Free Articles Carlat Reports | Carlat Publishing

In Brief

In Brief: Sexual Activity on the Decline

From The Carlat Psychiatry Report, College Mental Health

Topics: Free Articles | Sexual Dysfunction

IN BRIEF Alfred Kinsey caused widespread shock in 1948 when his surveys of sexual behavior revealed what was happening behind bedroom doors. This year, researchers from Kinsey’s institution (Indiana University) updated his work, and this time the surprise is about what is not happening. The new survey asked over 4,000 US adolescents and adults a

Clinical Update

What Gets in the Way of Antidepressants?

From The Carlat Psychiatry Report, ADHD

When patients don’t respond to an antidepressant, it’s a good idea to step back and look for anything that might be getting in the way. Major stress, substance use, medication nonadherence, anxiety, and medical and psychiatric comorbidities are high on that list, but recent research has added more possibilities that we’ll review in this article.

Clinical Update

Treating Common Medical Conditions in Patients With Chronic Mental Illnesses

From The Carlat Hospital Psychiatry Report, Minimizing Use of Restraints

After years of specialized training in psychopharmacology and psychotherapy, it can feel foreign or uncomfortable to prescribe a nonpsychiatric medication, such as an antibiotic, to a patient in need. Uncertainty about psychiatrists’ scope of practice leaves many of us feeling unsure about whether we should prescribe anything beyond psychiatric medica

Research Update

Opioid Agonist Treatment and Decreased Mortality

From The Carlat Addiction Treatment Report, Laboratory Testing

Topics: Free Articles | Medication for Opioid Use Disorder (MOUD) | Opioid epidemic | Opioid Use Disorder

Opioid agonist treatments, namely methadone and buprenorphine, save the lives of people with opioid use disorders. In this study, researchers break down how exactly these medications decrease mortality, and it’s not just by reducing overdoses. REVIEW OF: Santo T et al, JAMA Psychiatry 2021;78(9):979–993 STUDY TYPE: Systematic review and meta-ana

Clinical Update

School Inclusion: What You Need to Know

From The Carlat Child Psychiatry Report, Assessment in Children and Adolescents

Yamila is a 9-year-old autistic 3rd grader from a Spanish-speaking home with an individualized education plan (IEP) who attends a special education classroom with seven other students. She is a role model for her peers, compliant and never complaining. For two months Yamila has often been absent with stomachaches. After an extensive workup, Ya

Research Update

Intravenous Ketamine for Teen Depression

From The Carlat Child Psychiatry Report, Assessment in Children and Adolescents

Topics: adolescents | Depression | Free Articles | Ketamine | Suicidality

REVIEW OF: Dwyer JB et al, Am J Psychiatry 2021;178(4):352–362 TYPE OF STUDY: Randomized midazolam-controlled trial Treatment-resistant depression (TRD) is a growing concern in teenagers. Although intravenous ketamine has shown clear and immediate improvement of TRD in adults, there is little research to show its effectiveness in teens, and each

Clinical Update

Tarasoff: Making Sense of the Duty to Warn or Protect

From The Carlat Hospital Psychiatry Report, Testifying

Your hospitalized patient tells you that he is angry with his sister and intends to “bash her brains in.” He tells you she is sending him messages through the television that say she is going to kill him. Nurses note the patient has been tense and irritable and has been observed talking to himself. Tarasoff ruling: Background We often

Clinical Update

Principles of Verbal De-Escalation

From The Carlat Hospital Psychiatry Report, Testifying

Topics: aggression | Agitation | Emergency Department | Free Articles | verbal de-escalation

When our patients become agitated and threatening, we often think first about chemical or physical restraints—especially when staff’s physical safety seems at imminent risk. But it’s important to remember that coercive interventions can be humiliating and may lead to more agitation and violence. In fact, research indicates that restraints are corr

Introducing the Newsletter

Introducing The Carlat Geriatric Psychiatry Report

From The Carlat Geriatric Psychiatry Report, Dementia

Topics: Free Articles

Welcome to the inaugural issue of The Carlat Geriatric Psychiatry Report—our fifth CME newsletter. You’ve been asking for a source of unbiased reporting on geriatric psychiatry, and we’ve finally created one. We hope you’ll find it useful. Three years ago, I took a job as chief of psychiatry at MelroseWakefield Healthcare, and an importan

Welcoming Our New Editor-in-Chief

From The Carlat Geriatric Psychiatry Report, Dementia

Topics: Free Articles

It’s our pleasure to introduce Stephanie Collier, MD, MPH, as the editor-in-chief of CGPR. Dr. Collier is the director of education in the Division of Geriatric Psychiatry at McLean Hospital and an instructor in psychiatry at Harvard Medical School. Dr. Collier completed her psychiatry residency at Duke University Medical Center and her fellowship in

Clinical Update

How to Interview the Older Patient

From The Carlat Geriatric Psychiatry Report, Dementia

Topics: Free Articles

The expanding population of older adults has created a need for all clinicians to participate in their care. Interviewing techniques require adaptation in older adults, such as accounting for hearing or vision impairment and speaking slowly and clearly. This article will cover additional factors to consider when evaluating older patients. Functional as

Clinical Update

How to Distinguish the Dementias

From The Carlat Geriatric Psychiatry Report, Dementia

Topics: Free Articles

There are several types of dementia, and each has a different prognosis and treatment course. In this article I’ll outline my approach for distinguishing between the most common varieties—Alzheimer’s, vascular, Lewy body, and frontotemporal. In addition, I’ll cover how to differentiate between mild and major neurocognitive disorder (NCD).

Clinical Update

Using Equine-Assisted Psychotherapy

From The Carlat Child Psychiatry Report, Overarousal in Children and Adolescents

Sylvia is 7 years old, referred for long-standing school refusal after CBT proved ineffective. You confer with her therapist about trying a different approach. When patients are not amenable to usual therapy, equine-assisted psychotherapy (EAP) might be a good option. In this article we’ll talk about working with horses as an alternative

Expert Q&A

Decisional Capacity

From The Carlat Hospital Psychiatry Report, Capacity Assessments

CHPR: Can you start by telling us what criteria you use to assess capacity? Dr. Cheung: We generally look for evidence of capacity in four domains. These have become the standard criteria for assessing capacity, based on Dr. Paul Appelbaum’s work from many years ago (Appelbaum PS and Grisso T, N Engl J Med 1988;319(25):1635–1638). The domains are:

Clinical Update

Approaches to Autism Intervention

From The Carlat Child Psychiatry Report, Autism in Children and Adolescents

Your patient is a young child who has recently been diagnosed with autism. Her parents are asking about the available treatments, and in particular, they want to know whether they should pursue the 40-hour-per-week program recommended by the local autism society. As clinicians, we are often faced with questions from families about the “best” pr

Clinical Update

Intranasal Esketamine: New Hope for Suicidal Patients?