Informed Consent: An Ongoing Process for Focused Care

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

Informed consent is a foundation for good clinical practice and can provide legal protection. But informed consent is more than defensive medicine. It is a vehicle for framing good care. How often do people use the consent process? Malpractice companies recommend that the patient (or parent) sign consent whenever a medication is started. This might b

Benzodiazepines for Anxiety: Where They Fit In

Topics: Anxiety | Anxiety Disorder | Free Articles | Registered Articles

Benzodiazepines (BZDs) are widely used, rarely studied, and much maligned. So where exactly do they fit in today’s medication arsenal for treating anxiety? In this article, I will discuss when BZDs are appropriate and when they are not, and how to choose among the various BZDs. But before doing so, let’s first address the elephant that always see

Clozapine: A Fresh Look

Topics: Antipsychotics | Free Articles | Pharmacology Tips | Practice Tools and Tips

Several trials show it to be a superior treatment option, yet clozapine remains the “red-headed stepchild” of antipsychotics. Even though large studies reveal clozapine has impressive efficacy, particularly with treatment-resistant schizophrenia, many of us are reluctant to use it. According to one study, of the 30% of patients who have treatment

Abilify MyCite: Patient Care Breakthrough or Patent Extender?

Topics: Antipsychotics | Free Articles | Pharmacology Tips | Practice Tools and Tips

You’ve probably heard about a new “digital pill” called Abilify MyCite. The product, which was FDA approved in November 2017, is the first drug in the U.S. with a digital ingestion tracking system. MyCite consists of an aripiprazole pill that contains an embedded tiny sensing device (about the size of a grain of sand) called the ingestible even

Lithium: Practical Considerations for Children With Suicidal Thinking

Topics: Child Psychiatry | Depressive Disorder | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Billy, age 10, has periods of intense aggression alternating with moments of wanting to be dead, severe mood swings, poor sleep, and pervasive irritability. He has a family history of bipolar disorder. Other family members have responded well to lithium. Since they want to act assertively to help him, Billy’s family is open to medication trials and an

The Bipolar Spectrum: Practical Tips for Diagnosis and Treatment

Topics: Bipolar Disorder | Free Articles

Bipolar disorder has long been controversial in the field. Is it overdiagnosed or underdiagnosed? Does a “bipolar spectrum” truly exist, or is it a marketing tool for pharmaceutical companies that want you to prescribe more atypical antipsychotics? At a minimum, the bipolar spectrum includes those patients who meet criteria for both bipolar I and

Helping Patients With Stigma and Addiction

Topics: Addiction | Free Articles | Practice Tools and Tips

CATR: To start, can you please tell us a little more about your work at Harvard and Mass General? Dr. Kelly: Sure. I’m a clinical psychologist by training, and for the past 20 years, I have spent a lot of time researching the addiction treatment and recovery processes. I’ve looked at the effectiveness of different treatments, their mechanisms, an

Assessing Complex PTSD

Topics: Free Articles | PTSD

TCPR: We’ve been hearing more the last few years about the concept of complex PTSD. I know that there are similarities with conventional PTSD—which is covered in the DSM-5—but can you explain to our readers how complex PTSD is different from conventional PTSD? Dr. Schwartz: The first thing that I would say is that complex PTSD can sometimes be

Retirement Toolkits

Topics: Free Articles | Retirement

Presented in Partnership With the American Psychiatric Association These resources include materials that the American Psychiatric Association (APA) provides exclusively to its members, along with other practice management resources. Permission was granted to Carlat Publishing to provide them to its readership on a one-time basis. For information

Closing a Practice: Some Practical Suggestions

Topics: Free Articles | Practice Tools and Tips

Dr. R is a psychiatrist in his late 60s with a thriving private practice. One day, he suddenly feels dizzy and out of sorts. After being examined by another physician, he is diagnosed with a stroke. His neurologist cannot say if he will fully recover or be able to practice medicine again. Dr. R and his family know that he might suddenly need to retire.

Pharmacogenetic Testing: An Update

Topics: Diagnostic Testing | Free Articles | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

Given how many essentially equivalent medications we have to choose from, how great would it be to have a test that tells us which drug to prescribe for which patient? Everybody wants personalized medicine, and in some other specialties, such as oncology, this is becoming a standard part of treatment. In this article, we’ll review some of the basics o

Open Dialogue: A Novel Approach to Treating People With Psychotic Disorders

Topics: Free Articles | Inpatient Psychiatry

You are an attending on the inpatient unit of your community psychiatric hospital, and the nursing staff informs you of a new admission. Mary is a 26-year-old single woman with schizophrenia; this is her third psychiatric admission. For the past week, Mary has been feeling more suspicious, and she hasn’t been eating much due to a belief that she is be

How to Treat Adult ADHD

Topics: ADHD | Free Articles | Practice Tools and Tips

Over the past decade, it’s become apparent that ADHD does not suddenly end when children grow up, and that the disorder often continues into adulthood. Since 2011, I have run a clinic specializing in adult ADHD. ADHD is relatively common in adults, with conservative estimates of a 4%–5% prevalence in the adult population, equal in men and women (htt

From Infantile Autism to Autism Spectrum Disorder

Topics: Autism Spectrum Disorder | Child Psychiatry | DSM | Free Articles

Changes in diagnostic criteria not only affect the clinical and public perception of a disorder, but also its perceived prevalence. Such is the case with autism. The evolution of the autism diagnosis since it was introduced into the Diagnostic and Statistical Manual (DSM) in 1980 inarguably has altered its reported prevalence, rising from an estimated 1

Dialectical Behavior Therapy for Substance Use Disorders: A Primer

Topics: Addiction | Cognitive Behavioral Therapy | Free Articles | Substance Abuse

Angela is a 27-year-old woman who was just discharged from the hospital after a suicide attempt following her second arrest for DUI. She says she only drinks on the weekends, but she recently lost her third job due to absenteeism. She doesn’t like AA, and she was kicked out of residential substance abuse treatment after the staff caught her scratching

Reports of Gabapentin Misuse and Abuse Appear to Be True

Topics: Addiction | Free Articles | Substance Abuse

Gabapentin is FDA-approved for seizures and neuropathic pain, but it’s commonly used off-label for a variety of psychiatric and physical conditions, including anxiety, insomnia, borderline personality disorder, alcohol use disorders, and multiple pain disorders. Another aspect of gabapentin use that has come to light in recent years is a seemingly per

Psychopharmacology in Jails: An Introduction [Free Article]

Topics: Antidepressants | Antipsychotics | Anxiety Disorder | Free Articles | Gender & Sexuality | Practice Tools and Tips | Psychopharmacology Tips

Taking Back Control in Binge Eating Disorder

Topics: Child Psychiatry | Eating Disorders | Free Articles

Confined to the appendix in previous editions of the Diagnostic and Statistical Manual (DSM), binge eating disorder (BED) took a leap into the spotlight with its inclusion as an official diagnosis in 2013’s DSM-5. It is one of the more controversial of DSM-5 disorders, with some claiming that BED inappropriately turns overeating and obesity into a psy

Eating Disorders: Assessment and Treatment

Topics: Child Psychiatry | Eating Disorders | Free Articles | Inpatient Psychiatry

Conduct Disorder and Oppositional Defiant Disorder: A Primer

Topics: Child Psychiatry | Cognitive Behavioral Therapy | Free Articles | Practice Tools and Tips | Psychotherapy

Vignette: Richie was a 15-year-old boy referred for evaluation after multiple run-ins with the police for drug possession, fighting, and shoplifting. Richie was the oldest of three boys and looked up to a gang-involved cousin who was in prison for drug trafficking. The patient was enrolled in multisystemic therapy (MST) for both treatment and further e