Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
What is your policy on prescribing controlled substances for patients you've only ever seen via telehealth?
I do initiate stimulants via telehealth when state law allows but it is very state-specific. A full ADHD evaluation can be done remotely if you approach it with the same rigor as in person. On video, I can reliably observe psychomotor activity, fidgeting, restlessness, latency of response, distracti...
Do you type or take notes during psychiatry appointments while you talk with patients?
Taking handwritten notes during an interview, therapy session, or assessment creates a fundamentally visceral connection. Phenomenologically, putting pen to paper accentuates the gravity of examining another human mind. A screen creates a third entity in the room; a notebook remains quiet, unobtrusi...
How do you address parental concern about children becoming addicted to stimulants for ADHD treatment?
In the current environment with an epidemic of fatalities from opiates, the question about addiction to stimulants is timely. I present the parents with the data, which shows that controlled dosing leads to a steady level of dopamine and does not produce a high. Further, studies find that treated ki...
Are you prescribing lithium more or less often than you did five years ago for bipolar disorder?
I am prescribing lithium more often now than 5 years ago. Unfortunately, more psychiatrists are opting to provide bipolar patients with other mood stabilizers. There are excellent reasons to consider lithium for every bipolar patient who has not had an adequate trial (at least 6 months at confirmed ...
Do you ever give stimulant medication to cover a longer continuous period when treating first responders or healthcare workers who work long shifts?
I think this has to be taken on a case-by-case basis. Some patients with ADHD are genuinely so impaired without their medication that I don't know if they'd be safe acting in emergency situations without something to help them focus on priorities. The other side of that coin is that first responders...
Have you seen a rise in postpartum psychosis presentations in your own practice this year?
No.
When do you order brain imaging in young adults presenting with first-episode psychosis in the absence of clear neurologic red flags?
You should always consider brain imaging, at least at CT, in the first episode of psychosis. While this will be negative almost 99% of the time, it's always good to rule out that population that may have something else going on in the brain that we can actually attribute the psychosis to. Also, chec...
What pharmacological management do you consider for self-injurious behavior in patients with autism spectrum disorder?
This is a great question but requires a nuanced answer. It all depends. In short, what I think the clinician needs to know is whether the patient with ASD and self-injury has a treatable condition that is driving self-injury. Perhaps the most critical is whether the patient has a medical problem tha...
What do you recommend to patients when they are having an acute flare of fibromyalgia symptoms?
Great, this is a really important area and unmet need in the field of fibromyalgia management. Unlike other nociplastic disease states (e.g., migraine), there are no rigorously studied abortive therapies to rapidly treat a flare of centralized pain. Indeed, all the therapies we use for FM are intend...
What non-pharmacologic interventions or resources do you recommend for parents of patients with severe anxiety?
It depends on the type of anxiety, but a few things that I have found helpful over the years... Education about the physiology of anxiety, amygdala info, and the body’s response/cycle to anxiety is key. Help the patient understand that the goal cannot be to “get rid of” all anxiety; trying to contr...