IDD?
They are very interesting questions and I think “do no harm” relates to the issue of using any medication, whether it's an anti-epileptic drug or something for pain, or anything. Any medication can have an impact. When you think about someone with an intellectual or developmental disability (IDD) w...
What work-up do you recommend in patients with early-onset dementia?
After a thorough history (especially drugs, alcohol and Family Hx) - would do: imaging study, TSH, B12 level and consider genetic labs and CSF for early onset dementia.
What are the recommendations for considering deep brain stimulation in a patient with tremors and dementia or mild cognitive impairment?
In PD, studies with the strongest quality of evidence show a slight decline in global cognition in patients undergoing STN-DBS compared to GPi-DBS or medical therapy. However, the majority of controlled clinical trials and observational studies do not find changes in global cognition among these gro...
Do you avoid SSRIs in patients with a history of RCVS?
SSRIs are on a long list of medications associated with RCVS. The condition is relatively rare, and a very low percentage of patients have recurrences. If there is a strong indication for antidepressants, I would treat them with appropriate warnings.