Psychopharmacology and Psychiatry Updates

By Psychopharmacology Institute

Science & Medicine Medicine

What's Psychopharmacology and Psychiatry Updates about?

Practical psychopharmacology updates for mental health clinicians. Useful for psychiatry / mental health professionals. Expert interviews and soundbites from lectures. Practical and free of commercial bias. Not sponsored by any pharmaceutical company.

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LAST EPISODE

Prescribing Antipsychotics ...

01.12.2022

This episode discusses first- and second-generation antipsychotics during breastfeeding, including clozapine, the only psychiatric drug nearly always contraindicated.

Psychopharmacology and Psychiatry Updates episodes:

01.12.2022 Prescribing Antipsychotics During Breastfeeding This episode discusses first- and second-generation antipsychotics during breastfeeding, including clozapine, the only psychiatric drug nearly always contraindicated.
01.07.2022 Fluvoxamine for Treating COVID-19 How effective is fluvoxamine in patients with COVID-19? A 2-week course of full-dose fluvoxamine decreased clinical deterioration in outpatients with symptomatic COVID-19 infection.
01.02.2022 Prescribing Antidepressants During Breastfeeding Can we use antidepressants during breastfeeding? This episode discusses the use of antidepressants during breastfeeding, including SSRIs, TCAs, bupropion, and mirtazapine.
12.28.2021 Treatment Strategies for Acute and Chronic Insomnia Is it safe to use atypical antipsychotics for insomnia? Can we use benzodiazepines? This podcast features the different treatments for acute and chronic insomnia. It also addresses the differential diagnoses and some treatment options for insomnia and comorbid depressive disorders.
12.23.2021 Drug Use in Breastfeeding and Adverse Effects When it comes to drug use while breastfeeding, what really matters is not the infant dose but the effect on the infant. This episode discusses drug use in breastfeeding, common adverse reactions, and their relationship to maternal dosing.
12.18.2021 Marine Omega-3 Fatty Acid Supplementation for BPD A novel medication approach for borderline personality disorder is discussed. In this meta-analysis of fish oil for borderline personality disorder, the effect size relative to placebo was 0.54 (substantial) and for affective dysregulation was 0.74 (clinically very relevant).
12.13.2021 Breastfeeding and Estimating Infant Drug Exposure This episode discusses drug use in breastfeeding and how to estimate infant exposure with the milk-to-plasma ratio and the relative infant dose. Learn when these calculations can be helpful.
12.08.2021 A Method for Tapering Antipsychotics When tapering antipsychotics, conceptualize the process as "finding a new minimum effective dose." This could take months, likely years. This episode features some dose examples.
12.03.2021 Management of Psychiatric Comorbidities With Alcohol Use Disorder This episode discusses the prevalence and management of psychiatric comorbidities with alcohol use disorder. Learn some strategies for treating alcohol use disorder and comorbid depressive and anxiety disorders.
11.28.2021 Tips for Treating Perimenopausal Depression If your patient has perimenopausal depression, what are the treatment options? This podcast explains different treatment options, such as antidepressants, hormone therapy, and psychotherapy. It also addresses some strategies for managing vasomotor symptoms.
11.23.2021 Naltrexone, Acamprosate, and Disulfiram for Alcohol Use Disorder This episode discusses medications for alcohol use disorder, such as naltrexone, acamprosate, and disulfiram. It explains their clinical effects, the goals and benefits of treatment, side effects, liver function monitoring, precautions, contraindications, and dosing. Finally, it emphasizes the patient factors ...
11.18.2021 Subclinical Hypothyroidism in Depressed Adolescents From the various references cited in this episode, the metamessage is clear: Thyroid hormone belongs in the treatment toolkit of psychiatric specialists, and monitoring of TSH is our responsibility.
11.13.2021 Principles for Managing Alcohol Use Disorder This episode discusses the 3 approaches in the treatment of substance use disorders: Medications for alcohol use disorder, counseling, and 12-Step facilitation.
11.08.2021 ECT for Depressed Patients With Borderline Personality Disorder Previous recommendations and even APA guidelines have suggested that electroconvulsive therapy for depression is not as effective for patients with borderline personality disorder as it is for those without. This retrospective analysis of data from McLean Hospital suggests this assumption ...
11.03.2021 Assessing and Treating Alcohol Withdrawal This episode discusses alcohol withdrawal symptoms and consequences, including delirium tremens, management of alcohol withdrawal, and when to use symptom-triggered therapy or fixed-dose regimens.
10.29.2021 Lab Tests in Psychopharmacology Laboratory testing is essential in the practice of psychopharmacology. For example, which parameters should be monitored in patients taking carbamazepine, TCAs, atypical antipsychotics, or esketamine?
10.24.2021 Technology-Facilitated Adherence Enhancement and Family Involvement This episode discusses technology-facilitated adherence enhancement, including text messaging, a wireless system to track adherence, and the evidence of technology-facilitated adherence for patients with bipolar disorder. It also addresses an ecological momentary intervention and the involvement of family in treatment ...
10.19.2021 Drug-Induced Hyperthermic Syndromes in Psychiatry When a patient presents with markedly elevated temperature and altered mental status, is it neuroleptic malignant syndrome or serotonin syndrome? If you do not have a medication list, some clinical signs may help.
10.14.2021 How to Improve Adherence: Targeting Reasons for Nonadherence This episode discusses how to improve psychotropic drug adherence by targeting the reasons for nonadherence. It also discusses a 3-tiered approach to enhancing adherence, a patient questionnaire to evaluate the reasons for not taking medications, the top reasons for poor ...
10.09.2021 Esketamine: Postmarketing Safety Concerns How risky is esketamine? In this episode, we examine the safety of esketamine using postmarketing data that have been reported since the drug was approved and released.
10.04.2021 Nonadherence: Adverse Drug Reactions and Measuring Perceived Side Effects With FIBSER This episode discusses an algorithm for assessing adherence; the reasons for suboptimal adherence, including adverse drug reactions; measuring perceived side effects with the FIBSER scale; and how to help individuals communicate with providers about side effects.
09.29.2021 Neurocovid: Pharmacologic Recommendations for Delirium Associated With COVID-19 Delirium has been frequently found in patients who test positive for COVID-19. It has additional features that we do not typically see in ordinary delirium. The critical question is: How do you manage these patients?
09.24.2021 How to Assess Psychotropic Drug Adherence This episode discusses the assessment of adherence: Self-report, electronic medication monitoring systems, rating scales, medication possession ratio, questions for assessing medication adherence, and the recommended frequency of adherence monitoring.
09.19.2021 Citalopram for Acute and Preventive Efficacy in Bipolar Depression (CAPE-BD) A new randomized trial suggests that the efficacy of antidepressants for the treatment of bipolar depression is no greater than placebo. This tips the meta-analytic balance scale, which already pointed in this direction.
09.14.2021 Delirium, Catatonia, and COVID-19 This podcast offers a discussion on catatonia and delirium as well as treatments for their co-occurrence. Treatments discussed include benzodiazepines, amantadine, and memantine. We also address the management of COVID-19 delirium with antipsychotics.
09.09.2021 Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder Is psilocybin a potential treatment for major depression? There's certainly been a lot of press coverage, but to date, the reports are largely open trials in a variety of conditions, including OCD, substance use, PTSD, and patients with cancer and ...
09.04.2021 Dopamine and Depression: Clinical Considerations This podcast features a discussion on the need to highlight anhedonia and anergia as core symptoms of depression. We also cover the clinical utility of MAOIs in treating patients with melancholic or biological depression and Parkinson's disease.
08.30.2021 Haloperidol, Chlorpromazine, and Atypical Antipsychotics for Managing Delirium This podcast offers a discussion on the use of antipsychotics for managing delirium. Topics covered include: Choosing an antipsychotic, the advantages of IV haloperidol, different dosing strategies, and concerns regarding QT prolongation. We also examine chlorpromazine, olanzapine, quetiapine, and aripiprazole ...
08.25.2021 New Somatic Treatments for Child and Adolescent Depression First-line treatments for child and adolescent depression are cognitive–behavioral therapy, interpersonal therapy, fluoxetine, and escitalopram. What works besides routine first-line approaches? This episode discusses options to consider: Pharmaceuticals, nutraceuticals, somatomotor techniques (e.g., yoga), and neuromodulatory tools (e.g., ECT and TMS).
08.20.2021 Management of Delirium: Nonpharmacologic Strategies This episode discusses nonpharmacologic management strategies for delirium, such as the ones included in the ABCDE bundle.
08.15.2021 Emerging Complementary and Integrative Therapies for Geriatric Mental Health Are there any alternative medicine treatments that might be useful for your geriatric patients? We examine the evidence base for diet, herbal and nutritional supplements, and mind–body therapies for the prevention of dementia and the treatment of depression.
08.10.2021 Delirium: Assessment, Consequences, and Sequelae This episode discusses the assessment of delirium. This includes: EEG and neurological exam, cognitive dysfunctions present in delirium, recommended testing, differential diagnoses, and the consequences of delirium.
08.05.2021 In Search of a Dose-Response Relationship in SSRIs A meta-analysis of antidepressant doses and responses finds no evidence of improved outcomes with higher doses, just more side effects. However, this conclusion is based on fixed-dose comparison studies, which do not mirror the way we practice. Here we'll compare ...
07.31.2021 Valproate/Divalproex: Metabolism, Kinetics, and Warnings This episode discusses valproate kinetics and sublinear kinetics, valproic acid levels, its absolute contraindications, and what to consider when using the package insert.
07.26.2021 Managing Drug-Induced Movement Disorders A practical discussion on akathisia, extrapyramidal symptoms (EPS), tardive syndromes, and acute dystonia.
07.21.2021 Drug Metabolism: The Importance of Child-Pugh Classification for Staging Hepatic Impairment This episode discusses the Child-Pugh scale to assess hepatic impairment. It also covers the FDA's position on the inclusion of drug metabolism data for various Child-Pugh stages and cirrhosis.
07.16.2021 Impact of Smoking Behavior on Clozapine Blood Levels Clozapine blood levels can be influenced by many factors. These include dose, gender, age, body weight, caffeine, medications, and of course, smoking. How much is the reduction in clozapine levels actually due to cigarette smoking?
07.11.2021 The Child-Pugh Scale in Psychiatry This episode discusses the Child-Pugh Rating Scale and how to interpret it, two clinical cases, and the use of paliperidone and lurasidone in patients with hepatic impairment (Child-Pugh C).
07.06.2021 Managing Neuroleptic Malignant Syndrome: An Evidence-Based Update How should we approach the management of neuroleptic malignant syndrome? What is the role of bromocriptine, dantrolene, and ECT?
07.01.2021 Psychotropics and Hepatic Issues: Nonalcoholic Fatty Liver Disease How important are ALT and AST abnormalities when prescribing psychotropics? Should you adjust dosing in patients with elevated ALT and AST? Does inflammation alter drug kinetics?
06.26.2021 Alzheimer's Disease: Can We Lower the Risk? This meta-analysis is a useful reminder of risk factors to look for in your patients. You can also help them understand the long-term risks of Alzheimer's disease.
06.21.2021 Binge Eating Disorder: Diagnosis and Treatment How can you assess binge eating disorder? Which is the preferred screening instrument? What is the role of SSRIs, TCAs, and duloxetine?
06.16.2021 Unipolar Depression: A Psychopharmacology Algorithm What are the best treatment options for severe depression with melancholic features? Can you augment tricyclics? What is the preferred option for depression with mixed features?
06.11.2021 Bulimia Nervosa: Diagnostic and Treatment Essentials When should you suspect bulimia nervosa? What is the role of antidepressants, topiramate, and ondansetron?
06.06.2021 Primary Insomnia: Zolpidem, Behavioral Therapy and CBT-I What are the best treatment options for primary insomnia? What is the role of behavioral therapy and zolpidem?
06.03.2021 Anorexia Nervosa: Diagnosis and Treatment What diagnostic considerations should we keep in mind with anorexia nervosa? What are the most effective medications? Does zinc depletion play a role?
05.27.2021 Pharmacotherapy for Borderline Personality Disorder What is the role of pharmacotherapy in borderline personality disorder? Is there evidence supporting the use of antidepressants? Which antipsychotic can be helpful? Is lamotrigine effective?
05.22.2021 Food Avoidance: Diagnosis and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) What is ARFID (Avoidant/Restrictive Food Intake Disorder)? Are antidepressants helpful? What is the role of adjunctive olanzapine?
05.17.2021 Treating Bipolar Disorder in Later Life: Psychopharm Tips Do you treat older patients with bipolar disorder the same as younger patients? What is the optimal lithium dose? What is the role of second-generation antipsychotics such as quetiapine?
05.12.2021 Bereavement and Terminal Illness in Later-Life Depression How to assess prolonged grief? Is there a specific therapy? Is there a role for methylphenidate?

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