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Agitation
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
Dexmedetomidine (Igalmi™): Basic information
Agitation in patients with autism spectrum disorder
Autism spectrum disorder: Evaluation of irritability, agitation, aggressive behavior
Autism spectrum disorder: Medications to treat irritability, agitation, or aggressive behavior
Agitation associated with dementia
Why agitation associated with dementia is such an important clinical problem
“Agitation associated with dementia” now has an operational definition
Key points from the APA Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia
Brexpiprazole (Rexulti®) for “agitation associated with dementia due to Alzheimer’s disease”
Citalopram for agitation in Alzheimer’s disease
Case: Agitation in a patient with Alzheimer’s disease
Agitation in a pregnant woman
How to manage agitation in a pregnant woman
Anxiety Disorders
Anxiety Disorders—Panic disorder
How to evaluate outcomes in panic disorder
We need to learn more about difficult-to-treat panic disorder
Should we give high-dose SSRI for panic disorder?
How to correctly start, titrate, and optimize venlafaxine 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?
Should patients with panic attacks rebreathe the same air by using a paper bag?
Practice guidelines for anxiety disorders
Anxiety Disorders—Generalized anxiety disorder
Does vortioxetine work for Generalized Anxiety Disorder (GAD)?
Practice guidelines for anxiety disorders
Anxiety Disorders—Social anxiety disorder
What is performance anxiety (“stage fright”) and why is it important?
Clinical tips on using a beta-blocker for performance anxiety (“stage fright”)
Practice guidelines for anxiety disorders
Anxiety Disorders—Other articles
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD—Screening
How to screen all adult patients for *possible* ADHD
Why don’t we screen every patient for adult ADHD?
ADHD—Evaluation
Tips on history-taking in evaluating adults for possible ADHD
Executive functions: A simple and practical introduction
Emotional dysregulation is a HUGE problem in ADHD
ADHD—Neuropsychological testing
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—Medications—General Articles
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
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—Bupropion
Do you prescribe bupropion for ADHD in adults?
Seizure risk if atomoxetine and bupropion are used together?
ADHD—Treatment—Modafinil/ Armodafinil
ADHD—Treatment—Viloxaxine (Qelbree®)
ADHD—Treatment—Non-Medication Interventions
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 or conditions
ADHD in pregnancy and breastfeeding
Why we must plan for managing ADHD during pregnancy and breastfeeding
Tips on planning for pregnancy and breastfeeding in women with ADHD
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!
Famous People with ADHD (external link)
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
Look for “social camouflaging” when autism spectrum disorder is a possibility
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
Autism spectrum disorder: Evaluation of irritability, agitation, aggressive behavior
In ADHD and autism spectrum disorder, specifically look for the other
Practice guidelines for autism spectrum disorder
Autism spectrum disorder in adults: Interview with Edward Brodkin, MD
Autism Spectrum Disorder: Treatment
Autism spectrum disorder: Medications to treat irritability, agitation, or aggressive behavior
What interventions work for atypical sensory processing symptoms?
Does N-acetylcysteine (NAC) work for autism spectrum disorder?
Practice guidelines for autism spectrum disorder
Autism spectrum disorder: Resources for clinicians, patients, and families
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)
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?
Does bupropion really have a lower risk of switching 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?
What to tell patients after a single (“first”) episode of mania
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
Lorazepam for catatonia: How much? How long?
Which antipsychotics should be preferred for catatonia?
How to use ECT for catatonia
Getting authorization from a court for a patient’s medical guardian to be able to consent for ECT
What can we do about this important preventable cause of deaths on inpatient psychiatric units?
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)
Depressive Disorders
Depressive Disorders: Diagnosis and Evaluation
A Deeper Understanding of the DSM-5-TR® 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)
Should we check testosterone levels in men with “treatment-resistant” depression?
Depressive Disorders: Management
Depressive Disorders: Management—Overview and General Approach
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
We do have some options for the common problem of residual fatigue and somnolence
Should we consider a benzodiazepine for persons with major depressive disorder?
Do stimulant medications work for major depressive disorder?
Practice guidelines for depressive disorders
Depressive Disorders: Treatment—Transcranial Magnetic Stimulation (TMS)
What percentage of patients with MDD responds to TMS?
Who is more likely to respond to TMS?
Interview: Transcranial Magnetic Stimulation (TMS)
Depressive Disorders:Treatment—Bright Light Therapy
Depressive Disorders:Treatment—Premenstrual Dysphoric 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)
Depressive Disorders: Treatment—Complementary and Alternative Medicine
Depressive Disorders: Other topics
Feeding and Eating Disorders
Feeding and Eating Disorders—Screening
Why it is important for all of us to screen for eating disorders
How to screen for eating disorders
A simple tool to screen for eating disorders
Binge-Eating Disorder Screener-7 (BEDS-7)
Feeding and Eating Disorders—Evaluation
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
Pica
When should we diagnose pica as a DSM-5-TR™ Feeding and Eating Disorder?
Which comorbid conditions and complications should be looked for in patients with pica
Do medications have any role in the management of pica?
Recommended resources
Motor Disorders
Neurocognitive Disorders
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 disorders—General articles
Neurocognitive disorders in DSM-5-TR
In older adults, avoid medications with anticholinergic activity
Delirium
Mild neurocognitive disorder
Major neurocognitive disorder (Dementia)
“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?
Neuroimaging in persons with dementia
Practice guidelines for Alzheimer’s disease and other dementias
Neurocognitive disorder—Alzheimer's disease dementia
“Mixed pathologies” in Alzheimer’s disease
New, “disease-modifying” treatments for Alzheimer’s disease
Why amyloid-β and amyloid plaques are so important
Untangling exactly whom lecanemab is FDA-approved for
How well does lecanemab medication work?
Lecanemab carries an important boxed warning
Should we recommend treatment with lecanemab?
Practice guidelines for Alzheimer’s disease and other dementias
Neurocognitive disorder with Lewy bodies
What is Lewy body dementia?
An introduction to Neurocognitive disorder with Lewy bodies
DSM-5-TR 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 in dementia
Agitation associated with dementia
Why agitation associated with dementia is such an important clinical problem
“Agitation associated with dementia” now has an operational definition
Key points from the APA Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia
Brexpiprazole (Rexulti®) for “agitation associated with dementia due to Alzheimer’s disease”
Citalopram for agitation in Alzheimer’s disease
Case: Agitation in a patient with Alzheimer’s disease
Neuropsychiatric symptoms in dementia—Other articles
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—Antipsychotic augmentation
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
Panic Disorder—see Anxiety Disorders
Personality Disorders
Borderline personality disorder
How to screen for borderline personality disorder
Tips on evaluation and diagnosis of patients with “mood swings”
Borderline personality disorder: Should we disclose, discuss, and document the diagnosis?
Caveats about using medications in borderline personality disorder
Posttraumatic Stress Disorder (PTSD)
Posttraumatic stress disorder (PTSD)—Clinical features
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?
Posttraumatic stress disorder (PTSD)—Treatment
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
Posttraumatic stress disorder (PTSD)—Other articles
Practice guidelines for posttraumatic stress disorder (PTSD)
What can we do to support “National Post-Traumatic Stress Disorder Awareness Month”?
Psychogenic Polydipsia
Why does my patient drink such excessive amounts of fluids?
Psychogenic polydipsia: Clinical features and complications
How to diagnose psychogenic polydipsia
Options for managing psychogenic polydipsia
Schizophrenia-spectrum and other psychotic disorders
Clinical features
The terms “blunted affect” and “flat affect” are often used inappropriately
Does the patient have “true” hallucinations or pseudohallucinations?
What to ask and say to patients who “hear voices”
Evaluation
Which laboratory tests should we order in persons with first-episode psychosis?
Order an MRI of brain in first-episode psychosis?
Resources
The APA Practice Guideline for the Treatment of Patients with Schizophrenia, Third Edition
Practice guidelines for schizophrenia
Miscellaneous articles
Does estrogen have a role in schizophrenia
Estrogen as a treatment for schizophrenia?
Sexual dysfunctions
Sexual dysfunctions—Rating scales
An Introduction to the Changes in Sexual Functioning Questionnaire (CSFQ)
How to administer, score, and interpret the Changes in Sexual Functioning Questionnaire (CSFQ)
Arizona Sexual Experiences Scale (ASEX)
Sexual dysfunctions—Substance/medication-induced sexual dysfunction
Antidepressant-induced sexual dysfunction
How often does antidepressant-induc
Trazodone and priapism
Management of antidepressant-induced sexual dysfunction
Does bupropion treat antidepressant-induced sexual dysfunction?
PsychopharMYTH: “Vortioxetine does not cause sexual dysfunction”
Can gabapentin cause sexual side effects?
Sexual dysfunctions—Erectile disorder
Which laboratory tests in men with erectile dysfunction?
How to reduce the risk of erectile dysfunction
Should we be checking testosterone levels in older men?
Beta-blockers can worsen or improve erectile dysfunction
Which PDE-5 inhibitor for erectile dysfunction?
How long before sexual activity should PDE-5 inhibitors be taken?
Cyproheptadine (Periactin®) for antidepressant-induced sexual dysfunction (ADISD)?
Sexual dysfunctions—Premature (Early) Ejaculation
A primer on making the diagnosis of delayed ejaculation
Sexual dysfunctions—Female Sexual Interest/Arousal Disorder
Actively recommend vaginal lubricants to women who need them
Transdermal testosterone for hypoactive sexual desire disorder in postmenopausal women
Flibanserin (Addyi®)
Flibanserin (Addyi®) in postmenopausal women
Flibanserin (Addyi®): Basic information
Flibanserin (Addyi®): Systematic list of references
Sexual dysfunctions—Expert interview
YOU Ask the Expert: How to identify, assess, and manage medication-induced sexual dysfunction (Interview with Anita Clayton, MD)
Sexual dysfunctions—Other articles
Primary headache associated with sexual activity (including orgasmic headache)
Sleep-wake disorders
Circadian rhythm sleep-wake disorders
Circadian rhythm sleep-wake disorders: An overview
What is Delayed Sleep Phase Disorder?
Delayed Sleep Phase Disorder: Management
Excessive daytime sleepiness
How are drowsiness, excessive sleepiness, somnolence, hypersomnolence, and hypersomnia different?
Clinical tips on excessive daytime sleepiness (hypersomnolence)
Case: residual fatigue and somnolence
Case: excessive daytime sleepiness after remission of major depression
Right questions to ask about a patient with depression and excessive sleepiness
Medications for excessive daytime sleepiness (due to sleep apnea, narcolepsy, or shift work disorder)
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?
Jet lag disorder
Jet lag disorder is a real clinical condition
We need to actively prevent/ manage jet lag in our patients
Tips for the prevention and treatment of jet lag
How exactly to use melatonin or melatonin receptor agonists for jet lag
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 hypopnea
Obstructive Sleep Apnea Hypopnea—Screening
Obstructive sleep apnea is common and massively underdiagnosed
Are we missing the diagnosis of obstructive sleep apnea hypopnea (OSAH) in our patients with major depressive disorder?
STOP-Bang Questionnaire
How to screen for sleep apnea
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
Obstructive Sleep Apnea Hypopnea—Sleep studies
In a sleep study result, what is the Respiratory Disturbance (Distress) Index (RDI)?
Apnea-Hypopnea Index
What does the respiratory event index (REI) on a home sleep study mean?
Obstructive Sleep Apnea Hypopnea—Management
Clinical tips on excessive daytime sleepiness (hypersomnolence)
Tirzepatide (Zepbound®) for obstructive sleep apnea (OSA)
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-TR 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-TR 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
Non-Alcoholic or Alcohol-Free Beer
What are “non-alcoholic,” “alcohol-free,” “low alcohol,” and “reduced alcohol” beverages?
Non-alcoholic or alcohol-free beer in patients with past alcohol use disorder?
Is non-alcoholic beer safe in patients on monoamine oxidase (MAO) inhibitors?
Will non-alcoholic beer show up in breath or urine tests?
Where to find/ buy non-alcoholic or alcohol-free beer
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
Drug interactions with caffeine
Caffeine can significantly change serum clozapine levels
Let’s wake up to how much caffeine our patients are taking
Cannabis
Cannabis—General articles
Cannabis (“Marijuana”): Terminology
Acute effects of cannabis that we should warn patients about
Why and how to routinely ask and counsel patients about driving after cannabis use
Cannabis or cannabinoids for PTSD?
Cannabis or cannabinoids for dementia?
Only the minimum about cannabigerol (CBG)
Cannabis—Drug interactions
Which psychotropic medications does cannabis affect?
Cannabidiol (CBD): Drug interactions
Pharmacokinetics of cannabis or cannabinoids
Cannabidiol (CBD)
What is cannabidiol (CBD)?
What is the dose of cannabidiol (CBD) for anxiety disorders?
Cannabidiol (CBD): Clinical experience
Cannabidiol for schizophrenia or other psychotic disorders? An overview
What did randomized, double-blind clinical trials of cannabidiol in schizophrenia find?
What side effects can cannabidiol (CBD) cause in our patients?
Cannabidiol (CBD): Drug interactions
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
Fentanyl
Why we MUST know about fentanyl and fentanyl analogs
Fentanyl analogs and why they are so important
An overview of fentanyl opioid use disorder (addiction)
Special points in the management of fentanyl opioid use disorder (addiction)
Special tests are needed to identify fentanyl in the urine
Special issues in using naloxone for overdoses involving fentanyl
Miscellaneous
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
How to treat methamphetamine use disorder
Other stimulants
What is khat, and why is it important in mental health?
Tobacco/ Nicotine
Tobacco/ Nicotine—General Articles
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
Smoking and psychotropic medications
A primer on tobacco-free oral nicotine pouches
Nicotine Replacement Therapy (NRT)
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?
Don’t miss nicotine as a cause of the increase in pulse rate or blood pressure
Monitor pulse rate and blood pressure when bupropion and nicotine are combined
Varenicline
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
What are the potential side effects of varenicline (Chantix®)?
Clarification about the potential neuropsychiatric side effects of varenicline (Chantix®)
Electronic Cigarettes (E-cigarettes)
What are electronic cigarettes (e-cigarettes)?
Do electronic cigarettes (e-cigarettes) work for smoking cessation?
What “authorities” say about e-cigarettes for tobacco use disorder
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
Substance use and Bipolar disorders
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
Substance use—Miscellaneous articles
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 categories of “Contraception” and “Pregnancy and Lactation” (above)
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-TR® diagnostic criteria explained
DSM-5-TR® diagnostic categories
An overview of DSM-5-TR® diagnostic categories
Neurocognitive disorders in DSM-5-TR
An Overview of Trauma- and Stressor-Related Disorders
Substance-related and addictive disorders in the DSM-5-TR®
Neurocognitive disorders in DSM-5-TR®: Classification
DSM-5-TR® 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-TR® Criteria for Major Depressive Disorder
Diagnostic criteria for body dysmorphic disorder (BDD)
Understanding the DSM-5-TR® diagnostic criteria for alcohol withdrawal
Restless Legs Syndrome (RLS): DSM-5-TR® diagnostic criteria explained
DSM-5-TR® diagnostic criteria for Neurocognitive disorder with Lewy bodies explained
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