How to Treat Opiate Use Disorders

Topics: Addiction | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Opiate use disorder is increasingly common, and it is important to develop a systematic approach for treating it. In this article, I will discuss some of the more important elements of treatment, starting with the need to address patients’ denial and moving on to some of the nitty gritty aspects of medication-assisted treatment. Acknowledging the p

Addiction and Family: What You Need to Know

Topics: Addiction | Free Articles | Substance Abuse

George F. Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), doesn’t like the word “codependency,” and he likes the word “enabling” even less. “Codependency is a pejorative word, and it implies that someone else is at fault—and one of the major components of Alcoholics Anonymous is to take full responsib

The Explosion of the ADHD Diagnosis: The Key Causes

Topics: ADHD | Child Psychiatry | Free Articles

Rates of ADHD have increased significantly in the U.S. over the past several years, leading to an ongoing debate about the validity of the disorder. Because you are likely to be asked by patients (or their parents) about this issue, it’s helpful for you to have some background in exactly how much the prevalence has increased, and what factors may be d

Diagnosing Depression in Children and Adolescents

Topics: Child Psychiatry | Depressive Disorder | Free Articles

Today, the idea that adolescents and children, even young children, can have a major depressive disorder is widely accepted, but that was not always the case. Debates about the age at which “true” depression could manifest itself were widespread in child and adolescent psychiatry through the late 70s and into the early 80s (Pataki CS and Carlson GA,

The Twelve Steps Explained

Topics: Addiction | Free Articles | Substance Abuse

Step 1: The surrender  “We admitted we were powerless over alcohol—that our lives had become unmanageable.” The first step may happen on the first day a patient gets into treatment, or it may be what brings the patient to treatment. But much of the time, this step requires help: Someone needs to ask the questions to make the patient understand

Antidepressant Use in Children and Teenagers

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

Telepsychiatry: What You Need to Know

Topics: Free Articles | Practice Tools and Tips

The Carlat Psychiatry Report last covered telepsychiatry back in 2010. At that point, it seemed like a cool technology that some of you might want to use. Since then, telemedicine in general has taken off, with an estimated 67% of physicians using or planning to use telehealth in their practices. The appeal of telemedicine is clear, especially for ps

Are Skype, FaceTime, and Google Hangouts HIPAA Compliant?

Topics: Free Articles | Practice Tools and Tips

As you undoubtedly know, one of the purposes of HIPAA, a law originally passed in 1996, is to regulate the flow of protected health information (PHI). It says that you are allowed to communicate PHI in certain circumstances—like to collaborate with other doctors or to get paid by insurance companies. But it also lays out a series of safeguards that yo

Foster Care and Child Psychiatry: A Primer

Topics: Antipsychotics | Child Psychiatry | Free Articles | Practice Tools and Tips | Psychopharmacology Tips | Psychotherapy | PTSD

In this issue of CCPR we focus on the treatment of children in foster care systems. Nearly one in three of these children have significant psychiatric problems during their time in foster care—especially those related to trauma and neglect that brought them into the system (McMillen JC et al, J Am Acad Child Adolesc Psychiatry 2005;44(1):88–95). Rec

Taking the Worry Out of Social Anxiety Disorder [Free Article]

Topics: Anxiety Disorder | Free Articles

The Vast Landscape of Services that is “Rehab”

Topics: Addiction | Free Articles | Practice Tools and Tips | Psychotherapy | Substance Abuse

If a patient comes in and says, “doc, I think I need to go to rehab,” what should you do? Most people think of rehabs as residential facilities, but these days, the term “rehab” includes a broad spectrum of treatment settings, most of which, in fact, are not residential—only 10% of people receiving specialized addiction services go to resident

Fisher Wallace and Alpha-Stim for Depression? Claims vs Evidence

Topics: Brain Devices | Depressive Disorder | Free Articles | Practice Tools and Tips

Carly Simon swears by it. The daytime show “The Doctors” gave it a glowing review. Ads for it seem to be invading psychiatrists’ Google search results. We’re talking, of course, about the Fisher Wallace Stimulator, touted by the manufacturer as being an effective treatment for depression, anxiety, insomnia, and pain (Fisher Wallace website). The

Medication Strategies for Helping People with Autism Spectrum Disorders

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

Getting meds just right is challenging in autism. Sometimes we succeed. For example, a woman with minimal verbal ability is extremely aggressive. She is on a number of medications including valproate 1000 mg extended release, paroxetine 40 mg, ziprasidone 40 mg twice a day, alprazolam 1 mg twice a day, and a host of supplements. She settles down conside

OCD in Kids: CBT, SSRIs, Then What?

Topics: Child Psychiatry | Cognitive Behavioral Therapy | Free Articles | OCD | Research Updates

Pharmacotherapy for Alcohol Dependence

Topics: Addiction | Free Articles | Substance Abuse

Chances are good that we under-medicate alcoholics. According to one estimate, only 10% of alcoholics receive medications as part of their treatment (Jonas DE et al, JAMA 2014;311(18):1889–1900). That’s too bad, because these medications work. In the interview in this issue, we learn from Amy R. Krentzman, MSW, PhD, about techniques from positive

The New FDA-Approved EEG Test for ADHD: Should You Order It?

Topics: Antipsychotics | Child Psychiatry | Free Articles

Over the decades, finding a truly useful objective diagnostic test in psychiatry has proven both elusive and frustrating. The latest candidate is a device called the NEBA system, which was approved by the US Food and Drug Administration (FDA) in July of 2013. NEBA stands for Neuropsychiatric EEG-Based Assessment Aid for ADHD, and the FDA has allowed

How to Diagnose and Treat Gambling Disorder

Topics: Addiction | Free Articles

Your typical patient with a gambling disorder may not fit yesterday’s stereotype. Consider this case study: A 42-year-old woman presented for relationship issues and problems with gambling. She had begun gambling by buying scratch tickets when she was in her early 30s. At times, she would spend up to $300 per day on these lottery tickets. She ha

Vyvanse: A Look at America’s Most Prescribed Stimulant

Topics: ADHD | Child Psychiatry | Free Articles

Why has Vyvanse become by far the most prescribed stimulant in the United States? Great marketing? A great product? Some combination of the two? And more to the point, should you continue to choose it over its much cheaper competitors? Read on for our take on the Vyvanse phenomenon. Vyvanse (lisdexamfetamine) was first approved by the US Food and Dru

How to Use The ASAM Criteria in Your Practice

Topics: Free Articles | Practice Tools and Tips

The ASAM Criteria—the American Society of Addiction Medicine’s guidelines for addiction treatment—are not just a tool for program administrators and insurance bureaucrats. They provide a useful conceptual framework for thinking about your patients and what kind of care they need. In addition, insurance companies and government agencies often requi

Cognitive Enhancers: Smart Drugs or Bad Idea?

Topics: Addiction | Free Articles | Substance Abuse

Most of us prescribe cognitive enhancers every day. Examples include stimulants for attention-deficit/hyperactivity disorder (ADHD) and various dementia medications. Modafanil (Provigil), which is prescribed for sleep apnea and shift work sleep disorder, probably fits the bill, too. But today’s conversation about “smart drugs” is fundamentally