Dr. Talmadge, in your practice, do you ever prescribe benzodiazepines to people with substance abuse histories?

My standard practice in treating patients with very frequent panic attacks had always been to start both a benzo and an antidepressant, with the expectation of eventually tapering the benzo. But I noticed, both with my patients and those I inherited from other psychopharmacologists, that hardly anyone ever seemed to get off benzos despite my preparing the patient for this plan.

When Aricept (donepezil) was first approved by the FDA in 1996 for the treatment of Alzheimer’s Dementia (AD), there was an almost euphoric sense that we were finally beginning to make progress in treating a previously untreatable disease.

In 2003, the FDA approved Namenda (memantine) as a treatment for moderate to severe Alzheimer’s Dementia (AD). Backed by the legendary marketing expertise of Forest Labs, the medication has become remarkably popular, gradually eating into the market share of the cholinesterase inhibitors (CIs). The question, as always, is whether this popularity is justified by the data.

The U.S. Food and Drug Administration (FDA) has ordered manufacturers of atypical – or secondgeneration- antipsychotic medications – to add a new black-box warning to the drugs’ labels telling prescribers and patients that the drugs are associated with an increased risk of death when used to treat psychosis and behavioral problems in elderly patients with dementia.

TCR: Welcome back to The Carlat Report, Dr. Agronin. You were our expert in October of 2003 when we discussed the diagnosis of dementia, and I understand that since then you have been busy with a new textbook project.

As longtime TCR readers with good memories know, Alois Alzheimer (1864-1915) was a German neurohistologist who, in 1906, reported the phenomenon of plaques and tangles in the brain of a 51 year-old woman who had died after five years of progressive dementia (TCR October 2003).

By definition, a “progress note” should be a written record of the degree of our patients’ progress. We can all agree on this much, and this is pretty much where the agreement ends.

Should we use rating scales in our clinical practices? And if so, which ones? Do the benefits of scales compensate for the extra time it takes to administer them?

In this month’s interview, Dr. Brendel does a wonderful job explaining what psychiatrists need to know in order to become HIPAA-compliant. In this article, TCR really gets down and dirty with HIPAA, taking you by the hand to tell you exactly what to do, what forms to use, and where to get them.