Episode 18: Challenging Clinical Scenarios

Episode 18: Challenging Clinical Scenarios

Clinical Cases
On today's episode, we are working through six challenging clinical scenarios: everything from how to approach confrontational patients, to what to consider when deciding whether to answer personal questions from patients. I would love to hear what other tips and tricks you have for managing these clinical scenarios, so feel free to comment below! References 1.Moore, Gregory MD JD, Pfaff, JA MD. “Assessment and emergency management of the acutely agitated or violent adult.” UpToDate.com. 2 October 2018. Web. 24 November 2018. 2.Richmond, Janet, et al. “Verbal De-Escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-Escalation Workgroup.” Western Journal of Emergency Medicine, vol. 13, no. 1, 2012, pp. 17–25., doi:10.5811/westjem.2011.9.6864. 3.Sadock, Benjamin J., et al. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical…
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Episode 17: Gabapentin Abuse

Episode 17: Gabapentin Abuse

Medication Minute, Psychopharmacology
On today's Medication Minute, we will be discussing gabapentin, including its pharmacology, use in management of psychiatric diagnoses, and it’s more recent growing potential for abuse. Gabapentin is a gamma-aminobutyric acid analog that is was approved for use as an antiepileptic in 1993 and for post-herpetic neuralgia in 2004, but is also used off label for alcohol withdrawal symptoms, diabetic neuropathy, fibromyalgia, restless legs syndrome, and other types of neuropathic pain. References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2015. Print. Smith, Rachel V., et al. “Gabapentin misuse, abuse, and diversion: a systematic review.” Addiction, vol. 111, no. 7, 2016, pp. 1160-1174., doi:10.1111/add.13324. Reccoppa, Lawrence, et al. “Gabapentin abuse in inmates with prior history of…
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Episode 16: Long-Acting Injectable Antipsychotics

Episode 16: Long-Acting Injectable Antipsychotics

Psychopharmacology, Treatment
Today's episode covers the treatment option of long acting injectable antipsychotics, including first generation and second generation options, and also how to appropriately convert a patient from oral antipsychotics to a long-acting injection version. Estimated adherence rate in patients taking oral antipsychotics is about 60%. This can be due to the unpleasant potential side effects from antipsychotics, or due to the patient’s belief that they do not have an illness and do not need the treatment. Additionally, some patients may experience auditory hallucinations telling them that they do not need to take the medication. LAI’s can be an excellent treatment choice for patients who have difficulties with medication compliance. References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams…
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Episode 15: α2-Adrenergic Receptor Agonists and Antagonists

Episode 15: α2-Adrenergic Receptor Agonists and Antagonists

Medication Minute, Psychopharmacology
Today’s episode is part of our medication minute series, and today we will be doing a brief review of alpha 2 adrenergic receptor agonists and antagonists, in the context of their psychiatric uses. This discussion will include pharmacodynamics properties, indications for use, side effects and dosing. We discuss specifically clonidine, guanfacine, prazosin, and yohimbine. References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2015. Print. “Prazosin: Drug Information.” com. Web. 27 May 2018. “Clonidine: Drug Information.” com. Web. 27 May 2018. Stein, Murray B, PhD. “Pharmacotherapy for posttraumatic stress disorder in adults.” com. 28 March 2018. Web. 27 May 2018. Sareen, Jitender MD. “Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment and diagnosis.”…
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Episode 14: Generalized Anxiety Disorder

Episode 14: Generalized Anxiety Disorder

Assessment, Diagnoses, Treatment
Today’s episode is all about the assessment, diagnosis and management of generalized anxiety disorder. We will first review the epidemiology of GAD, followed by discussion of the clinical presentation, diagnostic criteria, and evaluation of GAD. We will then move on to management, including options for psychotherapy and pharmacotherapy. References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2015. Print. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington: American Psychiatric, 2014. Print. Stein, Murray B MD PhD, Sareen J MD. “Generalized Anxiety Disorder.” The New England Journal of Medicine, 373 (2015): 2059-2068. Web. 29 March 2018. Baldwin, David MA. “Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and…
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Episode 13: Treatment of Tobacco Use Disorder

Episode 13: Treatment of Tobacco Use Disorder

Assessment, Diagnoses, Psychopharmacology
Today’s episode focuses on managing tobacco use in our patients. As most mental health professionals come to find, cigarette smoking is a common comorbid condition in our patient population. Sometimes our patients are noncompliant with follow-up with a primary care physician, and as their psychiatrist we may be presented with the only opportunity to counsel that patient on the importance of smoking cessation as well as to provide treatment. Online Resources for Smoking Cessation The Great American Smokeout National Cancer Institute SmokeFree.gov Stop Smoking Center References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2015. Print. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington: American Psychiatric, 2014. Print. Rigotti, Nancy…
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Episode 12: A Review of Adult ADHD

Episode 12: A Review of Adult ADHD

Assessment, Diagnoses, Psychopharmacology
Today’s episode constitutes a review of adult ADHD, with focus on evaluation, diagnosis, management, prognosis, and other concerns regarding adult ADHD. Adult ADHD has long been a controversial topic. The reality is that 50-66% percent of children with ADHD will continue to suffer symptoms into adulthood, and it is no longer considered to be a condition which spontaneously remits with age. In addition, it has more recently been determined that a number of patients that can be diagnosed with adult-onset ADHD did not have symptoms in childhood. However, diagnosing and treating adult ADHD presents its own unique set of challenges, which we will discuss towards the end of today’s episode. UpToDate.com members can click here to view a comprehensive table regarding pharmacotherapy options for adult ADHD, including dosage and titration schedules. References…
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Episode 11: Alcohol Withdrawal

Episode 11: Alcohol Withdrawal

Assessment, Diagnoses, Psychopharmacology
Today’s topic is the management of acute alcohol withdrawal. On our last episode #10 from December 2017, we covered alcohol use disorder, including evaluation and management of this condition. Please review episode 10 for more information on alcohol use disorder. Today we will discuss epidemiology, DSM5 criteria, etiology, evaluation, clinical course and treatment of acute alcohol withdrawal. As previously discussed in episode 10, in the US the 12-month prevalence of AUD is estimated to be 4.6% in teenagers and 8.5% in adults. However, the prevalence of AUD in hospitalized patients is estimated to be as high as 40%, with about half of patients with AUD experiencing alcohol withdrawal with reduction or cessation of alcohol use. Most individuals do not experience significant withdrawal symptoms; however, withdrawal is common within the emergency…
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