Working With Transgender Patients

Topics: Gender & Sexuality | Practice Tools and Tips

Our profession has a number of obstacles to overcome in gaining the trust of transgender and gender non-conforming patients. We turn to this month’s expert, Jack Drescher, to better understand how to work with this population. TCPR: Tell us about this new diagnosis, gender dysphoria, and what it means for patients. Dr. Drescher: In DSM-IV, identif

Substance Use Disorder in Older Adults

Topics: Addiction | Practice Tools and Tips | Substance Abuse

CATR: Let’s start with diagnosis. Are there specific challenges in diagnosing substance use disorder (SUD) in older adults? Dr. Oslin: There definitely are, and DSM criteria can be hard to apply. Older adults are more likely to drink at home, much more likely to have medical problems, and may have interpersonal issues, but they will likely have fewer

Ask the Editor: Three Significant Food Interactions with ADHD Medications

Topics: Free Articles | Practice Tools and Tips | Psychopharmacology

Each month, Editor-in-Chief Chris Aiken, MD, gives advice on a different practice challenge. If you have a question you’d like Dr. Aiken to answer, please send an email to [email protected]. Dr. Aiken won’t be able to answer all questions received but will pick one each month that is of general interest. Dear Dr. Aiken: Patients of

Antidepressant-Induced Suicidality: What It Is and What You Should Do

Topics: Child Psychiatry | Depressive Disorder | Practice Tools and Tips

Do antidepressants actually cause children to be suicidal? If so, how do we detect it, and what should we do about it? In this article, we’ll give you a brief review of the most recent findings on antidepressant-induced suicidality (AIS) in children and adolescents, and then move on to some practical tips for how to evaluate and prevent this problem.

Current Use of Antidepressant Medication in Children

Topics: Child Psychiatry | Depressive Disorder | Practice Tools and Tips

Editor’s note: The issue of emergent suicidal thinking has weighed on us since the 2004 black box warning—amplified by the re-analysis of the now infamous study 329, which found the emergence of previously under-reported suicidal thinking. How do we offer hope for effective use of medication while balancing the potential risks? Dr. Danella Hafeman h

Calming Agitated Patients in an Emergency

Topics: Practice Tools and Tips

TCPR: You’ve worked for a long time as an emergency psychiatrist. Do you have any advice on how psychiatrists can de-escalate situations with agitated or even violent patients? Dr. Fishkind: When I work with an agitated patient, I start by saying, “Hi, I’m Dr. Fishkind. My job is to keep you safe today.” Your first job should be to take away an

The 10 Commandments for Verbal De-Escalation

Topics: Free Articles | Practice Tools and Tips

This text has been adapted with permission from the 10 Commandments for Safety by Avrim Fishkind, MD. Respect personal space: 2 arm-lengths. Do not be provocative. Body language is important. Do not cross your arms, stare, or conceal your hands. Establish verbal contact. Introduce yourself by name and title. Only 1 person should verbally inte

Ask the Editor

Topics: Practice Tools and Tips

Starting with this issue, Editor-in-Chief Chris Aiken, MD, will give advice on a different practice challenge. If you have a question you’d like Dr. Aiken to answer, please send an email to [email protected]. Dr. Aiken won’t be able to answer all questions received, but he will pick one each month that is of general interest. Me

Talking to Parents and Adolescent Patients About Substance Use

Topics: Addiction | Child Psychiatry | Practice Tools and Tips | Substance Abuse

CATR: To start us off, how does addiction differ in adolescents vs adults? Dr. Quigley: In adolescents it can be subtle. For example, there are culturally normative behaviors with alcohol and cannabis use, and kids get missed because people write it off as “just partying.” They miss the fact that the substance use has become extremely impairing. Ad

Including Parents in Autism Intervention

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

CCPR: Can you begin by telling us what is unique about the Profectum Foundation? Dr. Wieder: At Profectum, relationships are the driving force of intervention. We embraced the DIR (Developmental, Individual Difference, and Relationship-based) Model I developed with the late Dr. Stanley Greenspan. DIR was revolutionary. It redefined functional emotional

Treating Chronic Pain When There’s Addiction: A Primer

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

It can be challenging to manage chronic pain, even more so when our patients suffer from addiction. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain, and the risk of relapse due to the use of opioid analgesics. Since our mission is to minimize suffering and optimize functioning while helpin

Informed Consent: An Ongoing Process for Focused Care

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

Informed consent is a foundation for good clinical practice and can provide legal protection. But informed consent is more than defensive medicine. It is a vehicle for framing good care. How often do people use the consent process? Malpractice companies recommend that the patient (or parent) sign consent whenever a medication is started. This might b

Using Caution While Prescribing Opioids for Pain

Topics: Addiction | Practice Tools and Tips | Psychopharmacology

CATR: I know you’ve done a lot of research around overdose deaths, both intentional and unintentional, and how this may help psychiatrists more wisely prescribe opioids for pain. Can you start by giving us a little more background on that? Dr. Bohnert: Sure. I’ll start by talking a little about overdose deaths. The study that we did in the VA wit

Differentiating ADHD From Anxiety: Tips for Clinicians

Topics: ADHD | Anxiety | Child Psychiatry | Practice Tools and Tips

When parents bring in their kids for concentration, attention, and learning issues, it’s common to assume a provisional diagnosis of ADHD. In many children, however, anxiety can be the real cause of these problems. Studies have long shown that about two-thirds of children and adolescents who present for ADHD evaluation have comorbid conditions, inc

Clozapine: A Fresh Look

Topics: Antipsychotics | Free Articles | Pharmacology Tips | Practice Tools and Tips

Several trials show it to be a superior treatment option, yet clozapine remains the “red-headed stepchild” of antipsychotics. Even though large studies reveal clozapine has impressive efficacy, particularly with treatment-resistant schizophrenia, many of us are reluctant to use it. According to one study, of the 30% of patients who have treatment

Abilify MyCite: Patient Care Breakthrough or Patent Extender?

Topics: Antipsychotics | Free Articles | Pharmacology Tips | Practice Tools and Tips

You’ve probably heard about a new “digital pill” called Abilify MyCite. The product, which was FDA approved in November 2017, is the first drug in the U.S. with a digital ingestion tracking system. MyCite consists of an aripiprazole pill that contains an embedded tiny sensing device (about the size of a grain of sand) called the ingestible even

Prescribing and Managing Antipsychotics

Topics: Antipsychotics | Pharmacology Tips | Practice Tools and Tips | Registered Articles

TCPR: Dr. Schwartz, there are so many antipsychotics available. How do you choose in your own practice? Dr. Schwartz: Any drugs that have an FDA indication for a particular diagnosis are likely to be effective. I especially like to use those that have less risk of metabolic complications, such as ziprasidone, lurasidone, etc. If we are discussing eff

Lithium: Practical Considerations for Children With Suicidal Thinking

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

Billy, age 10, has periods of intense aggression alternating with moments of wanting to be dead, severe mood swings, poor sleep, and pervasive irritability. He has a family history of bipolar disorder. Other family members have responded well to lithium. Since they want to act assertively to help him, Billy’s family is open to medication trials and an

Helping Clinicians Manage Teen Suicide Risk

Topics: Child Psychiatry | Practice Tools and Tips

CCPR: Thank you, Dr. Pfeffer, for participating in this interview on youth suicide. To start us off, how have clinicians come to understand risk factors for teen suicide? Dr. Pfeffer: Historically, psychiatrists did not focus on identifying and treating risk factors for child and adolescent suicidal behavior. But after an increase in youth suicide r

Helping Patients With Stigma and Addiction

Topics: Addiction | Free Articles | Practice Tools and Tips

CATR: To start, can you please tell us a little more about your work at Harvard and Mass General? Dr. Kelly: Sure. I’m a clinical psychologist by training, and for the past 20 years, I have spent a lot of time researching the addiction treatment and recovery processes. I’ve looked at the effectiveness of different treatments, their mechanisms, an