For patients who smoke intermittently, you should start with nicotine replacement therapies, such as nicotine lozenges or gum, which can be used on a PRN basis.Patients who smoke more frequently, such as several times per day, will need consistent nicotine replacement from a patch to prevent the peaks and troughs...

Just getting adolescents to even find their medicine or remember to take it is a big challenge, says Jess Shatkin, MD, Professor of Adolescent Psychiatry and Pediatrics at the New York University School of Medicine, and author of “Born to be Wild: Why Teens Take Risks, and How We Can...

Although there’s been a lot of discussion about gabapentin’s abuse potential, gabapentin substance use disorders are pretty rare, with one study finding that only 2% of 44,148 patients using gabapentin alone met criteria for sustained overuse (Peckham et al, Pharmacotherapy, in press). The one area where you should show caution,...

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...