Oxcarbazepine: Close, but no Cigar

Topics: Bipolar Disorder | Carbamazepine | Free Articles | Mania | Mood Stabilizers | Oxcarbazepine | Pharmacology | Psychopharm Myths | Psychopharmacology

You are selecting a mood stabilizer for a 29-year-old woman with mania. If it works, she’ll need to take it long term, but with adherence rates hovering around 50% in this illness, that’s not a likely prospect. The FDA-approved options are not very high on tolerability, but what about oxcarbazepine? Oxcarbazepine (Trileptal) is often used in bipo

Using Mental Health Apps

Topics: Behavior therapy | Brief psychotherapy | Computers in Psychiatric Practice | Free Articles | Health Apps | Therapy during medication appointment | Therapy with Med Management

TCPR: Computer-assisted therapies have been around for decades. What makes mental health apps different? Dr. Torous: Computers have been used to support psychotherapy in many forms—email, video conferencing, texting, and online or desktop programs. Mental health apps take this to another level because they work through a device that most people keep

A Second Look at Genetic Testing

Topics: Free Articles | GeneSight | Genetic Testing | Pharmacology

Genetic tests are marketed with a bold claim: that a handful of genes can predict medication response. AssureRx’s GeneSight is the most popular of these tests, and in 2015 we reviewed the evidence behind its panel. In short, it was lacking, but the company has just released new data that may move it a little closer to the mainstream. What’s

Practicalities of Providing Volunteer Services for Youth Refugees or Asylum Seekers

Topics: Family Separation | Free Articles | Registered Articles | Trauma

We hear of many children and adolescents who are refugees, most seeking asylum. There are calls for professionals to meet the needs of these people. How hard is it to do this—to take time off from regular practice to work in a different setting? It’s easier than you might think. However, is this kind of work as rewarding as people say? Can it be a r

The FDA Campaigns Against Flavored Tobacco Products

Topics: eCigarettes | Free Articles | Smoking Cessation | Tobacco | Vaping

Electronic cigarette use, or vaping, is becoming increasingly common. Companies manufacturing e-cigarettes advertise them as alternatives to conventional cigarettes and even a pathway to smoking cessation. However, the popularity of vaping has sky-rocketed in high schools across the country with adolescents becoming addicted to nicotine daily. Monitorin

Does Mania Follow the Sun?

Topics: Bipolar Disorder | Free Articles | Mania

TABLE : SPRINGTIME MANIA Click here for the full PDF table showing sunlight peaks.   If dark nights can treat mania, can too much sunshine destabilize it? Yes and no. Mania is linked to rapid changes in sunlight, but not to the amount of light itself. Mania peaks in early spring when there’s a steep rise in sunlight. By the time the longe

Prescription CBD Is Available, But Are We Ready to Use It?

Topics: Anxiety | Cannabidiol | Free Articles | Psychopharmacology

Your patient comes in with a new medication on his list: CBD oil. He started taking it for anxiety and wants to know if it’s safe. You hedge, explaining that there is limited information available on unregulated products, but the patient is persistent. He says CBD oil is available as a prescription, and wonders if you could write one for it. Cannab

Wilderness Therapy: Dangerous Waste of Money or an Effective Therapeutic Intervention?

Topics: Child Psychiatry | Free Articles | Wilderness Therapy Programs

Wilderness therapy programs, aka “outdoor behavioral health programs,” purport to offer structured outdoor experiences for adolescents or adults that lead to psychological shifts and better functioning. Programs vary in length from a few days to months, although 30–90 days is common. The outdoor experiences include camping, canoeing, hiking, rock

Coffee: Healthy Study Aid or the Addiction We Hate to Acknowledge?

Topics: Addiction | Caffeine | Free Articles | Registered Articles | Substance Abuse

Caffeine permeates our society. It comes in many forms, including coffee and increasingly popular energy drinks. We consume it, and so do our patients. So, is it a harmless habit or a potentially harmful addiction? Let’s take a sip and find out. Is it addictive? The WHO in ICD-10 recognizes the diagnosis of substance dependence due to caffeine, an

Opioid Treatment Options

Topics: Free Articles | Practice Tools and Tips | Psychopharmacology Tips | Substance Abuse

Opioid use disorder (OUD) treatment can be tricky, in part because it doesn’t respond well to detox and counseling-only approaches. The overwhelming majority of people relapse after such attempts, or even become more vulnerable to overdose because of decreased tolerance after detoxing. And the trajectory in this country is worsening—in 2016, we aver

Does TMS Really Work in Depression?

Topics: Depressive Disorder | Free Articles | Research Update

Review of: Yesavage et al, JAMA Psychiatry 2018;75(9):884–893 Type of study: Randomized, sham-controlled trial Repetitive transcranial magnetic stimulation (rTMS) has been FDA-approved for treatment-resistant depression (TRD) since 2008. This non-invasive therapy uses an electromagnetic coil to stimulate electrical activity in the frontal cortex

Assessing and Treating Violence in Patients

Topics: Child Psychiatry | Free Articles | Practice Tools and Tips

School shootings keep happening in the US, and most of us have wondered at times whether one of our patients might carry out a violent act, shooting or otherwise. This article will help you assess and treat violent youth and advise families who are grappling with these issues. Most people with mental health conditions do not hurt others—our patients

Is Cannabis Bad for Cognition?

Topics: Free Articles | Research Update | Substance Abuse

Review of: Cobb SJ et al, JAMA Psychiatry 2018;75(6):585–595 Our patients typically tell us that, according to the internet, weed is perfectly safe and does not affect their ability to think or function. Thirty states and the District of Columbia have laws legalizing cannabis, supporting the notion that people have begun to think of marijuana as re

Behavioral Strategies for Suicide Prevention

Topics: Depressive Disorder | Free Articles | Psychotherapy

What can you do—beyond prescribing medications—to help your patients who have suicidal ideation? There are many strategies that you can teach your patients, even in the context of brief psychopharm visits. In this article, I’ll describe eight behavioral strategies that your patients are likely to find helpful. They are adapted from cognitive behav

Ask the Editor: Three Significant Food Interactions with ADHD Medications

Topics: Free Articles | Practice Tools and Tips | Psychopharmacology

Each month, Editor-in-Chief Chris Aiken, MD, gives advice on a different practice challenge. If you have a question you’d like Dr. Aiken to answer, please send an email to AskTheEditor@thecarlatreport.com. Dr. Aiken won’t be able to answer all questions received but will pick one each month that is of general interest. Dear Dr. Aiken: Patients of

Opioids Not Superior to Other Medicines for Some Chronic Pain

Topics: Addiction | Free Articles | Research Update | Substance Abuse

REVIEW OF: Krebs EE et al, JAMA 2018;319(9):872–882 Rising rates of opioid overdose deaths have sounded alarm bells over opioid prescribing practices for chronic pain. Unfortunately, and despite the absence of quality data on their risks vs benefits, long-term opioid management has remained a common approach to managing chronic musculoskeletal pain

The 10 Commandments for Verbal De-Escalation

Topics: Free Articles | Practice Tools and Tips

This text has been adapted with permission from the 10 Commandments for Safety by Avrim Fishkind, MD. Respect personal space: 2 arm-lengths. Do not be provocative. Body language is important. Do not cross your arms, stare, or conceal your hands. Establish verbal contact. Introduce yourself by name and title. Only 1 person should verbally inte

Bullying and Suicidality: Some Practical Tips

Topics: Bullying | Depression | Free Articles | Suicidality

What can you do when one of your patients reports being bullied? Research has shown that being bullied increases the risk of depression, anxiety, and suicidality in children. In this article, we’ll give you some tips for how to ask about bullying, how to assess its impact, and how to help your patients and their families deal with the problem. How

Non-Addictive, Pharmacological Options for Sleep

Topics: Addiction | Free Articles | Psychopharmacology Tips | Sleep Disorders | Substance Abuse

In this month’s interview with Dr. Eric Hermes, we learned about his approach to treating insomnia in patients with substance use disorders, with a focus on cognitive behavioral therapy. In this article, we’ll look at some non-addictive pharmacological options. That means we’re not going to review any of the benzodiazepines or the non-benzodiazepi

Antidepressant Augmentation Strategies: A Basic Guide

Topics: Antidepressants | Free Articles

Here’s a common scenario. You have a patient who has tried three or four antidepressants over the years; all have been somewhat effective at least initially, but eventually that effectiveness waned. Let’s imagine that the patient you’re seeing now is on antidepressant number 4, Lexapro, at a solid 20 mg dose. You could always keep pushing the d