In many cases, it will be immediately clear when an aggressive patient needs to be sent to the ER, says Ruth Gerson, MD, Director at the Bellevue Hospital Children’s Comprehensive Psychiatric Emergency Program in New York, NY. If a patient is hurting people, including himself, and you determine a clear...

The following tips for overcoming conflict in the medication consent process were excerpted from an informed consent article in the May/June issue of The Carlat Child Psychiatry Report:1. If it’s not an emergency, take your time. When life and limb are at stake, we should act immediately—but that doesn’t usually...

In addition to antipsychotics, parkinsonism symptoms can also develop through the use of non-psychiatric medicines, particularly metoclopramide (Reglan), an anti-nausea medicine. Neurologist David M. Kaufman, MD, of Montefiore Medical Center, Bronx, NY. Dr. Kaufman offered the following information in an Expert Q&A from The Carlat Psychiatry Report:What other disorders might...

According to most treatment guidelines, you should consider clozapine after inadequate response to at least two antipsychotics. For patients who are extremely aggressive or suicidal, the APA treatment guidelines state that a trial of clozapine may be reasonable as a first or second line antipsychotic. Here are some additional tips...

Always screen for disturbances of sleep—they often are the key to other problems a child might be having. Look at factors from issues at school or in the family, as well as digital exposure and dietary habits (caffeine, carbs, etc).The following is a brief primer on common sleep disorders, from...

It can be challenging to manage chronic pain, even more so when our patients suffer from addiction, says Michael McGee, MD, Chief Medical Officer, The Haven at Pismo, Avila Beach, CA. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain,...

In The Carlat Child Psychiatry Report, Sara Weekly, MD, child and adolescent psychiatrist and clinical assistant professor at New York University School of Medicine, gave the following advice on BED treatment strategies:Consider cognitive behavioral therapy: CBT currently has the strongest evidence base among psychotherapeutic options for treating BED, although Interpersonal...

Specimens of urine, blood, hair, saliva, sweat and even nails can be used to drug test. Some are more specific, sensitive and accurate than others, says Talia Puzantian, PharmD, BCCP, who goes over the following drug testing methods in The Carlat Addiction Treatment Report:Urine screening is noninvasive and the most-common...

Family members can tell you about your patient’s level of functioning, can confirm sleeping and eating schedules, and raise questions about cultural beliefs and values, says Alison Heru, MD, a professor of psychiatry at University of Colorado School of Medicine, and author of the book, “Working With Families in Medical...

Lithium’s effectiveness for mania in children is surprisingly robust. The Collaborative Lithium Trials, which is the largest double-blind placebo-controlled study to date, found lithium to be both effective and well tolerated in patients ages 7-17 with bipolar disorder (Findling et al, Pediatrics 2015; 136 (5):885-894).For bipolar disorder, lithium is typically...