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Episode 10: Alcohol Use Disorder

Episode 10: Alcohol Use Disorder

Assessment, Diagnoses
Today’s topic is the diagnosis and management of alcohol use disorder. Alcohol use disorder is a prevalent illness throughout the country, and it accounts for over 85,000 deaths per year in the United States, with an estimated yearly cost of alcohol use disorder estimated at over 250 billion dollars. In the US, the 12-month prevalence of AUD is estimated to be 4.6% in teenagers and 8.5% in adults, with the 18 to 29-year-old age group having the highest rate of 16.2%. There are a number of risk factors that can contribute to development of AUD, and these include male gender, Native American or Alaska Native races, co-occurring conduct disorder or antisocial behavior in adolescence, family history of AUD or other substance abuse, and comorbid schizophrenia or bipolar disorder. Alcohol is the…
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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,…
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Episode 8: Dementia in DSM5 – Part 2

Episode 8: Dementia in DSM5 – Part 2

Diagnoses
On today’s episode, we will discuss the second part of our 2-part discussion on neurocognitive disorders according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. In our previous discussion on neurocognitive disorders, we reviewed the evaluation of a patient with suspected delirium or neurocognitive disorder, the diagnosis and management of delirium, as well as the clinical presentation, diagnostic criteria, evaluation and treatment of major and minor neurocognitive disorder. Today, our discussion will turn to the specific etiologies of neurocognitive disorder as described in the DSM5. If you have not yet listened to part 1 of this discussion, I urge you to return to episode 5 originally aired on August 5th, 2017 to review those topics. (Please note: podcast states originally aired on 08/28/2017, however, this…
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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…
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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…
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Episode 5: Dementia in DSM5 – Part 1

Episode 5: Dementia in DSM5 – Part 1

Assessment, Diagnoses
On today’s episode, we will discuss the first part of a 2-part discussion on neurocognitive disorders according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Neurocognitive disorders involve acquired disruptions in one or more of the domains of cognition, which include Memory Language, Orientation, Judgment, Conductance of interpersonal relationships, Performing of tasks, and Problem-solving. It is important to be able to identify, diagnose, treat, and manage neurocognitive disorders in our patients as they can commonly be the basis for psychiatric symptoms, especially in our more elderly population. However, this proves to a challenging field in that it is not always black and white: there are a lot of gray areas as dementia can often have a multifactorial etiology. Neurocognitive disorders are a broad field, and…
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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."…
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Episode 3: Assessment of Safety in an Emergency Setting

Episode 3: Assessment of Safety in an Emergency Setting

Assessment
On today’s episode, our topic of discussion is the assessment of patient safety in an emergency setting. This is a topic that I think is a good review at any stage in our training, as safety of our patient’s while in a crisis should be our foremost concern. This will be a good review for residents who are currently taking call in an emergency department setting, as well as psychiatrists working in these positions. References Palmer, Brian A. “The Lifetime Risk of Suicide in Schizophrenia.” Archives of General Psychiatry 62 (2005): 247-253. Pirkis J, Burgess P. “Suicide and Recency of Health Care Contacts: A Systematic Review.” Br J Psychiatry. 1998: 173(6)462-474. Lund-Sorensen, Helene. “A nationwide cohort study of the association between hospitalization with infection and risk of death by suicide.”…
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Episode 2: Sleep-Wake Disorders

Episode 2: Sleep-Wake Disorders

Diagnoses
On today’s episode we will be discussing sleep-wake disorders. We will first discuss a quick overview of normal sleep architecture, as well as the tools available for evaluation of sleep. We will then delve into the specifics of the various sleep-wake disorders, as classified by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, including insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, and we will also touch briefly on non-REM sleep arousal disorders, nightmare disorder, REM sleep behavior disorder, restless legs syndrome, and substance/medication-induced sleep disorder. Please click here to view an EEG recording of the various sleep stages, as discussed in the episode. Please click here to view and print my sleep hygiene handout for patients. This handout can be used free-of-charge for printing…
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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…
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