Practice Tools and Tips

Article

Treating Chronic Pain When There’s Addiction: A Primer

Topics: Addiction | Practice Tools and Tips | Psychopharmacology

It can be challenging to manage chronic pain, even more so when our patients suffer from addiction. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain, and the risk of relapse due to the use of opioid analgesics. Since our mission is to minimize suffering and optimize functioning while helpin

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Article

Informed Consent: An Ongoing Process for Focused Care

Topics: Child Psychiatry | 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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Expert Q&A

Using Caution While Prescribing Opioids for Pain

Topics: Addiction | Practice Tools and Tips | Psychopharmacology

CATR: I know you’ve done a lot of research around overdose deaths, both intentional and unintentional, and how this may help psychiatrists more wisely prescribe opioids for pain. Can you start by giving us a little more background on that? Dr. Bohnert: Sure. I’ll start by talking a little about overdose deaths. The study that we did in the VA wit

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Article

Embracing Conflict in the Consent Process

Topics: Child Psychiatry | Practice Tools and Tips

What do you do when your teen patient declines an offer of medication yet the parents insist on it? How about if the teen is coming to you for medication and the parents are opposed to the idea? Does the teen have the right to request and receive medication? And what if the teen is using substances? CBD? Do you still treat, or do you refer elsewhere?

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Expert Q&A

Assessing and Treating Psychogenic Pain

Topics: Addiction | Neuroscience in Psychiatry | Practice Tools and Tips

CATR: To start, can you give us your take on the neurological process around pain? What’s going on in the brain that causes a patient pain? Dr. Schubiner: All pain is generated by what the neuroscientists call a salience network, or as I like to call it, the danger alarm mechanism. All pain is real. It’s just a question of whether that pain is bein

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Article

Is EEG Useful in Psychiatry?

Topics: Diagnostic Testing | Neuroscience in Psychiatry | Practice Tools and Tips

Is it useful for psychiatrists to order EEGs on their patients? That’s a perennially controversial question, and one that’s worth revisiting from time to time. The basics of EEG First developed in the 1920s, EEG entails applying electrodes to the scalp’s surface to measure electricity generated by neural activity. The brain works primarily via

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Expert Q&A

Neurofeedback in Psychiatry: What’s the Evidence?

Topics: Diagnostic Testing | Neuroscience in Psychiatry | Practice Tools and Tips

TCPR: You and your UMass colleagues recently reviewed the current research on the efficacy of neurofeedback in psychiatry (Begemann M et al, Trans Brain Rhyth 2016;1(1):19–29). But before going into the research, can you please describe what the procedure is and how it is done? Many of our readers wonder whether neurofeedback is a legitimate or effect

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Article

Differentiating ADHD From Anxiety: Tips for Clinicians

Topics: ADHD | Anxiety | Child Psychiatry | Practice Tools and Tips

When parents bring in their kids for concentration, attention, and learning issues, it’s common to assume a provisional diagnosis of ADHD. In many children, however, anxiety can be the real cause of these problems. Studies have long shown that about two-thirds of children and adolescents who present for ADHD evaluation have comorbid conditions, inc

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Expert Q&A

Warning Patients on the Dangers of Cannabis Use

Topics: Addiction | Practice Tools and Tips

CATR: To start, could you tell us a little about your work around substance use disorders, and specifically your experience with cannabis and adolescents? Dr. Gray: A large focus of my career has been on doing National Institutes of Health–sponsored research into better understanding substance use disorders in young people. So, that would include a

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Article

Clozapine: A Fresh Look

Topics: Antipsychotics | Pharmacology Tips | Practice Tools and Tips

Several trials show it to be a superior treatment option, yet clozapine remains the “red-headed stepchild” of antipsychotics. Even though large studies reveal clozapine has impressive efficacy, particularly with treatment-resistant schizophrenia, many of us are reluctant to use it. According to one study, of the 30% of patients who have treatment

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Expert Q&A

Prescribing and Managing Antipsychotics

Topics: Antipsychotics | Pharmacology Tips | Practice Tools and Tips

TCPR: Dr. Schwartz, there are so many antipsychotics available. How do you choose in your own practice? Dr. Schwartz: Any drugs that have an FDA indication for a particular diagnosis are likely to be effective. I especially like to use those that have less risk of metabolic complications, such as ziprasidone, lurasidone, etc. If we are discussing eff

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Article

Note From the Editor-in-Chief

Topics: Practice Tools and Tips

For this month’s issue, I asked two experts in family and couples therapy to remind us of how crucial it is to communicate with family members of patients. In the rush of a clinical day, it’s often easiest to simply deal with whomever shows up to the appointment—typically just the patient. I plead guilty. Recently I evaluated a man in his 60s who

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Article

Involving Families Enhances Patient Outcomes

Topics: Practice Tools and Tips

You are treating Mr. A for a depressive disorder, and you ask if he can bring his wife to his next appointment. When the couple arrives, you say to Mrs. A, “Welcome, and thank you for coming with your husband today. You’ve known him longer than I have, and I’m sure you’ll have some important observations. You can also ask your husband whether he

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Article

Tips for Effective Family Meetings

Topics: Practice Tools and Tips

Alison Heru, MD, gives the following additional advice for conducting effective family meetings: Meet with your patient’s family members at the initial assessment. I usually then touch base with the family members intermittently and tell them they are welcome at any time. In a family meeting, you should reassure everyone—including the patient

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Expert Q&A

Holding Effective Family Meetings

Topics: Practice Tools and Tips | Psychotherapy

TCPR: Why is it important for psychiatrists to meet with families of patients? Dr. Keitner: If you want to comprehensively understand your patients and modify variables that might impact treatment and outcome, it’s important to understand families. There has been a lot of research showing that the family environment can have a significant influence

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Article

Lithium: Practical Considerations for Children With Suicidal Thinking

Topics: Child Psychiatry | Depressive Disorder | 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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Expert Q&A

Helping Clinicians Manage Teen Suicide Risk

Topics: Child Psychiatry | Practice Tools and Tips

CCPR: Thank you, Dr. Pfeffer, for participating in this interview on youth suicide. To start us off, how have clinicians come to understand risk factors for teen suicide? Dr. Pfeffer: Historically, psychiatrists did not focus on identifying and treating risk factors for child and adolescent suicidal behavior. But after an increase in youth suicide r

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Expert Q&A

Helping Patients With Stigma and Addiction

Topics: Addiction | 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

Understanding the Bipolar Spectrum: Tips on Diagnosis

Topics: Bipolar Disorder | Practice Tools and Tips

TCPR: Dr. Aiken, before we get into some of the controversies about the bipolar spectrum, can you give us a brief history of bipolar disorder? Dr. Aiken: Certainly. The modern conception of bipolar disorder dates to the early 20th century, mainly to German psychiatrist Emil Kraepelin, who was a very astute observer. Kraepelin noticed that some patien

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Article

Tips on Managing Medications With Adolescents

Topics: Child Psychiatry | Practice Tools and Tips

Discussing medications with adolescents can be challenging. In general, my approach during the initial evaluation is to have a first evaluation appointment with the parents alone to gather relevant history, and then bring the teen back for a separate and individual appointment. Oftentimes, however, and particularly with older teens, I will see the famil

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