How common is physician burnout? One study estimated that 50% of U.S. physicians have “work-related distress” (Shanafelt TD, et al, Mayo Clin Proc. 2015;90(12):1600-13).John DiLallo, MD, a professor of psychiatry at the New York University School of Medicine, offered advice that might help you deal with practice stressors in The...

The decision to order lab tests can sometimes be a no-win situation. Tests are costly, and have the potential to yield false positive abnormalities, which may lead to further unnecessary testing. But if you don’t order tests, you could also miss a genuine problem.In an article from The Carlat Psychiatry...

All behavior is a code that a child uses to communicate, says Jessica Minahan, a board-certified behavior analyst and special educator, who co-authored The Behavior Code Companion. “Bad behavior” is often cloaked anxiety, and we can support education professionals by offering ideas that help anxious children.In an Expert Q&A in...

There are a lot of moving parts involved in closing your practice and retiring, says James T. Hilliard, an attorney and an assistant professor at Harvard Medical School. Subscribers can read the full article Hilliard wrote for the The Carlat Psychiatry Report. Here are four critical tasks:1. Inform your Board...

According to DSM-5, BPD is “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.” Based on the eight DSM-5 criteria for BPD, here are some questions you can ask patients to confirm a diagnosis:Identity disturbanceAsk patients, “Do you have a sense of where you’re going...

Despite lots of scientific investigation, the cause of TD remains relatively unknown. Most investigations seem to implicate hyper-functioning dopamine circuits. At least one study showed that antipsychotic medications, which block dopamine transmission, are beneficial in suppressing tics. (Robertson, MM. Arch Dis Child Educ Pract Ed 2012;97(5):166-175).That said, before you consider...

When children or adolescents come to your office showing signs of suicidal ideation, it’s necessary to conduct a focused assessment.During an interview in The Carlat Child Psychiatry Report, Cynthia Pfeffer, MD, Professor of psychiatry and director of the Childhood Bereavement Program at Weill Cornell Medicine, White Plains, NY, recommends that...

As more and more patients come to us asking if they have ADHD, we have to be cautious that we are not overdiagnosing the condition. In one study, only 5% of 260 students presenting with possible ADHD symptoms ended up meeting the DSM criteria.At universities, students who are high achievers...

An 11-year-old boy, who was admitted for suicidal ideation, is angry and wants to go home. He is marching up and down the hallways, screaming and flailing his arms in a menacing manner. You realize that medication to sedate him might be necessary, but you’re also considering a behavioral intervention.How...

Because of several factors, including high levels of dopamine, adolescents are prone to risky behavior. Controlling that risk and keeping kids safe isn’t something we as child psychiatrists can do on our own. It also takes support and help from parents, says Jess Shatkin, MD, an expert on adolescent behavior,...