Psychosis Carlat Reports | Carlat Publishing

Expert Q&A

From The Carlat Psychiatry Report, Psychotic Depression

Topics: Antipsychotics | Depression | Psychosis

TCPR: Is psychotic depression difficult to diagnose? Dr. Swartz: Psychotic depression is often missed and often misdiagnosed. A study of hospital units at four academic medical centers found that one in three cases of psychotic depression were missed (Rothschild AJ et al, J Clin Psychiatry 2008;69(8):1293–1296). This is important because these pati

Clinical Update

Medications to Rapidly Treat Psychotic Agitation

From The Carlat Hospital Psychiatry Report, Agitation

Topics: | | | | | | | | | | | | | | | | | | Agitation Antipsychotics Aripiprazole Benzodiazepines Chlorpromazine De-escalation Diphenhydramine Droperidol Emergency Haloperidol Hydroxyzine olanzapine Pharmacotherapy Promethazine Psychosis Quetiapine Risperidone Violence Ziprasidone

If you work in an emergency department (ED) or psychiatric inpatient unit, you’ve encountered agitated and even violent patients. We can help many patients settle down by listening empathically, validating their emotions, and offering oral medications, but even with our best efforts, these interventions do not always work. Medications help reduce agit

Research Update

Anti-NMDA Receptor Encephalitis or New-Onset Psychosis?

From The Carlat Hospital Psychiatry Report, Metabolic Side Effects

Review of: Xu X et al, Neurol Neuroimmunol Neuroinflamm 2019;7(1):e633 You may have heard of the book Brain on Fire: My Month of Madness by Susannah Cahalan (later made into a movie). Cahalan, a successful journalist, describes her brief psychotic episode that led to hospitalizations and mistaken psychiatric diagnoses. She was eventually diagnosed wi

Clinical Update

Deliberate Foreign Body Ingestion

From The Carlat Hospital Psychiatry Report, Psychiatric Emergencies

During morning rounds at your inpatient unit, you are informed by staff that your patient M, a 32-year-old woman with bipolar disorder and borderline personality disorder, has swallowed a small pencil. This is her fourth swallowing episode since her admission to the unit 2 weeks ago. Even though you had restricted her access to sharp objects, she has ma

Expert Q&A

Differentiating Psychotic Disorders: Does It Matter?

From The Carlat Child Psychiatry Report, Psychosis in Children and Adolescents

Topics: Child and adolescent | Prodrome | Psychosis

CCPR: Tell us a little about what you do and where you work. Dr. Stevens: In my role at The Menninger Clinic, I am responsible for developing and supervising personalized mental health care services for people receiving outpatient care. We diagnose and treat people who live in or travel to Houston seeking the highest-quality mental health care. CCPR

Expert Q&A

Cognitive Rehabilitation for Youth With Psychotic Disorders

From The Carlat Child Psychiatry Report, Psychosis in Children and Adolescents

Topics: Cognition | cognitive impact | Cognitive Rehabilitation Therapy (CRT) | Psychosis

CCPR: Please tell us a little bit about yourself. Dr. Ramsay: I’m a clinical psychologist at the University of Minnesota. I took a post-baccalaureate position in the psychiatry department at UC Davis, where I worked with Cam Carter’s lab studying the neural bases of aspects of cognitive disruption in people with psychotic disorders such as schizoph

Research Update

Steroid-Induced Psychosis in the Pediatric Population

From The Carlat Child Psychiatry Report, Depression in Children and Adolescents

Review of: Hodgins GE et al, J Child Adolesc Psychopharmacol 2018;28(5):354–359 Childhood psychosis is a rare disorder, and accurate diagnosis is crucial. Recently, clinicians at the University of Miami Miller School of Medicine reported a case of steroid-induced psychosis in a pediatric patient. In the case report, a 12-year-old Haitian girl wa

Research Update

Risk of Psychosis With Stimulants in ADHD Patients

From The Carlat Child Psychiatry Report, Depression in Children and Adolescents

Review of: Moran LV et al, N Engl J Med 2019;380(12):1128–1138 In 2007, the FDA required stimulant manufacturers to warn of possible psychosis with stimulants. But what is the real incidence? This study set out to find and discern if there is a difference between methylphenidate and amphetamine classes of medications. Drawing from two large comm

Research Update

Antipsychotics for Methamphetamine Psychosis

From The Carlat Addiction Treatment Report, Smoking Cessation

Topics: Antipsychotic | Meta-analysis | Methamphetamines | Psychosis

REVIEW OF: Srisurapanont M et al, Drug Alcohol Depend 2021;219:108467 STUDY TYPE: Systematic review and network meta-analysis Methamphetamine psychosis (MAP) is difficult to treat, and there are only so many antipsychotics in our repertoire. Randomized clinical trials (RCTs) to manage MAP are few and far between, and the literature thus far has in

Clinical Update

A Potentially Lethal Side Effect You Probably Never Heard Of

From The Carlat Psychiatry Report, Telepsychiatry

In January 2020, the FDA issued a strong warning about constipation on clozapine. With a fatality rate of 1 in 1000, this is not just a nuisance side effect, and it can happen with other antipsychotics and psychotropics as well. This type of constipation is caused by slowing of the gut, or gastric hypomotility, and it requires a unique approach. Fiber s

Expert Q&A

Raising the Bar in Schizophrenia Treatment

From The Carlat Psychiatry Report, Schizophrenia

Topics: Clozapine | Negative Symptoms | Psychosis | Schizophrenia | Second Generation Antipsychotics (SGAs)

TCPR: Antipsychotics are the standard of care in schizophrenia, but what can we do beyond that? Dr. Miller: Several things come to mind. Therapeutic alliance, addressing the full symptom picture, and greater use of clozapine in treatment-resistant cases. TCPR: Let’s start with therapeutic alliance. Dr. Miller: Nonadherence with medications is the

In Brief

In Brief: What Causes Affective Psychosis?

From The Carlat Psychiatry Report, Metabolism and Mental Health

Topics: Psychosis | Psychotic Depression

Psychotic depression and bipolar disorder are sometimes lumped together as the “affective psychoses.” Among the mood disorders, these two have a stronger biological basis, although environmental causes still contribute to their risk. In a meta-analysis of 68 studies (Rodriguez V et al, Schizophr Bull 2021 Jan 22:sbaa197), 6 environmental risk fact

Research Update

Are SSRIs Associated With Increased Rates of Violence?

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

REVIEW OF: Lagerberg et al, Eur Neuropsychopharm 2020;26:1–9 TYPE OF STUDY: Analysis of Swedish national registries Soon after the introduction of SSRIs in 1988, case reports began to emerge suggesting that they might trigger violence in a small subset of patients. At the time, such reports were mostly dismissed and attributed to the fact that p

Research Update

How to Switch Antipsychotics

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

Review of: Takeuchi H and Remington G, J Psychopharmacol 2020;34(8):914–919 Type of study: Meta-analysis of randomized controlled trials Antipsychotic switching is a routine part of schizophrenia care, but what’s the best way to go from one medication to another? This article compared three strategies: 1) abruptly stopping the old antipsychotic an

Clinical Update

Modern Challenges of Delusional Disorder

From The Carlat Psychiatry Report, When to Use Lithium

Topics: Antipsychotics | Delusional Disorder | Pimozide | Psychosis | Psychotic Depression

While positive symptoms like hallucinations and delusions are among the more treatment-responsive symptoms of schizophrenia, the treatment of delusional disorder often proves much more vexing. Delusional disorder is often a diagnosis of exclusion requiring that you rule out other causes like schizophrenia, primary mood disorder, or substance-induced ps

Clinical Update

How to Choose an Antipsychotic in Schizophrenia

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

It’s been over a decade since the CATIE trial changed the way we look at antipsychotic drugs. Since then, the number of second-generation antipsychotics has about doubled, and the number of clinical trials has risen even more. Antipsychotics are not all the same, though, and when it comes to schizophrenia, a few stand out in ways that can help you fin

Research Update

An Answer for Psychotic Depression

From The Carlat Psychiatry Report, Inflammation and Depression

REVIEW OF: Flint AJ et al, JAMA 2019;322(7):622–631 TYPE OF STUDY: Randomized, placebo-controlled trial Psychotic features in depression indicate a more severe form of the disease, with a higher risk of hospitalization and double the rate of disability compared with non-psychotic depression. A combination of an antipsychotic and an antidepressant is