Today, we will be discussing the challenges of managing antipsychotic medications in children and adolescents. We will explore various strategies that aim to balance symptom relief with potential side effects, while also guiding towards personalized and safer treatment options. Join us in discovering the art of precision in pediatric mental health care.Published On: 02/26/2024Duration: 19minutes, 25 secondsJoshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Here's a Throwback Thursday episode originally cast in March of 2021, where we're going to look at the question of whether adding a z hypnotic improves antidepressant response. And stay tuned to the very end where I'm going to update it with new research. We all know that when you sleep better, you feel better.CME: Take the CME Post-Test for this EpisodePublished On: 02/22/2024Duration: 27 minutes, 56 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dosing is not a collaborative venture when it comes to controlled substances, and here we look for the safe upper limits of stimulant dosing.CME: Take the CME Post-Test for this EpisodePublished On: 02/19/2024Duration: 22 minutes, 23 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The release of the fast-acting antidepressant Auvelity got us thinking about an older strategy to speed up antidepressants, benzodiazepines. So we're bringing you this Thursday throwback, do benzodiazepines treat depression? Benzos and sleep meds rarely earn a mention in textbooks on depression these days, but that has not always been the case.Today, in part one of a two-part series, we'll open up a forgotten repository of psychiatric research, where a stack of about 50 controlled trials has been archived away, suggesting that the GABAergic benzos might actually treat depression.CME: Take the CME Post-Test for this EpisodePublished On: 02/15/2024Duration: 27 minutes, 43 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Auvelity, a new rapid acting medication for depression, is a branded combination of two generic drugs. We look at its side effects, addictive potential, and whether you can just use the generic components.CME: Take the CME Post-Test for this EpisodePublished On: 02/12/2024Duration: 16 minutes, 44 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Auvelity, a new rapid acting medication for depression, is a branded combination of two generic drugs. We look at how it works and the clinical trials, including new data in treatment resistant depressionCME: Take the CME Post-Test for this EpisodePublished On: 02/05/2024Duration: 14 minutes, 02 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

How to choose a mood stabilizer in older adults.CME: Take the CME Post-Test for this EpisodePublished On: 01/29/2024Duration: 17 minutes, 40 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Bipolar disorder is different in the elderly. Today we look at the medical causes to watch out for.CME: Take the CME Post-Test for this EpisodePublished On: 01/22/2024Duration: 12 minutes, 19 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Have you ever wondered about using Deep Brain Stimulation, DBS, for kids dealing with Obsessive Compulsive Disorder, OCD? It's a hot topic among parents, but do we have enough evidence to back up this rather intense treatment? Let's dive in and take a closer look at deep brain stimulation.Published On: 01/14/2024Duration: 11minutes, 49 secondsJoshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

We interview Stephan Jackman, whose company is developing a new formulation of lithium, and bring updates on lithium in younger, older, and peripartum patients.CME: Take the CME Post-Test for this EpisodePublished On: 01/08/2024Duration: 16 minutes, 44 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

A year of research on lithium, including updates on its efficacy, renal risks, tremor, and a controlled trial of instant vs. extended releaseCME: Take the CME Post-Test for this EpisodePublished On: 01/01/2024Duration: 22 minutes, 06 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

In today’s podcast, we explore background knowledge, experiences, andmisconceptions surrounding psychodynamic therapy and discuss how we define evidence for it with our guest, Dr. Jonathan Shedler.Published On: 12/25/2023Duration: 52 minutes, 47 secondsMark L. Ruffalo, MSW, DPsa, Jonathan Shedler, PhD, and Geneva Valeska, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Callous unemotional behaviors can be challenging to understand. One community study of 1136 children (from 3rd-7th grade) found that 10%–32% of those with conduct disorder and 2%–7% of those without conduct disorder met the callous emotional specifier threshold in the DSM-5. In this episode, we will discuss what callous unemotional behaviors are, how they look like, how to assess these behaviors, types of interventions, and more. Dr. Meghan Rose Donohue joins us today to help us unpack this topic. She is an instructor in psychiatry and works in the division of child and adolescent psychiatry at Washington University School of Medicine.Published On: 12/18/2023Duration: 24 minutes, 33 secondsJoshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Callous unemotional behaviors can be challenging to understand. One community study of 1136 children (from 3rd-7th grade) found that 10%–32% of those with conduct disorder and 2%–7% of those without conduct disorder met the callous emotional specifier threshold in the DSM-5. In this episode, we will discuss what callous unemotional behaviors are, how they look like, how to assess these behaviors, types of interventions, and more. Dr. Meghan Rose Donohue joins us today to help us unpack this topic. She is an instructor in psychiatry and works in the division of child and adolescent psychiatry at Washington University School of Medicine.Published On: 12/18/2023Duration: 24 minutes, 33 secondsJoshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Sigmund Freud’s theories are challenged by his granddaughter, Sophie Freud.CME: Take the CME Post-Test for this EpisodePublished On: 12/11/2023Duration: 17 minutes, 53 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Sigmund Freud’s theories are challenged by his granddaughter, Sophie Freud.CME: Take the CME Post-Test for this EpisodePublished On: 12/04/2023Duration: 13 minutes, 40 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Richard Brown, MD, shows us how to use his top five natural therapies for ADHD: Pycnoginol, Rhodiola rosea, Racetams, American Ginseng.CME: Take the CME Post-Test for this EpisodePublished On: 11/27/2023Duration: 21 minutes, 07 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Around 50% of people with ADHD suffer from other cognitive problems, and Richard Brown, MD, describes them: 1) Working memory 2) Slow processing speed and 3) Dyslexia. CME: Take the CME Post-Test for this EpisodePublished On: 11/20/2023Duration: 13 minutes, 25 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

New research brings clarity to the big ketamine questions. How does it compare to ECT and antipsychotics? How much of it is placebo? Which is more effective – ketamine or esketamine? How do you sustain the benefits? Does it work better with psychotherapy?CME: Take the CME Post-Test for this EpisodePublished On: 11/13/2023Duration: 19 minutes, 46 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

New research brings clarity to the big ketamine questions. How does it compare to ECT and antipsychotics? How much of it is placebo? Which is more effective – ketamine or esketamine? How do you sustain the benefits? Does it work better with psychotherapy?CME: Take the CME Post-Test for this EpisodePublished On: 10/30/2023Duration: 19 minutes, 14 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Historian Edward Shorter takes us on a 200 year journey from the age of spa treatments to the birth of psychopharmacologyCME: Take the CME Post-Test for this EpisodePublished On: 10/30/2023Duration: 22 minutes, 23 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

There are many reasons why patients misuse medications. Today, Joseph Pierre shakes us out of our 1990s understanding of addiction and explains a new trend, misuse of uncontrolled medications like Bupropion, Quetiapine and the Gabapentinoids.CME: Take the CME Post-Test for this EpisodePublished On: 10/23/2023Duration: 24 minutes, 34 secondChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Sexuality is a broad term that encompasses sexual identity, activity, attitude toward sex, intimacy, partnership, and pleasure. In this podcast, we cover the basics of sexual function and the effects of aging, medical comorbidities, and mental health on sexuality. We discuss sexual health in long-term care settings and in older adults with cognitive disorders and suggest an approach to commonly encountered sexual health issues. Transcript: DR JAIN: Sexuality is a broad term that encompasses sexual identity, activity, attitude toward sex, intimacy, partnership, and pleasure. In this podcast, we cover the basics of sexual function and the effects of aging, medical comorbidities, and mental health on sexuality. We discuss sexual health in long-term care settings and in older adults with cognitive disorders and suggest an approach to commonly encountered sexual health issues. Welcome to The Carlat Psychiatry Podcast.This is another episode from the geriatric psychiatry team.I’m Neha Jain, an Associate professor of psychiatry, Medical Director for the Mood and Anxiety Disorders Program and Associate Program Director for the Geriatric Psychiatry Fellowship Program at the University of Connecticut Health Center, in Farmington, CT. In today’s podcast, I am joined by two of my colleagues. DR COLLIER: I’m Stephanie Collier, The Editor-in-Chief of The Carlat Geriatric Psychiatry Report. DR AZIZ: and I’m Dr. Rehan Aziz, an associate professor of psychiatry and neurology at Hackensack-Meridian School of Medicine. I am also the associate program director for geriatric psychiatry and general psychiatry at Jersey Shore University Medical Center, in Neptune, New Jersey. Let's begin our discussion with the topic Dr. Jain started out with. What are your thoughts about how sexual function and sexuality intersect in older adults? DR JAIN: Yes, first it is just important to acknowledge that older adults are sexually active because discussions about sexual issues are often avoided in healthcare settings. You know there is often discomfort on part of the patient or clinician, a lack of knowledge-I mean how much training do you remember in Med School and residency about sexual heath-right? Or a fear of embarrassment, or just plain ageist beliefs. However, a fulfilling sex life is a crucial aspect of quality of life for many seniors. DR COLLIER: It makes a lot of sense, the question is how do we bring this up when we are talking to our patients and assessing their sexual heath in clinical settings? DR JAIN: So, I tend to start first by just asking permission. You know, is it okay if I ask you a few questions about sexual health or sexual activity? Then I ask more open-ended questions, like do you have any concerns or questions do you have in terms of your sexual activity? Or, have you noticed changes in your sexual relationship with your partner over time? Many older adults will not disclose sexual health issues if there are others in the room, so I of try to ensure privacy when screening for sexual dysfunction. I ask about problems with libido, getting/maintaining an erection (for men), dryness or discomfort (for women), and for all genders difficulty achieving orgasm.DR AZIZ: Dr. Jain I had a question for you regarding that, so my experience is I will usually have patients come to the office.. and if they are accompanied by a patron there is no issue about asking about sexual function/activity, but often they are coming with caregivers or their children. And then it can become quite uncomfortable to ask them these questions. How do you handle those situations? DR JAIN: Absolutely, and first of all, I would say don't. You know, so do not ask the question if there is anybody other than the partner, and even sometimes when it is the sexual partner that is present, some people may not feel comfortabl. Usually, I try to sneak in at least some private unites with the patient, and I can just say to whoever is with them, I would like to ask them some questions in private if that is okay with you. And most of the time, the caregiver, whoever is there is completely open to it. Usually, you do not even need to to say why, because there is also other things when you are treating older adults, right, where you want come privacy. So, then I will escort whoever is with them outside, return and talk to the patient.And then bring the family member back in. DR. AZIZ: And do you find that patients are forthcoming when you are speaking to them one-on-one? I was reading that only 17% of older adults are asked about their sexual activity. DR JAIN: Right, and I think again that number is on us, right? So, we don't ask, but what I have found is that when I ask people are often surprisingly forthcoming and often as the discussion goes on it kind of eases the air and they vbecome more and more open, so usually I like to being it up fairly quickly, so know this is something on the agenda and something this is okay to take about. And usually I find that as they become more comfortable they open up more and more.​DR COLLER: What kind of questions do you use to open up?DR JAIN: So, again, do you have any concerns about your sexual activity? You know how is your intimate life with your partner going? And you know kind of gauge their interest/response, sometimes honestly ti seems like they have been waiting for someone to ask that question and they have all these things they feel like are so uncomfortable to talk about and getting that acid permission from the clinician goes such a long way, and if it seems like they are uncomfortable or hesitant I will just kind of back off. And then when I wrap up I will say, do you have any questions or concerns? They will come back to that, so really just bringing questions about sexual health out in the open, acknolegking that it is something that we do discuss in part of a clinical visit, and then sort of following the patients lead. DR COLLER: Is there anything you do differently with the older adults when you think go medical comorbidities, things you want to specifically ask about?DR JAIN: Yes, that is a great question. I specifically, I think we can't ask bout sexual health without asking about medical history. So may of the diseases that older adults deal with: Parkinson's disease, cancer, diabetes, and heart disease can contribute to sexual dysfunction. So, I will usually ask about the underlying medical history. I will also ask if they have noticed any relationship between the two. So if you have sexual dysfunction, do you recall if this happed before/after your diagnosis of X, Y, Z? And then the treatment recommendations usually based on the underlying causes, so you make be prescribing medications such as sildenafil, referring patients to urology or sexual health counseling, or suggesting evaluation for pelvic floor physical therapy for women. DR. AZIZ: Do you talk to them about sexually transmitted diseases? I saw that the rates have been increasing of gonorreah and chlamydia in older adults, pretty significantly over the last several years. Which means, they re having sex, we are just not taking them about it.  DR JAIN: Exactly, and I also think that at some point we sort of assuming that STDs were not going to be as common in older adults. So I always ask if they have any concerns about their or their partners sexual heath, undergoing screening for STDs is pretty common and easy to add it on to the rest of labs. Again, being open-ended, but at the same time being very straightforward, so there is no discomfort in bringing up concerns, and if they have additional concerns then they don't feel uncomfortable bringing those up. I do, you know, want to emphasize, because I have certainly been guilty of this, trying to avoid making assumptions about sexual orientation, or relationship status. And again following their lead, allowing them to disclose their preferences, at their own pace.DR COLLIER: It almost sounds like when you ask about bowel habits, for example, if you are feeling comfortable asking the question the patients feels more comfortable answering the questions. If you feel uncomfortable asking the questions, they will feel a little bit more embarrassed. So, asking in a very straightforward way- that's great advice. DR JAIN: And you know, we ask about invasive things all the time. You know, you're asking someone about their bowel habits is just as invasive as asking someone about their sexual health. So, I think to a big extent it's our won discomfort that plays into this. DR AZIZ: We know that depression and anxiety are important risk factors for sexual dysfunction, as are the medications used to treat them. SSRIs can cause hypoactive sexual desire, erectile dysfunction, and delayed ejaculation. So, when we have a patient that has sexual dysfunction and depression, or anxiety, how do you suggest we tailor our treatment and how duo we discuss these possible sides effects with them?DR JAIN: Yes, Dr. Aziz. So I think again, I think first of all being aware that some sexual side effects are just as much a risk for older adults as they are for younger adults. Before prescribing antidepressants and during the first few follow-ups after starting a new anti-depressant, I regularly discuss potential sexual side effects. Again, just with everything else, you know, stomach discomfort, headaches, insomnia-sexual side effects. These side effects may be influenced by the dosage and can sometimes persist even after discontinuing the medication. I tend to suggest taking a brief drug holidays quite a bit. So if you have planned sexual activity, you know, don't take your medication for 24-48 hours but in some cases where this is a persistent problem, recommend switching to antidepressants that are less likely to cause sexual side effects, like bupropion, mirtazapine, or vortioxetine. Do you have any other approached that might work in such a situation?DR COLLIER: Sometimes I also think about augmenting with bupropion, and I am curious what your thoughts are about that?DR JAIN: So, I personally, you know, I have read that approach. I just personally have not had much luck with it. I don't know what you think Rehan?DR AZIZ: I think I have had fair success with it. I will usually switch to bupropion, if clinically indicated, but also augmenting with bupropion seems like a fair strategy. If it is an older adult that is sexually active, and that is a concern for them, usually I will start with mirtazapine or bupropion from the beginning. And as you indicated there has been more data that vortioxetine may also be beneficial for having lover rates for sexual dysfunction that SSRIs. Question for you, my worry with the drug holidays is that it will become a permeant holiday. Have you seen that happen?DR JAIN: Interestingly, less than I would have thought. An, you know, drug compliance rates are in general not very good. People don't take medications everyday, despite what we like to think, so the people who come in complaining of sexual side effects and thinking about, what can I do to fix this? Generally seem to be somewhat more motivated, and often the sexual side effects are often if not entirely the reason behind the noncompliance. So if we can address that with the drug holiday, I think it actually makes them more likely to resume the medication. I am not above reminding people though, or cheering in on them "okay, how many days were you actually off it before you restarted?"And then sort of rendering those permitters. DR COLLIER: We talked about antidepressants, what about the antipsychotics? So we know that antipsychotics can also have negative effects on sexuality, reduced libido, causing erectile dysfunction and amenorrhea in younger adults. The sexual side effects are greater in first-generation and prolactin-inducing antipsychotics like risperidone and paliperidone. Dr. Jain, what is your process for addressing antipsychotics and sexual dysfunction? DR JAIN: Thats a great question, because again, when we think of sexual dysfunction we tend to think of antidepressants more than antipsychotics. But the same idea, before prescribing and during the first few follow-up visits after starting an antipsychotic, I will ask about any sexual side effects. In generally, the indications for antipsychotics are such that I don't usually recommend a drug holiday, however, if sexual side effects are present, I may suggest a switch to aripiprazole, which tends to have fewer sexual side effects. There are some newer antipsychotics out on the market now with similar profiles. Or recommending the use of adjuvant sildenafil to manage the dysfunction. DR AZIZ: It is well-known that sexual dysfunction can be affected by the aging process. As an example, women tend to have lower estrogen levels after menopause, which can lead to vulvovaginal atrophy and discomfort during sexual activity. Dr. Jain or Dr. Collier, how do you address this? DR JAIN: Again, a very common problem Rehan, and one that we doing ask about often I think. So always ask. If it is an issue of dryness or discomfort during sex, the first recommendation is usually to use a vaginal lubricant. I do encourage women to talk to their primary care physician or their gynecologist about possible treatment options as well, including local and systemic hormone therapy. For older men who are experiencing erectile and ejaculatory dysfunction, again emphasizing hat its very common, and then looking at modifiable risk factors like obesity, smoking, or hypertension. Additionally, I might suggest psychotherapy or a trial of a phosphodiesterase-5 inhibitor. DR COLLIER: This is another one of those topics that may not come up unless you ask about it, normalize it too. So I have found to day that it is helpful sometimes to say many of my patients experience this. Is this an issue for you as well? DR JAIN: Yes, and the other piece, is- I don't know if you have both seen this- is menopause can vary so widely among women. So, you know, anywhere from women who have premature menopause to in their 40s all the way to earn they are in late 50s. So this question has a very long life, you know, so we need to be asking it across the lifespan almost.DR AZIZ: Let's talk about treating inappropriate sexual behavior in dementia, it can be challenging for some clinicians. It can be very complicated if it happens in a long-term care setting or another community setting. How do you all approach it? DR COLLIER: Dr. Aziz, that is an excellent question and it also effects the family members. A significant concern. Different dementias can cause inappropriate sexual behavior. Alzheimer's dementia often causes a lack of interest in sexual activity, but it can also contribute to inappropriate behaviors. Frontotemporal dementia can lead to early sexual disinhibition, while other dementias may have it in later stages this could appear pretty early on. And then the effectiveness of psychotropic drugs for addressing inappropriate sexual behaviors is a little bit uncertain.The best of course is behavioral interventions. But what do they look like in practice Redirecting, distracting, reminding, they can be useful. But sometimes we have to think a little bit harder about what can stop these behaviors. Some clinicians do use jumpsuits or they button the shirt on backwards, so that the buttons are in the back so that way they don't expose themselves. But of course this is something where a clinician really needs to weigh the risks and benefits before suggesting something like that. DR AZIZ: Those are really interesting ideas. I think one thing to consider also is that patients may misinterpret behavior. So if personal care is being provided by a nurse or home health aid, they may experience that as a more intimate gesture or touch than it is meant to be and so there may be ways for a care giver to alter what they are doing or to redirect the patient. Dr. Jain how do you treat inappropriate sexual behavior? I mean luckily they are not that common, but when it happens, especially in a long term care setting it can be very upsetting for the staff and for family. DR JAIN: Yes, and it's one of those things where for us its just one of the many behaviors, unfortunately that can come with dementia, but it has a disproportionate effect in terms of distress for patients, for families, for caregivers. If behavioral interventions are not working there are case studies that suggest the use of antidepressants, particularly SSRIs, as well as antipsychotics. There is less evidence for the effectiveness of mood stabilizers, antihypertensives, and cimetidine. I have always struggles, you know, when though the option of using anti-androgens is there, I have always struggled with the ethical concerns with that, especially if the patients can not provide informed consent. So I wonder what your thought are about that?DR AZIZ: I think that's really complicated. So, I have never started an anti-androgen, but I have continued them. And these were patients who were in long-term care settings, so for me the decision process was that; well if they are not on it, they will have inappropriate behavior and they are going to be asked to leave the facility. So they re going to be in a worse situation because they will have no place to stay and no one providing care, and it was the only way to manage their very very aggressive and disturbing behavior. So it was with a heavy heart that I continued the anti-androgens; but I agree with you they are always a very very last resort choice. DR COLLIER: And I have had some success with the SSRI approach. Where inappropriate behavior absolutely stoped once a patient was at a high enough dose. So for tolerability and as you mentioned sort of the risk benefit ration, you should minimize the SSRIs and pushing the doe up hight enough to stop the inappropriate behaviors which can absolutely disappear. DR JAIN: That's a good point. Do you feel like you needed to use higher than usual doses? Or maybe even other does to achieve that effect with SSRIs?DR COLLIER: No, but it was going towards the higher FDA approved maximum range actually. Which generally, when we think about treating older adults they often benefit at lower does, but in terms of the sexual behavior I think it is dose dependent. DR AZIZ: How long did it take your patients to respond? DR COLLIER: This is a small number of patients that I am spreaking about, but it was a couple weeks. DR AZIZ: Okay, so we have to be patient.DR COLLIER: This happed actually in the inpatient setting where it was first noticed, so it was in an inpatient stay where as the dose increased the behaviors went down. And that was the only variable at the time. DR JAIN: Yes, I think that is the big thing with SSRIs, is with just the delay in repose you start something you titrate the dose and then there is just a lot of education with staff and family while we wait for the medications to kick in. I am curious abut sort of the ethical/legal aspect of this in terms of documentation, if you have any thoughts, in terms of who do you involve, especially if the patient does not have capacity. How do you make sure that this is in line with the current regulations and how do you document it all?DR COLLIER: I don't think the documentation would be particularly different here because you are still asking for informed consent, you are still going through the informed consent procedure and it the patient is not able to provide informed consent than it is a discussion the moves to the healthcare proxy or whoever is making decisions for the patient. So our documentation does not have to be extensive it can can be quite brief with the precautions of informed consent. Whether its treatments of inappropriate behaviors or other behavior where you are thinking of something. Say like an antipsychotic of a patient with dementia.DR AZIZ: I think I would add to that when we are using anti-androgens, just to be clear it is a form of chemical castrations o it is a difficult decision to make. But as I said its sometimes necessary ignorer for a patient to receive the care that they need. If a patient is hospitalized there is also the option to consult a bioethics committee for a second opinion, they can often be very helpful in looking at the case from an alternate point of view.DR JAIN: Yes, and I recall doing that when we were inpatient. What I have also done in the outpacing setting sometimes, if you don't have access to a bioethics committee, is in addition to family, involving another physician that's includied in the patients care. Often its there primary care doctor, family doctor, staff at the facility that they are residing. But again making sure that it is an informed decision and everyone is comfortable with it. DR COLLIER: Dr. Jain that is an excellent suggestion. We talked a little bit about the limitations in terms of medications and providing quality care to patients experience sexual disfunction. I think we can also focus on long term care settings, and let's discuss a little bit how this setting itself can hinder healthy expression of sexuality in older adults. DR AZIZ: So it's a significant issue in long term care settings. Multiple obstacles can prevent healthy sexual expression in those settings, including as staff bias (i.e., labeling such behaviors as "inappropriate"), insufficient privacy, the practice of separating couples upon admission to long- term care, concerns regarding consent and capacity, and lastly there can be discrimination against LGBTQ individuals. And for many of them it can be reason that they may avoid placement into long term care facilities. DR JAIN: I agree, and this is a topic that I feel very strongly about. And I think that as a clinician community we sort of want to lead the charge to avoid or reduce these restrictions. So providing risk and capacity assessment training as early as possible, staff can feels more confidence creating a safe environment for residence and in managing sexual behaviors and allowing residents to express their sexuality. Making simple changes to the environment, like offering Do Not Disturb signs or offering private spaces. Again you know, its a way without necessarily making it very obvious, just allowing people to feel more comfortable and feel okay with the idea of continuing to express their sexuality, even when they are not home anymore. But I don't think this often completely fixes the restrictions that you mentioned Dr. Aziz. I think traditionally or historically there has just been so much bias against sexual activity in facilities that its a cultural shift that is sort of slow incoming.I wonder what you experience has been Dr. Colllier?DR COLLIER: I think with everything change takes time, and I think that even with our best intentions, education does not really change the process or the outcomes necessarily. There is more that needs to be done on multiple levels, and as a clinician you can feel a little bit trapped; where dipole your best efforts you are not ensuring the optimal care for the patients in long term settingsDR JAIN: I have certainly been in those situations where all you can do is provide empathy and validation to the patient and really acknowledge their distress. There is also the high levels of discrimination that LGBTQ patients tend to face in long term care settings, and the stigma is often so internalized by older adults so they are hesitant to discuss sexuality. And as Rehan said, more likely to avoid long term care settings because ion that stigma. You know staff training/staff education I think even creating concrete policies where possible so that the system can adapt and become a route part of training. When we have team meetings and discussions avoiding sexual preferences and using more inclusive language when asking open-ended questions. And I think this is certainly where the older generation of clinician, of which I now include myself, has had to learn things and I think we continue to do that with each successive wave of clinicians. Connecting older LGBTQ adults to community resources, such as www.sageusa.org, which is the Services and Advocacy for LGBT Elders USA. Those are all things owe can of in out program; somebody put together a resource guide for LGBTQ older adults and it was interesting that nobody realized the need for it, but as soon as it was created it was distributed so widely because the need was there, we just never realized it.DR AZIZ: That sounds like an incredible document. Is that publicly available Dr. Jain?DR JAIN: I don't think it is but I don't know why it could not be, so I will find that out for you.I think that it's very important for us to acknowledge that sexuality remains a significant aspect of life for older adults, with or without sexual dysfunction; and we can help our patients by asking about there sexual health, by addressing their sexual dysfunction, by creating more education and more safety around this discussion. Treatment options like behavioral interventions, psychotherapy, and medications, those should all be considered and molded to the needs of each individual patient. DR COLLIER: The newsletter clinical update is available for subscribers to read in The Carlat Geriatric Psychiatry Report. Hopefully, people will check it out. Subscribers get print issues in the mail and email notifications when new issues are available on the website. Subscriptions also come with full access to all the articles on the website and CME credits. DR AZIZ: And everything from Carlat Publishing is independently researched and produced. There’s no funding from the pharmaceutical industry. DR JAIN: Yes, the newsletters and books we produce depend entirely on reader support. There are no ads and our authors don’t receive industry funding. That helps us to bring you unbiased information that you can trust. DR COLLIER: And don’t forget, you can now earn CME credits for listening to our podcasts. Just click the link in the description to access the CME post-test for this episode.As always, thanks for listening and have a great day! 

Both common, yet elusive, symptoms of depression, dementia, and delirium may overlap in older adults, which provides a diagnostic challenge. Even more confounding, these three disorders, the three Ds of geriatric psychiatry, frequently present simutaneously. In this episode, we will review key features to help distinguish between these disorders and provide some tips on their management.CME: Take the CME Post-Test for this episodePublished On: 10/09/23Duration: 16 minutes, 24 secondsStephanie Collier, MD, and Neha Jain, MD have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Social Rhythm Therapy helps patients regulate their circadian rhythm. It treats bipolar disorder, and here we show how to weave it in with medication therapy.CME: Take the CME Post-Test for this EpisodePublished On: 10/02/2023Duration: 20 minutes, 58 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Autistic kids and teens can become despondent or suicidal. When this happens, we need to take it as seriously as with anyone else. In today's podcast, Mara and I will explore the distinction between self-injurious behavior and suicidality in autistic children, communication patterns related tosuicide, the screening process for identifying suicidality, and the different levels of care required to effectively address this issue.CME: Take the CME Post-Test for this EpisodePublished On: 09/25/2023Duration: 21 minutes, 07 secondsJoshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

When a child grows up with untreated mental illness, there's a good chance it'll affect their identity. We'll look at how to work with that in the psychotherapy of ADHD.CME: Take the CME Post-Test for this EpisodePublished On: 09/14/2023Duration: 13 minutes, 07 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Child and adolescent psychiatrists are seeing increasing numbers of transgender and gender-diverse children and teens. This podcast will help clinicians understand the basics of gender-affirming care (GAC) as they work with families around issues of gender dysphoria.

You started a stimulant medication for a young woman with ADHD. When she returns her symptoms are 70% better, but what can we do about the rest? Today a conversation with psychiatrist Scott Shapiro about behavioral interventions for adult ADHD.CME: Take the CME Post-Test for this EpisodePublished On: 09/14/2023Duration: 13 minutes, 07 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Updates on dark therapy for mania from the 2023 International Bipolar Conference.CME: Take the CME Post-Test for this EpisodePublished On: 09/11/2023Duration: 15 minutes, 21 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

"I think that anxiety is the fever of psychiatry, not a disease, it's not a diagnosis, it's not an illness. It's just a symptom, usually of other illnesses or condition." - Nassir GhaemiCME: Take the CME Post-Test for this EpisodePublished On: 09/07/2023Duration: 21 minutes, 46 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

New research on light therapy in bipolar disorder from the 2023 International Bipolar Conference.CME: Take the CME Post-Test for this EpisodePublished On: 09/04/2023Duration: 10 minutes, 55 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

What is generalized anxiety disorder? Is it an anxious temperament, or is it a symptom of another mental illness such as depression, or is it a valid disorder on its own?CME: Take the CME Post-Test for this EpisodePublished On: 08/31/2023Duration: 19 minutes, 23 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Updates from the 2023 International Bipolar Conference: Avoid valproate (Depakote) in women of childbearing age; who to blame when patients are noncompliant; and functioning trumps symptom reduction.CME: Take the CME Post-Test for this EpisodePublished On: 08/28/2023Duration: 12 minutes, 20 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Is it autism or psychosis or both? Autistic traits and psychotic symptoms can look a lot alike. How common is psychosis in autism? And how can we differentiate co-occurring autistic traits from psychotic symptoms? Dr. Kristin Cadenhead gives us an approach for sorting through the history and addressing these problems separately.CME: Take the CME Post-Test for this EpisodePublished On: 08/21/2023Duration: 16 minutes, 04 secondsJoshua Feder, MD, and Mara Governman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Zuranolone (Zurzuvae) is newly approved for postpartum depression, but does it work in regular depression? And why did they put so many “Zs” in the name?CME: Take the CME Post-Test for this EpisodePublished On: 08/14/2023Duration: 22 minutes, 54 secondsChris Aiken, MD has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Lurasidone (Latuda) has gone generic. Find out where this antipsychotic fits in bipolar disorder with updates from the 2023 International Bipolar Conference.CME: Take the CME Post-Test for this EpisodePublished On: 08/07/2023Duration: 20 minutes, 25 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Do you see patients who have no motivation to do anything? Michael Posternak has a novel strategy for working with this depressive symptom during the medication visit in this special tribute to the late psychiatrist.CME: Take the CME Post-Test for this EpisodePublished On: 07/31/2023Duration: 23 minutes, 07 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Almost 90% of older adults have experienced at least one traumatic event in their lifetime, yet post-traumatic stress disorder (PTSD) continues to be overlooked in older patients. Clinicians should routinely assess for symptoms of PTSD, as a missed diagnosis can lead to poor health outcomes including increased suicide risk. In this episode, we will shed some light on assessing and treating PTSD in the older patient. CME: Take the CME Post-Test for this episodePublished On: 07/24/23Duration: 12 minutes, 27 secondsRehan Aziz, MD, and Prabhjot Gill, BS have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Bipolar disorder is not what it used to be, and today we’ll bring you updates on lithium from the 2023 International Bipolar Conference.CME: Take the CME Post-Test for this EpisodePublished On: 07/17/2023Duration: 21 minutes, 07 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Updates from the 2023 International Bipolar Conference, including new diagnostic tools for bipolar disorder. Stanford researchers propose a new subtype of depression.CME: Take the CME Post-Test for this EpisodePublished On: 07/10/2023Duration: 30 minutes, 43 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

50 years ago the APA removed code 302.0: Homosexuality from the DSM. Almost.CME: Take the CME Post-Test for this EpisodePublished On: 07/03/2023Duration: 19 minutes, 38 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

50 years ago the APA removed code 302.0: Homosexuality from the DSM. Almost.CME: Take the CME Post-Test for this EpisodePublished On: 06/26/2023Duration: 16 minutes, 10 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Several psychiatric medications prolong the QTc interval and place patients at risk of the dreaded torsade de pointes. Some patients are particularly vulnerable to QTc prolongation: the elderly, patients with heart disease and electrolyte imbalances, and patients taking certain medications, like thioridazine and ziprasidone. In this podcast, we provide a step-by-step guide so that you can keep your patients safe from this cardiovascular side effect.CME: Take the CME Post-Test for this episodePublished On: 6/18/2023Duration: 15 minutes, 00 secondsVictoria Hendrick, MD, and Prabhjot Gill, BS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Stephen Stahl steps down from the industry-sponsored podium to remind us of 3 reasons to use an MAOI: Atypical depression, treatment-resistant depression, and social anxiety disorder.CME: Take the CME Post-Test for this EpisodePublished On: 06/12/2023Duration: 26 minutes, 24 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Delirium is widespread among patients in ICUs and surgery units. In this podcast, we will review the workup and management of this common condition and give you tips to help prevent it in high-risk patients CME: Take the CME Post-Test for this episodePublished On: 6/05/2023Duration: 16 minutes, 05 secondsVictoria Hendrick, MD, and Prabhjot Gill, BS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Surprising health benefits of our riskiest meds: Lithium, quetiapine, and clozapine.CME: Take the CME Post-Test for this EpisodePublished On: 05/29/2023Duration: 17 minutes, 31 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Why valproate is the #1 contraindicated med in pregnancy, and what are the other close contenders.CME: Take the CME Post-Test for this EpisodePublished On: 05/22/2023Duration: 12 minutes, 00 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Whether due to COVID, conflict, climate, or common car crashes, children often lose their caregiver at the same time they experience trauma. Our podcast with Julian Ford will help you understand the proposed diagnostic criteria and ideas for intervention for this complex developmental trauma disorder.CME: Take the CME Post-Test for this EpisodePublished On: 05/15/2023Duration: 29 minutes, 55 secondsJoshua Feder, MD, and Mara Governman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

How to reduce unnecessary polypharmacy, and when it makes sense to keep it goingCME: Take the CME Post-Test for this EpisodePublished On: 05/08/2023Duration: 25 minutes, 24 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

How to reduce unnecessary polypharmacy, and when it makes sense to keep it goingCME: Take the CME Post-Test for this EpisodePublished On: 05/01/2023Duration: 20 minutes, 19 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Antipsychotics can be very effective for irritability in autism, but they are often unnecessary, and the side effects are truly problematic. Don’t be the prescriber who hears irritability in autism and immediately prescribes antipsychotics. There are usually multiple steps to try before using the FDA approved antipsychotic medications.CME: Take the CME Post-Test for this EpisodePublished On: 04/24/2023Duration: 15 minutes, 56 secondsJoshua Feder, MD, and Mara Governman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Learn how to assess and intervene with NSSI, including ideas for supporting autonomy while addressing the behavior.CME: Take the CME Post-Test for this EpisodePublished On: 04/17/2023Duration: 17 minutes, 46 secondsJoshua Feder, MD, and Mara Governman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

More red flags to watch for when prescribing controls, and how to manage them in practice.CME: Take the CME Post-Test for this EpisodePublished On: 04/10/2023Duration: 21 minutes, 22 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The DEA has warned pharmacists to watch for Red Flags in controlled prescriptions, and we’ll show you what they are and how to use them therapeutically in practice.CME: Take the CME Post-Test for this EpisodePublished On: 04/03/2023Duration: 15 minutes, 25 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

MAOIs rank high in efficacy and are pretty well tolerated too, as long as you watch for two critical interactions. CME: Take the CME Post-Test for this EpisodePublished On: 03/20/2023Duration: 22 minutes, 40 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Learn how to assess and intervene with NSSI, including ideas for supporting autonomy while addressing the behavior.CME: Take the CME Post-Test for this EpisodePublished On: 03/13/2023Duration: 20 minutes, 45 secondsJoshua Feder, MD, and Mara Governman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

David Healy shows how to figure out when psychiatric meds might be causing unusual symptoms.CME: Take the CME Post-Test for this EpisodePublication Date: 3/6/2023 Duration: 20 mins, 50 secondsChris Aiken, MD, and David Healy, MD, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Online clinics delivered at-home ketamine throughout the pandemic, and we’re just becoming aware of the consequences. CME: Take the CME Post-Test for this EpisodePublication Date: 2/27/2023Duration: 19 mins, 15 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Learn how clinicians can enhance their patient’s quality of life by improving sleep outcomes.CME: Take the CME Post-Test for this EpisodePublished On: 02/20/2023Duration: 18 minutes, 48 secondsLink to Finding a Sleep Specialist: Society of Behavioral Sleep Medicine MembersUnited States

Learn to identify sensory challenges to address these barriers to effective care in teens and adolescents.CME: Take the CME Post-Test for this EpisodePublished On: 02/13/2023Duration: 21 minutes, 4 secondsRelated Article: “Assessing Sensory Processing Challenges” The Carlat Child Psychiatry Report, October 2022Joshua Feder, MD, and Mara Governman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

This common pharmacokinetic reaction will help you manage many of bad medication reactions in psychiatric practice. But did it lead to Elvis Presley’s death? CME: Take the CME Post-Test for this episodePublication Date: 2/6/2023Duration: 23 mins, 26 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

A new medical investigation changes our understanding of Elvis Presley’s untimely death and offer some pearls for modern psychiatric practice.CME: Take the CME Post-Test for this episodePublication Date: 1/30/2023Duration: 21 mins, 36 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Adderall is in short supply, and the backlog is having a domino effect on other stimulants. CME: Take the CME Post-Test for this episodePublication Date: 1/23/2023Duration: 7 mins, 25 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

In this podcast, we will review strategies for the evaluation and management of HIV-associated mood and cognitive changes and we’ll list potential drug interactions between psychiatric and antiretroviral medications. CME: Take the CME Post-Test for this episodePublished On: 1/16/2023Duration: 15 minutes, 31 secondsReferenced Article: “Management of Depression and Neurocognitive Impairment in Patients With HIV,” The Carlat Hospital Psychiatry Report, Jan/Feb/March 2023Victoria Hendrick, MD, and Prabhjot Gill, BS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Top psychiatric findings from the 2022 Carlat Report.CME: Take the CME Post-Test for this episodePublication Date: 1/9/2023Duration: 26 mins, 50 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Over the counter substances are cheap and widely available compared to other substances of abuse. Some teens view them as safe or non-addictive because they are legal. In 2020, the National Institute on Drug Abuse reported that 3.2%–4.6% of high schoolers nationwide endorsed abusing OTC cough and cold medicines in 2019. In this podcast, we will review four commonly abused substances that are legally available for purchase: Dextromethorphan, antihistamines, pseudoephedrine, and Kratom.CME: Take the CME Post-Test for this episodePublished On: 1/2/2022Duration: 16 minutes, 17 secondsRelated Article: “Misuse of Over-the-Counter Medications”, The Carlat Child Psychiatry Report, September 2021Joshua Feder, MD, and Mara Governman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Treatment of delirium involves the correction of the underlying medical disturbance. But how do we best think through potential causes? Dr. Aziz shares his systematic approach and clinical pearls in conducting a physical exam and ordering the appropriate work-up.CME: Take the CME Post-Test for this episodePublished On: 12/26/22Duration: 18 minutes, 22 secondsReferenced Article: “Assessing and Treating Delirium in Older Adults,” The Carlat Geriatric Psychiatry Report, July 2022Rehan Aziz, MD, and Zachary Davis, BS have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The FDA has a new rating system for breastfeeding risks with medications. We look at what that changes for psychotropics.CME: Take the CME Post-Test for this episodePublication Date: 12/19/22Duration: 18 mins, 20 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any

Updates on the management of psych meds during pregnancy and breastfeeding, with help from Anita Clayton, MDCME: Take the CME Post-Test for this episodePublication Date: 12/12/22Duration: 14 mins, 30 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Updates on natural therapies for premenstrual dysphoric disorder (PMDD) and management of psych meds during pregnancy and breastfeeding, with help from Anita Clayton, MDCME: Take the CME Post-Test for this episodePublication Date: 10/13/22Duration: 13 mins, 00 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Bipolar disorder (BD) is challenging to diagnose in children and adolescents, yet timely and accurate diagnosis is crucial. CME: Take the CME Post-Test for this episodePublished On: 11/28/22Duration: 17 minutes, 29 secondsReferenced Article: “Bipolar Spectrum Disorders in Children and Adolescents ” The Carlat Child Psychiatry Report, Oct/Nov/Dec 2022Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial orother interests in any commercial companies pertaining to this educational activity

Joe Goldberg gathered the latest evidence on antidepressants in bipolar disorder at the 9th annual Mood Disorders Summit, and we summarize his findings.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 11/21/22Duration: 15 minutes, 56 seconds

Supervised Consumption Sites are clinical settings where patients can use drugs in as safe a manner as possible. Clients are supplied with sterile equipment and the clinics are staffed by medical professionals who can respond in the case of an overdose. Once controversial, research clearly shows the benefit of these sites, and they have started opening in the United States.CME: Take the CME Post-Test for this episode  Published On: 11/14/2022Duration: 14 minutes, 44 secondsReferenced Article: “Supervised Drug Consumption Sites,” The Carlat Addiction Psychiatry Report, July 2022Noah Capurso, MD, MHS, and Chris Clayton, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity

Lithium has hidden health benefits against stroke, cancer, dementia, and even the coronavirus.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 11/10/2022Duration: 16 minutes, 21 seconds

Benzos are never safe with opioids, but we clarify when the risk is lower and when the combo is best avoided.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 11/7/22Duration: 19 minutes, 30 seconds

Medication-induced hyperprolactinemia is more common than you might think and it can produce detrimental long-term health sequelae.  In this podcast, we will review the work-up and management of this common side effect.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 10/31/22Duration: 9 minutes, 16 secondsReferenced Article: “Psychiatric Medication–Induced Hyperprolactinemia,” The Carlat Hospital Psychiatry Report, July 2022Victoria Hendrick, MD, and  Prabhjot Gill, BS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

How to assess, treat, and when you can restart after a lamotrigine rash.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 10/24/22Duration: 17 minutes, 27 seconds

In this episode, we will discuss why assessment discrepancies arise, how we can manage them, and what these discrepancies tell us about a patient’s symptoms and response to treatment.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 10/17/22Duration: 23 minutes, 04 seconds

Is it ever normal to hear voices and is ginger ale really the best treatment for nausea?  CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Publication Date: 10/13/22Duration: 16 mins, 59 secondsArticle Referenced: “Medication Side Effects: Nausea, Sweating, and Dry Mouth,” The Carlat Psychiatry Report, June/July 2019

Lithium toxicity: How to avoid it, and what to do when it happens.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 10/10/22Duration:  8 minutes, 40 seconds

Today on throwback Thursday: Are newer antipsychotics better for cognition than their older, typical forbearers? CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 10/06/22Duration: 12 minutes, 40 secondsReferenced Article: “Do Antipsychotics Improve Cognition?,” The Carlat Psychiatry Report, May 2019 Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

When a school placement is a bad fit, medication and therapy are unlikely to make much difference. In this episode, we will help you understand and assist your patients to optimize their success in the least restrictive placement.CME: Take the CME Post-Test for this episode  Published On: 10/03/22Duration: 15 minutes, 40 secondsReferenced Article: “School Inclusion: What You Need to Know ” The Carlat Child Psychiatry Report, January 2022Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity

Today on throwback Thursday, learn how Viagra treats depression – well, you can probably guess how, but here’s a surprise: Viagra treats sexual dysfunction in women as well as men, and it we’ll show you how in this update of our very first podcast, May 13, 2019. Oh those were simpler times.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 09/29/2022Duration: 12 minutes, 42 secondsReferenced Article: “Treating Sexual Side Effects,” The Carlat Psychiatry Report, May 2019 Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

When to stop meds quickly, and when to do it slowly, in #2 of our 10 Commandment series.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 09/26/22Duration:  8 minutes, 40 seconds

Every patient and family you see is inescapably impacted by weight stigma or fat shaming and the damage from this bias can be lethal. CME: Take the CME Post-Test for this episode  Published On: 09/19/22Duration: 22 minutes, 54 secondsReferenced Article: “Addressing Weight Stigma in Clinical Practice,” The Carlat Child Psychiatry Report, July 2022Joshua Feder, MD, Mara Goverman, LCSW, and Sarah Nutter, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity

On 9/6/22 the FDA approved Stanford’s SAINT Neuromodulation, an accelerated version of TMS that has raised hopes with unusually high remission rates.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 09/12/22Duration: 14 minutes, 00 seconds

Antidepressants in mania and stimulants in psychotic disorders get called out in our first psychopharm commandment. CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 09/05/22Duration: 14 minutes,  48 seconds

The expanding population of older adults has created a need for all clinicians to participate in their care. Interviewing techniques require adaptation in older adults, such as accounting for hearing or vision impairment and speaking slowly and clearly. This podcast will cover additional factors to consider when evaluating older patients.CME: Take the CME Post-Test for this episodePublished On: 8/29/2022Duration: 18 minutes, 07 secondsReferenced Article: “How to Interview the Older Patient,” The Carlat Geriatric Psychiatry Report, January 2022 Stephanie Collier, MD, MPH, and Rehan Aziz, MD have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Silexan, an extract from Lavender with pharmaceutical properties, is one of only two treatments with a large effect size in generalized anxiety disorder. We rank all the treatments by strength and look to see if any of them can work when the SSRIs do not.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 08/22/22Duration: 25 minutes, 48 seconds

Richard Brown discusses symptoms that often get in the way of full recovery in ADHD, including dyslexia, and problems with working memory, processing speed, and executive function. CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 08/15/2022Duration: 13 minutes, 57 secondsReferenced Article: “Complementary Therapy in ADHD,” The Carlat Child Psychiatry Report, August 2022 Chris Aiken, MD, Kellie Newsome, PMHNP, and Richard Brown, MD , have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Nine years after DSM-5, Avoidant Restrictive Food Intake Disorder (ARFID) is still settling into clinical practice. Dr. Jennifer Thomas helps sort out the differential diagnosis between ARFID, anorexia, and other conditions and plan treatment in the context of comorbid conditions, such as anxiety disorders and Autism Spectrum Disorder.CME: Take the CME Post-Test for this episode  Published On: 07/25/2022Duration: 23 minutes, 15 secondsReferenced Article: “Diagnosing and Treating Avoidant/Restrictive Food Intake Disorder,” The Carlat Child Psychiatry Report, July 2022Joshua Feder, MD, Mara Goverman, LCSW, and Jennifer J. Thomas, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity

Topiramate can cause psychosis, or treat psychosis; worsen cognition, or improve it; cause depression or… You get the point. A look at the paradoxical world of psychopharmacology.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 08/01/2022Duration: 14 minutes, 16 seconds

Second-generation antipsychotics routinely breach the FDA’s level of concern of >7% body weight gain. This article examines the efficacy and safety of using off-label medications, such as metformin, to manage this side effect.CME: Take the CME Post-Test for this episode  Published On: 07/25/2022Duration: 13 minutes, 19 secondsReferenced Article: “Eating Disorders in Children and Adolescents ” The Carlat Child Psychiatry Report, July/August/September 2022Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity

Carl Salzman removes the stigma from the much aligned benzo, reminding us of when they are essential to treatment and when they cause harm. Dr. Salzman is the past chairman of the American Psychiatric Association’s Benzodiazepine Task Force.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 07/18/2022Duration: 22 minutes, 06 secondsReferenced Article: “Benzodiazepines: A Reevaluation of Their Benefits and Dangers,” The Carlat Child Psychiatry Report, June 2022 Chris Aiken, MD, Kellie Newsome, PMHNP, and Carl Salzman, MD have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Psychogenic polydipsia (PP), also known as primary polydipsia and potomania, was first described in the 1930s. It is surprisingly common with a prevalence rate between 3 to 25% in institutionalized patients. In this podcast, we will discuss how to accurately diagnose and manage psychogenic polydipsia in patients.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 07/11/2022Duration: 11 minutes, 37 secondsReferenced Article: “Management of Psychogenic Polydipsia,” The Carlat Hospital Psychiatry Report, 2022 Victoria Hendrick, MD, and Zachary Davis, BS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Bupropion-dextromethorphan combo in depression. Lithium for COVID-19. The top med for nicotine cessation. Mirtazapine in OCD. Mediterranean diet in depression. CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 07/04/2022Duration: 20 minutes, 21 secondsReferenced Article: Chris Aiken, MD, Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Atomoxetine (Strattera) was approved by the FDA for ADHD treatment in 2002, but how effective is it and where does it stack up against other treatments?CME: Take the CME Post-Test for this episodePublished On: 06/27/2022Duration: 13 minutes, 38 secondsReferenced Article: “Atomoxetine for Children and Adolescents: An Update,” The Carlat Child Psychiatry Report, January/February/March 2022Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Psychotic depression. Conrad Swartz shows us how to recognize this underdiagnosed illness, and why antipsychotics and antidepressants may not be the optimal treatment. CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 06/20/2022Duration:  18 minutes, 27 secondsReferenced Article: “Psychosis During Depression,” The Carlat Child Psychiatry Report, June 2022Chris Aiken, MD, Kellie Newsome, PMHNP, and Conrad Swartz, MD, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Why is it important for providers to understand how vaping devices work and what type of information should we be providing our patients with? CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 06/13/2022Duration: 30 minutes, 25 secondsReferenced Article: “A Primer on Vaping:15 Years On,” The Carlat Addiction Treatment Report, January 2022Noah Capurso, MD, MHS, and Sivabalaji Kaliamurthy, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

12 clinically relevant findings from the past 3 years on quetiapine (Seroquel), including new side effects, dosing strategies, withdrawal phenomena, and new uses in bipolar with OCD.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 06/6/2022Duration: 20 minutes, 27 secondsReferenced Article: “Quetiapine Reconsidered,” The Carlat Child Psychiatry Report, June 2022Chris Aiken, MD, Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The validity of bipolar disorder in children and adolescents has long been debated, and the history surrounding this diagnosis is controversial to say the least. In this podcast, we will discuss the evidence supporting whether bipolar disorder presents in youth, and how clinicians can best assess this disorder.CME: Take the CME Post-Test for this episode  Published On: 05/30/2022Duration: 29 minutes, 17 secondsReferenced Article: “Assessing Bipolar Disorder in Children and Adolescents,” The Carlat Child Psychiatry Report, October/November/December 2021Joshua Feder, MD, Mara Goverman, LCSW, and Anna Van Meter, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity

Tricyclics are much better tolerated than their reputation suggests, and countdown 6 reasons to use them, from melancholic depression to irritable bowel syndrome.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 05/23/2022Duration: 14 minutes, 16 secondsChris Aiken, MD, Kellie Newsome, PMHNP, Nassir Ghaemi, MD, MPH, and Joe Goldberg, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

When patients are not amenable to usual therapy, equine-assisted psychotherapy (EAP) might be a good option. In this podcast we’ll talk about working with horses as an alternative to, or in conjunction with, traditional therapy.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 05/16/2022Duration: 12 minutes, 38 secondsReferenced Article: “Using Equine-Assisted Psychotherapy,” The Carlat Child Psychiatry Report, October/November/December 2021Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

To start a conversation about race, you need to know the lingo. We interview psychiatrist Kali Cyrus on internalized racism, microaggressions, implicit bias, and more.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 05/09/2022Duration: 15 minutes, 33 secondsRelated Article: “Racism and Psychiatry,” The Carlat Psychiatry Report, May 2022Chris Aiken, MD, Kellie Newsome, PMHNP, and Kali Cyrus, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Do anticholinergic medications increase the risk of long-term cognitive decline and dementia? In this podcast, we will review the latest research examining the relationship between anticholinergic medication use and cognitive decline.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 05/02/2022Duration: 15 minutes, 58 secondsReferenced Article: “Anticholinergic Drugs and Risk of Cognitive Impairment and Dementia,” The Carlat Hospital Psychiatry Report, October/November/December 2021Victoria Hendrick, MD, Zachary N. Davis, BS, and Shelly Gray, PharmD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dr. Tammas Kelly shares tips on high dose thyroid in treatment-resistant bipolar depression.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 04/25/2022Duration: 14 minutes, 00 secondsRelated Article: “Thyroid Augmentation in Bipolar Disorder,” The Carlat Psychiatry Report, April 2022Chris Aiken, MD, Kellie Newsome, PMHNP, and Tammas Kelly, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

ADHD is one of the most treatable conditions in psychiatry if patients adhere to medication regimens. So, why are parents so resistant to stimulant medications and how can we approach these misconceptions?CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 04/21/2022Duration: 13 minutes, 38 secondsReferenced Article: “Talking with Parents about Stimulant Treatment,” The Carlat Child Psychiatry Report, April/May/June 2022“Cultural Competence: Impact on Clinical Care”, The Carlat Child Psychiatry Report, January/February/March 2021Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.Disclaimer: We had some technical difficulties while recording this episode and apologize for the sections of poor audio quality. We are improving our recording methods to provide you with the highest quality audio. Enjoy the episode.

A recent paper lists 5 therapies for treatment-resistant depression, but the research keeps rolling in, and we bring you 2 more to add to the list.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 04/18/2022Duration: 20 minutes, 15 secondsRelated Article: “Thyroid Augmentation in Bipolar Disorder,” The Carlat Psychiatry Report, April 2022Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

We often hear about the “Tarasoff warning” and the “duty to protect,” but what do these mean, and who was Tarasoff? In today’s episode, we’ll break down the Tarasoff rulings and how you can navigate the legal ambiguities surrounding our duty to protect. CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 04/14/2022Duration: 10 minutes, 47 secondsRelated Articles: “Tarasoff: Making Sense of the Duty to Warn or Protect,” The Carlat Hospital Psychiatry Report, January/February/March 2022Each State’s Laws Related to TarasoffVictoria Hendrick, MD, and Zachary Davis, BS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

From psychotherapy to ECT, pramipexole to lamotrigine, a walk through 20 therapies for bipolar depression.CME: Take the Podcast CME Post-Test here. Not subscribed to earn CME credit for listening? Click here to start earning CME credit for podcast episodes!Published On: 04/11/2022Duration: 25 minutes, 18 secondsRelated Article: “A Practical Guide to Light Therapy,” The Carlat Psychiatry Report, November 2019Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Zuranolone is a neurosteroid that is inching its way toward FDA approval in depression. In some ways it’s similar to brexanolone (Zulresso) – the IV therapy approved in 2019 for postpartum depression – and in other ways it’s different.CME: Take the CME Post-Test for this episodePublished On: 04/04/2022Duration: 12 minutes, 20 secondsRelated Articles: “Brexanolone: A New Treatment for Postpartum Depression,” The Carlat Psychiatry Podcast, August 2019“Brexanolone (Zulresso) for Postpartum Depression,” The Carlat Psychiatry Report, June 2019“Brexanolone: A New Treatment for Postpartum Depression,” The Carlat Psychiatry Report, January 2019Chris Aiken, MD, Kellie Newsome, PMHNP, and Margaret Chisolm, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Borderline personality disorder can be complicated to treat, especially in frantic and high stress settings like the emergency department or inpatient psychiatric unit. In today’s episode, we’ll address the best practices for managing patients with borderline personality disorder in emergency settings. CME: Take the CME Post-Test for this episodePublished On: 03/28/2022Duration: 27 minutes, 57 secondsRelated Article: “Borderline Personality Disorder in the ED,” The Carlat Hospital Psychiatry Report, January/February/March 2022Victoria Hendrick, MD, Zachary Davis, BS, and Victor Hong, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Naloxone saves lives, and it’s critical that we get naloxone into the hands of as many people as we can. In this podcast, Dr. Phillip Coffin and I will discuss the risk factors associated with opioid overdose, the different naloxone formulations, who should be prescribed naloxone, and how we as clinicians can promote the availability of naloxone in our communities. CME: Take the CME Post-Test for this episodePublished On: 03/24/2022Duration: 18 minutes, 58 secondsReferenced Article: “Naloxone Prescribing,” The Carlat Addiction Treatment Report, July/August 2021Noah Capurso, MD, MHS, and Phillip Coffin, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Margaret Chisolm, MD, shares a model of flourishing that moves beyond symptomatic treatment and helps patients find meaningful lives even when their medications do not work.CME: Take the CME Post-Test for this episodePublished On: 03/21/2022Duration: 15 minutes, 24 secondsRelated Articles: “Mental Illness and Flourishing,” The Carlat Psychiatry Report, March 2022Chris Aiken, MD, Kellie Newsome, PMHNP, and Margaret Chisolm, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Each year in the US, there are about 1.04 million divorces, affecting about 800,000 children, and it may not be the divorce itself that is hard on children, but how the divorce is handled. How can we navigate the complexities of treating a child with divorced or separated parents?CME: Take the CME Post-Test here.Published On: 03/17/2022Duration: 11 minutes, 45 secondsReferenced Article: “Clinical Complexity With Children and Adolescents”, The Child Psychiatry Report, January/February/March 2021Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.Earn CME credits for this episode through the link in the podcast notes, and if you haven’t subscribed to the online issue give us a try, and take $30 off your first year’s subscription with the promo code PODCAST. Your support helps us operate free of industry influence.

A new app for insomnia might also lift depression. We show you how it works and end with 7 practical tips to share with your patients who have insomnia. CME: Take the CME Post-Test for this episodePublished On: 03/14/2022Duration: 30 minutes, 24 secondsRelated Article: “A Prescription App for Insomnia,” The Carlat Psychiatry Report, March 2022Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Can we treat depression by targeting inflammation? Do SSRIs for post-stroke depression increase the risk of second intracranial hemorrhage? And how effective is the new combination treatment, olanzapine/samidorphan, for mitigating antipsychotic-induced weight gain? We will answer these questions in this Hospital Psychiatry Research Update Extravaganza!CME: Take the CME Post-Test for this episodePublished On: 03/10/2022Duration: 9 minutes, 58 secondsRelated Articles: “Can We Treat Depression by Targeting Inflammation?,” The Carlat Hospital Psychiatry Report, October/November/December 2021“New Combination Treatment Mitigates Antipsychotic-Induced Weight Gain,” The Carlat Hospital Psychiatry Report, July/August/September 2021“SSRIs and Intracerebral Hemorrhage Risk,” The Carlat Hospital Psychiatry Report, April/May/June 2021Victoria Hendrick, MD, has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.Earn CME credits for this episode through the link in the podcast notes, and if you haven’t subscribed to the online issue give us a try, and take $30 off your first year’s subscription with the promo code PODCAST. Your support helps us operate free of industry influence.

Omega-3 fatty acids do treat depression, but not with the formulations that are commonly found on the shelves. Here we point you in the right direction, and give a winding origin story of these essential fatty acids.CME: Take the CME Post-Test for this episodePublished On: 03/07/2022Duration: 22 minutes, 21 secondsChris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Do Antipsychotics Have Neurotoxic Effects in Youth? In this episode, we’ll be banging the drum of caution about antipsychotic use in children and adolescents. CME: Take the CME Post-Test for this episodePublished On: 03/03/2022Duration: 11 minutes, 21 secondsRelated Article: “Exploring the Potential Neurotoxicity of Antipsychotics in Younger Populations,” The Carlat Child Psychiatry Report, November/December 2019The American Academy of Child and Adolescent Psychiatry Practice Guidelines for AntipsychoticsJoshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.Earn CME credits for this episode through the link in the podcast notes, and if you haven’t subscribed to the online issue give us a try, and take $30 off your first year’s subscription with the promo code PODCAST. Your support helps us operate free of industry influence.

Lybalvi combines olanzapine with the opioid blocker samidorphan in hopes of curbing the weight gain on that antipsychotic. Here, we look at how well it works.CME: Take the CME Post-Test for this episodePublished On: 02/28/2022Duration: 25 minutes, 03 secondsEarn CME credits for this episode through the link in the podcast notes, and if you haven’t subscribed to the online issue give us a try, and take $30 off your first year’s subscription with the promo code PODCAST. Your support helps us operate free of industry influence.Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Methamphetamine is the second most abused drug in the U.S. We bring you up to speed on the basics in this episode.CME: Take the CME Post-Test for this episodePublished On: 02/21/2022Duration: 20 minutes, 52 secondsRelated Article: “A Novel Treatment for Methamphetamine Use Disorder,” The Carlat Psychiatry Report, February 2022.Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The new APA guidelines on schizophrenia go above and beyond the usual standards. Brian Miller shows us how to catch up.CME: Take the CME Post-Test for this episodePublished On: 02/14/2022Duration: 25 minutes, 58 secondsRelated Article: “Raising the Bar in Schizophrenia Treatment,” The Carlat Psychiatry Report, February 2022Earn CME credits for this episode through the link in the podcast notes, and if you haven’t subscribed to the online issue give us a try, and take $30 off your first year’s subscription with the promo code PODCAST. Your support helps us operate free of industry influence.Chris Aiken, MD, Kellie Newsome, PMHNP, and Brian Miller, MD, PhD, MPH, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The pharmaceutical industry created 3 myths around opioids: “Pain as the fifth vital sign,” the less-than-1% rate of addiction, and the diagnosis of pseudoaddiction. Inside, we look at what is true and what is exaggeration in these claims.CME: Take the CME Post-Test for this episodePublished On: 02/07/2022Duration: 17 minutes, 07 secondsRelated Article: “When Further Medication Trials Seem Futile,” The Carlat Psychiatry Report, June/July 2020Earn CME credits for this episode through the link in the podcast notes, and if you haven’t subscribed to the online issue give us a try, and take $30 off your first year’s subscription with the promo code PODCAST. Your support helps us operate free of industry influence.Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

A new Hulu series portrays the pharmaceutical industry’s role in the opioid crisis, but how much of it is real and how much is entertainment?CME: Take the CME Post-Test for this episodePublished On: 01/31/2022Duration: 22 minutes, 24 secondsChris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Lumateperone (Caplyta) just got FDA approved for bipolar depression. Find out how it compares to other atypical antipsychotics.CME: Take the CME Post-Test For This EpisodePublished On: 01/24/2022Duration: 24 minutes, 09 secondsChris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.Got feedback? Take the podcast survey.

Psychoanalyst Dan Buie describes 5 deficits that cause great suffering for people with personality disorders and how to work with them in therapy.CME: Take the CME Post-TestPublished On: 01/17/2022Duration: 18 minutes, 39 secondsRelated Article: “Working With Severe Personality Disorders,” The Carlat Psychiatry Report, January 2022Chris Aiken, MD, has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Psychoanalyst Dan Buie describes hateful reactions that are common when working with suicidal patients and how to manage these intense emotionsCME: Take the CME Post-Test for this episodePublished On: 01/10/2022Duration:  9 minutes, 16 secondsChris Aiken, MD, has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

In 2021 we uncovered some paradoxical effects of medications, including meds that can both cause and treat OCD (antipsychotics), depression (benzodiazepines and antidepressants), and cognitive problems (stimulants and anti-dementia medications).CME: Take the CME Post-Test for this episodePublished On: 01/03/2022Duration: 16 minutes, 0 secondsReferenced Articles: “Stimulants and Creativity,”The Carlat Psychiatry Report, February 2021“Brexpiprazole Ineffective in Mania,” The Carlat Psychiatry Report, October 2021“The Schizophrenia-OCD Overlap,” The Carlat Psychiatry Report, October 2021Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

DHHS recently unveiled the first major overhaul of its documentation guidelines for the E&M codes often used in outpatient psychiatry. We show you how to make those rules work for your patients.CME: Take the CME Post-Test for this episodePublished On: 12/27/2021Duration: 24 minutes, 16 secondsChris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.Got feedback? Take the podcast survey.