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Ask the Editor: Three Significant Food Interactions with ADHD Medications

Topics: Free Articles | Practice Tools and Tips | Psychopharmacology

Each month, Editor-in-Chief Chris Aiken, MD, gives advice on a different practice challenge. If you have a question you’d like Dr. Aiken to answer, please send an email to AskTheEditor@thecarlatreport.com. Dr. Aiken won’t be able to answer all questions received but will pick one each month that is of general interest. Dear Dr. Aiken: Patients of

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The 10 Commandments for Verbal De-Escalation

Topics: Free Articles | Practice Tools and Tips

This text has been adapted with permission from the 10 Commandments for Safety by Avrim Fishkind, MD. Respect personal space: 2 arm-lengths. Do not be provocative. Body language is important. Do not cross your arms, stare, or conceal your hands. Establish verbal contact. Introduce yourself by name and title. Only 1 person should verbally inte

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Non-Addictive, Pharmacological Options for Sleep

Topics: Addiction | Free Articles | Psychopharmacology Tips | Sleep Disorders | Substance Abuse

In this month’s interview with Dr. Eric Hermes, we learned about his approach to treating insomnia in patients with substance use disorders, with a focus on cognitive behavioral therapy. In this article, we’ll look at some non-addictive pharmacological options. That means we’re not going to review any of the benzodiazepines or the non-benzodiazepi

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Antidepressant Augmentation Strategies: A Basic Guide

Topics: Antidepressants | Free Articles

Here’s a common scenario. You have a patient who has tried three or four antidepressants over the years; all have been somewhat effective at least initially, but eventually that effectiveness waned. Let’s imagine that the patient you’re seeing now is on antidepressant number 4, Lexapro, at a solid 20 mg dose. You could always keep pushing the d

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Informed Consent: An Ongoing Process for Focused Care

Topics: Child Psychiatry | Free Articles | Practice Tools and Tips

Informed consent is a foundation for good clinical practice and can provide legal protection. But informed consent is more than defensive medicine. It is a vehicle for framing good care. How often do people use the consent process? Malpractice companies recommend that the patient (or parent) sign consent whenever a medication is started. This might b

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Abilify MyCite: Patient Care Breakthrough or Patent Extender?

Topics: Antipsychotics | Free Articles | Pharmacology Tips | Practice Tools and Tips

You’ve probably heard about a new “digital pill” called Abilify MyCite. The product, which was FDA approved in November 2017, is the first drug in the U.S. with a digital ingestion tracking system. MyCite consists of an aripiprazole pill that contains an embedded tiny sensing device (about the size of a grain of sand) called the ingestible even

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Lithium: Practical Considerations for Children With Suicidal Thinking

Topics: Child Psychiatry | Depressive Disorder | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Billy, age 10, has periods of intense aggression alternating with moments of wanting to be dead, severe mood swings, poor sleep, and pervasive irritability. He has a family history of bipolar disorder. Other family members have responded well to lithium. Since they want to act assertively to help him, Billy’s family is open to medication trials and an

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The Bipolar Spectrum: Practical Tips for Diagnosis and Treatment

Topics: Bipolar Disorder | Free Articles

Bipolar disorder has long been controversial in the field. Is it overdiagnosed or underdiagnosed? Does a “bipolar spectrum” truly exist, or is it a marketing tool for pharmaceutical companies that want you to prescribe more atypical antipsychotics? At a minimum, the bipolar spectrum includes those patients who meet criteria for both bipolar I and

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Expert Q&A

Helping Patients With Stigma and Addiction

Topics: Addiction | Free Articles | Practice Tools and Tips

CATR: To start, can you please tell us a little more about your work at Harvard and Mass General? Dr. Kelly: Sure. I’m a clinical psychologist by training, and for the past 20 years, I have spent a lot of time researching the addiction treatment and recovery processes. I’ve looked at the effectiveness of different treatments, their mechanisms, an

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Expert Q&A

Assessing Complex PTSD

Topics: Free Articles | PTSD

TCPR: We’ve been hearing more the last few years about the concept of complex PTSD. I know that there are similarities with conventional PTSD—which is covered in the DSM-5—but can you explain to our readers how complex PTSD is different from conventional PTSD? Dr. Schwartz: The first thing that I would say is that complex PTSD can sometimes be

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Closing a Practice: Some Practical Suggestions

Topics: Free Articles | Practice Tools and Tips

Dr. R is a psychiatrist in his late 60s with a thriving private practice. One day, he suddenly feels dizzy and out of sorts. After being examined by another physician, he is diagnosed with a stroke. His neurologist cannot say if he will fully recover or be able to practice medicine again. Dr. R and his family know that he might suddenly need to retire.

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From Infantile Autism to Autism Spectrum Disorder

Topics: Autism Spectrum Disorder | Child Psychiatry | DSM | Free Articles

Changes in diagnostic criteria not only affect the clinical and public perception of a disorder, but also its perceived prevalence. Such is the case with autism. The evolution of the autism diagnosis since it was introduced into the Diagnostic and Statistical Manual (DSM) in 1980 inarguably has altered its reported prevalence, rising from an estimated 1

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Dialectical Behavior Therapy for Substance Use Disorders: A Primer

Topics: Addiction | Cognitive Behavioral Therapy | Free Articles | Substance Abuse

Angela is a 27-year-old woman who was just discharged from the hospital after a suicide attempt following her second arrest for DUI. She says she only drinks on the weekends, but she recently lost her third job due to absenteeism. She doesn’t like AA, and she was kicked out of residential substance abuse treatment after the staff caught her scratching

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Research Update

Reports of Gabapentin Misuse and Abuse Appear to Be True

Topics: Addiction | Free Articles | Substance Abuse

Gabapentin is FDA-approved for seizures and neuropathic pain, but it’s commonly used off-label for a variety of psychiatric and physical conditions, including anxiety, insomnia, borderline personality disorder, alcohol use disorders, and multiple pain disorders. Another aspect of gabapentin use that has come to light in recent years is a seemingly per

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Taking Back Control in Binge Eating Disorder

Topics: Child Psychiatry | Eating Disorders | Free Articles

Confined to the appendix in previous editions of the Diagnostic and Statistical Manual (DSM), binge eating disorder (BED) took a leap into the spotlight with its inclusion as an official diagnosis in 2013’s DSM-5. It is one of the more controversial of DSM-5 disorders, with some claiming that BED inappropriately turns overeating and obesity into a psy

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Conduct Disorder and Oppositional Defiant Disorder: A Primer

Topics: Child Psychiatry | Cognitive Behavioral Therapy | Free Articles | Practice Tools and Tips | Psychotherapy

Vignette: Richie was a 15-year-old boy referred for evaluation after multiple run-ins with the police for drug possession, fighting, and shoplifting. Richie was the oldest of three boys and looked up to a gang-involved cousin who was in prison for drug trafficking. The patient was enrolled in multisystemic therapy (MST) for both treatment and further e

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How to Treat Opiate Use Disorders

Topics: Addiction | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Opiate use disorder is increasingly common, and it is important to develop a systematic approach for treating it. In this article, I will discuss some of the more important elements of treatment, starting with the need to address patients’ denial and moving on to some of the nitty gritty aspects of medication-assisted treatment. Acknowledging the p

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Addiction and Family: What You Need to Know

Topics: Addiction | Free Articles | Substance Abuse

George F. Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), doesn’t like the word “codependency,” and he likes the word “enabling” even less. “Codependency is a pejorative word, and it implies that someone else is at fault—and one of the major components of Alcoholics Anonymous is to take full responsib

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The Explosion of the ADHD Diagnosis: The Key Causes

Topics: ADHD | Child Psychiatry | Free Articles

Rates of ADHD have increased significantly in the U.S. over the past several years, leading to an ongoing debate about the validity of the disorder. Because you are likely to be asked by patients (or their parents) about this issue, it’s helpful for you to have some background in exactly how much the prevalence has increased, and what factors may be d

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Diagnosing Depression in Children and Adolescents

Topics: Child Psychiatry | Depressive Disorder | Free Articles

Today, the idea that adolescents and children, even young children, can have a major depressive disorder is widely accepted, but that was not always the case. Debates about the age at which “true” depression could manifest itself were widespread in child and adolescent psychiatry through the late 70s and into the early 80s (Pataki CS and Carlson GA,

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