Practice_tools_and_tips - Articles - Page 2

Narcotics Anonymous: What to Tell Your Patients

November 8, 2018

Most of us are pretty familiar with Alcoholics Anonymous (AA), and asking about AA attendance and participation is routine during appointments with patients trying to curb their alcohol use. But what about Narcotics Anonymous (NA)?

Using Medical Management in Treating Opioid Use Disorder

November 8, 2018

Andrew Saxon, MD

Andrew Saxon, MD Professor, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Director, Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA. Chair, Council on Addiction Psychiatry. Dr. Saxon has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

To set the stage for understanding medical management, we need to go back about 20 years to the inception of the landmark COMBINE Study. This study was a very large clinical trial for alcohol use disorder (AUD) that compared naltrexone, acamprosate, and their combination, and also looked at two behavioral interventions.

Opioid Treatment Options

November 8, 2018

Opioid use disorder (OUD) treatment can be tricky, in part because it doesn’t respond well to detox and counseling-only approaches. The overwhelming majority of people relapse after such attempts, or even become more vulnerable to overdose because of decreased tolerance after detoxing.

Harnessing Beneficial Drug Interactions

November 1, 2018

Rehan Aziz, MD and Chris Aiken, MD

Rehan Aziz, MD Associate Professor of Psychiatry and Neurology at Rutgers Robert Wood Johnson School of Medicine. Dr. Aziz has disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity. Chris Aiken, MD Editor-in-Chief, The Carlat Psychiatry Report. Dr. Aiken has disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity.

It’s nice when we can get our patients better with a single medication, but that’s not always possible. Sometimes the right combination of meds can do the trick, but studies of polypharmacy are scarce. In this article we dig through that research, small and limited as it is, to highlight a few useful combinations where the drug interaction can benefit your patient.

EXPERT Q&A

Effects of Drug Interactions

November 1, 2018

Neil Sandson, MD

Neil Sandson, MD.
Clinical Associate Professor, Department of Psychiatry at University of Maryland School of Medicine

Dr. Sandson has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

When it comes to computer alerts for drug interactions, the two issues to pay attention to are toxicity and loss of efficacy. Toxicity is the bigger concern, particularly if the drug has a “narrow therapeutic index,” where modest differences in the level can have dangerous effects.

Assessing and Treating Violence in Patients

November 1, 2018

School shootings keep happening in the US, and most of us have wondered at times whether one of our patients might carry out a violent act, shooting or otherwise. This article will help you assess and treat violent youth and advise families who are grappling with these issues.

Note From the Editor-in-Chief

October 1, 2018

Bachaar Arnaout, MD

Bachaar Arnaout, MD Editor-in-Chief

Addiction spares no age group, but it often goes undetected in older adults age 65 or older, and its treatment poses age-specific challenges.

How Ethnicity Influences Medication Response

October 1, 2018

Donna Lisi, PharmD. and Chris Aiken, MD.

Donna Lisi, PharmD. Contributing writer to the Carlat Psychiatry Report newsletters. Chris Aiken, MD. Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Drs. Lisi and Aiken have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity.

From cultural expectations to genetic variations, ethnicity has a strong effect on medication response. In this article, we’ll review five areas where ethnic groups can differ in their biological response to psychiatric medications.

Working With Transgender Patients

October 1, 2018

Jack Drescher, MD

Jack Drescher, MD.
Clinical professor of psychiatry at Columbia University, College of Physicians and Surgeons; member of the DSM-5 work group on sexual and gender identity disorders.

Dr. Drescher has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

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, MD, to better understand how to work with this population.

Substance Use Disorder in Older Adults

October 1, 2018

David Oslin, MD

David Oslin, MD Professor of Psychiatry, Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania Medical Center Dr. Oslin has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

As we age, we are more vulnerable to a lot of things—the same amount of alcohol or the same amount of any of these substances is going to cause more impairment in an older person vs a younger one. As an example, our stability and gait can worsen as we get older, so any substance that affects gait or balance will have a larger effect.