Treating Agitation in ICU Patients with AUD?

Topics: Agitation | Alcohol use disorder | Delirium | Withdrawal

REVIEW OF: Vourc’h M et al, JAMA 2021;325(8):732–741 STUDY TYPE: Randomized clinical trial It’s known that people who drink unhealthy amounts of alcohol are more likely to get agitated if they’re admitted to the ICU. What to do about it is less well understood. In this study, researchers reasoned that mimicking some of alcohol’s effects

Benzodiazepines in Older Adults

Topics: Addiction | Anxiety | Ashton manual | Beers criteria | Benzodiazepines | Cognitive Behavioral Therapy for Insomnia | Dementia | Fall risk | Hypnotics | Insomnia | Opioids | Overdose | Silexan | taper | Withdrawal

CGPR: When do you start benzodiazepines in older adults? Dr. Aiken: The best evidence for benzodiazepines in the elderly is in panic disorder, followed by phobias, social anxiety disorder, and generalized anxiety disorder. Benzodiazepines are also the mainstay of treating catatonia, rapid eye movement sleep behavior disorder, and alcohol withdrawal. Ho

Outpatient Management of Opioid Addiction

Topics: Cannabis | Depression | Existing marijuana | Potency | Substance Use Disorder | Weed | Withdrawal

CCPR: Tell us about your position and what you do. Dr. Gomez-Luna: I directed a short-term adolescent residential program, where I saw a need for identifying and treating kids’ co-occurring conditions. I did another fellowship in addiction psychiatry, then joined studies at Yale on tobacco use and electronic nicotine devices in adolescents. Now I’m

Assessing and Treating Cannabis Use Disorder

Topics: Cannabis | Depression | Marijuana | Potency | Substance Use Disorder | Weed | Withdrawal

CCPR: Tell us a little bit about your background. Dr. Gobbi: I trained in medicine, psychiatry, and psychotherapy in Rome, Italy, then received a PhD in neuroscience, working in preclinical psychopharmacology. I now work in our mood disorder clinic and ER, and I direct our basic psychopharmacology lab (neurobiological psychiatry unit), including resear

Managing Substance-Related Agitation

Topics: Agitation | Substance Use Disorder | Withdrawal

In emergency departments, psychiatrists are often consulted on patients presenting with agitation. In many cases, these patients are under the influence of substances—either from intoxication or withdrawal. It is important to recognize when a patient is under these effects, as acute management of the agitation will vary drastically depending on which

Nicotine Patch for Cannabis Withdrawal?

Topics: Cannabis | nicotine | Withdrawal

REVIEW OF: Gilbert DG et al, Psychopharmacology (Berl) 2020;237(5):1507–1519 As more and more states legalize marijuana and the prevalence of cannabis use increases, more people will be experiencing cannabis withdrawal symptoms, which are difficult to treat. The authors of this study hypothesized that the degree of negative affect experienced in ca

Management of Opioid Withdrawal in the Emergency Setting

Topics: Collaborative care | Detoxification | Harm reduction | Opioid Use Disorder | Opioids | Withdrawal

Opioid withdrawal is being seen more frequently in emergency settings. From 2005 to 2014, it is estimated that the rate of US emergency department (ED) visits due to opioids doubled from 89.1 per 100,000 people to 177.7 per 100,000 (Agency for Healthcare Research and Quality, www.tinyurl.com/2xr8hp8h). For many patients, the ED is their only contact wit

Kratom: A Primer

Topics: Buprenorphine | Opioids | Pain | Withdrawal

Many mental health providers are starting to hear about kratom from their patients. Consumed in Southeast Asia (except for Malaysia, where it is banned) for centuries, it’s a plant that has opioid-like qualities but is not regulated. Kratom is a tropical tree with the scientific name Mitragyna speciosa, native to Southeast Asia. Kratom is widely av

How to Come Off a Psych Med Part 2: Antidepressants, Stimulants, and Benzos

Topics: Antidepressants | Benzodiazepines | Deprescribing | Withdrawal

TCPR: Before we talk about your experience with tapering medications, tell us about the population you work with.Dr. Gupta: In the past, I worked at the Connecticut Mental Health Center for Yale University. There I saw patients with pretty serious mental illness: mainly psychotic disorders, severe trauma, addictions, and serious psychosocial stressors

Are SSRIs Associated With Increased Rates of Violence?

Topics: Deprescribing | Mania on Antidepressants | Medication adherence | polypharmacy | Psychosis | Psychotic Depression | Schizophrenia | Tags | Tardive dyskinesia | Withdrawal

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

A New Proposal for SSRI Withdrawal

Topics: Pharmacology | Pharmacology Tips | SSRIs | Withdrawal

Review of: Horowitz MA and Taylor D, Lancet Psychiatry, March 2019, published online Type of Study: Literature review and clinical guideline Withdrawal problems rank among patients’ top concerns with antidepressants. They include insomnia, flu-like symptoms, irritability, distractibility, and unusual sensory experiences such as “brain zaps.” To

SSRI withdrawal symptoms

Topics: Pharmacology | Pharmacology Tips | SSRIs | Withdrawal

Withdrawal problems rank among patients’ top concerns with antidepressants. They include insomnia, flu-like symptoms, irritability, distractibility, and unusual sensory experiences such as “brain zaps.” Use this PDF tool to check if the patient is having any SSRI withdrawal symptoms at baseline.