Practice Tools and Tips

Expert Q&A

Interviewing and Evaluating Patients With Intellectual Disability

Topics: Practice Tools and Tips | Psychopharmacology Tips

TCPR: Let’s start with the basics. What exactly is the definition of intellectual disability (ID)? Dr. Gentile: DSM-5 identifies it as an IQ of 70 or lower. Then there are ranges: mild, moderate, and severe/profound. Someone in the mild range has an IQ, generally, of 70 at the upper end and 50 to 55 at the lower end. The moderate range is 50 or 55

Read More
Article

Psychotherapy for the Intellectually Disabled: The Skills System Approach

Topics: Practice Tools and Tips | Psychotherapy

Patients with intellectual disability often have difficulty controlling their emotions, which is what leads to so-called “challenging behaviors.” These behaviors include a range of aggressive and impulsive interactions, such as assault to self or others, stealing, fire-setting, sexual offenses, and other problematic situations. These are, unfortunat

Read More
Article

Helping People With Co-Occurring Mental Health and Substance Use Disorders

Topics: Practice Tools and Tips | Psychopharmacology Tips | Substance Abuse

Patients with co-occurring disorders (COD, also known as “dual diagnosis”) are often regarded as among the most challenging patients to treat. You need to track two conditions that interact in unpredictable ways, with patients who may not be inclined to follow your recommendations. It’s no surprise that such patients typically have poorer outcomes

Read More
Expert Q&A

When Dual Diagnosis Patients Request Addictive Medications: What to Do?

Topics: Practice Tools and Tips | Substance Abuse

CATR: A common dual diagnosis scenario is that we are treating a patient for depression or anxiety, the patient is on an SSRI and a benzodiazepine, and then suddenly we find out the patient is also on methadone maintenance or has been using medical marijuana regularly. Then we have to decide what to do. For example, should we continue to prescribe the b

Read More
CME Post-Test

Take The CME Post-Test for Dual Diagnosis, CATR, August 2017

Topics: Practice Tools and Tips | Psychopharmacology Tips | Research Updates | Substance Abuse

The post-test for this issue is available for one year after the publication date to subscribers only (December 31, 2017). By successfully completing the test you will be awarded a certificate for 1 CME credit. Click here to take your CME test. Note: All of the CME tests are available in the “My Account” section of the site when you are logged

Read More
Article

ConsumerLab.com: Guiding Patients Toward OTCs That Won’t Hurt Them

Topics: Anxiety Disorder | Natural Medications | Practice Tools and Tips

“It’s rare that my patients don’t at some point or another try an over-the-counter sleep aid, anxiety preparation, or antidepressant supplement,” says TCPR board member Richard Gardiner, MD, who practices psychiatry in Mendocino County, California. While supplements may be helpful—we covered this topic in TCPR’s November/December 2016 issue

Read More
Article

Eight Strategies to Help Patients Maintain Recovery

Topics: Addiction | Practice Tools and Tips | Psychotherapy

Robert is a 48-year-old executive who was suspended from his job after getting a DUI that was reported in a local newspaper. He was referred to you after completing a 30-day court-ordered rehabilitation program. When he comes to your office, he appears anxious and withdrawn, and he makes little eye contact. He reports a desire to stay sober, but admits

Read More
Article

Recognizing and Reversing Relapse

Topics: Addiction | Practice Tools and Tips | Psychotherapy

I first met 32-year-old Miranda after a drug relapse that followed a stay in a residential addiction treatment facility. She had begun experimenting recreationally with prescription opioids in her early 20s, but her use escalated after she was involved in a car accident a few years later and a doctor began prescribing opioids for pain. Because of her in

Read More
Expert Q&A

Treatment vs. Recovery

Topics: Addiction | Practice Tools and Tips | Psychotherapy

CATR: You have seen recovery from two perspectives—a person in recovery and a person who treats substance use disorders. What does it mean to be in recovery? Mr. Pond: For many people, the word “recovery” means being in AA or another 12-step program where the goal is to stay abstinent. It’s a culture of mutual support where people help and a

Read More
Article

Managing Behavioral and Psychological Symptoms of Dementia (BPSD)

Topics: Dementia | Practice Tools and Tips | Psychotherapy

Richard is an 88-year-old former airline pilot who was diagnosed with Alzheimer’s dementia 5 years ago. He managed well at home with his wife initially, but a year ago he required admission to a skilled nursing facility because of worsening symptoms. His transition was difficult. Sometimes he hovered around the exit door and elevators and tried to lea

Read More
Article

Some Helpful CBT Techniques for Specific Disorders

Topics: Practice Tools and Tips | Psychotherapy

When we first set about planning this article, its working title was “The Most Evidence-Based Psychotherapies.” But as we scoured the literature, it became clear that there’s no scientific consensus about which techniques are best (one exception to this being techniques for OCD—see page 3). In fact, the latest official statement on the subject b

Read More
Expert Q&A

Cognitive Behavior Therapy for Insomnia

Topics: Practice Tools and Tips | Psychotherapy | Sleep Disorders

TCPR: Dr. Perlis, you are one of the major researchers of cognitive behavior therapy for insomnia. Why are you so interested in the topic of insomnia? Dr. Perlis: Because insomnia is so ubiquitous and misunderstood with respect to its health consequences and “treatability.” At the core of this is the widespread misconception that insomnia is prim

Read More
Article

Treating Tourette’s Disorder

Topics: Child Psychiatry | OCD | Practice Tools and Tips | Psychotherapy

David was a 12-year-old boy referred for consultation by his child psychiatrist for help in managing his severe Tourette’s disorder. David had developed onset of eye blinking at age 6 in the context of problems paying attention in his first-grade classroom. He tended to call out answers and wasn’t completing tests or his homework. By age 8, he had d

Read More
Expert Q&A

Assessing and Diagnosing Tic Disorders

Topics: Child Psychiatry | OCD | Practice Tools and Tips

CCPR: Would you describe your clinical work in tic disorders and how that operates? I think readers will want to know about the number of patients you see and how the clinic is structured. Dr. Greenberg: I work in the obsessive compulsive disorder (OCD) and related disorders program, and I see both kids with tics and OCD or OCD-related disorders as w

Read More
Article

From the Street to the Prescription Pad: Psychedelics Return to Psychiatry

Topics: Practice Tools and Tips | Psychopharmacology | Psychotherapy | Substance Abuse

You’ve been treating Bob, a 37-year-old combat veteran with refractory PTSD, for the past 15 years. After two psychotherapists gave him a club drug, he returns to your office reporting he’s been symptom-free for two months. Jean, a 67-year-old woman you’ve been treating for anxiety associated with stage 4 breast cancer, tells you that after ­inge

Read More
Article

Pharmacogenetic Testing: An Update

Topics: Diagnostic Testing | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

Given how many essentially equivalent medications we have to choose from, how great would it be to have a test that tells us which drug to prescribe for which patient? Everybody wants personalized medicine, and in some other specialties, such as oncology, this is becoming a standard part of treatment. In this article, we’ll review some of the basics o

Read More
Expert Q&A

MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder

Topics: Practice Tools and Tips | Psychopharmacology | Psychotherapy | Substance Abuse

Ms. Petitt’s manages the program that selects and trains researchers for the MDMA-assisted psychotherapy protocols MAPS Public Benefit Corporation is conducting. The program has reviewed 300 applicants, and is in the midst of training 80 people who will work on therapy teams for Phase 3 trials. In addition to the training program, Ms. Petitt has also

Read More
Expert Q&A

Understanding Pharmacogenetics Research

Topics: Diagnostic Testing | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

TCPR: Dr. Uher, you have been a co-investigator on the major studies of pharmacogenetics in psychiatry. It’s a complicated field, and I thought you could explain how the research is actually done. Dr. Uher: The basic goal of this kind of research is to try to find an association between a genetic variant and the clinical response to a particular m

Read More
Research Update

Switching Antidepressants May Be No Better Than Staying the Course

Topics: Depressive Disorder | Practice Tools and Tips | Research Update

Review of: Bschor T, Kern H, Henssler J, Baethge C. Switching the antidepressant after nonresponse in adults with major depression: A systemic literature search and meta-analysis. J Clin Psychiatry 2016. doi:10.4088/JCP.16r10749. [Epub ahead of print] Study type: Meta-analysis Clinical trials have shown that the response rate of major depression t

Read More
Article

How to Treat Adult ADHD

Topics: ADHD | Practice Tools and Tips

Over the past decade, it’s become apparent that ADHD does not suddenly end when children grow up, and that the disorder often continues into adulthood. Since 2011, I have run a clinic specializing in adult ADHD. ADHD is relatively common in adults, with conservative estimates of a 4%–5% prevalence in the adult population, equal in men and women (htt

Read More