Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
What has your experience been with using SSRIs to treat negative symptoms of schizophrenia?
Thirty years ago, I tried various SSRIs for negative symptoms, with no improvement according to the patient and caregivers.
How have you incorporated Eye Movement Desensitization and Reprocessing (EMDR) into your outpatient psychiatric practice?
Training is formal and takes one week, and the training I had was truly excellent and experiential. The EMDRIA website has a list of trainers and trainings. I have found EMDR to be a powerful modality that rapidly clears the negative emotions related to past traumatic or unpleasant events. I use it ...
How do you manage sleep disturbances in patients with Alzheimer’s disease without relying heavily on deliriogenic medications?
Sleep disturbances are common in older people and in those with Alzheimer’s disease (AD) in particular, and there are often multiple etiologies. Whether sleep disturbances increase the risk for AD, or are a result, metanalyses have suggested that the magnitude of sleep impairment correlates with the...
When do you consider the use of N-acetylcysteine (NAC) in patients with trichotillomania?
Great question! NAC comes up frequently in clinical discussions of trichotillomania, and it's worth being clear-eyed about what we actually know. NAC restores extrasynaptic glutamate homeostasis via the cystine-glutamate antiporter (system Xc⁻), which increases tonic activation of presynaptic mGluR2...
How long do you continue benzodiazepines in patients who have recovered from catatonia?
As others have already responded, it is case-dependent. In an otherwise healthy patient whose underlying medical or psychiatric condition causing catatonia had stabilized, there is likely a way to gradually taper off benzodiazepines without a risk of relapse.However there are other cases that are mo...
What is your approach to patients requesting prescription sleep aids, such as trazodone, quetiapine, or olanzapine, at discharge after they have found them beneficial during a prolonged hospitalization?
I don't see the harm in continuing a patient on trazodone or melatonin on discharge until they see their PCP, if they were benefiting from it in the hospital. For example, if you see a dementia patient with sundowning and have helped them sleep peacefully with trazodone, melatonin, or low-dose Remer...
When do you refer patients with difficult-to-treat depression for consideration of TMS or esketamine?
We typically tend to refer patients with treatment-resistant depression (TRD), which is defined as failure to respond to two or more adequate trials of antidepressant medications. An adequate trial is determined by both dose and duration and generally requires at least 4 weeks of treatment at a dose...
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...