Medical Comorbidities

Clinical Update

Primer: Physical Examination in Addiction Practice

Topics: Addiction | Medical Comorbidities | Prevention | Substance Use | Substance use disorders

Patients with substance use disorders (SUD) often have unaddressed medical issues. As addiction providers, we may be a patient’s only line of contact with health care personnel. Thus, keeping an eye out for medical problems could help reduce associated complications and even save a life. This article will take you through the sections of a basic physi

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Expert Q&A

Screening and Prophylaxis of Infectious Diseases in Addiction Practice

Topics: Addiction | Addiction Treatment | Hepatitis | HIV | Medical Comorbidities | Prevention | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Springer: I’m an infectious disease doctor who is addiction medicine board certified as well. My background clinically is treating HIV and infectious diseases, as well as opioid use disorder (OUD) and alcohol use disorder (AUD). My research is about how to best integrate infectious disease and OUD trea

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Clinical Update

PrEP: Introduction to the Basics

Topics: Addiction | Addiction Treatment | HIV | Medical Comorbidities | Medication | Pharmacology | Prevention | Substance Use | Substance use disorders

Great strides have been made in HIV treatment and prevention during the last 2 decades, resulting in falling numbers of new HIV infections during that time span. But since 2013, the rate of new infections has mostly plateaued at just under 40,000 new infections per year (www.hiv.gov). Those at highest risk of infection remain men who have sex with men,

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Expert Q&A

Perioperative Management of Patients on Buprenorphine Maintenance

Topics: Addiction | Addiction Treatment | Buprenorphine | Medical Comorbidities | Medication | Opioid epidemic | Opioid Use Disorder | Opioids | Pain | Pharmacology | Suboxone | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

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Expert Q&A 2

Opioid Use Disorders and Serious Mental Illness

Topics: Addiction Treatment | Alcohol use disorder | Behavioral treatment | Bipolar Disorder | Buprenorphine | Co-occurring disorders | Collaborative care | Depression | Literacy | Medical Comorbidities | Methadone

CATR: Please tell us about your clinical focus. Dr. Gomez-Luna: My principal role is within an organization called Behavioral Health Care, a behavioral health organization in Connecticut that serves a wide array of populations, from children and adolescents all the way to late adulthood (www.bhcare.org). We provide clinical services to communities for

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Research Update

Omega-3s and Metabolic Risks in Schizophrenia

Topics: Complementary treatments | Complimentary Medicine | Diabetes | Medical Comorbidities | Metabolic syndrome | Metformin | Natural Medications | natural treatments | Negative Symptoms | Omega-3 | Research Update

REVIEW OF: Pawełczyk T et al, Schizophr Res 2021;230:61–68 TYPE OF STUDY: Randomized, double-blind, placebo-controlled trial Patients with schizophrenia are at greater risk for metabolic syndrome, whether from lifestyle, antipsychotic side effects, or the illness itself. Omega-3 fatty acids have metabolic benefits in the general population, and lev

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Clinical Update

Depression, Vitamin D, and COVID-19

Topics: COVID19 | Medical Comorbidities | Vitamin D

Your patient with a history of depression comes to see you with a magazine article in hand. She has read that vitamin D deficiency causes depression and wants to know if she can get hers checked. Based on what we already know about this patient, there’s a good chance her levels are low. In the US, 1 in 4 people have low vitamin D levels, and the rate

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Clinical Update

Six Tips for Working With Older Adults

Topics: Benzodiazepines | Depression | Geriatric Psychiatry | Medical Comorbidities

In the US, 1 in 7 adults are over the age of 65, and the growth in this population is far outpacing the growth in geriatric psychiatrists. As a result, general clinicians are increasingly called on to provide the majority of care for older adults. In this article I’ll share some tips for working with this population. Tip 1: Communication Many olde

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Research Update

Beta Blockers and Depression: The Controversy Revisited

Topics: Alpha Agonists | Beta-blockers | Guanfacine | Medical Comorbidities | Research Update

Review of: Agustini B et al, J Hum Hypertens 2020;34(11):787–794 Study Type: Cross-sectional Antihypertensives are among the world’s most widely prescribed drugs, but many of them impact pathways associated with depression. Beta blockers have long been believed to cause depression, but most of the studies suggesting this were carried out decades a

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Research Update

Beta Blockers and Depression: The Controversy Revisited

Topics: Medical Comorbidities

Review of: Agustini B et al, J Hum Hypertens 2020 Jan 30 Study Type: Cross-sectional Antihypertensives are among the world’s most widely prescribed drugs, but many of them impact pathways associated with depression. Beta blockers have long been believed to cause depression, but most of these studies were carried out decades ago and their findings ha

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Clinical Update

How COVID-19 Affects the Brain

Topics: C-Reactive Protein | Coronavirus | COVID19 | CRP | Lamictal | Lamotrigine | Medical Comorbidities | Neurology | Neuroscience in Psychiatry | Traumatic Brain Injury (TBI)

The COVID-19 pandemic is a source of many stress-related conditions, from grief to depression to PTSD. But there’s another problem we need to look out for in those who’ve been infected with the virus: neuropsychiatric effects. The novel coronavirus can potentially invade neurons, and the immune response to this virus can affect the brain as well. Si

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Expert Q&A

Inflammatory Biomarkers in Depression

Topics: Bupropion | C-Reactive Protein | CRP | Depression | Depressive Disorder | Dopamine | Exercise | Inflammation | Laboratory Testing in Psychiatry | Medical Comorbidities | Norepinephrine | Nortriptyline | Nutrition | Obesity | Treatment-Resistant Depression | Wellbutrin

TCPR: What is inflammation? Dr. Miller: Inflammation is the body’s natural response to infection or wounding. It’s important for survival, but if it goes on too long it damages the body in various ways. It contributes to heart disease, cancer, metabolic disorders, and neurodegenerative disorders. Ultimately, it can change set points in the brain th

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Highlights

Highlights From This Issue

Topics: Bupropion | C-Reactive Protein | CRP | Depression | Depressive Disorder | Dopamine | Exercise | Inflammation | Laboratory Testing in Psychiatry | Medical Comorbidities | Norepinephrine | Nortriptyline | Nutrition | Obesity | Treatment-Resistant Depression | Wellbutrin

Inflammation contributes to treatment resistance in depression and can be measured with a blood test, C-reactive protein (CRP). An elevated CRP predicts a favorable response to certain antidepressants, as well as specific lifestyle interventions. Nuedexta’s expanded use in dementia is based on questionable efficacy, but it is safer than many

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Research Update

Mood Stabilizers and Stroke Risk in Bipolar Disorder

Topics: Bipolar Disorder | Lithium | Medical Comorbidities | Mood Stabilizers | Pharmacology

Review of: Chen PH et al, Br J Psychiatry 2018;1–6. doi:10.1192/bjp.2018.203 Study Type: Case-crossover study People living with bipolar disorder already have a decreased life expectancy of 10+ years compared to the general population (Crump C et al, JAMA Psychiatry 2013;70:931–939). Most of these years of lost life have been attributed to cardiov

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Expert Q&A

Distinguishing Between Medical and Psychiatric Conditions

Topics: Laboratory Testing in Psychiatry | Medical Comorbidities | Practice Tools and Tips | Psychopharmacology Tips

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Article

Traumatic Brain Injury in Psychiatric Practice

Topics: Medical Comorbidities

A casual glance at front-page headlines and scientific publications has probably raised your awareness of traumatic brain injury (TBI) and the TBI-related symptoms that might bring a patient to your office. In the popular press, reports often focus on injuries from combat and sports—such as those resulting from improvised explosive devices (IEDs) or h

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Article

Chronic Pain, Comorbidity, and Treatment Complexity

Topics: Medical Comorbidities

Chronic pain is typically defined as pain lasting longer than three months, resulting from either a disease process or bodily injury that has not resolved as expected. It is a major and complex public health reality for almost one-third of the US population. More than 116 million Americans have chronic pain conditions, contributing to healthcare costs a

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Article

Fatigue: Causes and Treatments

Topics: Medical Comorbidities

How often are you faced with patients who come to you with “I’m exhausted,” “I have no energy,” “I’m dragging,” or “I can’t stay awake”? If you’re like most psychiatrists, you see this often, and at times simply giving a sleep aid is an unsatisfying or ineffective solution. Up to one half of the general population, and one of

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Article

Drugs in the Pipeline: ALKS–5461

Topics: Medical Comorbidities

Since our feature article on “New Antidepressants” in the May 2012 TCPR, you may have heard some buzz about yet another new antidepressant undergoing clinical trials, this one with the less-than-sexy name ALKS-5461. Some news outlets have promoted it as “revolutionary.” What exactly is it? While most current antidepressants act on the monoami

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Expert Q&A

Integrating Primary Care and Mental Health Care

Topics: Medical Comorbidities

TCPR: Dr. Gardner, you are the head of psychiatry at an integrated health clinic. Please tell us why it important for psychiatric services to be integrated into primary care settings. Dr. Gardner: Integration destigmatizes and defragments care for providers and patients. For example, people with severe mental illness have a life expectancy 25 years s

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