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Agitation
General articles
An overview of agitation and aggressiveness in mental health settings
Safety first! Preventing injury due to violence by patients
Advanced tips for verbal de-escalation of agitated/ aggressive patients
When calm needs to be injected: Intramuscular and intravenous injections for agitation or aggressiveness
How to manage agitation in a pregnant woman
Dexmedetomidine (Igalmi™): Basic information
Agitation in autism spectrum disorder
Autism spectrum disorder: Evaluation of irritability, agitation, aggressive behavior
Autism spectrum disorder: Medications to treat irritability, agitation, or aggressive behavior
Agitation in dementia
Key points from the APA Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia
Citalopram for agitation in Alzheimer’s disease
Case: Agitation in a patient with Alzheimer’s disease
Anxiety Disorders
Relaxation practice: A simple and powerful tool for anxiety, tension, and Insomnia
Gabapentin (Neurontin®) for anxiety disorders?
Does vortioxetine work for Generalized Anxiety Disorder (GAD)?
We need to learn more about difficult-to-treat panic disorder
Should we give high-dose SSRI for panic disorder?
How common is difficult-to-treat or “treatment-resistant” panic disorder?
Panic disorder: Switch or augment?
Would you ever use bupropion to treat panic disorder?
Do you prescribe beta blockers for panic disorder?
Which beta blocker and for how long?
How to evaluate outcome in panic disorder
What is performance anxiety (“stage fright”) and why is it important?
Clinical tips on using a beta-blocker for performance anxiety (“stage fright”)
Cannabis or cannabinoids for PTSD?
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD: Screening
ADHD-Evaluation
Tips on history-taking in evaluating adults for possible ADHD
Neuropsychological testing for diagnosing ADHD?
What is the role of neuropsychological testing in patients with ADHD?
What neuropsychological deficits may be present in patients with ADHD?
ADHD-Treatment
ADHD-Treatment-General
Tips for prescribing ADHD medications
Converting stimulants: Equivalent doses
A dozen tips to manage loss of appetite due to a stimulant (in adults)
Tips for managing abuse potential of medications for ADHD
Tips to help patients with ADHD who struggle in the morning
Does lisdexamfetamine really have lower abuse potential?
How are methylphenidate and amphetamines metabolized?
Combine a stimulant and atomoxetine?
Pros and cons of short-acting preparations of psychostimulants
Converting from OROS methylphenidate to amphetamine is a two-step process
Stimulant medications and irritability in children with ADHD
What if you refuse an early refill of a stimulant medication?
What to look for in stimulant withdrawal (including a physical sign that is little known)
Stimulant “holidays” (breaks) in adults with ADHD?
How to get full-day coverage with stimulants
Eight tips for reducing the risk of abuse/diversion of stimulants
Can psychostimulant medications cause or worsen Raynaud’s phenomenon?
Laws about prescriptions for psychostimulants
Are stimulants useful after traumatic brain injury?
ADHD-Treatment-Methylphenidate preparations
Methylphenidate preparations: Index and links
Should we prescribe dexmethylphenidate (Focalin) rather than methylphenidate (Ritalin)?
Converting from OROS methylphenidate to amphetamine is a two-step process
Should we combine methylphenidate and guanfacine?
Methylphenidate (Ritalin, Ritalin SR®, Ritalin LA®): Basic information
Dexmethylphenidate (Focalin®, Focalin XR®): Basic Information
First ADHD medication to be taken at *bedtime*–Why? How?
ADHD-Treatment-Amphetamine preparations
Amphetamine preparations: Index and links
Pros and cons of dextroamphetamine versus levoamphetamine
Does lisdexamfetamine really have lower abuse potential?
Amphetamine (Dynavel-XR®) extended-release oral suspension: Basic information
Amphetamine extended-release orally disintegrating tablets (Adzenys XR-ODT): Basic information
What is the maximum dose of mixed amphetamine salts?
Dextroamphetamine (Dexedrine®): Basic Information
Lisdexamfetamine (Vyvanse®): Basic Information
Mixed amphetamine salts (Adderall®, Adderall XR®): Basic Information
Mixed salts of a single-entity amphetamine product (Mydayis®): Basic information
Triple-bead preparation of mixed amphetamine salts (Mydayis®)
Ketogenic diet and amphetamines
ADHD-Treatment-Atomoxetine
Atomoxetine (Strattera®): Basic Information
Don’t ignore atomoxetine for ADHD in adults
Order genetic testing for a patient on atomoxetine?
Seizure risk if atomoxetine and bupropion are used together?
Combine a stimulant and atomoxetine?
It makes a big difference—atomoxetine once a day or twice a day?
What can we do for somnolence/ sedation on atomoxetine?
ADHD-Treatment-Alpha-2 agonists
Clonidine (Kapvay®) extended-release tablets: Basic Information
Guanfacine versus clonidine for ADHD
Guanfacine (Intuniv®): Basic Information
Should we combine methylphenidate and guanfacine?
Guanfacine versus clonidine for ADHD
Does guanfacine work for ADHD in adults?
ADHD-Treatment-Other medications
Do you prescribe bupropion for ADHD in adults?
Does modafinil work for ADHD?
Viloxazine extended-release (Qelbree®): Basic information
ADHD-Treatment-Psychotherapy
Drug interactions involving ADHD medications
Important interactions when using two medications for ADHD
Vitamin C if on a stimulant?
Seizure risk if atomoxetine and bupropion are used together?
Be careful if a person is on both a stimulant and an antipsychotic
What could happen when changing from an antipsychotic to a stimulant?
Can a dopamine agonist (pramipexole, ropinirole) and a stimulant be combined?
Ketogenic diet and amphetamines
ADHD with comorbid disorders
ADHD with comorbid bipolar disorder
Comorbid Bipolar Disorder and ADHD
How common is ADHD in persons with bipolar disorder?
How to treat ADHD in persons with bipolar disorder
ADHD with comorbid substance use disorder
Stimulants for ADHD with a history of a substance use disorder?
How should ADHD be treated in persons with stimulant (including cocaine) use disorder
Tips for managing abuse potential of medications for ADHD
Does lisdexamfetamine really have lower abuse potential?
ADHD-Resources
Start here to learn about ADHD and executive dysfunction
BEST Books on Adult ADHD: for Clinicians
BEST Books on Adult ADHD: For Patients and/or Families
Book Review: ADD-Friendly Ways to Organize Your Life
Book review: Mindfulness Prescription for ADHD
Alarmy: An alarm that makes you PROVE that you are really awake!
ADHD as a difference in cognition, not a disorder. Talk from TEDx (YouTube video)
Four C’s for dealing with ADHD (YouTube video)
Things that can masquerade as ADHD (YouTube video)
ADHD-Miscellaneous
Autism spectrum disorder
Autism spectrum disorder: Screening, Diagnosis, and Evaluation
Autism spectrum disorder
Understanding the diagnostic criteria for autism spectrum disorder
Tips on diagnosing autism spectrum disorder
How to not miss the diagnosis of autism spectrum disorder in adults (Interview with Edward Brodkin, MD)
Adult Autism Spectrum Quotient (AQ)
How to screen adults for autism spectrum disorder
How to score and interpret the Adult Autism Spectrum Quotient (AQ)
Atypical sensory processing is common and clinically important
Practice guidelines for autism spectrum disorder
Autism spectrum disorder in adults: Interview with Edward Brodkin, MD
Autism Spectrum Disorder: Treatment
Practice guidelines for autism spectrum disorder
What interventions work for atypical sensory processing symptoms?
Does N-acetylcysteine (NAC) work for autism spectrum disorder?
Autism spectrum disorder: Resources for clinicians, patients, and families
BEST books on Adult Asperger’s Syndrome: For clinicians
Autism spectrum disorder: Inpatient hospitals and residential treatment
Resources on autism spectrum disorder for patients and families
An inspiring TEDx talk by a person with Asperger’s syndrome
TED talk: For persons with Asperger’s syndrome
Bipolar and Related Disorders
Bipolar disorders-General topics
Bipolar disorder or substance use? Tips on resolving the diagnostic confusion
How to elicit what our patients really think about their diagnosis
How to get better outcomes in bipolar disorder (Video interview with Gary Sachs, MD)
How to elicit what our patients really think about their diagnosis
YOU ask the Expert: Bipolar disorders (Joseph Goldberg, MD)
Complementary/ herbal products can sometimes cause mania
BEST Books on Bipolar Disorder: For Patients and/or Families
An Unquiet Mind
Practice guidelines for bipolar disorders
Bipolar disorders-Screening, Diagnosis, and Evaluation
Diagnosing Bipolar Disorder
How to EFFECTIVELY screen patients for possible bipolar disorder
Tips on differentiating unipolar from bipolar depression
Identifying bipolar disorder: Part one
Identifying bipolar disorder, Part two: The Bipolarity Index
Identifying bipolar disorder, Part three: MoodCheck
What are the differences between hypomania and mania, and why do we care?
Was it really hypomania?
What is antidepressant-induced mania or hypomania?
What are the risk factors for antidepressant-induced mania or hypomania?
5-HTTLPR and antidepressant-induced mania
Why we must identify and characterize psychotic features in manic episodes
The Mood Disorders Questionnaire is being used inappropriately
Don’t use screening questionnaires for bipolar disorder
“Specifiers” for mood disorders
Bipolar disorder with rapid cycling
What is bipolar disorder with rapid cycling?
How common is bipolar disorder with rapid cycling?
What are the risk factors for bipolar disorder with rapid cycling?
Bipolar disorder with rapid cycling: Management
Bipolar disorders with mixed features
Understanding “mixed features” in episodes of mood disorders
Tips on correctly diagnosing mixed features
A practical guide to the management of bipolar disorders with mixed features
A patient with bipolar disorder with mixed features who can’t tolerate medications due to over-sedation
Bipolar disorders-Management
Management of manic episodes
Divalproex (valproate) loading dose
Combination therapy (mood stabilizer plus antipsychotic) for acute mania?
How should antidepressant-induced mania or hypomania be managed?
Management of bipolar depression
When NOT to use antidepressants in bipolar depression
Which antidepressants have a greater or lesser risk in bipolar depression?
Should we try to avoid serotonin-norepinephrine reuptake inhibitors (SNRIs) in bipolar disorder?
Difficult-to-treat bipolar depression
Bipolar depression: Factors affecting treatment selection and outcomes
Pearls in treating bipolar depression: Interview with Joseph Goldberg, MD
Management of bipolar disorder with rapid cycling
Bipolar disorder with rapid cycling: Management
Maintenance (preventive) treatment
How to do relapse prevention in bipolar disorder
These relapse prevention strategies can improve outcomes in bipolar disorders
A key strategy for preventing relapse and aborting manic episodes
How to know who will respond better to lithium
A practical guide to the management of bipolar disorders with mixed features
A strategy for patients who decline every medication option
What medications should we prescribe for bipolar II disorder?
Oxcarbazepine (Trileptal®)
Does oxcarbazepine (Trileptal®) work for bipolar disorder?
Advantages and Disadvantages of Trileptal® (oxcarbazepine) versus Tegretol® (carbamazepine)
Oxcarbazepine (Trileptal®): Plasma levels
How to start, titrate, and dose oxcarbazepine (Trileptal®)
Other interventions
Can lamotrigine monotherapy be used for maintenance treatment in bipolar I disorder?
Does gabapentin (Neurontin®) work for bipolar disorder?
Minimizing caffeine may be helpful in bipolar disorder
Bipolar disorders-Comorbidities
Comorbidity in bipolar disorders: Introduction
Bipolar disorder with comorbid ADHD
Comorbid Bipolar Disorder and ADHD
How common is ADHD in persons with bipolar disorder?
How to treat ADHD in persons with bipolar disorder
Bipolar disorder with comorbid substance use disorders
How common is the comorbidity of bipolar disorders and substance use disorders?
Tips on treating patients with BOTH a bipolar disorder AND a substance use disorder
Tips on treating alcohol use disorder in persons with a bipolar disorder
Bipolar disorder with comorbid anxiety disorders
Bipolar disorders with comorbid anxiety disorders
How to treat comorbid anxiety disorders in bipolar disorders with medications
The Manic-Panic Connection: Comorbid Bipolar Disorder and Panic Disorder
Bipolar disorder with comorbid panic disorder: Treatment
Bipolar disorder with comorbid OCD
Comorbid obsessive-compulsive disorder (OCD) in bipolar disorders
How should obsessive-compulsive disorder (OCD) comorbid with bipolar disorder be treated?
–Body dysmorphic disorder
See Obsessive-Compulsive and Related Disorders
Catatonia
Catatonia: General
Let’s be clear about these fundamental concepts about catatonia
Let’s clarify common misunderstandings about some clinical signs found in catatonia
Catatonia: Evaluation and Diagnosis
How to systematically examine patients for catatonia
How to carry out the Lorazepam Challenge Test in catatonia
Is brain imaging useful in catatonia?
Catatonia: Management
Depressive Disorders
Depressive Disorders: Diagnosis and Assessment
A Deeper Understanding of the DSM-5 Criteria for Major Depressive Disorder
Grief versus Major Depression
Tips on differentiating unipolar from bipolar depression
“Specifiers” for mood disorders
How to diagnose atypical features in depressive and bipolar disorders
What to assess for if atypical features are present in a depressive episode
Understanding “mixed features” in episodes of mood disorders
Anxious distress (in depressive episodes)
Cognitive dysfunction in major depressive disorder
Excessive daytime sleepiness after remission of major depression
Can beta-blockers cause depression or is this a myth?
Seasonal Affective Disorder
Can oral contraceptives cause or worsen depression?
How to diagnose premenstrual dysphoric disorder (PMDD)
Depressive Disorders: Treatment
When treating major depression, follow these three steps
All three phases of treatment are very important in major depressive disorder
Tips on the continuation phase of treatment for major depressive disorder
Which persons with major depressive disorder need maintenance (preventive) treatment?
Does improving sleep improve depression too?
How to manage atypical features in depressive and bipolar disorders
Should we consider a benzodiazepine for persons with major depressive disorder?
Premenstrual Dysphoric Disorder (PMDD): Management (Part 1)
Premenstrual Dysphoric Disorder (PMDD): Management (Part 2)
Premenstrual dysphoric disorder (PMDD): Management (Part 3)
Tips on Premenstrual Dysphoric Disorder (Interview with Vivien Burt, MD)
We do have some options for the common problem of residual fatigue and somnolence
What percentage of patients with MDD responds to TMS?
Who is more likely to respond to TMS?
Interview: Transcranial Magnetic Stimulation (TMS)
Omega-3 fatty acids for depressive disorders?
S-adenosylmethionine (SAMe) for depressive disorders: An overview
Do stimulant medications work for major depressive disorder?
Bright light therapy: Instructions to patients
Bright light therapy: Devices
Practice guidelines for depressive disorders
Should we check testosterone levels in men with “treatment-resistant” depression?
Depressive Disorders: Other topics
Feeding and Eating Disorders
Screening for Eating Disorders
Why it is important for all of us to screen for eating disorders
How to screen for eating disorders
How to evaluate persons who have or may have an eating disorder
Binge-Eating Disorder Screener-7 (BEDS-7)
Binge-eating disorder
What exactly is binge-eating disorder?
Binge-eating disorder screener-7 (BEDS-7)
What are the medication options for treating binge-eating disorder?
Lisdexamfetamine (Vyvanse®) for binge-eating disorder
Food addiction
Yale Food Addiction Scale (PENDING)
Instruction sheet for the Yale Food Addiction Scale (PENDING)
Recommended resources
Medical conditions (non-psychiatric)
Anemia
Let’s ask about heavy menstrual bleeding
Laboratory testing to identify iron deficiency
How to order and interpret iron studies
Celiac disease
Bariatric surgery
What to do about medications after bariatric surgery
How to manage lithium treatment before and after bariatric surgery
Why, who, and how to monitor for increased alcohol use after bariatric surgery
Why and how to monitor and evaluate for suicide risk after bariatric surgery
Cardiovascular disease
Also see: Hypertension
Cardiovascular risk screening form
Cardiovascular risk calculators
When to do an electrocardiogram (ECG or EKG)
An overview of antihypertensive medications
Using psychiatric medications in patients with cardiac disease
Antidepressants in cardiac disease
Is bupropion a good choice in persons with heart disease?
Is vortioxetine safe in patients with heart disease?
Is vilazodone safe in patients with heart disease?
Do modafinil/ armodafinil need cardiovascular monitoring?
Cardiovascular adverse effects of stimulants in children and adolescents
QTc prolongation due to psychiatric medications
How to look up whether a drug can cause QTc prolongation or torsades
Three SSRIs that may cause QT prolongation
Doesn’t escitalopram cause QTc prolongation?
Can mirtazapine increase the risk of QT prolongation?
Antipsychotics and QTc prolongation
Antibiotics, antipsychotics, and QTc prolongation
Lithium’s effects on the electrocardiogram (ECG, EKG)
What to do about the risk of arrhythmias with lamotrigine
Do modafinil/ armodafinil need cardiovascular monitoring?
What to do about the risk of QT prolongation with methadone
Ondansetron (Zofran®), QT prolongation, and psychotropic medications
Does buprenorphine cause QT prolongation and torsades de pointes?
Myocarditis
Clozapine-induced myocarditis or cardiomyopathy
Drug interactions with cardiovascular medications
Very important drug interactions between warfarin and psychotropic medications
Direct-acting oral anticoagulants (DOACs) and antidepressants
Other articles
A primer on Brugada syndrome for non-specialists
Quiz: Cardiovascular adverse effects
Chronic Fatigue Syndrome
Chronic Fatigue Syndrome
Management of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/ CFS)
COVID-19
COVID-19 drug interaction checker
Nirmatrelvir-ritonavir (Paxlovid™): Drug interactions with psychiatric medications
A simple guide to the COVID-19 vaccines
A primer on tests for identifying 2019 Coronavirus (SARS-CoV-2) infection
Important recommendations regarding sex and coronavirus
What mental health clinicians can do about the coronavirus
Could psychotropic medications affect the immune response to coronavirus?
Helping persons with OCD deal with the coronavirus pandemic
The relationship between COVID-19 and mental disorders (and what we should do about it)
Mental disorders and the immune system
Diabetes mellitus
SGLT2 inhibitors: A new class of medications for type 2 diabetes
Who’s job is it to check for drug interactions?
Falls
How to evaluate older adults for the risk of and risk factors for falling
What can we do to reduce the risk of falls in elderly patients?
What can we do about medications and the risk of falls in elderly patients?
Dizziness/ Orthostatic hypotension
Glaucoma
Psychotropic medications and glaucoma
Are psychiatric medications safe AFTER laser iridotomy for narrow-angle glaucoma?
Headache/ Migraine
Why is migraine important for mental health clinicians?
The prodromal phase of migraine
The migraine aura
Migraine headache and associated symptoms
The postdromal phase of migraine
How to diagnose migraine and its subtypes
Tips on diagnosing migraine
Primary headache associated with sexual activity (including orgasmic headache)
Atypical sensory processing is common in persons with migraine
Hyperlipidemia
Check for these causes if triglycerides are high
For moderate hypertriglyceridemia, implement these lifestyle interventions
The lipid panel (profile): Why, when, and how to order it
Hypertension
How to correctly measure blood pressure
Should we use automated blood pressure instruments?
High blood pressure has been redefined in 2017
What blood pressure target for patients with hypertension?
Lithium and antihypertensives: Be careful!
Do psychostimulant medications cause clinically-significant increases in blood pressure?
How exactly should blood pressure be monitored in persons on stimulants
How to manage stimulant-induced hypertension
Key facts about increased blood pressure on venlafaxine
Beta-blockers can worsen or improve erectile dysfunction
Iron deficiency
Let’s ask about heavy menstrual bleeding
Laboratory testing to identify iron deficiency
How to order and interpret iron studies
Are we missing iron deficiency without anemia?
The FIRST thing you should do if your patient has Restless Legs Syndrome
Irritable bowel syndrome (IBS)
Clinical features and diagnosis of irritable bowel syndrome (IBS)
Overview of the management of irritable bowel syndrome (IBS)
What should persons with irritable bowel syndrome (IBS) eat?
Which foods and beverages can cause excessive abdominal gas or bloating?
Can lactose in medication pills cause intolerance?
Loperamide (Immodium®) abuse: Change in packaging
Liver disease
Hepatic (liver) function tests
How to order and interpret hepatic (liver) function tests
How to use antidepressants in persons with liver disease
False-positive elevation of plasma ammonia
Liver injury due to psychiatric medications
A resource for looking up hepatotoxicity with a medication, herb, or supplement
Antidepressants can injure the liver, some more than others
What can we do about liver injury due to a second-generation antipsychotic?
Disulfiram and liver toxicity
When and how often should hepatic function tests be done in patients on disulfiram?
Liver Toxicity Knowledge Base (LTKB)
Using psychiatric medications in liver disease
How to use antidepressants in persons with liver disease
Neutropenia/ Agranulocytosis
Why we sometimes specifically order a “Complete Blood Count with Differential”
A primer on the Absolute Neutrophil Count (ANC)
Benign ethnic neutropenia (BEN)
Is it true that mirtazapine (Remeron®) can cause agranulocytosis?
How to use lithium to treat neutropenia
Overweight and obesity
What body mass index (BMI) is and why it matters
Why it is important to treat obesity
What is the relationship between obesity and mental disorders?
What terminology should we use for being overweight or obese?
Melanocortin 4 receptor (MC4R) and weight gain
Overweight and obesity: Management
Should we prescribe medications for weight loss?
An overview of medications for the treatment of obesity
A generic alternative to naltrexone/bupropion (Contrave®)?
Bupropion plus naltrexone (Contrave): Basic information
Metformin for weight gain or obesity unrelated to antipsychotic medications?
A simple primer on what GLP-1 agonists are
Semaglutide injection (Wegovy™) for weight loss in obesity and overweight
Semaglutide injection (Wegovy™): Side effects
Semaglutide injection (Wegovy™): Serious side effects, warnings, and contraindications
Semaglutide injection (Wegovy™): Basic information
Orlistat (Xenical®): Basic Information
Phentermine and topiramate extended-release (Qsymia®): Basic Information
There are three different types of intermittent fasting
How well does intermittent fasting work for overweight and obesity?
Who should NOT do intermittent fasting?
How exactly to do time-restricted eating
What side effects can occur with intermittent fasting?
How well does intermittent fasting work? And, for what?
What to do about psychotropic medications after bariatric surgery
Why and how to monitor and evaluate for suicide risk after bariatric surgery
Why, who, and how to monitor for increased alcohol use after bariatric surgery
Parkinson's disease
Clinical tips on managing Parkinson’s disease psychosis
Parkinson’s disease psychosis: Introduction
Punding in Parkinson’s disease: An overview
Let’s not miss depression in persons with Parkinson’s disease!
How to treat depression in persons with Parkinson’s disease
Pimavanserin (Nuplazid®): Basic information
Pimavanserin (Nuplazid®): Efficacy for Parkinson’s disease psychosis
Pimavanserin (Nuplazid®): Potential adverse effects
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) and Mental Health
Why mental health clinicians need to learn about Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS): Clinical features
Polycystic Ovarian Syndrome (PCOS): Diagnostic evaluation
Polycystic Ovarian Syndrome (PCOS): Management
Does valproate increase the risk of Polycystic Ovary Syndrome (PCOS)?
Postural Tachycardia Syndrome
Postural Tachycardia Syndrome (POTS)
What to do about cognitive impairments (“brain fog”) in postural tachycardia syndrome (POTS)
Renal Disease
Evaluation of renal function
Renal (kidney) function tests
What serum creatinine is and why it is important
What is estimated GFR (eGFR)?
How to interpret the BUN/creatinine ratio when you get labs back
What factors may affect the serum creatinine level?
Can creatine supplements lead to “false” elevation in serum creatinine?
How to Collect a 24-Hour Urine Sample
What are the stages of chronic kidney disease?
Psychotropic medications that are not metabolized (mostly excreted unchanged)
Renal disease–Antidepressants
Antidepressants in renal (kidney) disease
Bupropion in renal disease
Is mirtazapine safe to use after a renal transplant?
Renal disease–Lithium
Which preparation of lithium carbonate is less likely to harm the kidneys?
Lithium-induced polyuria and diabetes insipidus
Lithium-induced polyuria and diabetes insipidus: Evaluation
Lithium-induced polyuria and diabetes insipidus: Treatment
Lithium-induced renal impairment: Clinical recommendations
Case: Rising serum creatinine in a patient on lithium
Case: Elevated serum creatinine that remained stable for many years
Renal disease–Other medications
Warning! Topiramate can cause kidney stones
Important warning regarding gabapentin and pregabalin in renal failure
Seizure disorder
Thyroid disorders
Tips on thyroid function testing
More on interpreting thyroid function tests
What is ” central” (secondary or tertiary) hypothyroidism?
What do you make of these thyroid function test results?
Antithyroid antibodies
How should lithium-induced hypothyroidism be evaluated?
A primer on subclinical hypothyroidism
Motor Disorders
Neurocognitive Disorders
General
Practice guidelines for delirium
Practice guidelines for dementias
Neurocognitive disorders in DSM-5
What is Mild Neurocognitive Disorder
“Mixed pathologies” in Alzheimer’s disease
Sundowning in patients with dementia is important!
Does new-onset psychosis late in life predict the onset of dementia?
In older adults, avoid medications with anticholinergic activity
Evaluation of cognitive functions
Evaluation of cognitive functioning-General articles
Avoid these common mistakes regarding clinical cognitive testing
Advanced tips on the most important single test for evaluating cognitive functioning
What to do about cognitive complaints in brief outpatient visits
Evaluation of specific cognitive domains
First, which cognitive domains are impaired and to what extent?
Tips for interviewing patients with dementia
Cognitive domains that we need to evaluate: Complex attention
Cognitive domains: Executive function
Cognitive domains: Language
Understanding abnormalities of language: Aphasias
Advanced tips on evaluating verbal fluency clinically
Cognitive domains: Learning and memory
Do you assess semantic advantage in your patients?
Montreal Cognitive Assessment (MOCA)
Montreal Cognitive Assessment (MOCA)
Montreal Cognitive Assessment: Spanish version (MoCA-S)
Items on the Montreal Cognitive Assessment (MoCA)
How to administer the Montreal Cognitive Assessment (MoCA)
How to score the Montreal Cognitive Assessment (MoCA)
What cut-off score should we use for the MoCA?
Montreal Cognitive Assessment (MOCA): Psychometric properties
Alternate versions of the Montreal Cognitive Assessment (MoCA)
Other clinical tests of cognitive functioning
Mini-Cog© clinical screening test for cognitive impairment
Clock Drawing Test: A complete guide for clinicians
Six arguments against the Mini-Mental State Exam
Miscellaneous articles
How to test for B vitamins in patients with cognitive impairment
Neuroimaging in persons with dementia
How exactly to evaluate anticholinergic burden
Neurocognitive disorder with Lewy bodies
What is Lewy body dementia?
An introduction to Neurocognitive disorder with Lewy bodies
DSM-5 diagnostic criteria for Neurocognitive disorder with Lewy bodies explained
Neurocognitive disorder with Lewy bodies: Clinical features
Neurocognitive disorder with Lewy bodies: Diagnosis
Differentiating neurocognitive disorder with Lewy bodies from delirium
Neurocognitive disorder with Lewy bodies: Treatment
Neuropsychiatric symptoms
Key Points from the APA Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia
Citalopram for agitation in Alzheimer’s disease
Valproate for neuropsychiatric symptoms in dementia?
Melatonin agonists for sundowning in major neurocognitive disorder (dementia)?
Carbamazepine for neuropsychiatric symptoms in persons with dementia?
Gabapentin for neuropsychiatric symptoms of dementia?
Obsessive-Compulsive and Related Disorders
Body dysmorphic disorder
Diagnosis
Diagnostic criteria for body dysmorphic disorder (BDD)
Why it is important to identify and treat body dysmorphic disorder (BDD)
Are we misdiagnosing body dysmorphic disorder as something else?
Are we missing body dysmorphic disorder?
Treatment
Tips on engaging patients with body dysmorphic disorder (BDD) in treatment
Body dysmorphic disorder: Pharmacological treatment
How to use serotonin reuptake inhibitors to treat body dysmorphic disorder
What to do if serotonin reuptake inhibitors don’t work for body dysmorphic disorder
Body dysmorphic disorder: Cognitive-behavior therapy
Resources for clinicians and patients
BEST books about body dysmorphic disorder
Obsessive-compulsive disorder (OCD)
OCD--General articles
OCD: Interview with Katharine Phillips, MD
OCD: Interview with Elna Yadin, PhD
The Obsessive-Compulsive Inventory-Revised (OCI-R)
OCD: Prognosis
BEST books about OCD for patients and families
Comorbid obsessive-compulsive disorder (OCD) in bipolar disorders
Rumination is a common and important (but neglected) symptom
Practice guidelines for obsessive-compulsive disorders (OCD)
OCD—Management
OCD—Management—SSRIs
Which SSRIs for OCD?
Is fluvoxamine more effective for OCD than other SSRIs?
Higher than usual doses of SSRIs for OCD?
SSRIs for obsessive-compulsive disorder (OCD): How high can we go?
OCD—Management—Clomipramine and other TCAs
Clomipramine versus SSRIs for OCD
Add clomipramine to an SSRI for OCD?
Concerns about combining clomipramine and SSRIs
How exactly to add clomipramine to an SSRI
When and how to check the clomipramine level
How to interpret clomipramine and desmethylclomipramine levels
TCAs other than clomipramine for OCD?
OCD—Management—Other medications
PANDAS
Skin picking disorder
Personality Disorders
Posttraumatic Stress Disorder (PTSD)
Four types of symptoms are present in PTSD
Not all trauma is associated with posttraumatic stress disorder (PTSD)
What is nightmare disorder and why is it important?
PTSD-associated nightmares: Menu of treatment options
Does prazosin work for PTSD? If so, for which symptoms?
How exactly should we dose prazosin in PTSD?
(Relative) contraindications to prazosin for PTSD-associated nightmares
Warning! Prazosin can lead to hypotension/ syncope after the first dose
These medications can be very problematic along with prazosin
Practice guidelines for posttraumatic stress disorder (PTSD)
What can we do to support “National Post-Traumatic Stress Disorder Awareness Month”?
Pregnancy and Lactation
Pregnancy
General articles
General approach to treating women during pregnancy and lactation
Pregnancy registries
Pregnancy and psychotropic medications: Online resources
Does this medication increase the risk of bad outcomes in pregnancy?
Specific treatments
Potential risks of second-generation (atypical) antipsychotics in pregnancy
Tips on using lithium during pregnancy
Is the use of lamotrigine during pregnancy safe?
Does methylphenidate during pregnancy increase the risk of congenital malformations?
What are the possible risks of using lurasidone (Latuda®) during pregnancy
Bright light therapy for depressive disorders during pregnancy?
Repetitive transcranial magnetic stimulation (rTMS) for depressive disorders during pregnancy?
How to manage agitation in a pregnant woman
Serious dangers to avoid if it is essential to physically restrain a pregnant woman
Why we must recognize and treat sleep disorders during pregnancy
Is it safe to recommend an antihistamine for insomnia during pregnancy?
Are the Z-drugs (zolpidem and others) safe to take during pregnancy?
Conclusions about the potential risks of benzodiazepines during pregnancy
Lactation/ Breastfeeding
Lactation/ Breastfeeding: General articles
General approach to treating women during pregnancy and lactation
Tips on psychotropic medications during breastfeeding
Lactation and psychotropic medications: Resources
Lactation/ Breastfeeding: Specific treatment
Is sertraline safe in lactation?
Is methylphenidate safe to take during lactation (breastfeeding)?
What should we recommend about lamotrigine and breastfeeding?
Schizophrenia-spectrum and other psychotic disorders
Clinical features
The terms “blunted affect” and “flat affect” are often used inappropriately
Evaluation
Which laboratory tests should we order in persons with first-episode psychosis?
Order an MRI of brain in first-episode psychosis?
Treatment-Estrogen?
Does estrogen have a role in schizophrenia
Estrogen as a treatment for schizophrenia?
Resources
The APA Practice Guideline for the Treatment of Patients with Schizophrenia, Third Edition
Practice guidelines for schizophrenia
Sexual dysfunctions
Antidepressant-induced sexual dysfunction
Which laboratory tests in men with erectile dysfunction?
YOU Ask the Expert: How to identify, assess, and manage medication-induced sexual dysfunction (Interview with Anita Clayton, MD)
Arizona Sexual Experiences Scale (ASEX)
An introduction to the Changes in Sexual Functioning Questionnaire (CSFQ)
How to administer, score, and interpret the Changes in Sexual Functioning Questionnaire (CSFQ)
Flibanserin (Addyi®)
Flibanserin (Addyi®) in postmenopausal women
Flibanserin (Addyi®): Basic information
Flibanserin (Addyi®): Systematic list of references
Transdermal testosterone for hypoactive sexual desire disorder in postmenopausal women
Which laboratory tests in men with erectile dysfunction?
How to reduce the risk of erectile dysfunction
Which PDE-5 inhibitor for erectile dysfunction?
Should we be checking testosterone levels in older men?
Sleep-wake disorders
Circadian rhythm sleep-wake disorder
Circadian rhythm sleep-wake disorders: An overview
What is Delayed Sleep Phase Disorder?
Delayed Sleep Phase Disorder: Management
Excessive daytime sleepiness
Clinical tips on excessive daytime sleepiness (hypersomnolence)
Medications for excessive daytime sleepiness (due to sleep apnea, narcolepsy, or shift work disorder)
Excessive daytime sleepiness after remission of major depression
Insomnia disorder
Insomnia disorder—Evaluation
Sleep log: Ten important questions about the person’s sleep
Insomnia? Ask about medications
MAO inhibitor-induced insomnia
Insomnia disorder—Hypnotics
FDA-approved medications for the treatment of insomnia (hypnotics)
Non-addictive sleep medications
Best hypnotics in elderly patients?
Hypnotics to avoid in the elderly (older adults)
Which hypnotics to use or avoid in persons with sleep apnea
Doxepin (Silenor®): Basic Information
Suvorexant (Belsomra®): Basic Information
Is quetiapine (Seroquel®) a reasonable option for treating insomnia?
Practical tips on using hypnotics: Benzodiazepines
Temazepam (Restoril®): Basic Information
Practical tips on using hypnotics: the Z drugs
Hypnotic if waking up in the middle of the night?
Eszopiclone (Lunesta®): Basic Information
Zolpidem (Ambien® and Ambien CR®): Basic Information
Zaleplon (Sonata®): Basic Information
Pros and cons of ramelteon (Rozerem) as a hypnotic
Ramelteon (Rozerem®): Basic Information
Does melatonin work for insomnia?
What are the potential side effects of melatonin?
Can melatonin increase blood sugar?
Low-dose preparations of melatonin
Which brand and preparation of melatonin to recommend
Insomnia disorder—Sleep hygiene and Cognitive-behavior therapy
Sleep hygiene worksheets
When should we recommend sleep restriction therapy?
How exactly to do sleep restriction therapy
How to “sell” sleep restriction therapy to persons with insomnia
Insomnia disorder—Tools
Sleep masks for better sleep
Which blue-light-blocking glasses to recommend
Blue-light-blocking glasses for persons with bipolar disorder?
Blue-light-blocking glasses for delayed sleep phase disorder?
Narcolepsy
What is sleep paralysis and why is it important?
How are hypnagogic/ hypnopompic “hallucinations” different?
What causes should we consider for hypnagogic/ hypnogogic “hallucinations”?
Nightmare disorder
What is nightmare disorder and why is it important?
PTSD-associated nightmares: Menu of treatment options
Does prazosin work for PTSD? If so, for which symptoms?
Obstructive sleep apnea
How to screen for sleep apnea
STOP-Bang Questionnaire (my summary and link to the questionnaire)
How to know if our patients snore—even if they live alone
Epworth Sleepiness Scale (my brief summary and link to the scale itself)
How to measure neck circumference
In a sleep study result, what is the Respiratory Disturbance (Distress) Index (RDI)?
Apnea-Hypopnea Index
Clinical tips on excessive daytime sleepiness (hypersomnolence)
Which hypnotics to use or avoid in persons with sleep apnea
Are dual orexin receptor antagonists (DORAs) safe in obstructive sleep apnea?
Rapid eye movement (REM) sleep behavior disorder
What is REM sleep behavior disorder and why is it so important?
REM sleep behavior disorder: Screening and diagnosis
Management of REM sleep behavior disorder
Restless Legs Syndrome
Are we missing iron deficiency without anemia?
The FIRST thing you should do if your patient has Restless Legs Syndrome
Clinical features of Restless Legs Syndrome (RLS)
Restless legs syndrome (RLS): DSM-5 diagnostic criteria explained
How to order and interpret iron studies
Sleep paralysis
Substance-Related and Addictive Disorders
Urine drug screen
Which urine drug screen (UDS) should we order?
Which urine drug screen do most workplaces require?
For how long are substances detected in a urine drug screen (UDS)?
False-positive urine drug screen: Principles and a table for reference
Opioids in the urine drug screen
Will zolpidem be detected on a standard urine drug screen?
“Fingerprint” metabolites that uniquely identify substances in a urine drug screen
Alcohol
Basic facts
Three key statistics about alcohol use: Bad, worse, and worst news
What is a “standard” drink?
How much alcohol intake is “normal”?
Alcohol, not marijuana, is the real gateway drug
Screening
How to screen for alcohol use disorder
Real-life examples: How to identify recent alcohol use in urine and blood tests
Why, who, and how to monitor for increased alcohol use after bariatric surgery
Alcohol withdrawal
Understanding the DSM-5 diagnostic criteria for alcohol withdrawal
Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)
Which benzodiazepines for alcohol withdrawal syndrome (AWS)?
Alcohol withdrawal syndrome: Benzodiazepine regimens
How exactly to prescribe thiamine for the prevention of Wernicke-Korsakoff syndrome
Treatment
APA Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder
How exactly to prescribe thiamine for the prevention of Wernicke-Korsakoff syndrome
Tips on using naltrexone for alcohol use disorder
How high can we go with naltrexone for alcohol use disorder?
Tips on using naltrexone extended-release injectable (Vivitrol®)
How to order, store, and administer naltrexone extended-release injection (Vivitrol®)
Find a Vivitrol® prescriber
Could extended-release naltrexone injection work for alcohol use disorder even if oral naltrexone did not?
Naltrexone (Revia®, Vivitrol®): Basic information
Tips on using acamprosate (Campral®) for alcohol use disorder
Disulfiram: A shortcut to sobriety?
How to use disulfiram to help with alcoholism
Caffeine
Caffeine and mental health
How much caffeine is too much?
Key things clinicians should know about caffeine withdrawal
Minimizing caffeine may be helpful in bipolar disorder
Caffeine can significantly change serum clozapine levels
Interactions that can significantly affect caffeine metabolism
Should those with migraine not consume caffeine?
Caffeine content of coffee and tea
Should we recommend decaffeinated coffee?
Caffeine content of soft drinks
Caffeine content of “energy” drinks
Cannabis
General
What all these terms mean: Cannabis, marijuana, hemp, THC, CBD, dronabinol, and so on?
Acute effects of cannabis that we should warn patients about
Which psychotropic medications does cannabis affect?
Why and how to routinely ask and counsel patients about driving after cannabis use
Cannabis use disorder
Cannabis withdrawal
Cannabinoid Hyperemesis Syndrome
Hypnotics
Kratom
Opioids
Opioid use disorder
Opioid use disorder is a VERY serious condition
Clinical pearls on prescribing buprenorphine (Suboxone®)
Clinical pearls about prescribing buprenorphine: Part Two
Buprenorphine (Subutex®, Suboxone®)
Buprenorphine extended-release injection (Sublocade®)
Opioids in the urine drug screen
Tips for our opioid-dependent patients
Naltrexone (Revia®, Vivitrol®): Basic information
Tips on using naltrexone extended-release injectable (Vivitrol®)
Naltrexone extended-release injection (Vivitrol®): The how to
Why we MUST know about fentanyl and fentanyl analogs
Special tests are needed to identify fentanyl in the urine
Special issues in using naloxone for overdoses involving fentanyl
An overview of fentanyl opioid use disorder (addiction)
Special points in the management of fentanyl opioid use disorder (addiction)
Fentanyl analogs and why they are so important
Loperamide abuse: Tips for mental health clinicians
NeuroStim System-2 (NSS-2) BRIDGE
Psychedelics
Considerable beneficial effects are reported by psilocybin users
What side effects can occur with psilocybin
Is psilocybin addictive?
Can psilocybin lead to suicide or other self-harm?
What we need to know about hallucinogen persisting perception disorder (HPPD)
Can psychedelics cause serotonin toxicity (syndrome)?
Can a psychedelic be taken along with lithium?
Stimulants
Prescription stimulant medications
Eight tips for reducing the risk of abuse/diversion of stimulants
Does lisdexamfetamine really have lower abuse potential?
Methamphetamine
Methamphetamine use: What, Who, How, and Why
What harms can result from methamphetamine use?
Three scenarios in which psychosis can occur in a methamphetamine user
Methamphetamine withdrawal
How to treat methamphetamine use disorder
Other stimulants
What is khat and why is it important in mental health?
Tobacco/ Nicotine
Are you evaluating and treating tobacco use disorder in your patients?
High-yield tips for evaluating patients who use tobacco
A simple questionnaire to help guide tobacco cessation treatment
A practical guide to the management of tobacco use disorder
Are varenicline (Chantix) and bupropion safe for smoking cessation in persons with mental disorders?
Varenicline (Chantix®): Basic Information
A practical guide to using varenicline (Chantix®) for tobacco (smoking) cessation
A practical guide to nicotine replacement therapy (NRT)
How exactly should nicotine patches be used?
How exactly should nicotine gum be used?
How exactly should nicotine lozenges be used?
How exactly should nicotine oral inhalers be used?
How exactly should nicotine nasal spray be used?
Do electronic cigarettes (e-cigarettes) work for smoking cessation?
What “authorities” say about e-cigarettes for tobacco use disorder
What are electronic cigarettes (e-cigarettes)?
Smoking and psychotropic medications
Finding treatment for addictions
How to find a certified addiction psychiatrist
How to find treatment facilities for substance use disorders (addiction)
SAMHSA National Helpline (Treatment Referral Routing Service)
How to choose a rehab
Private facilities for the treatment of substance use disorders
Miscellaneous
How common is the comorbidity of bipolar disorders and substance use disorders?
Bipolar disorder or substance use? Tips on resolving the diagnostic confusion
Tips on treating patients with BOTH a bipolar disorder AND a substance use disorder
Tips on dealing with “slips” in recovery
Never crave alone
What happened to polysubstance dependence?
Practice guidelines for substance-related and addictive disorders
How to learn addiction psychiatry
Suicidality
Suicidality: General articles
Five horrifying statistics about suicide we should all know
Suicide trends
How NOT to talk about suicide
Types of suicidal behaviors
Suicidality: Risk factors
In whom can antidepressants increase the risk of suicidality?
What can we do about suicidality associated with antidepressants?
Why and how to monitor and evaluate for suicide risk after bariatric surgery
Can isotretinoin (Accutane®, Roaccutane®) cause depression or suicidality?
What do published studies on isotretinoin and depression/ suicidality show?
Suicidality: Screening and Evaluation
The Three-Step Ladder: A better, easier way to start to ask about suicidal ideation
How to evaluate and categorize the type of suicidal ideation
Quick tips in suicide assessment: Interview with Jack Krasuski, MD
Suicidality: Management
Tips on reducing the risk of death by suicide
In suicidal patients, avoid 90-day prescriptions of these medications
Which psychiatric medications are particularly lethal in overdose?
Suicidality: Resources
BEST books on suicide risk assessment and management
Practice guidelines for suicidality and self-harm
Call 988, the “Suicide & Crisis Lifeline”
Suicidality: Miscellaneous articles
Suicide: A New Conceptualization, A Neglected Question, and Specific Medications (Interview with David Sheehan, MD)
TED talk: The bridge between suicide and life
Traumatic brain injury (TBI)
Traumatic brain injury (TBI): An introduction for mental health clinicians
Glasgow Coma Scale
Are stimulants useful after traumatic brain injury?
What can we do to reduce the risk of falls in elderly patients?
What can we do about medications and the risk of falls in elderly patients?
Women's mental health
Also see the category of Pregnancy and Lactation (above)
Contraception
Can oral contraceptives cause or worsen depression?
Which contraceptive after oral-contraceptive-related depression?
Oral contraceptives and lamotrigine
Does lamotrigine decrease the effectiveness of oral contraceptives?
Are you about to prescribe a medication that could lead to an unwanted pregnancy?
What to do about contraception in women on carbamazepine or oxcarbazepine
Can oral contraceptives affect clozapine levels?
Long-acting contraceptives
List of brand names of oral contraceptives (External link)
Psychotropic medications and intrauterine devices (IUDs)
Premenstrual symptoms
How to diagnose premenstrual dysphoric disorder (PMDD)
Premenstrual Dysphoric Disorder (PMDD): Management (Part 1)
Premenstrual Dysphoric Disorder (PMDD): Management (Part 2)
Premenstrual dysphoric disorder (PMDD): Management (Part 3)
Tips on Premenstrual Dysphoric Disorder (Interview with Vivien Burt, MD)
Perimenopausal symptoms
DSM-5 diagnostic criteria explained
DSM-5 diagnostic categories
An overview of DSM-5 diagnostic categories
An overview of Trauma- and Stressor-Related Disorders
Substance use diagnostic categories in the DSM-5
Neurocognitive disorders in DSM-5: Classification
DSM-5 diagnostic criteria explained
Understanding the diagnostic criteria for autism spectrum disorder
Understanding “mixed features” in episodes of mood disorders
How to diagnose atypical features in depressive and bipolar disorders
“Specifiers” for mood disorders
Manic or hypomanic episodes: Diagnostic criteria
Was it really hypomania?
A Deeper Understanding of the DSM-5 Criteria for Major Depressive Disorder
Diagnostic criteria for body dysmorphic disorder (BDD)
Understanding the DSM-5 diagnostic criteria for alcohol withdrawal
Restless Legs Syndrome (RLS): DSM-5 diagnostic criteria explained
DSM-5 diagnostic criteria for Neurocognitive disorder with Lewy bodies explained
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