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Simple and Practical Mental Health

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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

Funny but soooo true! Short video about a problem many people with ADHD have

How to screen all your patients for Adult ADHD

Why don’t we screen every patient for adult ADHD?

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?

Tips for prescribing ADHD medications

Converting stimulants: Equivalent doses

A dozen tips to manage loss of appetite due to a stimulant (in adults)

Childhood ADHD: Persistence into adulthood

Tips for managing abuse potential of medications for ADHD

Does lisdexamfetamine really have lower abuse potential? 

Do you prescribe bupropion for ADHD in adults?

Vitamin C if on a stimulant?

Tips for remembering to do things

Comorbid Bipolar Disorder and ADHD

How common is ADHD in persons with bipolar disorder?

How to treat ADHD in persons with bipolar disorder

Alarmy: An alarm that makes you PROVE that you are really awake!

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

Famous people who had a mental disorder

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)

Autism Spectrum Disorder

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

What interventions work for atypical sensory processing symptoms?

Bipolar and Related Disorders

Bipolar disorders-General topics

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?

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

Bipolar disorder or substance use? Tips on resolving the diagnostic confusion

Bipolar disorders-Screening, Diagnosis, and Evaluation

Diagnosing Bipolar Disorder

Identifying bipolar disorder: Part one

Identifying bipolar disorder, Part two: The Bipolarity Index

Identifying bipolar disorder, Part three: MoodCheck

How to EFFECTIVELY screen patients for possible bipolar disorder

Was the hypomania or mania “antidepressant-induced”?

What are the differences between hypomania and mania, and why do we care?

Was it really hypomania?

Why we must identify and characterize psychotic features in manic episodes

Tips on differentiating unipolar from bipolar depression

The Mood Disorders Questionnaire is being used inappropriately

Don’t use screening questionnaires for bipolar disorder

“Specifiers” for mood disorders

Understanding “mixed features” in episodes of mood disorders

Bipolar disorders-Treatments

How to do relapse prevention in bipolar disorder

Bipolar disorder with rapid cycling: Management

Can lamotrigine monotherapy be used for maintenance treatment in bipolar I disorder? 

Does gabapentin (Neurontin®) work for bipolar disorder?

Does oxcarbazepine work for bipolar disorder?

What medications should we prescribe for bipolar II disorder?

Combination therapy (mood stabilizer plus antipsychotic) for acute mania?

Should we try to avoid serotonin-norepinephrine reuptake inhibitors (SNRIs) in bipolar disorder?

Divalproex (valproate) loading dose

Can lamotrigine monotherapy be used for maintenance treatment in bipolar I disorder?

Pearls in treating bipolar depression: Interview with Joseph Goldberg, MD

How to know who will respond better to lithium

When NOT to use antidepressants in bipolar depression

Which antidepressants have greater or lesser risk in bipolar depression?

Difficult-to-treat bipolar depression

Bipolar depression: Factors affecting treatment selection and outcomes.

A strategy for patients who decline every medication option

Minimizing caffeine may be helpful in bipolar disorder

These relapse prevention strategies can improve outcomes in bipolar disorders 

A key strategy for preventing relapse and aborting manic episodes

Bipolar disorders-Comorbidities

Comorbidity in bipolar disorders: Introduction

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 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

Comorbid obsessive-compulsive disorder (OCD) in bipolar disorders

How should obsessive-compulsive disorder (OCD) comorbid with bipolar disorder be treated?

Catatonia

Which antipsychotics should be preferred for catatonia?

Lorazepam for catatonia: How much? How long?

How to carry out the Lorazepam Challenge Test in catatonia

How to use ECT for catatonia

Depressive Disorders

A Deeper Understanding of the DSM-5 Criteria for Major Depressive Disorder

Grief versus Major Depression

“Specifiers” for mood disorders

Cognitive dysfunction in major depressive disorder

How to diagnose atypical features in depressive and bipolar disorders

What to assess for if atypical features are present in a depressive episode

How to manage atypical features in depressive and bipolar disorders

Tips on differentiating unipolar from bipolar depression

Anxious distress (in depressive episodes)

When treating major depression, follow these three steps

All three phases of treatment are very important in major depressive disorder

Continuation treatment of MDD is very important!

Does improving sleep improve depression too?

Should we consider a benzodiazepine for persons with major depressive disorder?

Excessive daytime sleepiness after remission of major depression

an beta-blockers cause depression or is this a myth?

Seasonal Affective Disorder

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

Can oral contraceptives cause or worsen depression?

Premenstrual dysphoric disorder (PMDD)

Tips on Premenstrual Dysphoric Disorder

How to treat Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder (PMDD): Management (Part two)

Premenstrual dysphoric disorder (PMDD): Management part three

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?

BEST Books on Depressive disorders: for patients and families

Terrific TED talk about Depression, Treatment, and Hope

Interview: Transcranial Magnetic Stimulation (TMS)

Feeding and 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

Binge-Eating Disorder Screener-7 (BEDS-7)

New medication approved by FDA for Binge-Eating Disorder

Yale Food Addiction Scale

Instruction sheet for the Yale Food Addiction Scale

Should we prescribe medications for weight loss?

Why it is important to treat obesity

Medications for the treatment of obesity: Overview

Melanocortin 4 receptor (MC4R) and weight gain

Medical conditions (non-psychiatric)

Anemia

Are we missing iron deficiency without anemia?

Let’s ask about heavy menstrual bleeding

Laboratory testing to identify iron deficiency

How to order and interpret iron studies

Celiac disease

Celiac disease and absorption of psychotropic medications

Chronic Fatigue Syndrome

Chronic Fatigue Syndrome

COVID-19

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

Warning about using psychotropic medications along with treatments for COVID-19

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

Headache

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

Hypertension

How to correctly measure blood pressure

Should we use automated blood pressure instruments?

High blood pressure has been redefined in 2017

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)

Renal Disease

What do the stages of chronic kidney disease mean?

Thyroid Disorders

Tips on thyroid function testing

Antithyroid antibodies

Primary versus secondary (central) hypothyroidism 

What is ” central” (secondary or tertiary) hypothyroidism?

How should lithium-induced hypothyroidism be evaluated?

Motor Disorders

What exactly do tics look like?

Tips on differentiating tics from things they may be confused with 

Neurocognitive Disorders

General

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 neurocognitive disorders

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)

Mini-Cog© clinical screening test for cognitive impairment

Clock Drawing Test: A complete guide for clinicians

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?

How to test for B vitamins in patients with cognitive impairment

Six arguments against the Mini-Mental State Exam

Neuroimaging in persons with dementia

What to do about cognitive complaints in brief outpatient visits

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

Are we missing Body Dysmorphic Disorder?

Body Dysmorphic Disorder: Pharmacological treatment

BEST books about Body Dysmorphic Disorder

Obsessive-compulsive disorder (OCD)

SSRIs for OCD

Higher than usual doses of SSRIs for OCD?

SSRIs for obsessive-compulsive disorder (OCD): How high can we go? 

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

OCD: Second-line medications

Antipsychotic “augmentation” for OCD

Is fluvoxamine more effective for OCD than other SSRIs?

TCAs other than clomipramine for OCD?

N-acetylcysteine (NAC) for obsessive-compulsive disorder (OCD)?

OCD: Prognosis

OCD: Interview with Katharine Phillips, MD

OCD: Interview with Elna Yadin, PhD

The Obsessive-Compulsive Inventory-Revised (OCI-R)

BEST books about OCD for patients and families

Skin picking disorder

Excoriation (skin picking) disorder

How to treat excoriation (skin picking) disorder: Pharmacological treatment

How to treat excoriation (skin picking) disorder: Psychological treatment

Personality Disorders

How to screen for borderline personality disorder

Post Traumatic Stress Disorder

PTSD symptoms

Not all trauma is associated with posttraumatic stress disorder (PTSD)

Practice guidelines for 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

Schizophrenia-Spectrum and Other Psychotic Disorders

Which laboratory tests in persons with first-episode psychosis?

Does estrogen have a role in schizophrenia

Estrogen as a treatment for schizophrenia?

Order an MRI of brain in first-episode psychosis?

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?

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

Insomnia disorder

Sleep log: Ten important questions about the person’s sleep

Insomnia? Ask about medications

Non-addictive sleep medications

Which brand and preparation of melatonin to recommend?

Sleep masks for better sleep

Blue-blocking glasses

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

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?

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 apnea

How to screen for sleep apnea

How to know if your patient snores if s/he sleeps alone!

How to measure neck circumference

In a sleep study result, what is the Respiratory Disturbance (Distress) Index (RDI)?

Apnea-Hypopnea Index

STOP-Bang Questionnaire (my summary and link to the questionnaire)

Epworth Sleepiness Scale (my brief summary and link to the scale itself)

Which hypnotics to use or avoid in persons with sleep apnea

Substance-Related and Addictive Disorders

General

How to learn addiction psychiatry

What happened to polysubstance dependence?

Urine drug screen according to DOT regulations

False positive urine drug screen results: Principles and a table for reference

SAMHSA National Helpline (Treatment Referral Routing Service)

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

Kratom: A primer for clinicians

Alcohol

Alcohol, not marijuana, is the real gateway drug

How to screen for alcohol use disorder

How much alcohol intake is “normal”?

What is a “standard” drink?

Three key statistics about alcohol use: Bad, worse, and worst news

How to use disulfiram to help with alcoholism

Disulfiram: A shortcut to sobriety?

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

APA Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

Tips on using acamprosate (Campral®) for alcohol use disorder

Tips on using naltrexone for alcohol use disorder

Caffeine

Let’s wake up to how much caffeine our patients are taking

How much caffeine is too much?

Let’s educate ourselves about the caffeine content of different beverages

Minimizing caffeine may be helpful in bipolar disorder

Which three soft drinks have ZERO caffeine?

Are your patients drinking so-called “energy” drinks?

What do you call a cow that has been sterilized?

Caffeine can significantly change serum clozapine levels

Interactions that can significantly affect caffeine metabolism

Cannabis

What all these terms mean: Cannabis, marijuana, hemp, THC, CBD, dronabinol, and so on?

You may be missing cannabis withdrawal

Which psychotropic medications does cannabis affect?

What is cannabinoid hyperemesis syndrome?

Cannabinoid Hyperemesis Syndrome (CHS): Clinical features

Cannabinoid Hyperemesis Syndrome (CHS): Management

Capzasin-HP cream: Information and instructions for patients

Hypnotics

Non-addictive sleep medications

Will zolpidem be detected on a standard urine drug screen? 

Nicotine

Smoking and psychotropic medications

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)? 

Opioids

Clinical pearls on prescribing buprenorphine (Suboxone®)

Clinical pearls about prescribing buprenorphine: Part Two

News: July 7, 2016. Buprenorphine prescribing limit raised significantly

Loperamide abuse: Tips for mental health clinicians

Opioids in the urine drug screen

Tips for our opioid-dependent patients

NeuroStim System-2 (NSS-2) BRIDGE 

Stimulants

Eight tips for reducing the risk of  abuse/diversion of stimulants

Does lisdexamfetamine really have lower abuse potential?

What is khat and why is it important in mental health?

Suicidality

How NOT to talk about suicide

The Three-Step Ladder: A better, easier way to start to ask about suicidal ideation

Suicide trends

Types of suicidal behaviors

BEST books on suicide risk assessment and management

Can isotretinoin (Accutane®, Roaccutane®) cause depression or suicidality?

What do published studies on isotretinoin and depression/ suicidality show?

Quick tips in suicide assessment: Interview with Jack Krasuski, MD

Suicidality: An interview with David Sheehan, MD (included medications for suicidality)

TED talk: The bridge between suicide and life

Suicide prevention

Suicide Hotline

Women's mental health

Contraception

Can oral contraceptives cause or worsen depression?

Which contraceptive after oral-contraceptive-related depression?

Does estrogen have a role in schizophrenia

Estrogen as a treatment for schizophrenia?

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?

Can oral contraceptives affect clozapine levels?

Long-acting contraceptives

List of brand names of oral contraceptives (External link)

Psychotropic medications and intrauterine devices (IUDs)

Perimenopausal Symptoms

Tips on managing perimenopausal symptoms

Adjunctive estrogen for perimenopausal depression?

Pregnancy and Lactation

General approach to treating women during pregnancy and lactation

Pregnancy registries

Are you about to prescribe a medication that could lead to an unwanted pregnancy?

Tips on using lithium during pregnancy

Is use of lamotrigine during pregnancy safe?

Pregnancy and psychotropic medications: Online resources

Is sertraline safe in lactation?

Tips on psychotropic medications during breastfeeding

Lactation and psychotropic medications: Resources

Serious dangers to avoid if it is essential to physically restrain a pregnant woman

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