Eight Strategies to Help Patients Maintain Recovery

Topics: Addiction | Practice Tools and Tips | Psychotherapy

Robert is a 48-year-old executive who was suspended from his job after getting a DUI that was reported in a local newspaper. He was referred to you after completing a 30-day court-ordered rehabilitation program. When he comes to your office, he appears anxious and withdrawn, and he makes little eye contact. He reports a desire to stay sober, but admits

Recognizing and Reversing Relapse

Topics: Addiction | Practice Tools and Tips | Psychotherapy

I first met 32-year-old Miranda after a drug relapse that followed a stay in a residential addiction treatment facility. She had begun experimenting recreationally with prescription opioids in her early 20s, but her use escalated after she was involved in a car accident a few years later and a doctor began prescribing opioids for pain. Because of her in

Treatment vs. Recovery

Topics: Addiction | Practice Tools and Tips | Psychotherapy

CATR: You have seen recovery from two perspectives—a person in recovery and a person who treats substance use disorders. What does it mean to be in recovery? Mr. Pond: For many people, the word “recovery” means being in AA or another 12-step program where the goal is to stay abstinent. It’s a culture of mutual support where people help and a

Managing Behavioral and Psychological Symptoms of Dementia (BPSD)

Topics: Dementia | Practice Tools and Tips | Psychotherapy

Richard is an 88-year-old former airline pilot who was diagnosed with Alzheimer’s dementia 5 years ago. He managed well at home with his wife initially, but a year ago he required admission to a skilled nursing facility because of worsening symptoms. His transition was difficult. Sometimes he hovered around the exit door and elevators and tried to lea

Cognitive Behavior Therapy for Insomnia

Topics: Practice Tools and Tips | Psychotherapy | Sleep Disorders

TCPR: Dr. Perlis, you are one of the major researchers of cognitive behavior therapy for insomnia. Why are you so interested in the topic of insomnia? Dr. Perlis: Because insomnia is so ubiquitous and misunderstood with respect to its health consequences and “treatability.” At the core of this is the widespread misconception that insomnia is prim

Treating Tourette’s Disorder

Topics: Child Psychiatry | OCD | Practice Tools and Tips | Psychotherapy

David was a 12-year-old boy referred for consultation by his child psychiatrist for help in managing his severe Tourette’s disorder. David had developed onset of eye blinking at age 6 in the context of problems paying attention in his first-grade classroom. He tended to call out answers and wasn’t completing tests or his homework. By age 8, he had d

Assessing and Diagnosing Tic Disorders

Topics: Child Psychiatry | OCD | Practice Tools and Tips

CCPR: Would you describe your clinical work in tic disorders and how that operates? I think readers will want to know about the number of patients you see and how the clinic is structured. Dr. Greenberg: I work in the obsessive compulsive disorder (OCD) and related disorders program, and I see both kids with tics and OCD or OCD-related disorders as w

From the Street to the Prescription Pad: Psychedelics Return to Psychiatry

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

You’ve been treating Bob, a 37-year-old combat veteran with refractory PTSD, for the past 15 years. After two psychotherapists gave him a club drug, he returns to your office reporting he’s been symptom-free for two months. Jean, a 67-year-old woman you’ve been treating for anxiety associated with stage 4 breast cancer, tells you that after ­inge

MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder

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

Ms. Petitt’s manages the program that selects and trains researchers for the MDMA-assisted psychotherapy protocols MAPS Public Benefit Corporation is conducting. The program has reviewed 300 applicants, and is in the midst of training 80 people who will work on therapy teams for Phase 3 trials. In addition to the training program, Ms. Petitt has also

Understanding Pharmacogenetics Research

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

TCPR: Dr. Uher, you have been a co-investigator on the major studies of pharmacogenetics in psychiatry. It’s a complicated field, and I thought you could explain how the research is actually done. Dr. Uher: The basic goal of this kind of research is to try to find an association between a genetic variant and the clinical response to a particular m

Switching Antidepressants May Be No Better Than Staying the Course

Topics: Depressive Disorder | Practice Tools and Tips | Research Update

Review of: Bschor T, Kern H, Henssler J, Baethge C. Switching the antidepressant after nonresponse in adults with major depression: A systemic literature search and meta-analysis. J Clin Psychiatry 2016. doi:10.4088/JCP.16r10749. [Epub ahead of print] Study type: Meta-analysis Clinical trials have shown that the response rate of major depression t

Promoting Children’s Gender Health: A Guideline for Professionals

Topics: Child Psychiatry | Practice Tools and Tips

Monique (The patient’s name has been changed for privacy purposes.) is an African-American 16-year-old youth from a small city in Southern California who lives with her foster parents. She was referred to a community-based mental health provider because of significant depression and anxiety. In working with her, the therapist discovers that gender wor

Identifying and Deterring Drug Abuse and Diversion via PDMPs

Topics: Practice Tools and Tips | Substance Abuse

David is a 30-year-old male referred by the department of corrections after spending two years in jail for drug possession. On interview, he says he has “extreme social anxiety” that’s kept him out of work for several years. He also cites difficulty concentrating due to “adult ADD.” He looks relaxed and comfortable, and says he can’t recall

Using Natural Supplements

Topics: Natural Medications | Practice Tools and Tips

Patients are increasingly asking us about complementary and alternative treatments for their psychiatric issues. If you don’t know much about these treatments, you may end up saying something like, “Well, we don’t have as much data on these as we do for standard treatments—they might help, but we just don’t know. Let me refer you to….”

Benefits of Alpha-Stim

Topics: Brain Devices | Depressive Disorder | Natural Medications | Practice Tools and Tips

Buprenorphine Treatment to Be Expanded

Topics: Practice Tools and Tips

Two recent federal initiatives have catapulted buprenorphine to the forefront of treatment for opioid use disorders. On July 6, 2016, the federal Department of Health and Human Services (HHS) published a final rule that raised the number of patients a single physician can treat from 100 to 275. Then, on July 22, President Obama signed the Comprehensive

Managing Drug-Seeking Patients

Topics: Practice Tools and Tips | Substance Abuse

CATR: What’s your initial approach to patients who ask for controlled substances? Dr. Raskin: First, it’s important to exclude the possibility that someone may have an unrecognized or undertreated medical condition. In an addiction treatment setting, this has often been done before the patient sees you, but in other settings it can be more chall

Sexual Side Effects of the Newer Antidepressants

Topics: Practice Tools and Tips | Psychopharmacology Tips | Sexual Dysfunction

It’s no secret that SSRIs and SNRIs cause sexual dysfunction (SD) in a large proportion of patients who take them. The exact size of that proportion, though, is difficult to pinpoint with any reliability. Most of the large clinical trials of antidepressants ascertain side effects through spontaneous reports, and research subjects are understandably em

Discussing Side Effects With Patients

Topics: Practice Tools and Tips

TCPR: Dr. Mago, you’ve taken quite an interest in teaching about side effects of medications. Dr. Mago: Yes, I got interested in doing research on and teaching about side effects because I could not get answers to the questions that came up in my patients. I think that as clinicians, we need to fully understand the importance of side effects for o

Substance Abuse in Health Care Professionals

Topics: Addiction | Practice Tools and Tips

Dr. Jones is a popular and successful primary care doctor. Over the last few months, though, colleagues have noticed that he hasn’t seemed himself. He’s been seen in the hospital at odd hours, his normally professional demeanor has turned snappish, and at times he smells strongly of sweat and cigarettes. Patients have started complaining that he has