Embracing Conflict in the Consent Process

Topics: Child Psychiatry | Practice Tools and Tips

What do you do when your teen patient declines an offer of medication yet the parents insist on it? How about if the teen is coming to you for medication and the parents are opposed to the idea? Does the teen have the right to request and receive medication? And what if the teen is using substances? CBD? Do you still treat, or do you refer elsewhere?

Assessing and Treating Psychogenic Pain

Topics: Addiction | Neuroscience in Psychiatry | Practice Tools and Tips

CATR: To start, can you give us your take on the neurological process around pain? What’s going on in the brain that causes a patient pain? Dr. Schubiner: All pain is generated by what the neuroscientists call a salience network, or as I like to call it, the danger alarm mechanism. All pain is real. It’s just a question of whether that pain is bein

Is EEG Useful in Psychiatry?

Topics: Diagnostic Testing | Neuroscience in Psychiatry | Practice Tools and Tips

Is it useful for psychiatrists to order EEGs on their patients? That’s a perennially controversial question, and one that’s worth revisiting from time to time. The basics of EEG First developed in the 1920s, EEG entails applying electrodes to the scalp’s surface to measure electricity generated by neural activity. The brain works primarily via

Neurofeedback in Psychiatry: What’s the Evidence?

Topics: Diagnostic Testing | Neuroscience in Psychiatry | Practice Tools and Tips

TCPR: You and your UMass colleagues recently reviewed the current research on the efficacy of neurofeedback in psychiatry (Begemann M et al, Trans Brain Rhyth 2016;1(1):19–29). But before going into the research, can you please describe what the procedure is and how it is done? Many of our readers wonder whether neurofeedback is a legitimate or effect

Warning Patients on the Dangers of Cannabis Use

Topics: Addiction | Practice Tools and Tips

CATR: To start, could you tell us a little about your work around substance use disorders, and specifically your experience with cannabis and adolescents? Dr. Gray: A large focus of my career has been on doing National Institutes of Health–sponsored research into better understanding substance use disorders in young people. So, that would include a

Note From the Editor-in-Chief

Topics: Practice Tools and Tips

For this month’s issue, I asked two experts in family and couples therapy to remind us of how crucial it is to communicate with family members of patients. In the rush of a clinical day, it’s often easiest to simply deal with whomever shows up to the appointment—typically just the patient. I plead guilty. Recently I evaluated a man in his 60s who

Involving Families Enhances Patient Outcomes

Topics: Practice Tools and Tips

You are treating Mr. A for a depressive disorder, and you ask if he can bring his wife to his next appointment. When the couple arrives, you say to Mrs. A, “Welcome, and thank you for coming with your husband today. You’ve known him longer than I have, and I’m sure you’ll have some important observations. You can also ask your husband whether he

Tips for Effective Family Meetings

Topics: Practice Tools and Tips

Alison Heru, MD, gives the following additional advice for conducting effective family meetings: Meet with your patient’s family members at the initial assessment. I usually then touch base with the family members intermittently and tell them they are welcome at any time. In a family meeting, you should reassure everyone—including the patient�

Holding Effective Family Meetings

Topics: Practice Tools and Tips | Psychotherapy

TCPR: Why is it important for psychiatrists to meet with families of patients? Dr. Keitner: If you want to comprehensively understand your patients and modify variables that might impact treatment and outcome, it’s important to understand families. There has been a lot of research showing that the family environment can have a significant influence

Tips on Managing Medications With Adolescents

Topics: Child Psychiatry | Practice Tools and Tips

Discussing medications with adolescents can be challenging. In general, my approach during the initial evaluation is to have a first evaluation appointment with the parents alone to gather relevant history, and then bring the teen back for a separate and individual appointment. Oftentimes, however, and particularly with older teens, I will see the famil

Note From the Editor-in-Chief

Topics: Practice Tools and Tips

While I appreciate all of my TCPR subscribers, there’s one subscriber whom I value above all the others: my father. A psychiatrist who practices in the Bay Area, my father has been a loyal subscriber since Volume 1, Number 1, in January of 2003. For several years now, he has been asking me to publish an issue on how to retire from a psychiatric practi

Understanding Risk-Taking in Adolescents

Topics: Child Psychiatry | Practice Tools and Tips | Psychotherapy

CCPR: Hello, Dr. Shatkin. Your latest book, Born to Be Wild, is about understanding why adolescents are impulsive and take so many risks. Why did you decide to write about this topic? Dr. Shatkin: I’ve long been interested in the public health perspective of psychiatry and the importance of prevention, and I began further exploring the reasons for

Financial Planning for Retirement

Topics: Practice Tools and Tips

TCPR: How is financial advising different for medical professionals? Wiens: Because of the lengthy period of training, doctors begin their first “real” jobs 8–10 years after many of their friends from college. And, depending on specialty, burnout may cause a physician to retire a few years earlier than the average American. Both these factors l

Psychopharmacology for Patients With Intellectual Disability

Topics: Practice Tools and Tips | Psychopharmacology Tips

Anne, a 23-year-old woman with moderate intellectual disability, comes into your office accompanied by a staff member of her group home. The staffer reports that Anne has been aggressive toward her roommate and has appeared more aloof over the last week. He is ­curious whether you can prescribe a medication to prevent future episodes of aggression.

Interviewing and Evaluating Patients With Intellectual Disability

Topics: Practice Tools and Tips | Psychopharmacology Tips

TCPR: Let’s start with the basics. What exactly is the definition of intellectual disability (ID)? Dr. Gentile: DSM-5 identifies it as an IQ of 70 or lower. Then there are ranges: mild, moderate, and severe/profound. Someone in the mild range has an IQ, generally, of 70 at the upper end and 50 to 55 at the lower end. The moderate range is 50 or 55

Psychotherapy for the Intellectually Disabled: The Skills System Approach

Topics: Practice Tools and Tips | Psychotherapy

Patients with intellectual disability often have difficulty controlling their emotions, which is what leads to so-called “challenging behaviors.” These behaviors include a range of aggressive and impulsive interactions, such as assault to self or others, stealing, fire-setting, sexual offenses, and other problematic situations. These are, unfortunat

Helping People With Co-Occurring Mental Health and Substance Use Disorders

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

Patients with co-occurring disorders (COD, also known as “dual diagnosis”) are often regarded as among the most challenging patients to treat. You need to track two conditions that interact in unpredictable ways, with patients who may not be inclined to follow your recommendations. It’s no surprise that such patients typically have poorer outcomes

When Dual Diagnosis Patients Request Addictive Medications: What to Do?

Topics: Practice Tools and Tips | Substance Abuse

CATR: A common dual diagnosis scenario is that we are treating a patient for depression or anxiety, the patient is on an SSRI and a benzodiazepine, and then suddenly we find out the patient is also on methadone maintenance or has been using medical marijuana regularly. Then we have to decide what to do. For example, should we continue to prescribe the b

Take The CME Post-Test for Dual Diagnosis, CATR, August 2017

Topics: Practice Tools and Tips | Psychopharmacology Tips | Research Updates | Substance Abuse

The post-test for this issue is available for one year after the publication date to subscribers only (December 31, 2017). By successfully completing the test you will be awarded a certificate for 1 CME credit. Click here to take your CME test. Note: All of the CME tests are available in the “My Account” section of the site when you are logged

ConsumerLab.com: Guiding Patients Toward OTCs That Won’t Hurt Them

Topics: Anxiety Disorder | Natural Medications | Practice Tools and Tips

“It’s rare that my patients don’t at some point or another try an over-the-counter sleep aid, anxiety preparation, or antidepressant supplement,” says TCPR board member Richard Gardiner, MD, who practices psychiatry in Mendocino County, California. While supplements may be helpful—we covered this topic in TCPR’s November/December 2016 issue�