The COMBINE Study: A Core Paper in the Treatment of AUD

Topics: Acamprosate | Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Pharmacology | Psychotherapy | Research | Research Update | Substance Use | Substance use disorders | Therapy during medication appointment | Therapy with Med Management

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

Treating Alcohol Use Disorder

Topics: Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Substance Use Disorder | Therapy with Med Management

CATR: Can you tell us about the role of medications for alcohol use disorder (AUD)? Dr. Arias: Medications are a very important part of AUD treatment. They can and should be used as a first-line treatment in any reasonable medical setting—primary care or psychiatry, or a specialty addiction setting. Unfortunately, very few patients ever receive them.

Turning Nightmares Into Dreams

Topics: Behavior therapy | Behavioral therapy | Brief psychotherapy | Nightmares | Psychotherapy | PTSD | Sleep Disorders | Therapy during medication appointment | Therapy with Med Management

TCPR: What is nightmare disorder? Dr. Krakow: This is a sleep disorder in DSM-5 characterized by repeated, distressing nightmares. Some patients awaken from the dreams and others do not, but either way they usually remember the dreams, sometimes vividly. These nightmares often involve themes of threat, fear, and other distressing emotions. An important

Psychotherapy and Medication in Recurrent Depression

Topics: Brief psychotherapy | Deprescribing | Depression | Depressive Disorder | Prevention | Psychotherapy | Therapy during medication appointment | Therapy with Med Management | Treatment-Resistant Depression

TCPR: When depression is recurrent, we usually continue the antidepressant indefinitely. Has that practice come under challenge? Dr. Fava: Yes. Antidepressant drugs are certainly important during the depressive episode, but what we are starting to question is whether they are as effective in preventing relapse. A meta-analysis from 12 years ago found t

Side Effects of Psychotherapy

Topics: Behavior therapy | Behavioral therapy | Behavioral treatment | Brief psychotherapy | Cognitive Behavioral Therapy | Exercise | Psychotherapy | Therapy during medication appointment | Therapy with Med Management

TCPR: What are side effects to psychotherapy?Dr. Linden: Side effects are adverse reactions to a therapy that is correctly applied. TCPR: Why do you say “correctly” applied?Dr. Linden: When I talk about side effects, I’m not talking about boundary violations or mistakes by the therapist. I’m talking about unwanted events that are caused by the

Brief Therapy During the Medication Visit

Topics: Behavior therapy | Behavioral therapy | Behavioral treatment | Brief psychotherapy | Cognitive Behavioral Therapy | Exercise | Psychotherapy | Therapy during medication appointment | Therapy with Med Management

TCPR: How does a brief therapy session differ from the 50-minute hour?Dr. Sudak: What’s different is the scope of what you can tackle in those 25–30 minutes. There’s a greater need to organize the session and make decisions about what you can take on. For example, trauma is a subject that you’d probably defer to a longer session. TCPR: How do y

Take a Breather: A Mindful Tactic for Borderline Dysphoria

Topics: Agitation | Behavior therapy | Borderline Personality Disorder | BPD | Crisis intervention | Mindfulness | Psychotherapy | Self-injury | Therapy during medication appointment | Therapy with Med Management

Managing the intense, explosive dysphoria experienced by patients with borderline personality disorder (BPD) is one of the tougher challenges we face. These complex states, with elements of anxiety, rage, depression, and shame, are hard for patients to tolerate, let alone examine. Worse, they can generate dangerous solutions: suicide, self-harm, and o

A Pragmatic Approach to Borderline Personality Disorder

Topics: Borderline Personality Disorder | BPD | Brief psychotherapy | Psychotherapy | Therapy during medication appointment | Therapy with Med Management

TCPR: Tell us about this new approach to borderline personality disorder (BPD): good psychiatric management. Dr. Choi-Kain: We have many effective therapies for BPD. There’s dialectical behavior therapy (DBT), transference-focused therapy, and mentalization-based therapy. Good psychiatric management borrows from the other approaches, but differs in t

When Further Medication Trials Seem Futile

Topics: Depression | Depressive Disorder | MAOIs | Patient relationship | Pramipexole | Psychiatric interviewing | Therapy during medication appointment | Therapy with Med Management | Treatment-Resistant Depression

TCPR: When it comes to medication trials, how do you know when enough is enough?Dr. Goldberg: I don’t think I would ever say “enough is enough,” but there is a point at which the probability of medicines having a big effect becomes very, very low. In depression, that point is pretty black-and-white in my mind: 5 trials. In a study from Massachuset

Using Mental Health Apps

Topics: Behavior therapy | Brief psychotherapy | Computers in Psychiatric Practice | Free Articles | Health Apps | Therapy during medication appointment | Therapy with Med Management

TCPR: Computer-assisted therapies have been around for decades. What makes mental health apps different? Dr. Torous: Computers have been used to support psychotherapy in many forms—email, video conferencing, texting, and online or desktop programs. Mental health apps take this to another level because they work through a device that most people keep

A New Way to Talk to Patients about Medication

Topics: Collaborative care | Medication adherence | Patient relationship | Psychiatric interviewing | Psychotherapy | Therapy with Med Management

TCPR: We all want to communicate better with patients, particularly around medications. You’ve lead workshops on this for several decades. Tell us about the model you developed out of that work. Dr. Shea: The Medication Interest Model (MIM) is a set of over 100 interview techniques that create shared decision making regarding all disease states from