Practice Tools and Tips

Expert Q&A

Becoming a Board-Certified Addiction Clinician

Topics: Addiction Treatment | Board Certification | Practice Tools and Tips

CATR: To start off, could you tell us why a psychiatrist or any other physician would want to be board-certified in addiction? Dr. Weaver: Patients with addiction are common in psychiatric or any other practice. You’re going to see patients who have these issues, so it’s good to be prepared and able to focus on treating addiction, as well as to be

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Article

Narcotics Anonymous: What to Tell Your Patients

Topics: Practice Tools and Tips | Substance Abuse

Most of us are pretty familiar with Alcoholics Anonymous (AA), and asking about AA attendance and participation is routine during appointments with patients trying to curb their alcohol use (see the November/December 2015 CATR for more info on AA). But what about Narcotics Anonymous (NA)? Is it just an opioid-focused version of AA? In this article, we

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Expert Q&A

Using Medical Management in Treating Opioid Use Disorder

Topics: Practice Tools and Tips | Substance Abuse

CATR: We often hear about an intervention called medical management (MM) for treating addiction. Could you tell us what MM is? Dr. Saxon: To set the stage for understanding medical management, we need to go back about 20 years to the inception of the landmark COMBINE Study. This study was a very large clinical trial for alcohol use disorder (AUD) that

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Article

Opioid Treatment Option

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

Opioid use disorder (OUD) treatment can be tricky, in part because it doesn’t respond well to detox and counseling-only approaches. The overwhelming majority of people relapse after such attempts, or even become more vulnerable to overdose because of decreased tolerance after detoxing. And the trajectory in this country is worsening—in 2016, we aver

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Article

Harnessing Beneficial Drug Interactions

Topics: Practice Tools and Tips | Psychopharmacology Tips

It’s nice when we can get our patients better with a single medication, but that’s not always possible. Sometimes the right combination of meds can do the trick, but studies of polypharmacy are scarce. In this article we dig through that research, small and limited as it is, to highlight a few useful combinations where the drug interaction can benef

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Expert Q&A

Effects of Drug Interactions

Topics: Practice Tools and Tips | Psychopharmacology Tips

TCPR: We’re seeing a lot of computer alerts for drug interactions. Which ones should we pay attention to? Dr. Sandson: The two issues to pay attention to are toxicity and loss of efficacy. Toxicity is the bigger concern, particularly if the drug has a “narrow therapeutic index,” where modest differences in the level can have dangerous effects. Li

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Article

Assessing and Treating Violence in Patients

Topics: Child Psychiatry | Practice Tools and Tips

School shootings keep happening in the US, and most of us have wondered at times whether one of our patients might carry out a violent act, shooting or otherwise. This article will help you assess and treat violent youth and advise families who are grappling with these issues. Most people with mental health conditions do not hurt others—our patients

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Article

Note From the Editor-in-Chief

Topics: Addiction | Practice Tools and Tips

Addiction spares no age group, but it often goes undetected in older adults age 65 or older, and its treatment poses age-specific challenges. In this issue, we interview Dr. David Oslin to unpack some of these challenges and talk about screening tools, physiological changes, and psychosocial stressors, as well as general treatment approaches in older ad

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Article

How Ethnicity Influences Medication Response

Topics: Practice Tools and Tips | Psychopharmacology Tips

From cultural expectations to genetic variations, ethnicity has a strong effect on medication response. In this article, we’ll review five areas where ethnic groups can differ in their biological response to psychiatric medications. Drug metabolism Most medications are metabolized in the liver, and patients’ liver metabolism varies. Slow metabol

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Expert Q&A

Working With Transgender Patients

Topics: Gender & Sexuality | Practice Tools and Tips

Our profession has a number of obstacles to overcome in gaining the trust of transgender and gender non-conforming patients. We turn to this month’s expert, Jack Drescher, to better understand how to work with this population. TCPR: Tell us about this new diagnosis, gender dysphoria, and what it means for patients. Dr. Drescher: In DSM-IV, identif

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Expert Q&A

Substance Use Disorder in Older Adults

Topics: Addiction | Practice Tools and Tips | Substance Abuse

CATR: Let’s start with diagnosis. Are there specific challenges in diagnosing substance use disorder (SUD) in older adults? Dr. Oslin: There definitely are, and DSM criteria can be hard to apply. Older adults are more likely to drink at home, much more likely to have medical problems, and may have interpersonal issues, but they will likely have fewer

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Article

Ask the Editor

Topics: 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. ADHD medications: Three

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Article

Antidepressant-Induced Suicidality: What It Is and What You Should Do

Topics: Child Psychiatry | Depressive Disorder | Practice Tools and Tips

Do antidepressants actually cause children to be suicidal? If so, how do we detect it, and what should we do about it? In this article, we’ll give you a brief review of the most recent findings on antidepressant-induced suicidality (AIS) in children and adolescents, and then move on to some practical tips for how to evaluate and prevent this problem.

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Expert Q&A

Current Use of Antidepressant Medication in Children

Topics: Child Psychiatry | Depressive Disorder | Practice Tools and Tips

Editor’s note: The issue of emergent suicidal thinking has weighed on us since the 2004 black box warning—amplified by the re-analysis of the now infamous study 329, which found the emergence of previously under-reported suicidal thinking. How do we offer hope for effective use of medication while balancing the potential risks? Dr. Danella Hafeman h

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Expert Q&A

Calming Agitated Patients in an Emergency

Topics: Practice Tools and Tips

TCPR: You’ve worked for a long time as an emergency psychiatrist. Do you have any advice on how psychiatrists can de-escalate situations with agitated or even violent patients? Dr. Fishkind: When I work with an agitated patient, I start by saying, “Hi, I’m Dr. Fishkind. My job is to keep you safe today.” Your first job should be to take away an

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Article

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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Article

Ask the Editor

Topics: Practice Tools and Tips

Starting with this issue, Editor-in-Chief Chris Aiken, MD, will give 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 he will pick one each month that is of general interest. Me

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Expert Q&A

Talking to Parents and Adolescent Patients About Substance Use

Topics: Addiction | Child Psychiatry | Practice Tools and Tips | Substance Abuse

CATR: To start us off, how does addiction differ in adolescents vs adults? Dr. Quigley: In adolescents it can be subtle. For example, there are culturally normative behaviors with alcohol and cannabis use, and kids get missed because people write it off as “just partying.” They miss the fact that the substance use has become extremely impairing. Ad

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Expert Q&A

Including Parents in Autism Intervention

Topics: Autism Spectrum Disorder | Child Psychiatry | Practice Tools and Tips

CCPR: Can you begin by telling us what is unique about the Profectum Foundation? Dr. Wieder: At Profectum, relationships are the driving force of intervention. We embraced the DIR (Developmental, Individual Difference, and Relationship-based) Model I developed with the late Dr. Stanley Greenspan. DIR was revolutionary. It redefined functional emotional

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Article

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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