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Clinical Update

From The Carlat Child Psychiatry Report, Clinical Complexity With Children and Adolescents

Each year in the US, there are about 1.04 million divorces, affecting about 800,000 children. Beyond that, 1.9 million cohabiting (and unmarried) couples break up each year, of whom 60% have children (www.census.gov/data/developers/data-sets/acs-1year.html). It may not be the divorce itself that is hard on children, but how the divorce is handled (ie, a

Clinical Update

Managing Video Gaming in Children and Teens

From The Carlat Child Psychiatry Report, Mood Disorders in Children and Adolescents

Topics: Computer addiction | electronic use | Free Articles | videogaming addiction

CCPR: We are here to talk about managing video gaming in children and adolescents, which is a ubiquitous habit that might be even more pronounced given that we’re in the middle of a pandemic. Dr. Dilley, can you start with the relationship between mood disorders and gaming? Dr. Dilley: There is a complex relationship between mood disorders and gaming

Article

Transcranial Magnetic Stimulation (TMS) for Depression in Children and Adolescents

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

Editor’s note: This article is about the “usual” TMS that we have been hearing about for many years. We are covering trigeminal nerve stimulation (eTNS) separately in this issue in a News of Note as it is far newer with far less clarity about its utility. The search for safer treatment With concerns about both safety and efficacy surrounding a

Research Update

Steroid-Induced Psychosis in the Pediatric Population

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

Review of: Hodgins GE et al, J Child Adolesc Psychopharmacol 2018;28(5):354–359 Childhood psychosis is a rare disorder, and accurate diagnosis is crucial. Recently, clinicians at the University of Miami Miller School of Medicine reported a case of steroid-induced psychosis in a pediatric patient. In the case report, a 12-year-old Haitian girl wa

Research Update

Risk of Psychosis With Stimulants in ADHD Patients

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

Review of: Moran LV et al, N Engl J Med 2019;380(12):1128–1138 In 2007, the FDA required stimulant manufacturers to warn of possible psychosis with stimulants. But what is the real incidence? This study set out to find and discern if there is a difference between methylphenidate and amphetamine classes of medications. Drawing from two large comm

Article

Cognitive Behavioral Therapy for Substance Use Disorders

From The Carlat Addiction Treatment Report, Dual Diagnosis in Addiction Medicine

Topics: Cognitive Behavioral Therapy | Free Articles | Substance Use Disorder

Cognitive behavioral therapy (CBT) is one of the most widely used psychotherapies. It was developed in the 1960s by Aaron Beck specifically for the treatment of depression, but its core principles were quickly adapted and applied to a variety of diagnoses. We now have evidence-based CBT interventions not only for depression but also for anxiety, PTSD, b

Clinical Update

Reducing the Stigma of Addiction Through Language and Terminology

From The Carlat Addiction Treatment Report, Substance Use in Health Professionals

Topics: Disparities | Engagement | Free Articles | Opioid Use Disorder | Stigma

The words we use in discussing addiction shape the way our patients, fellow clinicians, and communities think about substance use disorders. Addiction has long been viewed as a moral failing, and the terminology of addiction has reinforced this belief. Here, we review the evidence that documents how terminology can perpetuate—or reduce—the stigma as

Clinical Update

Breastfeeding and Addiction

From The Carlat Addiction Treatment Report, Addiction in Pregnancy

Addiction providers typically treat one patient at a time. But once we start working with a patient who is breastfeeding, that number jumps to two (or more in the case of twins, triplets, etc). Although breastfeeding has a host of infant health benefits, many providers do not feel confident managing patients who are nursing. In order to deliver the best

Clinical Update

An Unexpected Opioid: Loperamide Misuse

From The Carlat Addiction Treatment Report, Stimulant Use Disorder

Topics: Free Articles | Opioids | Over the counter medication | safety | Side Effects

Loperamide, a common antidiarrheal available at pharmacies across the country, has unexpectedly become one of the latest in a growing trend of over-the-counter medications being repurposed for recreational use. Over the past 10 years, the broader public has discovered that supratherapeutic doses of loperamide can result in opioid-like euphoric effects.

Clinical Update

Perioperative Pain Management in Opioid Use Disorder

From The Carlat Addiction Treatment Report, Integrating Pharmacotherapy and Psychotherapy

When your patients with opioid use disorder (OUD) develop pain due to medical illness or trauma, pain management can get tricky. When they seek pain control, they may be perceived as “drug seeking” in medical settings. Studies have shown that providing adequate pain management for these patients is a particular challenge (Department of Veterans Affa

Clinical Update

The “Z-Drugs”: Safety Issues and Misuse Potential

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Originally marketed as safer alternatives to benzodiazepines, the Z-drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—were considered devoid of misuse potential. But recent data and FDA warnings suggest we’ve been hitting the snooze on them for too long. Here, we review their risks and discuss safe prescribing. Medical risks

Clinical Update

Harm Reduction Strategies—A Primer

From The Carlat Addiction Treatment Report, Harm Reduction

As is frequently the case with chronic diseases, cure is often neither possible nor an appropriate goal in addiction treatment. That’s where the concept of “harm reduction” comes in. Such strategies can help prevent death, serious injury, or other negative consequences of substance use in patients who are continuing to use drugs or struggle with a

Expert Q&A

Getting Uncomfortable with Esketamine

From The Carlat Psychiatry Report, Esketamine

Esketamine (Spravato) was approved for treatment-resistant depression in 2019. In this interview, Dr. Williams (who has no relationship with Janssen Pharmaceuticals, Inc) addresses some lingering doubts that have been raised about the medicine. TCPR: Where does esketamine fit in the list of interventional therapies for depression, like repetitive tra

Clinical Update

A Potentially Lethal Side Effect You Probably Never Heard Of

From The Carlat Psychiatry Report, Telepsychiatry

In January 2020, the FDA issued a strong warning about constipation on clozapine. With a fatality rate of 1 in 1000, this is not just a nuisance side effect, and it can happen with other antipsychotics and psychotropics as well. This type of constipation is caused by slowing of the gut, or gastric hypomotility, and it requires a unique approach. Fiber s

Clinical Update

How to Prescribe Omega-3 Fatty Acids

From The Carlat Psychiatry Report, Living With Mental Illness

Omega-3 fatty acids (“fish oil”) claim broad benefits in physical and mental health and have even made it into a few treatment guidelines in psychiatry. But most products on the shelf do not have the right ingredients for psychiatric use. In this article, I’ll review how and when to use omega-3s. Mechanism Omega-3s are “essential fatty acids

Clinical Update

An Off-Label Guide to Gabapentin

From The Carlat Psychiatry Report, Schizophrenia

Gabapentin (Neurontin) is not a medication that would make the FDA proud. Less than 1% of its outpatient use is for an FDA indication, and a good portion of the off-label use takes place in psychiatry. These trends sparked a backlash in the 2000s, when Pfizer paid a $1.3 billion fine for misleading marketing practices. Recent reports of misuse of gabape

Clinical Update

ECT Worked: Now What?

From The Carlat Psychiatry Report, Therapy

Juan is a 72-year-old man with severe depression who has not responded to numerous antidepressant trials. He is reluctant to undergo a course of electroconvulsive therapy (ECT), but agrees to do so if one last medication trial doesn’t work. After failing to respond to escitalopram augmented with aripiprazole, Juan receives a course of ECT and has a te

Research Update

Lemborexant and Sleep Architecture in the Elderly

From The Carlat Psychiatry Report, Therapy

REVIEW OF: Moline M et al, J Clin Sleep Med 2021. Epub ahead of print. TYPE OF STUDY: Randomized, double-blind, parallel-group study As we age, sleep architecture worsens in ways that reduce sleep quality, particularly after age 55. Unfortunately, most hypnotics either do not improve sleep quality (eg, the z-hypnotics) or slightly worsen it (eg, t

Research Update

Comparison of GI Side Effects of Antidepressants

From The Carlat Psychiatry Report, Therapy

REVIEW OF: Oliva V et al, Prog Neuropsychopharmacol Biol Psychiatry 2021;109:110266 TYPE OF STUDY: Meta-analysis of placebo-controlled trials Antidepressants often cause gastrointestinal (GI) side effects, but it’s not clear which ones are the worst actors. A recent meta-analysis helps to clarify the picture. The investigators searched the li

Clinical Update

Disulfiram: An Underused Strategy for Alcohol Use Disorders

From The Carlat Psychiatry Report, Depression

Alcohol ranks third among preventable causes of death in the US, but it is by far the most undertreated. Fewer than 8% of people with alcohol use disorders (AUDs) receive treatment for their disease, and only a minority of them receive FDA-approved medications. Those medications are acamprosate (Campral), naltrexone (Vivitrol, ReVia), and disulfiram (An