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Home » Topics » General Psychiatry

General Psychiatry
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Efficacy and Atypicals: It’s Hand-to-Hand Combat

February 1, 2004
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Things were bound to get ugly. The total market for antipsychotics is $10 billion, there are five very similar atypicals jockeying for an extra nibble of that huge pie, and each atypical is backed by an aggressive pharmaceutical firm. You do the math.
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The Diabetes Conundrum

February 1, 2004
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
If you who have chosen to spend inordinate amounts of your precious time reading these pages over the last year, you will remember the February 2003 (TCR, 1:2) issue in which TCR slammed Zyprexa for causing diabetes. Well, we're going to slam Zyprexa again this year, but not quite as viciously.
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Antipsychotic Updates

February 1, 2004
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Tired of industry-funded antipsychotic trials? The NIMH comes to the rescue with the "CATIE" project (Clinical Antipsychotic Trials of Intervention Effectiveness). Blissfully un-industry-funded researchers have enrolled 1500 schizophrenic patients at 50 different sites, and have randomly assigned them to Zyprexa, Seroquel, Risperdal, Geodon, or Trilafon (perphenazine).
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Dr. John Buse on Diabetes and Atypicals

February 1, 2004
John Buse, M.D., Ph.D.
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
John Buse, M.D., Ph.D.John Buse, M.D., Ph.D. Chief and Associate Professor Division of General Medicine & Epidemiology University of North Carolina School of Medicine



Dr. Buse, as an endocrinologist with a specialty in diabetes, I'm hoping you can help educate both myself and my psychiatrist readers about diabetes and antipsychotics. To begin with, we've been hearing a lot lately about the "metabolic syndrome." What is it?
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Choosing Atypicals

February 1, 2004
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Raymond Cavanaugh, M.D., is a psychiatrist in private practice in Lawrence and Lynn, Massachusetts, and has an interesting take on the differences between the atypicals.
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Cymbalta: Dual the Reuptake, Triple the Hype

January 1, 2004
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
We have some good news and we have some bad news. First, the good news: Cymbalta (generic name: duloxetine) is an effective dual reuptake antidepressant with a good safety profile. Now, the bad news: it appears to have no advantages over existing antidepressants.
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ECT: The Very Latest

January 1, 2004
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Whether you do ECT (electroconvulsive therapy) or not, and research indicates that less than 8% of you actually perform it (Hermann et al, Am J Psychiatry 1998; 155:889-894), you need to know about it, because you will have to decide when to refer your treatment-resistant patients for it, and you will have to know what to say to them about it as they pepper you with a multitude of questions, as they always do (and should).
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Antidepressant Updates

January 1, 2004
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Sorry, no earthshaking developments in the antidepressant world in 2003, but here are some developments that you’ll find useful in your practice.
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EXPERT Q&A

Dr. John O’Reardon on Antidepressant Augmentation

January 1, 2004
John O'Reardon, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
John O’Reardon, M.D.John O’Reardon, MD. Medical Director, Treatment Resistant Depression Clinic Associate Professor of Psychiatry, University of Pennsylvania School of Medicine



Dr. O'Reardon, you had mentioned at the end of our last interview (see TCR, Vol. 1, No. 1) some of the augmentation and combination strategies that you like to use in your clinic but we didn't have time to get into the actual specifics of these. To begin with, how do you decide when to augment? What kinds of drug failures do you try to establish?
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The First ECT

January 1, 2004
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
The first ECT (electroconvulsive therapy), was performed by an Italian psychiatrist, Ugo Cerletti, who had initially assessed the safety of the treatment with dogs. He performed the first treatment on a human on April 18, 1938.
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