...

Many pages of The Carlat Report have been devoted to how we cause our patients to become obese with some of the medications we prescribe. In this article, we review ways in which we can atone for our sins.

Too many of our patients smoke, especially those with schizophrenia. Amazingly, the best estimate is that 85% of patients with schizophrenia are regular smokers (Am J Psychiatry 1986; 143:993-997). While we may not have a whole lot of time during our sessions to discuss smoking, it’s still helpful to tuck away some smoking cessation tools in your arsenal.

Dr. Guttmacher, as the Chief of Psychiatry at a large state hospital (the Rochester Psychiatric Center), you have a wealth of experience caring for the chronically mentally ill. I know you have been giving quite a bit of thought lately to medical issues that psychiatrists may be missing in this population.

Archeological evidence suggests that tobacco grew in the Americas as long ago as 6000 B.C., and that the custom of smoking it began with the Mayans, sometime around 1000 B.C. The first European to smoke is thought to be Rodrigo de Jerez, who, with Christopher Columbus, observed the custom in Cuba in 1493.

Okay, we’re assuming, number one, that you have done a good job diagnosing ADD or ADHD, and that ADHD is the primary diagnosis, far out-shadowing any comorbid problems that may also be present. And number two, we are assuming that you, the patient, and the parents (if the patient is under age) have all agreed that now is the time for a medication trial.

Six short years ago, an influential study came out in Archives of General Psychiatry that was widely interpreted as showing that therapy adds little of value to the treatment of ADHD (Arch Gen Psychiatry 1999; 56:1073-1086).

The Official TCR ADHD Medication Comparison Chart

On February 9, 2005, Health Canada (HC) announced that it was suspending sales of Adderall XR in Canada because of concerns that it might lead to sudden death and stroke. The FDA, however, has begged to differ.

Dr. Diller, you’re a rare bird in the ADHD world in that you are skeptical of our reliance on stimulants for treating this condition, and yet you have an unusually good grasp and appreciation of how and when to use them. What is your background?