Practical Approaches to Vetting Clinical Research

Topics: adolescents | children | Clinical practice | inquiry | pediatric | PICOT | Practice Tools and Tips | Research | teens

CCPR: Tell us a bit about your current work. What is your population? Whom do you treat? Dr. Courtney: My clinical population are patients with concurrent addictions and mental health issues. These patients present complex clinical challenges, and so I have made efforts to use a method to think about and sort through those problems. CCPR: Please sha

How to Evaluate Adolescents

Topics: Child Psychiatry | Practice Tools and Tips

Every so often the stars align themselves in such a way that you will be referred an "easy" adolescent. This is a teenager who looks and dresses like you, who is seeking help on his or her own urging, who describes depressive or anxiety symptoms articulately, and who responds well to standard treatment. This article is for the rest of the time. In

Dr. Claudia Baldassano on Interviewing Tips in Bipolar Disorder

Topics: Bipolar Disorder | Practice Tools and Tips

TCR: Dr. Baldassano, as the Director of the Bipolar Outpatient Clinic of U Penn, how many patients with bipolar disorder do you typically evaluate in a given week? Dr. Baldassano: About 80 patients a week, and that would include consultations, patients referred directly to me, and patients that I see in supervision with U Penn residents. TCR: Are mo

Telepsychiatry: From Crisis to Opportunity

Topics: Billing | Computers in Psychiatric Practice | Coronavirus | COVID19 | HIPAA | Practice Tools and Tips | Psychiatric interviewing | Skype | Telemed

TCPR: Do patients like telepsych?Dr. Yellowlees: Yes. The studies show very high levels of patient satisfaction, higher even than what we see with in-person care. Most of those studies were done before 2010, when the technology was not as good and patients often traveled to their primary care doctor’s office to connect by telemed. I suspect the satisf

Prior Authorizations for Psychiatric Medications: A Primer for Frustrated Clinicians

Topics: Practice management | Practice Tools and Tips | Prescription costs

Prior authorization (PA) requirements for medications are time-consuming and frustrating for both clinicians and patients. In this article, we’ll describe how they work, how they affect patient care, and how to most efficiently work around them. The basics PA requirements began in the 1980s as a measure to rein in high-cost procedures like hospita

The New Billing Codes

Topics: Billing | Practice management | Practice Tools and Tips

Just when you thought you had mastered evaluation and management (E/M) codes, CMS launched a new batch of recommendations for medication management codes (99212–99215). Most changes are for the better. Clinicians can now choose whether to bill based on the time spent on the visit or the complexity of their decision making. The definition of complexity

A Guide to Online and Overseas Pharmacies

Topics: Clinical practice | Generics | Insurance | Internet | Pharmacy | Practice Tools and Tips | Prescription costs

You’ve probably seen these scenarios in your practice. A patient doing well on Latuda can’t afford the $800 monthly cost with a new insurance plan. Another patient on disulfiram can’t find the medication because there is a nationwide shortage. Someone else expresses interest in medications used in other countries like amisulpride, tianeptine, or a

A New Contraindication for Ambien and the Z-Hypnotics

Topics: FDA Warnings | Hypnotics | Insomnia | News of Note | Practice Tools and Tips | Psychopharmacology | Psychopharmacology Tips | Sleep

“Complex sleep behavior” is a euphemism for various problems that can happen after ingesting a sleeping pill. They range from cooking and emailing to driving a car or even sexual assault, all done in an amnestic state that is not recalled upon awakening. In 2007 the FDA placed warnings about these behaviors on all medications approved for insomnia,

Is Paxil the Best SSRI for Anxiety?

Topics: Antidepressants | Anxiety | Anxiety Disorder | Generalized Anxiety Disorder | Panic Disorder | Pharmaceutical Industry | Pharmacology | Pharmacology Tips | Practice Tools and Tips | Psychopharm Myths | Psychopharmacology | Psychopharmacology Tips | PTSD | Social Anxiety Disorder | SSRIs

Dear Dr. Aiken: Your review of Paxil’s risks in the May issue failed to mention a benefit that’s unique to this drug. Isn’t it the best SSRI for anxiety? Dr. Aiken: Paroxetine’s (Paxil’s) reputation as the anti-anxiety SSRI got off to a running start. It was first launched for panic disorder in 1996, two years before its approval for depres

Parenting Strategies for Patients With Mental Illness

Topics: Parenting Strategies | Practice Tools and Tips | Working With Families

“To love and work” was how Freud saw the goal of psychiatric treatment. Mental illness robs people of many meaningful roles, from work to parenting. We spoke with Marie Yap, director of the award-winning Parenting Strategies program, to learn how to help our patients function better as parents and prevent psychiatric disorders in their children.

What Can Our Pregnant Patients Do to Prevent Mental Illness in Their Children?

Topics: Practice Tools and Tips | Pregnancy

TCPR: Expectant mothers often want to come off psychiatric medications. From their perspective, mental illness takes place in the brain and won’t affect the fetus, while psychiatric medications are quite dangerous. What can we tell them?Dr. Freedman: There are risks with psychiatric medications, but the only one that is contraindicated in pregnancy

Becoming a Board-Certified Addiction Clinician

Topics: Addiction Treatment | Board Certification | Practice Tools and Tips

CATR: To start off, could you tell us why a psychiatrist or any other physician would want to be board-certified in addiction? Dr. Weaver: Patients with addiction are common in psychiatric or any other practice. You’re going to see patients who have these issues, so it’s good to be prepared and able to focus on treating addiction, as well as to be

Narcotics Anonymous: What to Tell Your Patients

Topics: Practice Tools and Tips | Substance Abuse

Most of us are pretty familiar with Alcoholics Anonymous (AA), and asking about AA attendance and participation is routine during appointments with patients trying to curb their alcohol use (see the November/December 2015 CATR for more info on AA). But what about Narcotics Anonymous (NA)? Is it just an opioid-focused version of AA? In this article, we�

Using Medical Management in Treating Opioid Use Disorder

Topics: Practice Tools and Tips | Substance Abuse

CATR: We often hear about an intervention called medical management (MM) for treating addiction. Could you tell us what MM is? Dr. Saxon: To set the stage for understanding medical management, we need to go back about 20 years to the inception of the landmark COMBINE Study. This study was a very large clinical trial for alcohol use disorder (AUD) that

Opioid Treatment Options

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

Opioid use disorder (OUD) treatment can be tricky, in part because it doesn’t respond well to detox and counseling-only approaches. The overwhelming majority of people relapse after such attempts, or even become more vulnerable to overdose because of decreased tolerance after detoxing. And the trajectory in this country is worsening—in 2016, we aver

Harnessing Beneficial Drug Interactions

Topics: Practice Tools and Tips | Psychopharmacology Tips | Registered Articles

It’s nice when we can get our patients better with a single medication, but that’s not always possible. Sometimes the right combination of meds can do the trick, but studies of polypharmacy are scarce. In this article we dig through that research, small and limited as it is, to highlight a few useful combinations where the drug interaction can benef

Effects of Drug Interactions

Topics: Practice Tools and Tips | Psychopharmacology Tips

TCPR: We’re seeing a lot of computer alerts for drug interactions. Which ones should we pay attention to? Dr. Sandson: The two issues to pay attention to are toxicity and loss of efficacy. Toxicity is the bigger concern, particularly if the drug has a “narrow therapeutic index,” where modest differences in the level can have dangerous effects. Li

Assessing and Treating Violence in Patients

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

School shootings keep happening in the US, and most of us have wondered at times whether one of our patients might carry out a violent act, shooting or otherwise. This article will help you assess and treat violent youth and advise families who are grappling with these issues. Most people with mental health conditions do not hurt others—our patients

Note From the Editor-in-Chief

Topics: Addiction | Practice Tools and Tips

Addiction spares no age group, but it often goes undetected in older adults age 65 or older, and its treatment poses age-specific challenges. In this issue, we interview Dr. David Oslin to unpack some of these challenges and talk about screening tools, physiological changes, and psychosocial stressors, as well as general treatment approaches in older ad

How Ethnicity Influences Medication Response

Topics: Practice Tools and Tips | Psychopharmacology Tips

From cultural expectations to genetic variations, ethnicity has a strong effect on medication response. In this article, we’ll review five areas where ethnic groups can differ in their biological response to psychiatric medications. Drug metabolism Most medications are metabolized in the liver, and patients’ liver metabolism varies. Slow metabol