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.”…
Read More
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…
Read More
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…
Read More
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…
Read More
Episode 9: Suvorexant

Episode 9: Suvorexant

Medication Minute, Psychopharmacology
Today’s episode is part of my Medication Minute series. As previously described, these shorter episodes feature information regarding a specific subset of psychiatric medication management. On today’s episode, I want to discuss a newer medication called suvorexant, or trade name Belsomra, an orexin antagonist that was FDA-approved for treatment of insomnia. References Bonnet, MH PhD, DL Arand PhD. “Treatment of insomnia in adults.” UpToDate, 10 August 2017. Web. 23 August 2017. Yang, Lily P.H. “Suvorexant: First Global Approval.” Drugs, vol. 74, no. 15, 2014, pp. 1817-1822., doi:10.1007/s40265-014-0294-5. “Suvorexant.” Wikipedia, Wikimedia Foundation, 9 Aug. 2017, en.wikipedia.org/wiki/Suvorexant. “Suvorexant: Drug Information.” UpToDate, 2017. Web. 23 August 2017. Vermeeren, Annemiek, et al. “On-the-Road Driving Performance the Morning after Bedtime Use of Suvorexant 20 and 40 Mg: A Study in Non-Elderly Healthy Volunteers.” Sleep, vol. 38,…
Read More
Episode 7: Augmentation Strategies for Treatment of Unipolar Depression

Episode 7: Augmentation Strategies for Treatment of Unipolar Depression

Psychopharmacology
On today’s episode, we will be discussing options for augmentation strategies in the treatment of unipolar depression. For many patients suffering from unipolar major depression, they can continue to suffer from symptoms despite treatment with multiple adequate trials of antidepressants. The decision to add an augmentation agent is one that is most often made in such cases of depression that are what we call “resistant” to treatment. Generally speaking, there a rough algorithm exists for which steps a clinician should take in treatment a patient with depression that is not responding to initial monotherapy antidepressant treatment. First, the clinician can consider switching treatment to another antidepressant within the same class or within another class. The clinician can also consider switching treatment to psychotherapy or in the case of patients who…
Read More
Episode 6: Antidepressant-Induced Sexual Dysfunction

Episode 6: Antidepressant-Induced Sexual Dysfunction

Medication Minute, Psychopharmacology
On today’s episode, we will be discussing treatment of antidepressant-induced sexual dysfunction. This is a topic that is incredibly important in terms of medication management in our patients and the side effects from some of those medications, and it is a topic that is often overlooked. It can be embarrassing and anxiety-provoking for medical students, residents, and even attending psychiatrists to ask these questions of our patients. However, it is a vital aspect of our assessment, and even more so when so many medications can cause such an undesirable side effect. First, we will discuss the evaluation of these side effects during psychiatric assessment, followed by a discussion of the management techniques for antidepressant-induced sexual dysfunction. References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of…
Read More
Episode 4: Valbenazine

Episode 4: Valbenazine

Psychopharmacology
Today’s episode is the first in my new Medication Minute series of this podcast. These shorter episodes will feature information regarding a specific subset of psychiatric medication management; anything from a new drug that is available to important side effects of a medication. On today’s episode, I want to discuss a new medication called valbenazine (Ingrezza), which recently became the first FDA-approved drug to treat tardive dyskinesia. References Meyer, Jonathan M., MD. "Valbenazine for Tardive Dyskinesia." Current Psychiatry 16.5 (May 2017): 40-45. Print. Hauser, Robert A., MD, MBA, and Et Al. "KINECT 3: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Valbenazine for Tardive Dyskinesia." American Journal of Psychiatry. N.p., 21 Mar. 2017. Web. 14 July 2017. Gelenberg, Alan J., MD. "Valbenazine (Ingrezza): The First Drug Approved to Treat TD."…
Read More
Episode 1: Medication-Induced Movement Disorders

Episode 1: Medication-Induced Movement Disorders

Psychopharmacology
On today’s episode, we will be discussing medication-induced movement disorders. This is a broad topic, in which we find that many of the medications we use to help our patients not only in the mental health field, but in the general medical field as well, are capable of causing abnormal movements that range from embarrassing and uncomfortable for the patient to dangerous medical emergencies. Because of the breadth of this topic, we will be discussing mainly the induction of movement disorders caused most frequently by psychiatric medications, mainly neuroleptic agents. Drug-Induced Movement Disorders was a very helpful resource in researching for this episode. If you are interested in further information regarding drug-induced movement disorders, click here to view and purchase: Please click here to view video of rabbit syndrome, as discussed…
Read More