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Clinical Update

Treating Common Medical Conditions in Patients With Chronic Mental Illnesses

Topics: contraception | Free Articles | hyperlipidemia | hypertension | hypothyroidism | medical conditions | Obesity | sexually transmitted diseases | urinary tract infections | UTI

After years of specialized training in psychopharmacology and psychotherapy, it can feel foreign or uncomfortable to prescribe a nonpsychiatric medication, such as an antibiotic, to a patient in need. Uncertainty about psychiatrists’ scope of practice leaves many of us feeling unsure about whether we should prescribe anything beyond psychiatric medica

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Research Update

Opioid Agonist Treatment and Decreased Mortality

Topics: Free Articles | Medication for Opioid Use Disorder (MOUD) | Opioid epidemic | Opioid Use Disorder

Opioid agonist treatments, namely methadone and buprenorphine, save the lives of people with opioid use disorders. In this study, researchers break down how exactly these medications decrease mortality, and it’s not just by reducing overdoses. REVIEW OF: Santo T et al, JAMA Psychiatry 2021;78(9):979–993 STUDY TYPE: Systematic review and meta-ana

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Clinical Update

Tarasoff: Making Sense of the Duty to Warn or Protect

Topics: Crime | Criminal behavior | duty to protect | duty to warn | Free Articles | Legal issues | Tarasoff

  Your hospitalized patient tells you that he is angry with his sister and intends to “bash her brains in.” He tells you she is sending him messages through the television that say she is going to kill him. Nurses note the patient has been tense and irritable and has been observed talking to himself. Tarasoff ruling: Background We often

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Clinical Update

Principles of Verbal De-Escalation

Topics: aggression | Agitation | Emergency Department | Free Articles | verbal de-escalation

When our patients become agitated and threatening, we often think first about chemical or physical restraints—especially when staff’s physical safety seems at imminent risk. But it’s important to remember that coercive interventions can be humiliating and may lead to more agitation and violence. In fact, research indicates that restraints are corr

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Welcoming Our New Editor-in-Chief

Topics: Free Articles

It’s our pleasure to introduce Stephanie Collier, MD, MPH, as the editor-in-chief of CGPR. Dr. Collier is the director of education in the Division of Geriatric Psychiatry at McLean Hospital and an instructor in psychiatry at Harvard Medical School. Dr. Collier completed her psychiatry residency at Duke University Medical Center and her fellowship in

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Introducing the Newsletter

Introducing The Carlat Geriatric Psychiatry Report

Topics: Free Articles

Welcome to the inaugural issue of The Carlat Geriatric Psychiatry Report—our fifth CME newsletter. You’ve been asking for a source of unbiased reporting on geriatric psychiatry, and we’ve finally created one. We hope you’ll find it useful.  Three years ago, I took a job as chief of psychiatry at MelroseWakefield Healthcare, and an importan

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Clinical Update

How to Interview the Older Patient

Topics: Free Articles

The expanding population of older adults has created a need for all clinicians to participate in their care. Interviewing techniques require adaptation in older adults, such as accounting for hearing or vision impairment and speaking slowly and clearly. This article will cover additional factors to consider when evaluating older patients. Functional as

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Clinical Update

How to Distinguish the Dementias

Topics: Free Articles

There are several types of dementia, and each has a different prognosis and treatment course. In this article I’ll outline my approach for distinguishing between the most common varieties—Alzheimer’s, vascular, Lewy body, and frontotemporal. In addition, I’ll cover how to differentiate between mild and major neurocognitive disorder (NCD). 

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Clinical Update

Using Equine-Assisted Psychotherapy

Topics: ADHD | Anxiety Disorder | Autism Spectrum Disorder | Equine Assisted Psychotherapy | Equine therapy | Free Articles | PTSD | Trauma

  Sylvia is 7 years old, referred for long-standing school refusal after CBT proved ineffective. You confer with her therapist about trying a different approach. When patients are not amenable to usual therapy, equine-assisted psychotherapy (EAP) might be a good option. In this article we’ll talk about working with horses as an alternative

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Expert Q&A

Decisional Capacity

Topics: Aid to capacity evaluation (ACE) | Capacity | Collaborative care | Decisional Capacity | Dispositional capacity | Free Articles | Medical incapacity hold | Surrogate decision-maker

CHPR: Can you start by telling us what criteria you use to assess capacity? Dr. Cheung: We generally look for evidence of capacity in four domains. These have become the standard criteria for assessing capacity, based on Dr. Paul Appelbaum’s work from many years ago (Appelbaum PS and Grisso T, N Engl J Med 1988;319(25):1635–1638). The domains are:

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Clinical Update

Approaches to Autism Intervention

Topics: ABA | Applied Behavioral Analysis | Autism | Developmental Relationship Based Intervention | DRBI | Free Articles | Naturalistic Developmental-Behavioral Intervention | NDBI | treatment

Your patient is a young child who has recently been diagnosed with autism. Her parents are asking about the available treatments, and in particular, they want to know whether they should pursue the 40-hour-per-week program recommended by the local autism society. As clinicians, we are often faced with questions from families about the “best” pr

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Clinical Update

Intranasal Esketamine: New Hope for Suicidal Patients?

Topics: Depression | Esketamine | Fast-acting | Free Articles | Intra-nasal | Ketamine | Management | Psychopharmacology | Suicidality

It’s likely your patients have asked you about esketamine. The buzz is that it’s a rapid-acting miracle cure for suicidal depression. Dr. Thomas Insel, former director of NIMH, declared that ketamine “might be the most important breakthrough in antidepressant treatment in decades” (www.nimh.nih.gov/about/directors/thomas-insel/blog/2014/ketamine

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Expert Q&A

Serotonin Syndrome Versus NMS

Topics: Free Articles | Serotonin

CHPR: Can you start by telling us about yourself? Dr. Tormoehlen: Sure. I am a neurologist and have completed a medical toxicology fellowship. I am an attending physician for the neurology service at Indiana University Health Methodist Hospital, as well as for the toxicology service at Methodist, University, Riley, and Eskenazi Hospitals. I also run th

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Clinical Update

Deliberate Foreign Body Ingestion

Topics: Borderline Personality Disorder | Deliberate foreign body ingestion | DFBI | Free Articles | Gastroenterology | Malingering | Management | Obsessive compulsive disorder/OCD | Personality Disorders | Pica | Psychosis | Self-injury | Swallowing

During morning rounds at your inpatient unit, you are informed by staff that your patient M, a 32-year-old woman with bipolar disorder and borderline personality disorder, has swallowed a small pencil. This is her fourth swallowing episode since her admission to the unit 2 weeks ago. Even though you had restricted her access to sharp objects, she has ma

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Expert Q&A

Combination Treatment for Schizophrenia

Topics: Adjunct treatment | Antidepressant | Antipsychotic | Benzodiazepine | CATIE | Combination treatment | Free Articles | Mood stabilizer | Outcomes | Psychopharmacology | Schizoaffective disorder | Schizophrenia | Substance Use Disorder

CHPR: You recently published a study on the use of adjunctive medications in patients with schizophrenia (Stroup TS et al, JAMA Psychiatry 2019;76(5):508–515). Your findings were provocative as you found that adjunctive medications often help improve patients’ outcomes, yet many clinicians avoid polypharmacy because of concern that patients will exp

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Research Update

Antipsychotic Dosing: How High?

Topics: Antipsychotics | Free Articles | Research Update

Review of: Leucht S et al, Am J Psychiatry 2020;177(4):342–353 (published correction appears in Am J Psychiatry 2020;177(3):272) How high should we go when dosing antipsychotics in schizophrenia? Surprisingly little is known about optimal doses. During drug development, dosing is estimated from animal studies, but more detailed studies in humans ar

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Clinical Update

Prescribing to Children of Divorce

Topics: Collaborative care | custody agreement | Divorce | Free Articles | Medication | Separation

Each year in the US, there are about 1.04 million divorces, affecting about 800,000 children. Beyond that, 1.9 million cohabiting (and unmarried) couples break up each year, of whom 60% have children (www.census.gov/data/developers/data-sets/acs-1year.html). It may not be the divorce itself that is hard on children, but how the divorce is handled (ie, a

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Clinical Update

Managing Video Gaming in Children and Teens

Topics: Computer addiction | electronic use | Free Articles | videogaming addiction

CCPR: We are here to talk about managing video gaming in children and adolescents, which is a ubiquitous habit that might be even more pronounced given that we’re in the middle of a pandemic. Dr. Dilley, can you start with the relationship between mood disorders and gaming? Dr. Dilley: There is a complex relationship between mood disorders and gaming

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Article

Transcranial Magnetic Stimulation (TMS) for Depression in Children and Adolescents

Topics: adolescents | Brain Devices | children | Depression | Free Articles | pediatric | safety | teens | TMS | Transcranial Magnetic Stimulation

Editor’s note: This article is about the “usual” TMS that we have been hearing about for many years. We are covering trigeminal nerve stimulation (eTNS) separately in this issue in a News of Note as it is far newer with far less clarity about its utility. The search for safer treatment With concerns about both safety and efficacy surrounding a

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Research Update

Steroid-Induced Psychosis in the ­Pediatric Population

Topics: adolescents | Child Psychiatry | children | Free Articles | pediatric | Psychosis | Research Update | steroids | teens

Review of: Hodgins GE et al, J Child Adolesc Psychopharmacol 2018;28(5):354–359 Childhood psychosis is a rare disorder, and accurate diagnosis is crucial. Recently, clinicians at the University of Miami Miller School of Medicine reported a case of steroid-induced psychosis in a pediatric patient. In the case report, a 12-year-old Haitian girl wa

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