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Home » Topics » Clinical Update

Clinical Update
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Clinical Update

When Shorter Is Better

April 14, 2023
Chris Aiken, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Chris Aiken, MD. Editor-in-Chief of The Carlat Psychiatry Report; Assistant Professor, NYU Langone Department of Psychiatry; practicing psychiatrist, Winston-Salem, NC.

Dr. Aiken has no financial relationships with companies related to this material.

Four scenarios where a time-limited approach to medication is ideal.


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Clinical Update

Treating Irritability in Autism: Functional and Medication Approaches

April 1, 2023
Joshua Feder, MD
From The Carlat Child Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Joshua D. Feder, MD. Editor-in-Chief, The Carlat Child Psychiatry Report.

Dr. Feder has no financial relationships with companies related to this material.

Antipsychotics can be very effective for irritability in autism, but they are often unnecessary, and the side effects are truly problematic. Don’t be the prescriber who hears irritability in autism and immediate prescribes antipsychotics. There are usually multiple steps to try before using the FDA approved antipsychotic medications.


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Clinical Update

Confused About Acute Confusional States? A Primer on Delirium

April 1, 2023
Michael Strong, MD and Alexander Thompson, MD, MBA, MPH
From The Carlat Hospital Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Michael Strong, MD. Assistant professor of clinical psychiatry, Perelman School of Medicine at the University of Pennsylvania. Philadelphia, PA.
Alexander Thompson, MD, MBA, MPH. Clinical professor of psychiatry and emergency medicine; director, C-L Psychiatry, University of Iowa. Iowa City, IA. 
Dr. Strong and Dr. Thompson have no financial relationships with companies related to this material.

Delirium is widespread among patients in ICUs and surgery units. We review the workup and management of this common condition and give you tips to help prevent it in high-risk patients.


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Clinical Update

Gabapentin: A Double-Edged Sword

April 1, 2023
Noah Capurso, MD and Shram Shukla, MD
From The Carlat Addiction Treatment Report
Issue Links: Editorial Information | PDF of Issue

Shram Shukla, MD. Addiction psychiatry fellow, Yale School of Medicine. New Haven, CT.

Noah Capurso, MD, MHS. Assistant professor of psychiatry, Yale University. New Haven, CT. Editor-in-chief of The Carlat Addiction Treatment Report.

Dr. Shukla and Dr. Capurso have no financial relationships with companies related to this material.

Gabapentin has become one of the most widely prescribed medications in America. At the same time, concerns have emerged about its association with opioid overdose deaths. In this article, we review the data behind gabapentin treatment: when it should be used, how to use it, and when it should be avoided.


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Clinical Update

Naltrexone: A Jack of All Trades?

April 1, 2023
Julio Cesar Nunes, MD
From The Carlat Addiction Treatment Report
Issue Links: Editorial Information | PDF of Issue

Julio Cesar Nunes, MD. Psychiatry resident, Yale University. New Haven, CT.

Noah Capurso, MD, MHS. Assistant professor of psychiatry, Yale University. New Haven, CT. Editor-in-chief of The Carlat Addiction Treatment Report.

Dr. Nunes and Dr. Capurso have no financial relationships with companies related to this material.

Naltrexone was once hailed as a treatment for all addictive disorders. While the hype has not entirely panned out, it still holds an important place in our armamentarium of addiction treatments. Here, we review the evidence for its use and provide prescribing recommendations.


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Clinical Update

Four Controversial Diagnoses in Psychiatry: Are They Valid?

March 8, 2023
Chris Aiken, MD and Tony Thrasher, DO, DFAPA
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Chris Aiken, MD. Editor-in-Chief of TCPR. Practicing psychiatrist. Winston-Salem, NC.

Tony Thrasher, DO, DFAPA. Immediate past president, American Association for Emergency Psychiatry (AAEP). Medical Director of Crisis Services, Milwaukee County Behavioral Health. Milwaukee, WI. Clinical Associate Professor, Medical College of Wisconsin. Milwaukee, WI.

Dr. Aiken and Dr. Thrasher have no financial relationships with companies related to this material.

From Google to TikTok, patients are diagnosing themselves with disorders that didn’t make it in the DSM. We take an open look at the validity of sensory processing disorder, slow cognitive speed, “ring of fire” ADHD, and complex PTSD.


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Clinical Update

Deep Rivers Run Quiet. An Update on Social Anxiety Disorder

March 8, 2023
Steven Hamilton, PhD, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Steven Hamilton, MD, PhD. The Permanente Medical Group, Department of Psychiatry, Kaiser Permanente San Francisco Medical Center. Dr. Hamilton has no financial relationships with companies related to this material.

SSRIs and CBT treat social anxiety disorder, but what do you do when they don’t work? Steven Hamilton describes 5 other pharmacotherapy options and shows us how to distinguish social anxiety from normal shyness.


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Clinical Update

The Medical Evaluation of Anorexia

February 1, 2023
Chris Aiken, MD and Garrett Rossi, MD.
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Chris Aiken, MD. Editor-in-Chief of The Carlat Psychiatry Report. Assistant Professor, NYU Langone Department of Psychiatry. Practicing psychiatrist, Winston-Salem, NC.
Garrett Rossi, MD. Adult psychiatrist, AtlantiCare Regional Medical Center, Pomona, NJ.

Dr. Aiken and Dr. Rossi have no financial relationships with companies related to this material.

When do you order labs, how do you weight patients, and what signs and symptoms should prompt a higher level of care?


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Clinical Update

Anorexia: An Update for the Psychopharmacologist

January 31, 2023
Chris Aiken, MD and Garrett Rossi, MD.
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Chris Aiken, MD. Editor-in-Chief of The Carlat Psychiatry Report. Assistant Professor, NYU Langone Department of Psychiatry. Practicing psychiatrist, Winston-Salem, NC.
Garrett Rossi, MD. Adult psychiatrist, AtlantiCare Regional Medical Center, Pomona, NJ.

Dr. Aiken and Dr. Rossi have no financial relationships with companies related to this material.

A half-dozen reviews have concluded that no medication is effective for anorexia. We agree, but they may have overlooked a common supplement with evidence to help: Zinc.


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Clinical Update

Mania in Older Adults

January 31, 2023
Julia Cromwell, MD
From The Carlat Geriatric Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Julia Cromwell, MD. Inpatient geriatric psychiatrist, Mass General Brigham Salem Hospital. Salem, MA. Dr. Cromwell has no financial relationships with companies related to this material.

In older adults, mania is more likely to be secondary to a medication or due to a neurological or
medical illness. We provide a mnemonic to help systematically think through the most likely
causes of secondary mania, which can help guide our workup.


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