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Anemia
Let’s ask about heavy menstrual bleeding
Laboratory testing to identify iron deficiency
How to order and interpret iron studies
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
Celiac disease
Chronic Fatigue Syndrome
Chronic Fatigue Syndrome
Management of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/ CFS)
Constipation
Check for these “alarm” symptoms/ signs in patients with constipation
Non-medication interventions that we should recommend for constipation
Over-the-counter treatments for constipation: A simple and practical guide
Management of clozapine-induced constipation
Why and how to recommend increased intake of soluble fiber
How to choose and use a fiber supplement
Don’t recommend docusate (Colace®) for constipation
COVID-19
Warning about using psychotropic medications along with treatments for COVID-19
COVID-19 drug interaction checker
Nirmatrelvir-ritonavir (Paxlovid™): Drug interactions with psychiatric medications
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)
Diabetes mellitus/ Prediabetes
Insulin resistance
Does your patient have “insulin resistance”?
What can we do to manage insulin resistance?
Prediabetes
What exactly is “prediabetes” and why is it so important?
Metformin
Metformin to prevent or treat metabolic adverse effects due to antipsychotics
Who is more likely to benefit from metformin for management of metabolic adverse effects?
Metformin for antipsychotic-induced weight gain in children and adolescents?
Potential adverse effects of metformin
Tips on prescribing metformin
Metformin AND topiramate for metabolic adverse effects?
SGLT-2 inhibitors
SGLT2 inhibitors: A new class of medications for type 2 diabetes
Who’s job is it to check for drug interactions?
GLP-1 receptor agonists
A simple primer on what GLP-1 receptor agonists are
Semaglutide injection (Wegovy™) for weight loss in obesity and overweight
Does tirzepatide (Zepbound™) produce *even more* weight loss than semaglutide (Wegovy®)?
Semaglutide injection (Wegovy™): Basic information
Semaglutide injection (Wegovy™): Serious side effects, warnings, and contraindications
Semaglutide injection (Wegovy™): Side effects
Tirzepatide (Zepbound™): Basic information
Liraglutide (Victoza®, Saxenda®)
Dyslipidemia
Dyslipidemia—Overview
Dyslipidemia is a huge contributor to disease and death—but often undiagnosed and untreated
Dyslipidemia—Evaluation
The lipid panel (profile): Why, when, and how to order it
How to monitor for dyslipidemia in patients treated with an antipsychotic
A brief primer on lipoprotein(a)
Dyslipidemia—Management
Elevated LDL cholesterol or triglycerides must be brought down without much delay
Recommendations for dietary fats in a healthy diet
Specific dietary changes that we should recommend for elevated LDL cholesterol
What to advise patients about saturated and unsaturated fats
Hypertriglyceridemia
An Introduction to Hypertriglyceridemia
Check for these causes if triglycerides are high
Elevated LDL cholesterol or triglycerides must be brought down without much delay
Hypertriglyceridemia: Non-medication management
For moderate hypertriglyceridemia, implement these lifestyle interventions
Omega-3 fatty acids for the treatment of hypertriglyceridemia
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?
How to identify specific medications for possible deprescribing in older adults at risk of falls
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: See “Dyslipidemia”
Hyperprolactinemia
What is our role in patients with hyperprolactinemia?
How to measure and interpret serum prolactin
Potential harms from hyperprolactinemia
Hypertension
Instructions to patients for measuring blood pressure and pulse rate at home
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?
“White coat hypertension”, “white coat effect”, and what we should do about them
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
We sometimes have to prescribe differently based on the Child-Pugh score or class
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
Overweight and obesity: General articles
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
Thyroid function testing
Tips on thyroid function testing
More on interpreting thyroid function tests
What do you make of these thyroid function test results?
Hypothyroidism
Antithyroid antibodies
How should lithium-induced hypothyroidism be evaluated?
A primer on subclinical hypothyroidism
What is ” central” (secondary or tertiary) hypothyroidism?
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