CARLAT PUBLISHING The Carlat Report https://www.thecarlatreport.com/rss/articles Gender Affirming Care in Exile: Targeting the Leader p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; color: #000000}

The president of the US branch of WPATH built one of the largest youth gender clinics in the country, then watched it close under political fire. Now she's facing a malpractice lawsuit from a former patient. We examine the unpublished study at the center of the controversy.
]]> Mon, 11 May 2026 02:00:00 -0400 https://www.thecarlatreport.com/blogs/2-the-carlat-psychiatry-podcast/post/6292-gender-affirming-care-in-exile-targeting-the-leader http://www.thecarlatreport.com/blogs/2/post/6292 When Social Withdrawal Becomes Invisible Pathology Have you ever heard of hikikomori? Literally: "pulling inward."

First described by Japanese psychiatrist Tamaki Saito in 1998 — and for decades assumed to be a uniquely Japanese problem. 

It isn't.

A 2025 meta-analysis of 19 studies and 58,000+ participants found cases across Europe, North America, and beyond. US estimates put prevalence around 2–3%. Roughly 1 in 40 Americans.



]]> Fri, 08 May 2026 18:00:00 -0400 https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6291-when-social-withdrawal-becomes-invisible-pathology http://www.thecarlatreport.com/blogs/1/post/6291 Assessing the Evidence in Child and Adolescent Psychiatry Not all studies are created equal — and in child psychiatry, the stakes of getting it wrong are high. Dr. Spielmans introduces the PICOT framework, exposes common sources of bias in clinical trials, and offers practical tools for vetting the research before it reaches your patients.

]]> Fri, 08 May 2026 12:41:38 -0400 https://www.thecarlatreport.com/articles/6288-assessing-the-evidence-in-child-and-adolescent-psychiatry http://www.thecarlatreport.com/articles/6288 SSRIs Help Modestly With Pediatric OCD SSRIs are standard for pediatric OCD, but how much do they actually move the needle? An individual participant data meta-analysis puts a number on it, and the answer is more nuanced than the guidelines suggest. Baseline severity, it turns out, matters more than most clinicians realize.

]]> Fri, 08 May 2026 12:16:47 -0400 https://www.thecarlatreport.com/articles/6283-ssris-help-modestly-with-pediatric-ocd http://www.thecarlatreport.com/articles/6283 Helping Patients Tolerate Anti-Manic Treatments Mania requires rapid treatment, but side effects often undermine adherence. Learn practical strategies to improve tolerability and when to consider off-label or behavioral options.

]]> Thu, 07 May 2026 15:54:07 -0400 https://www.thecarlatreport.com/articles/6278-helping-patients-tolerate-anti-manic-treatments http://www.thecarlatreport.com/articles/6278 Gender Affirming Care in Exile: The Trials p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; color: #000000}

Medical societies are reversing decades of support for gender-affirming care in youth — but is it the science driving the shift, or the politics? This episode walks through the evidence, from randomized trials to regret rates, and finds a more complicated picture than either side presents.
]]> Mon, 04 May 2026 02:00:00 -0400 https://www.thecarlatreport.com/blogs/2-the-carlat-psychiatry-podcast/post/6273-gender-affirming-care-in-exile-the-trials http://www.thecarlatreport.com/blogs/2/post/6273 Herpes Zoster Vaccination and Dementia Risk Could a shingles vaccine lower dementia risk? A natural experiment in Wales—where vaccine eligibility turned on a single birthdate—found a 20% relative reduction in new dementia diagnoses over seven years. It's not proof of causation, but it's the strongest quasi-experimental evidence yet, and one more reason to make the recommendation.

]]> Sat, 02 May 2026 14:11:51 -0400 https://www.thecarlatreport.com/articles/6266-herpes-zoster-vaccination-and-dementia-risk http://www.thecarlatreport.com/articles/6266 Prazosin and Cyproheptadine for AUD: A Promising Combination When standard treatments fall short in alcohol use disorder, could a prazosin–cyproheptadine combination help? A new randomized trial suggests this pairing may significantly reduce high-risk drinking.

]]> Fri, 01 May 2026 15:45:20 -0400 https://www.thecarlatreport.com/articles/6276-prazosin-and-cyproheptadine-for-aud-a-promising-combination http://www.thecarlatreport.com/articles/6276 Learning Objectives, Borderline Personality Disorder, TCPR, May 2026 After reading these articles, you should be able to…


]]> Fri, 01 May 2026 01:23:53 -0400 https://www.thecarlatreport.com/articles/6280-learning-objectives-borderline-personality-disorder-tcpr-may-2026 http://www.thecarlatreport.com/articles/6280 CME Post-Test, Borderline Personality Disorder, TCPR, May 2026 By successfully completing the test you will be awarded a certificate for 1 CME credit.

]]> Fri, 01 May 2026 01:00:00 -0400 https://www.thecarlatreport.com/articles/6274-cme-post-test-borderline-personality-disorder-tcpr-may-2026 http://www.thecarlatreport.com/articles/6274 Diagnosing Borderline Personality Dr. Zimmerman explains why BPD is underdiagnosed and how a single high-yield screening question can change your assessment.

]]> Fri, 01 May 2026 00:00:00 -0400 https://www.thecarlatreport.com/articles/6279-diagnosing-borderline-personality http://www.thecarlatreport.com/articles/6279 Do “Other” Events Trigger Post-Traumatic Stress Disorder? What if a patient’s most traumatic experience doesn’t meet DSM-5 criteria? This study explores how other life events can trigger PTSD-level symptoms—challenging how we define trauma.


]]> Fri, 01 May 2026 00:00:00 -0400 https://www.thecarlatreport.com/articles/6277-do-other-events-trigger-post-traumatic-stress-disorder http://www.thecarlatreport.com/articles/6277 Treating Antipsychotic-Induced Weight Gain with GLP-1 Agonists GLP-1 agonists have transformed obesity care—now emerging research suggests they may also reverse antipsychotic-induced weight gain without worsening psychiatric symptoms.

]]> Fri, 01 May 2026 00:00:00 -0400 https://www.thecarlatreport.com/articles/6275-treating-antipsychotic-induced-weight-gain-with-glp-1-agonists http://www.thecarlatreport.com/articles/6275 Gender Affirming Care in Exile: The Lawsuits p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; color: #000000}

Two malpractice cases — one worth $2 million — are reshaping the standards of gender-affirming care. This episode traces what went wrong, what held up in court, and what every clinician needs to know when referring patients for gender affirming procedures.
]]> Mon, 27 Apr 2026 02:00:00 -0400 https://www.thecarlatreport.com/blogs/2-the-carlat-psychiatry-podcast/post/6262-gender-affirming-care-in-exile-the-lawsuits http://www.thecarlatreport.com/blogs/2/post/6262 Table: Psychiatric Medications in Pregnancy and Lactation Table: Psychiatric Medications in Pregnancy and Lactation]]> Fri, 24 Apr 2026 17:00:36 -0400 https://www.thecarlatreport.com/articles/6261-table-psychiatric-medications-in-pregnancy-and-lactation http://www.thecarlatreport.com/articles/6261 Use of Psychiatric Medications in Breastfeeding Patients When new mothers are admitted to the inpatient psychiatric unit, they might ask about the safety of taking psychiatric medications while breastfeeding.

]]> Fri, 24 Apr 2026 17:00:36 -0400 https://www.thecarlatreport.com/articles/5320-use-of-psychiatric-medications-in-breastfeeding-patients http://www.thecarlatreport.com/articles/5320 Depression in Pregnancy: Diagnosis and Treatment Prenatal depression is common, affecting 10%–15% of pregnant patients.



]]> Fri, 24 Apr 2026 16:38:54 -0400 https://www.thecarlatreport.com/articles/6257-depression-in-pregnancy-diagnosis-and-treatment http://www.thecarlatreport.com/articles/6257 PTSD Diagnosis and Treatment Many of your patients will most likely have been exposed to significant trauma, such as adverse childhood experiences, domestic or sexual violence, and the hardships associated with homelessness or substance use.


]]> Fri, 24 Apr 2026 16:38:54 -0400 https://www.thecarlatreport.com/articles/6256-ptsd-diagnosis-and-treatment http://www.thecarlatreport.com/articles/6256 Dissociative Identity Disorder: Diagnosis and Treatment Occasionally you will encounter patients who report having multiple personalities or distinct identities, also called alters. Formerly called “multiple personality disorder,” this condition is now termed dissociative identity disorder (DID). 

]]> Fri, 24 Apr 2026 16:38:54 -0400 https://www.thecarlatreport.com/articles/5225-dissociative-identity-disorder-diagnosis-and-treatment http://www.thecarlatreport.com/articles/5225 Topiramate (Eprontia, Qudexy XR, Topamax, Trokendi XR) Fact Sheet Naltrexone, an opioid antagonist, is the first-line medication for alcohol use disorder (AUD)—though it is also approved for opioid use disorder (OUD).



]]> Tue, 21 Apr 2026 16:33:31 -0400 https://www.thecarlatreport.com/articles/6201-topiramate-eprontia-qudexy-xr-topamax-trokendi-xr-fact-sheet http://www.thecarlatreport.com/articles/6201 Naltrexone (ReVia, Vivitrol) Fact Sheet Naltrexone, an opioid antagonist, is the first-line medication for alcohol use disorder (AUD)—though it is also approved for opioid use disorder (OUD).



]]> Tue, 21 Apr 2026 16:33:31 -0400 https://www.thecarlatreport.com/articles/6200-naltrexone-revia-vivitrol-fact-sheet http://www.thecarlatreport.com/articles/6200 Gabapentin (Gralise, Horizant, Neurontin) Fact Sheet Gabapentin is effective as an off-label medication to ease alcohol withdrawal symptoms and to reduce cravings over the long term in patients with alcohol use disorder (AUD).



]]> Tue, 21 Apr 2026 16:33:31 -0400 https://www.thecarlatreport.com/articles/6199-gabapentin-gralise-horizant-neurontin-fact-sheet http://www.thecarlatreport.com/articles/6199 Disulfiram (Antabuse) Fact Sheet Disulfiram is an aversive treatment, causing a buildup of ethanol’s metabolite acetaldehyde in the serum, which in turn causes symptoms such as flushing, dizziness, nausea, and vomiting if patient consumes alcohol.


]]> Tue, 21 Apr 2026 16:33:31 -0400 https://www.thecarlatreport.com/articles/6198-disulfiram-antabuse-fact-sheet http://www.thecarlatreport.com/articles/6198 Acamprosate (Campral) Fact Sheet [G] Acamprosate is best for maintaining abstinence in patients who have already quit drinking, but it can be helpful even after patients relapse. Naltrexone is the better choice for patients who are still drinking, since it is better at helping patients quit. Acamprosate is preferred over naltrexone in patients with hepatic impairment.

]]> Tue, 21 Apr 2026 16:33:31 -0400 https://www.thecarlatreport.com/articles/5082-acamprosate-campral-fact-sheet-g http://www.thecarlatreport.com/articles/5082 Lithium Goes Mainstream p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; color: #000000}

In the 1950s, a young Danish psychiatrist named Mogens Schou staked his career — and his family — on a mineral most of his colleagues dismissed as dangerous nonsense. This is the story of how lithium went from fringe curiosity to the gold standard for bipolar disorder, and the bitter scientific battle that nearly derailed it.
]]> Mon, 20 Apr 2026 02:00:00 -0400 https://www.thecarlatreport.com/blogs/2-the-carlat-psychiatry-podcast/post/6152-lithium-goes-mainstream http://www.thecarlatreport.com/blogs/2/post/6152 Clinically Significant Drug Interactions Generally, when pressed for time, most clinicians will use one of the following online drug interaction checkers.

]]> Sun, 19 Apr 2026 15:43:40 -0400 https://www.thecarlatreport.com/articles/5280-clinically-significant-drug-interactions http://www.thecarlatreport.com/articles/5280 Are We Preparing Autistic Patients for Adulthood? We support autistic children. We abandon autistic adults. 

In our latest Child Psychiatry Report, Mary Baker-Ericzen, research professor at San Diego State University and clinical psychologist at the Intricate Mind Institute, asks clinicians to consider a different question at every visit: Is this patient building the skills they'll need when the system stops showing up for them?


]]> Fri, 17 Apr 2026 18:00:00 -0400 https://www.thecarlatreport.com/blogs/1-the-carlat-psychiatry-blog/post/6048-are-we-preparing-autistic-patients-for-adulthood http://www.thecarlatreport.com/blogs/1/post/6048 Atomoxetine (Strattera) Fact Sheet for Patients Atomoxetine treats attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults.


]]> Fri, 17 Apr 2026 16:35:47 -0400 https://www.thecarlatreport.com/articles/6037-atomoxetine-strattera-fact-sheet-for-patients http://www.thecarlatreport.com/articles/6037 Autism Spectrum Disorder Patients with autism spectrum disorder (ASD) may be admitted to inpatient units for a variety of reasons.

]]> Fri, 17 Apr 2026 16:35:47 -0400 https://www.thecarlatreport.com/articles/5195-autism-spectrum-disorder http://www.thecarlatreport.com/articles/5195 Borderline Personality Disorder: Diagnosis and Treatment Patients with borderline personality disorder (BPD) account for about 20% of psychiatric inpatients and can often present challenges on the unit. In this fact sheet, we describe a systematic approach to diagnosis.



]]> Fri, 17 Apr 2026 15:35:32 -0400 https://www.thecarlatreport.com/articles/6092-borderline-personality-disorder-diagnosis-and-treatment http://www.thecarlatreport.com/articles/6092