Dr. Simone Vigod describes her approach to prescribing medications during pregnancy. She starts by assessing the severity of the symptoms and the impact on function. Women usually fall into two categories: those who are not on medication and have become symptomatic, and those who have been taking medication, who are perhaps in remission, and are unsure about going off medication during pregnancy.

Excessive salivation is a common and troubling adverse effect of clozapine therapy, occurring in about 30% of patients. Recently, Israeli researchers evaluated another potential treatment, metoclopramide (Reglan), which is a drug for nausea and other gastrointestinal problems. Since metoclopramide commonly causes dry mouth, the authors of this paper reasoned that it might work for clozapine-induced hypersalivation.

Skin picking disorder is a compulsive behavior affecting 5% of people. N-acetylcysteine is an antioxidant that increases glutamate, and studies have shown that it is effective for excoriation’s sister disorder, trichotillomania (hair pulling). These data prompted investigators to try N-acetylcysteine in the treatment of SPD.

When patients become severely suicidal, we have few good treatment options. Recognizing the need for more options, Israeli researchers studied the use of very low doses of buprenorphine in suicidal patients. Patients with suicidal ideation were recruited from four medical centers.

In the summer of 2011, the Food and Drug Administration (FDA) reported that post-marketing surveillance showed that patients taking greater than 40 mg/day of citalopram were at greater risk of QT prolongation. Shortly thereafter, the Department of Veterans Affairs (VA) alerted its providers to this warning. VA researchers recently published a study detailing the results of this warning on patients.

Psychoanalytic training may not be right for you, but here are some analytic concepts that can be useful to anyone practicing psychiatry.~ The unconscious: Patients are often unaware of patterns of behavior and their underlying conflicts. Unacceptable feelings like aggression and sadness may be banned from conscious thought, and therefore...

The patient is a 31-year-old, single female attorney, who was referred by her primary care physician for somatic complaints that have been worked up thoroughly, with normal results. In the past, she has been worried about and has pursued various diagnoses, including endometriosis, neurofibromatosis, and ovarian cancer, and has doctor-shopped...

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Dr. Twersky-Kengmana is an early-career psychiatrist, trained in a mainstream residency, and she prescribes medication to the majority of her patients. Yet, about 10% of her practice is psychoanalytic. In this article, she discusses the current status of psychoanalysis, some of the evidence for its efficacy, and why she has found it so useful for her patients.

Patient details have been fictionalized in this presentation of real cases that represent common critical issues.