Probuphine: Promises and Problems

Topics: Addiction | Practice Tools and Tips | Psychopharmacology Tips

Ever wish you could improve treatment compliance among your patients who receive buprenorphine? Ever wish you could offer them the benefit of sublingual buprenorphine while avoiding the risk of diversion and abuse? Well, now you can—maybe. In May of this year, the FDA approved Probuphine, an implantable form of buprenorphine that lasts up to six month

Treating Addiction in Health Care Professionals

Topics: Addiction | Practice Tools and Tips

Evaluating and Treating Pain in Psychiatric Patients

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

TCPR: Dr. Clark, recently a local pain clinic asked me if I wanted to do some psychiatric consultation there. I ended up declining, partly because I really didn’t know what I was supposed to do as a psychiatrist working in a pain clinic. Can you provide some insight? Dr. Clark: I think psychiatrists are being underutilized in chronic pain managemen

Vilazodone Not Effective for Cannabis Dependence

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

Applying Dialectical Behavior Therapy to Addiction

Topics: Addiction | Cognitive Behavioral Therapy | Practice Tools and Tips | Substance Abuse

What’s New with the FDA Labeling for Pregnancy and Lactation?

Topics: Pharmaceutical Industry | Practice Tools and Tips | Psychopharmacology Tips | Women's Issues in Psychiatry

We’ve been hearing for some time now about the FDA’s plans to revise the long-standing categories A, B, C, D, and X designations for risk of using medications in pregnancy. The new rule (referred to as PLLR for Pregnancy and Lactation Labeling Rule) was proposed in 2008, finalized in 2014, and implementation began during the summer of 2015. What

How to Evaluate and Treat Mood Disorders in Pregnancy

Topics: Mood Stabilizers | Pharmaceutical Industry | Practice Tools and Tips | Psychopharmacology Tips | Women's Issues in Psychiatry

I’m a Psychoanalyst—and Here’s Why I Love It

Topics: Practice Tools and Tips | Psychotherapy

Some of you might be surprised to see an entire issue of The Carlat Psychiatry Report devoted to psychoanalysis. Do psychiatrists still practice it? Does it actually work? To paraphrase Mark Twain, the demise of psychoanalysis has been greatly exaggerated. I am an early-career psychiatrist, trained in a mainstream residency, and I prescribe medicati

Anger, Anxiety, and Pain: A Description of an Analytic Session

Topics: Practice Tools and Tips | Psychotherapy

[Editor’s note: Due to confidentiality concerns, patient details are fictionalized, but are representative of common clinical issues.] The patient is a 31-year-old, single female attorney, who was referred by her primary care physician for somatic complaints that have been worked up thoroughly, with normal results. In the past, she has been worried

Motivational Interviewing: Ten Tips

Topics: Addiction | Practice Tools and Tips | Substance Abuse

1. Be curious, not an expert. Training and expertise can get in the way of our really hearing the client’s story. For example, a client says “I don’t think my drinking is a problem.” Some of us are indoctrinated in the concept that denial is a part of the addiction problem—and in this case we might automatically interpret this statement as de

Five Psychoanalytic Concepts for Your Practice

Topics: Practice Tools and Tips | Psychotherapy

Psychoanalytic training may not be right for you, but here are some analytic concepts that can be useful to anyone practicing psychiatry. ~ The unconscious: Patients are often unaware of patterns of behavior and their underlying conflicts. Unacceptable feelings like aggression and sadness may be banned from conscious thought, and therefore inaccessi

Early Trauma and Epigenetics: Can Psychotherapy Demethylate Our Genes?

Topics: Practice Tools and Tips | Psychotherapy

We know that childhood trauma can scar our patients psychologically—but new research suggests it might actually change their genes. The effect of the environment on genetics is referred to as epigenetics. In one study, monkeys who had been separated from their mothers were found to have widespread methylation of their DNA (Provencal N et al, J Neurosc

How Psychoanalysis Works

Topics: Practice Tools and Tips | Psychotherapy

TCPR: Dr. Plakun, what would you say is the essence of psychoanalysis? Dr. Plakun: It’s both a form of treatment and a theory of mind and development. The treatment involves the exploration of the unconscious meaning of symptoms and behaviors. The idea is that many of our patients’—and our own—personality traits and behaviors are governed by

Psychopharmacology in Jails: An Introduction

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

If you are interested in part-time correctional work, the best place to start is often the local jail—as opposed to a prison. What’s the difference between the two? A jail is a criminal justice facility operated by a city or county. It houses people who are awaiting trial or who have received short sentences, typically one year or less. In contrast,

Correctional Psychiatry: Salary and Benefits Are Generous

Topics: Practice Tools and Tips

The average annual wage for U.S. psychiatrists in 2015 is about $194,000 (U.S. Bureau of Labor Statistics). According to a 2011 salary survey, the average salary of a prison psychiatrist in the U.S. is $204,909. Further breaking this down by state, here are some salary figures for psychiatrists working in a correctional setting: New York: $200,147

The Experience of Correctional Psychiatry

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

TCPR: Dr. Gariety, please tell us a bit about your background. Dr. Gariety: I’ve been in practice for 23 years, starting out in community mental health, followed by 13 years in the federal bureau of prisons. Currently I work for a large regional medical group in the private sector. TCPR: Tell me a bit more about the correctional setting. D

When Physicians Become Addicted: How Well Do Treatment Programs Work?

Topics: Addiction | Practice Tools and Tips | Research Updates

Four Newer Antidepressants: Should You Use Them?

Topics: Antidepressants | Depressive Disorder | Practice Tools and Tips | Psychopharmacology Tips | Seasonal Affective Disorder

Since 2011, 3 new antidepressants have been approved by the FDA, and another (ketamine) has been generating buzz as a potential off-label medication for depression. In this article, we’ll take a step back and review the data on vilazodone (Viibryd), levomilnacipran (Fetzima), vortioxetine (Brintellix), and ketamine. Vilazodone (Viibryd) Vilazodone

Understanding Conduct Disorder

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

Thinking Creatively About Treatment-Resistant Depression

Topics: Antidepressants | Depressive Disorder | Practice Tools and Tips | Psychopharmacology Tips | Seasonal Affective Disorder

TCPR: The term “treatment-resistant depression” is sort of thrown around a bit. I’m sure that there are various formal or informal definitions of it, but how do you think about it? Dr. Bodkin: The formal definition basically requires 2 failures of distinctly different antidepressants at robust doses for adequate duration. But personally, I thin