The Carlat Psychiatry Podcast: Recent Episodes
Pocket Psychiatry: A Carlat Podcast
Clear, engaging, and practical updates on clinical psychiatry. Hosted by Chris Aiken, MD, and Kellie Newsome, PMHNP. Earn CME for listening at www.thecarlatreport.com/podcastcme
The modern DSM began as a short list of 12 well-validated diagnoses. But the list expanded as the authors changed the goals from validity to reliability. Lost in this history is a missing page that helps separate adult ADHD from its mimics.
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Published On: 08/10/2026
Duration: 14 minutes, 39 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Nine studies have tried to find out whether ADHD can start in adulthood, we dig into the data and find some answers to the controversy.
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Published On: 08/03/2026
Duration: 13 minutes, 07 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
DSM-5 loosened the criteria for adult ADHD, but did it get too lose? We look at what recent prosecutions of telehealth companies mean for those trying to diagnose this disorder on the front-lines.
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Published On: 07/27/2026
Duration: 15 minutes, 10 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dr. Shireen Rizvi provides an overview of Dialectical Behavior Therapy (DBT) and the treatment of Borderline Personality Disorder.
Women clear some psychiatric medications more slowly, lose bone density at higher rates, and face greater medical consequences from alcohol and smoking than men. This final episode in a four-part series covers side effects, drug metabolism, drugs of abuse, urine incontinence, and what we do — and don't — know about prescribing for transgender patients.
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Published On: 07/13/2026
Duration: 17 minutes, 37 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Estrogen shapes nearly every neurotransmitter system in the brain, and when it starts to fall, psychiatric disorders often follow. This episode walks through what psychiatrists need to know about the perimenopause: which conditions worsen, which treatments help, and when to call the OB-GYN about hormone replacement therapy.
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Published On: 07/06/2026
Duration: 18 minutes, 37 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Premenstrual hormones can destabilize mood, worsen ADHD, trigger psychosis, and drive binge eating. This episode walks through the tools to manage hormonal fluctuations in female patients, from SSRIs to overlooked supplements to the lamotrigine-contraceptive drug interaction.
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Published On: 06/23/2026
Duration: 23 minutes, 32 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Women and men respond to psychiatric medications differently. In this first of a four-part series, Chris Aiken and Kellie Newsome walk through why valproate is risky for women, and when it’s worth using; why the FDA cut the zolpidem dose in half for female patients, and why SSRIs outperform tricyclics in women with depression. Plus: a sneak preview of DSM-6.
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Published On: 06/22/2026
Duration: 27 minutes, 32 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Psilocybin is going mainstream: Trump has signed an executive order opening psychedelics to patients with severe mental illness, and one in eight American adults has already tried it. But as we dig into the research, a more complicated picture emerges, one that separates the profound personal experience from the clinical evidence.
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Published On: 06/15/2026
Duration: 18 minutes, 34 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dr. Roger Solomon provides a comprehensive introduction to Eye Movement Desensitization and Reprocessing (EMDR), explaining the adaptive information processing model that underlies the treatment, walking through all eight phases of the protocol, and discussing how EMDR can be applied across a wide range of presentations—from single-incident trauma to complex trauma with dissociation. Dr. Solomon also addresses how clinicians can determine client readiness, navigate repressed memories, and leverage the generalization effect when working with patients who have extensive trauma histories.
What if the patients we assume are safest from suicide are actually the ones we miss? Today we're talking about suicide risk in autistic youth, why it's higher than many clinicians expect, how distress shows up differently, and what small changes in our assessment process and treatment can make a real difference.
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Published On: 06/01/2026
Duration: 18 minutes, 29 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
It's 1979, and Johns Hopkins has just shut down the first gender surgery clinic in the US. But investigations into the biological roots of gender identity are about to reopen those doors — and reshape how medicine thinks about sex, gender, and who gets to decide.
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Published On: 05/25/2026
Duration: 11 minutes, 52 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In 1966, Johns Hopkins opened the first gender surgery clinic in the US. Thirteen years later, a single study shut it down. We examine what the research said, what it didn't say, and how new standards of care emerged from the ashes.
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Published On: 05/18/2026
Duration: 13 minutes, 39 seconds
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 president of the US branch of WPATH built one of the largest youth gender clinics in the country, then watched it close under political fire. Now she's facing a malpractice lawsuit from a former patient. We examine the unpublished study at the center of the controversy.
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Published On: 05/11/2026
Duration: 16 minutes, 11 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this
Medical societies are reversing decades of support for gender-affirming care in youth — but is it the science driving the shift, or the politics? This episode walks through the evidence, from randomized trials to regret rates, and finds a more complicated picture than either side presents.
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Published On: 05/04/2026
Duration: 13 minutes, 09 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Two malpractice cases — one worth $2 million — are reshaping the standards of gender-affirming care. This episode traces what went wrong, what held up in court, and what every clinician needs to know when referring patients for gender affirming procedures.
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Published On: 04/20/2026
Duration: 12 minutes, 18 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In the 1950s, a young Danish psychiatrist named Mogens Schou staked his career — and his family — on a mineral most of his colleagues dismissed as dangerous nonsense. This is the story of how lithium went from fringe curiosity to the gold standard for bipolar disorder, and the bitter scientific battle that nearly derailed it.
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Published On: 04/20/2026
Duration: 16 minutes, 01 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dr. Frank Yeomans is an Adjunct Associate Clinical Professor of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons. He is one of the developers of Transference-Focused Psychotherapy (TFP). In this episode, he offers a deep dive into the theory and clinical practice of TFP as a treatment for Borderline Personality Disorder. Drawing on object relations theory, Dr. Yeomans explains how BPD is understood through the lens of identity integration and split internal representations, and walks clinicians through the full arc of TFP treatment — from thorough assessment and diagnostic feedback, through contracting and frame-setting, to active intervention using clarification, confrontation, and interpretation. He also addresses the clinical use of countertransference as a window into the patient's internal world, signs of therapeutic progress, and how object relations principles can be applied even outside a formal TFP frame.
Published On: 4/16/2026
Duration: 40 minutes, 21 seconds
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Before lithium became a cornerstone of psychiatry, it was in soda, spa water, and salt shakers. Trace lithium’s journey from Victorian health fad to life-saving mood stabilizer, and discover why the uric acid theory that launched it may be making a comeback.
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Published On: 04/13/2026
Duration: 12 minutes, 48 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Legal questions come up in clinical care of autistic children and adults more often than many of us expect. A parent asks for a custody letter; a school requests documentation for services; a patient asks about disability benefits or driving. When autistic patients face legal systems, clinicians can help, but only if we stay within our role.
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Published On: 04/06/2025
Duration: 19 minutes, 01 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Narcissism, antisocial, pedophilia… A lot of psychiatric terms have been used to explain Jeffrey Epstein. We’ll look at what fits.
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Published On: 03/30/2026
Duration: 12 minutes, 34 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Narcissism, antisocial, pedophilia… A lot of psychiatric terms have been used to explain Jeffrey Epstein. We’ll look at what fits.
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Published On: 03/23/2026
Duration: 23 minutes, 38 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Does money lead to happiness? What kind of stress causes depression? Why the FDA change their requirements for new drug approvals? And what happened between Jeffrey Epstein and Ghislaine Maxwell that launched an enterprise of abuse?
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Published On: 03/16/2026
Duration: 16 minutes, 49 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Narcissism, antisocial, pedophilia… We examine the diagnoses people invoke to explain Jeffrey Epstein and determine if any fit.
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Published On: 03/09/2026
Duration: 15 minutes, 29 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Pramipexole has moved up the in our algorithm for treatment resistant depression. Today, learn how to use this dopamine agonist.
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Published On: 03/02/2026
Duration: 19 minutes, 24 seconds
Chris 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 moves pramipexole up in the algorithm for treatment resistant depression.
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Published On: 02/23/2026
Duration: 13 minutes, 41 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We interview Steve Hayes, originator of Acceptance and Commitment Therapy, on the personal struggles that inspired the treatment.
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Published On: 02/16/2026
Duration: 19 minutes, 01 seconds
Chris Aiken, MD, Kellie Newsome, PMHNP, and Steven Hayes, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
An interview with Steve Hayes, originator of Acceptance and Commitment Therapy (ACT), on how his struggle with panic disorder inspired his work.
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Published On: 02/09/2026
Duration: 20 minutes, 32 seconds
Chris Aiken, MD, and Steven Hayes, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
A parent sits across from you and asks, "Why can't my child just take the same anxiety medicine that helps me?” Sounds reasonable, but the evidence tells a very different story.
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Published On: 02/02/2025
Duration: 17 minutes, 53 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
How a new FDA approved device for difficult-to-treat depression engages the brain through the sensory nerves in part II of our interview with Linda Carpenter.
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Published On: 01/26/2026
Duration: 12 minutes, 33 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We interview Linda Carpenter, lead investigator on the new FDA approved device for difficult-to-treat depression.
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Published On: 01/19/2026
Duration: 20 minutes, 49 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Marsha Linehan finds the core principles of DBT in a Buddhist monastery, challenges the psychoanalytic establishment, and returns to the hospital where her journey started.
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Published On: 01/12/2026
Duration: 16 minutes, 50 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Marsha Linehan makes it out of a long-term psychiatric hospital and vows to develop a better approach to suicidality, reinventing therapy for borderline personality disorder.
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Published On: 01/05/2026
Duration: 16 minutes, 50 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
How a tip from Carl Jung inspired Alcoholics Anonymous and the 12-step recovery movement.
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Published On: 12/29/2025
Duration: 08 minutes, 55 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Are psychosis and OCD ever normal? We explore this question from Carl Jung’s breakdown to a new neurologic condition, hyperphantasia.
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Published On: 12/22/2025
Duration: 15 minutes, 41 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today’s episode is one we’ve been sitting with for a long time. We’re talking about how to survive psychologically in a world where hatred is persistent, not abstract, not metaphorical but recurring, and sometimes lethal.
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Published On: 12/19/2025
Duration: 19 minutes, 01 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Some of the people who revolutionized psychiatry lived with mental illness themselves.
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Published On: 12/15/2025
Duration: 15 minutes, 15 seconds
Chris 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 help bipolar patients manage holiday stress, and a new drug interaction with lithium and GLP1 agonists like semaglutide (Ozempic).
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Published On: 12/08/2025
Duration: 18 minutes, 33 seconds
Chris Aiken, MD has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
SAINT TMS is now available. We take a closer look at its record-breaking effect size.
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Published On: 12/01/2025
Duration: 16 minutes, 04 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
SAINT TMS is now available. We take a closer look at its record-breaking effect size.
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Published On: 11/24/2025
Duration: 09 minutes, 53 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dr. Kenneth Levy provides an overview of the major evidence-based treatments for Borderline Personality Disorder and explains why clinicians shouldn’t limit themselves to just one model. Despite their different styles, these treatments share core elements and similar effectiveness, and Dr. Levy makes the case that therapists best serve patients when they understand multiple approaches and remain flexible in how they use them.
Published On: 11/20/2025
Duration: 48 minutes, 12 seconds
For years, autism care has centered on one model, but that’s changing. The American Academy of Child and Adolescent Psychiatry just redefined what evidence-based care really means. This shift could transform how we support children and families.
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Published On: 11/17/2025
Duration: 24 minutes, 07 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Owen Muir, MD, believes TMS ought to come before antidepressants for many teens with depression, but does the FDA agree with him?
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Published On: 11/10/2025
Duration: 13 minutes, 39 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dr. Owen Muir is affiliated with Brainsway, Mind Medicine, Ampa, Magnus Medical, Neurolief, and Soinera Bio. Dr. Aiken has reviewed this educational activity and has determined that there is no commercial bias as a result of this financial relationship.
Do TMS and psychotherapy share a common mechanism? We talk with Owen Muir about how to engage patients with this magnetic therapy.
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Published On: 11/03/2025
Duration: 18 minutes, 43 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dr. Owen Muir is affiliated with Brainsway, Mind Medicine, Ampa, Magnus Medical, Neurolief, and Soinera Bio. Dr. Aiken has reviewed this educational activity and has determined that there is no commercial bias as a result of this financial relationship.
Working with young adults who are navigating ADHD is rarely straightforward. They’re often dealing with more than just distractibility or missed deadlines. There’s anxiety, identity shifts, life transitions, and sometimes a long history of feeling misunderstood. This isn’t about checking boxes on a symptom list, it’s about understanding how their brain, their environment, and their story all interact. Today, we’re going to unpack that.
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Published On: 10/27/2025
Duration: 16 minutes, 14 seconds
Joshua Feder, MD, and Geneva Valeska have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
More teens are saying they can’t sleep because they’re worried about the environment. Today, we’re asking: How do we respond to climate anxiety without pathologizing it?
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Published On: 10/20/2025
Duration: 14 minutes, 06 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today, we'll be talking about psychedelics and addiction psychiatry, what they are, how they work, and what the research actually tells us.
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Published On: 10/13/2025
Duration: 23 minutes, 38 seconds
Noah Capurso, MD, MHS, and Snehal Bhatt, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
More teens are saying they can’t sleep because they’re worried about the environment. Today, we’re asking: How do we respond to climate anxiety without pathologizing it?
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Published On: 10/06/2025
Duration: 15 minutes, 56 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
There are two variations of long-acting injectable buprenorphine on the market. But what differentiates them, who might benefit, and how well do they work? Find out in today’s podcast.
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Published On: 09/29/2025
Duration: 11 minutes, 36 seconds
Noah Capurso, MD, MHS, and Geneva Valeska have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Lithium, pramipexole, bupropion, carbamazepine, valproate, and trazodone. Meds that require special skill to start:
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Published On: 09/15/2025
Duration: 17 minutes, 27 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Meds that require special skill to start: Clozapine and lamotrigine.
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Published On: 09/15/2025
Duration: 10 minutes, 19 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dr. Josh Feder shares how to talk with kids about school shootings and help them feel safe.
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Published On: 09/12/2025
Duration: 04 minutes, 04 seconds
Joshua Feder, MD, and Geneva Valeska have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Ziprasidone and quetiapine. One goes better fast, one slow. Also the mystery of ghost pills, and a research update on pramipexole.
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Published On: 09/08/2025
Duration: 13 minutes, 47 seconds
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 FDA just approved the cyclobenzaprine (Tonmya, Flexeril) for fibromyalgia. We look at three risks that medication raises in psychiatry.
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Published On: 09/01/2025
Duration: 16 minutes, 42 seconds
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 FDA just approved Ketarx for surgical pain, but the company has its eyes on depression.
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Published On: 08/15/2025
Duration: 18 minutes, 30 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Meds that require special skill to start: Atomoxetine and prazosin, plus a new FDA warning on stimulants.
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Published On: 08/18/2028
Duration: 08 minutes, 28 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Meds that require special skill to start: Antipsychotics, Cobenfy, and a research update on antidepressant metabolism in Asians.
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Published On: 08/11/2025
Duration: 12 minutes, 19 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Before you cook, oil the pan; before you plant that spring lawn, aerate the soil. Before you start a psych med, these are six things you need to have in place.
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Published On: 08/04/2025
Duration: 13 minutes, 18 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We interview psychoanalyst William Meyer on a therapeutic approach to postpartum depression.
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Published On: 07/28/2025
Duration: 14 minutes, 18 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We look at how often postpartum depression converts to bipolar, and what that means for treatment.
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Published On: 07/21/2025
Duration: 10 minutes, 27 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today, we are focusing on how families are responding mentally and emotionally to disaster, and how children process loss when a parent or caregiver dies.
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Published On: 07/17/2025
Duration: 19 minutes, 48 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Brexanolone has quietly exited the pharmaceutical stage, and we look at what that means for its stand-in, zuranolone (Zurzuvae), in postpartum depression.
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Published On: 07/14/2025
Duration: 12 minutes, 50 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We explore the DSM-style criteria for Hubris Syndrome, a variation of narcissism that can be induced by too much power and adoration.
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Published On: 07/07/2025
Duration: 11 minutes, 44 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Two ways to approach narcissism in therapy, and how AI can ramp up the problem.
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Published On: 06/30/2025
Duration: 10 minutes, 44 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
There’s a hidden placebo response to watch for when patients stop meds on their own.
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Published On: 06/23/2025
Duration: 13 minutes, 43 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We look at a hidden placebo effect that can confuse the picture when starting a medication.
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Published On: 06/16/2025
Duration: 13 minutes, 22 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Artificial Intelligence is full of medical information. Here’s how to use it wisely.
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Published On: 06/09/2025
Duration: 18 minutes, 48 seconds
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 teen is using substances—how do you decide what kind of treatment makes sense? Outpatient therapy? A more structured program? We’re breaking it down.
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Published On: 06/02/2025
Duration: 20 minutes, 08 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Imagine turning 18 and suddenly being responsible for every major life decision. Yikes. That includes medical, financial, and personal, without guidance. For many young adults with developmental disabilities, these transitions can be overwhelming. How can clinicians and families provide the right level of support while respecting autonomy or at least encouraging it? That's what we're exploring today.
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Published On: 05/25/2025
Duration: 13 minutes, 06 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Many families struggle to find OCD treatment for their children. Specialty-trained therapists are limited, and wait lists are usually long. Online therapy is an option, but how well does it work? Today, we discuss a study that examines online cognitive behavioral therapy with exposure and response prevention for kids with OCD.
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Published On: 05/19/2025
Duration: 11 minutes, 16 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today, we’re tackling a big question: How young is too young to treat children with medication for ADHD?
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Published On: 05/12/2025
Duration: 14 minutes, 36 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
MTHFR is a genetic test that aims to clarify who will respond to methylfolate in depression. But is it worth testing for?
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Published On: 05/05/2025
Duration: 18 minutes, 52 seconds
Chris Aiken, MD, Victor Hoffbrand, DM, DSc, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We learn how psychiatrists figured out that low folate causes depression, and how the vitamin can treat depression even when serum levels are normal.
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Published On: 04/28/2025
Duration: 08 minutes, 29 seconds
Chris Aiken, MD, Victor Hoffbrand, DM, DSc, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We interview Victor Hoffbrand on the discovery of folate and look at how this vitamin can help or harm the action of anticonvulsants in bipolar disorder.
CME: Take the CME Post-Test for this Episode
Published On: 04/21/2025
Duration: 16 minutes, 40 seconds
Chris Aiken, MD, Victor Hoffbrand, DM, DSc, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
1 in 3 Americans were victims of online scams in the past year. Even when you know your patient is being scammed, it is hard to pull them out. We speak with Cathy Wilson about the therapeutic techniques to break psychological trap.
CME: Take the CME Post-Test for this Episode
Published On: 04/14/2025
Duration: 11 minutes, 27 seconds
Chris Aiken, MD, Cathy Wilson, LPC, ACS, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
1 in 3 Americans were victims of online scams in the past year. Learn the signs, and the psychological traps that can make people lose everything.
How to help patients build fulfilling lives even in the face of unremitted illness.
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Published On: 04/07/2025
Duration: 13 minutes, 13 seconds
Chris Aiken, MD, Cathy Wilson, LPC, ACS, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
The Fentanyl overdose crisis is now one of the leading causes of death among adolescents, and it is happening in every corner of the country. Stay with us as we talk about the state of the crisis and the steps we can take to save lives.
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Published On: 03/31/2025
Duration: 15 minutes, 41 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In today's podcast, we explore the connection between social media, mental health, and today's youth.
CME: Take the CME Post-Test for this Episode
Published On: 03/24/2025
Duration: 12 minutes, 58 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
How to help patients build fulfilling lives even in the face of unremitted illness.
CME: Take the CME Post-Test for this Episode
Published On: 03/17/2025
Duration: 15 minutes, 19 seconds
Chris Aiken, MD, Margaret Chislom, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
How post is postpartum? And how fast do you need to intervene?
CME: Take the CME Post-Test for this Episode
Published On: 03/10/2025
Duration: 16 minutes, 31 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We look at the ideal times to intervene for antipsychotic weight gain and panic attacks.
CME: Take the CME Post-Test for this Episode
Published On: 03/03/2025
Duration: 12 minutes, 50 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Sometimes we have a window of opportunity to make a difference. In this series we discuss time-frames where panic, clozapine, and metformin have the greatest benefits.
CME: Take the CME Post-Test for this Episode
Published On: 02/24/2025
Duration: 11 minutes, 53 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Sometimes we have a window of opportunity to make a difference. In this series we discuss time-frames where lithium, clozapine, and metformin have the greatest benefits.
CME: Take the CME Post-Test for this Episode
Published On: 02/17/2025
Duration: 19 minutes, 28 seconds
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Sometimes we have a window of opportunity to make a difference. Here, we discuss time-frames where lithium, clozapine, and metformin have the greatest benefits.
CME: Take the CME Post-Test for this Episode
Published On: 02/10/2025
Duration: 17 minutes, 23 seconds
Chris 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 your patient’s life story can unlock psychotherapeutic avenues of treatment on our interview with Margaret Chisolm.
CME: Take the CME Post-Test for this Episode
Published On: 02/03/2025
Duration: 16 minutes, 41 seconds
Chris Aiken, MD, Margaret Chisolm, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Learn how an understanding of patient’s temperament and the meaning of their life story can unlock psychotherapeutic avenues of treatment on our interview with Margaret Chisolm.
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Published On: 01/27/2025
Duration: 18 minutes, 12 seconds
Chris Aiken, MD, Margaret Chisolm, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Margaret Chisolm shares the Perspectives model, a way of assessing patients that builds on the DSM takes the famous manual a few steps further.
CME: Take the CME Post-Test for this Episode
Published On: 01/20/2025
Duration: 22 minutes, 23 seconds
Chris Aiken, MD, Margaret Chisolm, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Depression and cognitive impairment on benzos, tardive dyskinesia, anticholinergics, and neurotoxicity from high dose stimulants. These are the side effects that patients aren’t likely to notice until it’s too late.
CME: Take the CME Post-Test for this Episode
Published On: 01/13/2025
Duration: 07 minutes, 41 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Allen Frances shares his approach to chronic depression.
CME: Take the CME Post-Test for this Episode
Published On: 01/06/2025
Duration: 16 minutes, 47 seconds
Chris Aiken, Allen Frances, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Allen Frances shares his approach to chronic depression.
CME: Take the CME Post-Test for this Episode
Published On: 12/30/2024
Duration: 16 minutes, 45 seconds
Chris Aiken, MD, Allen Frances, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Allen Frances shows us how to put the common ingredients of effective therapy into practice at every visit.
CME: Take the CME Post-Test for this Episode
Published On: 12/23/2024
Duration: 16 minutes, 53 seconds
Chris Aiken, Allen Frances, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Allen Frances shows us how to adjust our therapeutic approach for problems that are simple and those a bit more complex.
CME: Take the CME Post-Test for this Episode
Published On: 12/16/2024
Duration: 21 minutes, 45 seconds
Chris Aiken, Allen Frances, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We talk with Nick Rosenlicht, MD about what’s gone wrong in the mental health care system.
CME: Take the CME Post-Test for this Episode
Published On: 12/09/2024
Duration: 23 minutes, 57 seconds
Chris Aiken, Nicholas Rosenlicht, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
How to treat ADHD in bipolar disorder without destabilizing mood part 2: non-stimulants and supplements.
CME: Take the CME Post-Test for this Episode
Published On: 12/02/2024
Duration: 11 minutes, 01 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
How to treat ADHD in bipolar disorder without destabilizing mood part 1: stimulants and non-stimulants.
CME: Take the CME Post-Test for this Episode
Published On: 11/25/2024
Duration: 17 minutes, 26 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
You’ll never be 100% sure if a patient has bipolar, ADHD, or both, but we’ll get you as close as we can.
CME: Take the CME Post-Test for this Episode
Published On: 11/18/2024
Duration: 17 minutes, 24 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today, we delve into the complicated world of psychiatric diagnoses and their impact on treatment.
CME: Take the CME Post-Test for this Episode
Published On: 11/11/2024
Duration: 34 minutes, 20 seconds
Mark L. Ruffalo, MSW, DPsa and Nassir Ghaemi, MD, MPH, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
How to assess med response when the patient reports is a poor guide: long-term mood stabilizers, sleep meds, and rapid cycling.
CME: Take the CME Post-Test for this Episode
Published On: 11/04/2024
Duration: 18 minutes, 12 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
A new med combo for alcohol use disorder, antipsychotic dose reduction in schizophrenia, and two new tips for using stimulants in ADHD.
CME: Take the CME Post-Test for this Episode
Published On: 10/28/2024
Duration: 24 minutes, 12 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
New studies change how we think about lithium and weight gain, and updates on lumateperone, lavender, and esketamine in depression
CME: Take the CME Post-Test for this Episode
Published On: 10/21/2024
Duration: 24 minutes, 43 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We count down the top 10 research updates of the past year with a focus on treatment resistant depression and benzo withdrawal.
CME: Take the CME Post-Test for this Episode
Published On: 10/14/2024
Duration: 19 minutes, 35 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
KarXT (Cobenfy) is the first antipsychotic that doesn’t block dopamine. We trace the origins of this new drug to a South Asian herb used for over 5,000 years, up to the three EMERGENT trials that led to its FDA approval.
CME: Take the CME Post-Test for this Episode
Published On: 10/07/2024
Duration: 12 minutes, 28 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today, we are talking about using cognitive behavioral therapy to treat Obsessive-Compulsive Disorder in clinical settings.
CME: Take the CME Post-Test for this Episode
Published On: 09/30/2024
Duration: 20 minutes, 20 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
A new medication is knocking on the door for FDA approval in PTSD, and it isn’t MDMA. We cover that, and 8 other off label medications.
CME: Take the CME Post-Test for this Episode
Published On: 09/23/2024
Duration: 27 minutes, 18 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Should we follow the FDA and give SSRIs, or venture off label with the fabled prazosin?
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Published On: 09/16/2024
Duration: 18 minutes, 35 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Learn what therapies work for PTSD, what goes on in session, and how to prevent PTSD when your patient calls after a trauma.
CME: Take the CME Post-Test for this Episode
Published On: 09/09/2024
Duration: 16 minutes, 10 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
The transition to college can be challenging for any adolescent, but when an adolescent has psychological conditions, or they're dealing with other mental health concerns, it is especially difficult to navigate this transition.
CME: Take the CME Post-Test for this Episode
Published On: 09/02/2024
Duration: 24 minutes, 47 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Why do some people get PTSD after a trauma and not others? What goes on in the brain during PTSD.
CME: Take the CME Post-Test for this Episode
Published On: 08/26/2024
Duration: 17 minutes, 38 seconds
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Why do some people get PTSD after a trauma and not others? What goes on in the brain during PTSD.
CME: Take the CME Post-Test for this Episode
Published On: 08/19/2024
Duration: 16 minutes, 03 second
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today, we are talking about dysmorphology and genetic disorders in psychiatry. Dr. Marilyn Jones joins us to help us identify and understand these conditions. Dr. Jones tells us about the prevalence and diagnostic considerations for these conditions, such as 22q and Fragile X. Join us as we talk about the importance of early identification, genetic testing, and strategies for supporting individuals and families affected by these conditions.
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Published On: 08/12/2024
Duration: 29 minutes, 29 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Research updates on benzo discontinuation, iloperidone in mania, lithium, schizophrenia, ECT, a new circadian psychotherapy, and therapy for multi-trauma PTSD.
CME: Take the CME Post-Test for this Episode
Published On: 08/05/2024
Duration: 16 minutes, 10 second
Chris Aiken and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
The Holmes Report looked at racial, social, and economic biases in psychoanalysis. Beverly Stoute, MD, shares the findings.
CME: Take the CME Post-Test for this Episode
Published On: 07/29/2024
Duration: 22 minutes, 11 second
Chris Aiken, MD, Beverly Stoute, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Beverly Stoute, MD, shares research on the origins of unconscious racial bias.
CME: Take the CME Post-Test for this Episode
Published On: 07/22/2024
Duration: 11 minutes, 12 second
Chris Aiken, MD, Beverly Stoute, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We talk with Beverly Stoute, MD, about how unconscious racial biases play out between therapist and patient.
CME: Take the CME Post-Test for this Episode
Published On: 07/15/2024
Duration: 16 minutes, 40 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Kyle Greenway developed the Montreal Model to pair ketamine with psychotherapy. In this 3-part series, he shows us how to do it.
CME: Take the CME Post-Test for this Episode
Published On: 07/08/2024
Duration: 23 minutes, 38 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Kyle Greenway developed the Montreal Model to pair ketamine with psychotherapy. In this 3-part series, he shows us how to do it.
CME: Take the CME Post-Test for this Episode
Published On: 07/01/2024
Duration: 18 minutes, 55 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Kyle Greenway developed the Montreal Model to pair ketamine with psychotherapy. In this 3-part series, he shows us how to do it.
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Published On: 06/24/2024
Duration: 19 minutes, 13 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
An FDA panel just rejected MDMA assisted therapy. We look at the reasons why, and what this means for the future of psychedelic therapy.
CME: Take the CME Post-Test for this Episode
Published On: 06/17/2024
Duration: 25 minutes, 59 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Did boundary violations sink MDMA assisted psychotherapy? We explore the reasons behind the FDA panel’s rejection of this psychedelic therapy.
CME: Take the CME Post-Test for this Episode
Published On: 06/10/2024
Duration: 20 minutes, 01 second
Chris 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 episode, Dr. DePhilippis tells us all about Contingency Management: what it is, how it works, and its evidence for the treatment of stimulant use disorders.
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Published On: 06/03/2024
Duration: 43 minutes, 29 second
Noah Capurso, MD, Dominick DePhilippis, MD have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Clinicians who have lived with mental illness share how it impaired them - and strengthened
them - on the job.
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Published On: 05/27/2024
Duration: 21 minutes, 50 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
As we delved into Carl Jung's archetype of the wounded healer last Monday, it reminded us of something we learned about the serotonin transporter gene. Has modern genetics discovered a pathway to the archetype? You be the judge in this throwback to a 2021 episode.
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Published On: 05/20/2024
Duration: 22 minutes, 31 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Clinicians who have lived with mental illness show us how to build a deeper empathy from our past wounds, starting with Carl Jung.
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Published On: 05/13/2024
Duration: 11 minutes, 14 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Clinicians who live with mental illness share the do’s and don’t’s of self-disclosure
CME: Take the CME Post-Test for this Episode
Published On: 05/06/2024
Duration: 21 minutes, 46 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
14 clinicians with mental illness share how they ask patients about mania, depression, psychosis, OCD, panic disorder, addiction, trauma, and suicide.
CME: Take the CME Post-Test for this Episode
Published On: 04/29/2024
Duration: 19 minutes, 54 second
Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
What steps should clinicians take if psychopharmacologic treatments and school behavioral strategies are insufficient for managing a child with ADHD? We've all been there. ADHD, attention deficit hyperactivity disorder, of course, affects millions of children and adolescents worldwide and can significantly impact focus, impulses, and engagement with friends.
Parents and caregivers need to understand the different kinds of medications and therapies that are available to help manage ADHD. In this podcast, Mara and I will explore the various treatment options for ADHD in children and discuss how to navigate the process of selecting more effective treatments.
Published On: 04/22/2024
Duration: 26 minutes, 43 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In today's episode, Dr. Brian Hurley provides expert insights into the current state of stimulant use disorder, its implications across different regions, and available treatment options.
CME: Take the CME Post-Test for this Episode
Published On: 04/15/2024
Duration: 30 minutes, 43 second
Noah Capurso, MD, Brian Hurley, MD have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Does psychiatry keep making the same mistakes? Edward Shorter gives us a historical perspective.
CME: Take the CME Post-Test for this Episode
Published On: 04/08/2024
Duration: 22 minutes, 16 second
Chris Aiken, MD, Edward Shorter, PhD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Viibryd has gone generic, but is it worth prescribing? We review all there is to know about vilazodone in this update from our #1 most read article of 2023.
CME: Take the CME Post-Test for this Episode
Published On: 04/01/2024
Duration: 12 minutes, 47 second
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
All sorts of medications are prescribed for anxiety in older adults. Today, we look at when and how to discontinue them.
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Published On: 03/25/2024
Duration: 22 minutes, 47 second
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today we are discussing dissociative identity disorder (DID) and related topics
Published On: 03/18/2024
Duration: 17 minutes, 31 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Today, I am discussing narcissistic personality with Dr. Frank Yeomans, a world leader in the psychotherapy of personality disorders.
Published On: 03/11/2024
Duration: 31 minutes, 17 seconds
Mark Ruffalo, MSW, DPsa and Frank Yeomans, MD, PhD have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity
Today, Avoidant/Restrictive Food Intake Disorder (ARFID) and its treatment
modalities in the world of mental health are explored.
Published On: 03/04/2024
Duration: 17 minutes, 23 seconds
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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: 02/26/2024
Duration: 19minutes, 25 seconds
Joshua 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.
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Published On: 02/22/2024
Duration: 27 minutes, 56 second
Chris 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.
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Published On: 02/19/2024
Duration: 22 minutes, 23 second
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 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.
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Published On: 02/15/2024
Duration: 27 minutes, 43 second
Chris 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.
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Published On: 02/12/2024
Duration: 16 minutes, 44 second
Chris 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 depression
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Published On: 02/05/2024
Duration: 14 minutes, 02 second
Chris 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.
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Published On: 01/29/2024
Duration: 17 minutes, 40 second
Chris 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.
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Published On: 01/22/2024
Duration: 12 minutes, 19 second
Chris 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: 01/14/2024
Duration: 11minutes, 49 seconds
Joshua 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.
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Published On: 01/08/2024
Duration: 16 minutes, 44 second
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 year of research on lithium, including updates on its efficacy, renal risks, tremor, and a controlled trial of instant vs. extended release
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Published On: 01/01/2024
Duration: 22 minutes, 06 second
Chris 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, and
misconceptions surrounding psychodynamic therapy and discuss how we define evidence for it with our guest, Dr. Jonathan Shedler.
Published On: 12/25/2023
Duration: 52 minutes, 47 seconds
Mark 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: 12/18/2023
Duration: 24 minutes, 33 seconds
Joshua 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.
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Published On: 12/11/2023
Duration: 17 minutes, 53 second
Chris 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.
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Published On: 12/04/2023
Duration: 13 minutes, 40 second
Chris 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.
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Published On: 11/27/2023
Duration: 21 minutes, 07 second
Chris 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.
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Published On: 11/20/2023
Duration: 13 minutes, 25 second
Chris 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?
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Published On: 11/13/2023
Duration: 19 minutes, 46 second
Chris 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?
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Published On: 10/30/2023
Duration: 19 minutes, 14 second
Chris 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 psychopharmacology
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Published On: 10/30/2023
Duration: 22 minutes, 23 second
Chris 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.
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Published On: 10/23/2023
Duration: 24 minutes, 34 second
Chris 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 settings
DR 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!
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Published On: 10/09/23
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Published On: 09/18/2023
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Published On: 09/14/2023
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Published On: 09/11/2023
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Published On: 09/07/2023
Duration: 21 minutes, 46 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Published On: 09/04/2023
Duration: 10 minutes, 55 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Published On: 08/31/2023
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Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Published On: 08/14/2023
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Chris Aiken, MD has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Published On: 08/07/2023
Duration: 20 minutes, 25 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Published On: 07/31/2023
Duration: 23 minutes, 07 seconds
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Published On: 07/24/23
Duration: 12 minutes, 27 seconds
Rehan Aziz, MD, and Prabhjot Gill, BS have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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Published On: 07/17/2023
Duration: 21 minutes, 07 seconds
Chris 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.
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Published On: 07/10/2023
Duration: 30 minutes, 43 seconds
Chris 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.
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Published On: 07/03/2023
Duration: 19 minutes, 38 seconds
Chris 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.
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Published On: 06/26/2023
Duration: 16 minutes, 10 seconds
Chris 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.
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Published On: 6/18/2023
Duration: 15 minutes, 00 seconds
Victoria 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.
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Published On: 06/12/2023
Duration: 26 minutes, 24 seconds
Chris 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
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Published On: 6/05/2023
Duration: 16 minutes, 05 seconds
Victoria 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.
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Published On: 05/29/2023
Duration: 17 minutes, 31 seconds
Chris 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.
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Published On: 05/22/2023
Duration: 12 minutes, 00 seconds
Chris 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.
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Published On: 05/15/2023
Duration: 29 minutes, 55 seconds
Joshua 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 going
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Published On: 05/08/2023
Duration: 25 minutes, 24 seconds
Chris 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 going
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Published On: 05/01/2023
Duration: 20 minutes, 19 seconds
Chris 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.
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Published On: 04/24/2023
Duration: 15 minutes, 56 seconds
Joshua 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.
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Published On: 04/10/2023
Duration: 21 minutes, 22 seconds
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 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.
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Published On: 04/03/2023
Duration: 15 minutes, 25 seconds
Chris 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.
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Published On: 03/27/2023
Duration: 17 minutes, 43 seconds
Joshua Feder, MD, and Mara Governman, LCSW, 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.
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Published On: 03/20/2023
Duration: 22 minutes, 40 seconds
Chris 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.
Published On: 03/13/2023
Duration: 20 minutes, 45 seconds
Joshua 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.
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Publication Date: 3/6/2023
Duration:20 mins, 50 seconds
Chris 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.
Publication Date: 2/27/2023
Duration:19 mins, 15 seconds
Chris 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.
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Published On:02/20/2023
Duration: 18 minutes, 48 seconds
Link to Finding a Sleep Specialist: Society of Behavioral Sleep Medicine Members
United States
Learn to identify sensory challenges to address these barriers to effective care in teens and adolescents.
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Published On:02/13/2023
Duration: 21 minutes, 4 seconds
Related Article: “Assessing Sensory Processing Challenges” The Carlat Child Psychiatry Report, October 2022
Joshua 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?
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Publication Date: 2/6/2023
Duration: 23 mins, 26 seconds
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 medical investigation changes our understanding of Elvis Presley’s untimely death and offer some pearls for modern psychiatric practice.
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Publication Date: 1/30/2023
Duration: 21 mins, 36 seconds
Chris 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.
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Publication Date: 1/23/2023
Duration: 7 mins, 25 seconds
Chris 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.
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Published On: 1/16/2023
Duration: 15 minutes, 31 seconds
Referenced Article: “Management of Depression and Neurocognitive Impairment in Patients With HIV,” The Carlat Hospital Psychiatry Report, Jan/Feb/March 2023
Victoria 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.
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Publication Date: 1/9/2023
Duration: 26 mins, 50 seconds
Chris 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.
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Published On: 1/2/2022
Duration: 16 minutes, 17 seconds
Related Article: “Misuse of Over-the-Counter Medications”, The Carlat Child Psychiatry Report, September 2021
Joshua 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.
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Published On: 12/26/22
Duration: 18 minutes, 22 seconds
Referenced Article: “Assessing and Treating Delirium in Older Adults,” The Carlat Geriatric Psychiatry Report, July 2022
Rehan 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.
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Publication Date: 12/19/22
Duration: 18 mins, 20 seconds
Chris 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, MD
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Publication Date: 12/12/22
Duration: 14 mins, 30 seconds
Chris 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, MD
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Publication Date: 10/13/22
Duration: 13 mins, 00 seconds
Chris 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.
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Published On: 11/28/22
Duration: 17minutes, 29 seconds
Referenced Article: “Bipolar Spectrum Disorders in Children and Adolescents ” The Carlat Child Psychiatry Report, Oct/Nov/Dec 2022
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or
other 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.
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Published On: 11/21/22
Duration: 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.
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Published On: 11/14/2022
Duration: 14 minutes, 44 seconds
Referenced Article: “Supervised Drug Consumption Sites,” The Carlat Addiction Psychiatry Report, July 2022
Noah 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.
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Published On: 11/10/2022
Duration: 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.
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Published On: 11/7/22
Duration: 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.
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Published On: 10/31/22
Duration: 9 minutes, 16 seconds
Referenced Article: “Psychiatric Medication–Induced Hyperprolactinemia,” The Carlat Hospital Psychiatry Report, July 2022
Victoria 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.
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Published On: 10/24/22
Duration: 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.
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Published On: 10/17/22
Duration: 23 minutes, 04 seconds
Is it ever normal to hear voices and is ginger ale really the best treatment for nausea?
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Publication Date: 10/13/22
Duration: 16 mins, 59 seconds
Article 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.
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Published On: 10/10/22
Duration: 8 minutes, 40 seconds
Today on throwback Thursday: Are newer antipsychotics better for cognition than their older, typical forbearers?
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Published On: 10/06/22
Duration: 12 minutes, 40 seconds
Referenced 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.
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Published On: 10/03/22
Duration: 15 minutes, 40 seconds
Referenced Article: “School Inclusion: What You Need to Know ” The Carlat Child Psychiatry Report, January 2022
Joshua 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.
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Published On: 09/29/2022
Duration: 12 minutes, 42 seconds
Referenced 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.
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Published On: 09/26/22
Duration: 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.
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Published On: 09/19/22
Duration: 22 minutes, 54 seconds
Referenced Article: “Addressing Weight Stigma in Clinical Practice,” The Carlat Child Psychiatry Report, July 2022
Joshua 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.
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Published On: 09/12/22
Duration: 14 minutes, 00 seconds
Antidepressants in mania and stimulants in psychotic disorders get called out in our first psychopharm commandment.
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Published On: 09/05/22
Duration: 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.
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Published On: 8/29/2022
Duration: 18 minutes, 07 seconds
Referenced 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.
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Published On: 08/22/22
Duration: 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.
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Published On: 08/15/2022
Duration: 13 minutes, 57 seconds
Referenced 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.
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Published On: 07/25/2022
Duration: 23 minutes, 15 seconds
Referenced Article: “Diagnosing and Treating Avoidant/Restrictive Food Intake Disorder,” The Carlat Child Psychiatry Report, July 2022
Joshua 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.
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Published On: 08/01/2022
Duration: 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.
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Published On: 07/25/2022
Duration: 13 minutes, 19 seconds
Referenced Article: “Eating Disorders in Children and Adolescents ” The Carlat Child Psychiatry Report, July/August/September 2022
Joshua 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.
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Published On: 07/18/2022
Duration: 22 minutes, 06 seconds
Referenced 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.
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Published On: 07/11/2022
Duration: 11 minutes, 37 seconds
Referenced 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.
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Published On: 07/04/2022
Duration: 20 minutes, 21 seconds
Referenced 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?
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Published On: 06/27/2022
Duration: 13 minutes, 38 seconds
Referenced Article: “Atomoxetine for Children and Adolescents: An Update,” The Carlat Child Psychiatry Report, January/February/March 2022
Joshua Feder, MD, and Mara Goverman, LCSW, 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?
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Published On: 06/27/2022
Duration: 13 minutes, 38 seconds
Referenced Article: “Atomoxetine for Children and Adolescents: An Update,” The Carlat Child Psychiatry Report, January/February/March 2022
Joshua 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.
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Published On: 06/20/2022
Duration: 18 minutes, 27 seconds
Referenced Article: “Psychosis During Depression,” The Carlat Child Psychiatry Report, June 2022
Chris 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?
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Published On: 06/13/2022
Duration: 30 minutes, 25 seconds
Referenced Article: “A Primer on Vaping:15 Years On,” The Carlat Addiction Treatment Report, January 2022
Noah 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.
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Published On: 06/6/2022
Duration: 20 minutes, 27 seconds
Referenced Article: “Quetiapine Reconsidered,” The Carlat Child Psychiatry Report, June 2022
Chris 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.
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Published On: 05/30/2022
Duration: 29 minutes, 17 seconds
Referenced Article: “Assessing Bipolar Disorder in Children and Adolescents,” The Carlat Child Psychiatry Report, October/November/December 2021
Joshua 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.
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Published On: 05/23/2022
Duration: 14 minutes, 16 seconds
Chris 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.
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Published On: 05/16/2022
Duration: 12 minutes, 38 seconds
Referenced Article: “Using Equine-Assisted Psychotherapy,” The Carlat Child Psychiatry Report, October/November/December 2021
Joshua 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.
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Published On: 05/09/2022
Duration: 15 minutes, 33 seconds
Related Article: “Racism and Psychiatry,” The Carlat Psychiatry Report, May 2022
Chris 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.
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Published On: 05/02/2022
Duration: 15 minutes, 58 seconds
Referenced Article: “Anticholinergic Drugs and Risk of Cognitive Impairment and Dementia,” The Carlat Hospital Psychiatry Report, October/November/December 2021
Victoria 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.
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Published On: 04/25/2022
Duration: 14 minutes, 00 seconds
Related Article: “Thyroid Augmentation in Bipolar Disorder,” The Carlat Psychiatry Report, April 2022
Chris 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?
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Published On: 04/21/2022
Duration: 13 minutes, 38 seconds
Referenced 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 2021
Joshua 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.
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Published On: 04/18/2022
Duration: 20 minutes, 15 seconds
Related Article: “Thyroid Augmentation in Bipolar Disorder,” The Carlat Psychiatry Report, April 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.
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.
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Published On: 04/14/2022
Duration: 10 minutes, 47 seconds
Related Articles: “Tarasoff: Making Sense of the Duty to Warn or Protect,” The Carlat Hospital Psychiatry Report, January/February/March 2022
Each State’s Laws Related to Tarasoff
Victoria 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.
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Published On: 04/11/2022
Duration: 25 minutes, 18 seconds
Related Article: “A Practical Guide to Light Therapy,” The Carlat Psychiatry Report, November 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.
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.
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Published On: 04/04/2022
Duration: 12 minutes, 20 seconds
Related 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 2019
Chris 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.
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Published On: 03/28/2022
Duration: 27 minutes, 57 seconds
Related Article: “Borderline Personality Disorder in the ED,” The Carlat Hospital Psychiatry Report, January/February/March 2022
Victoria 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.
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Published On: 03/24/2022
Duration: 18 minutes, 58 seconds
Referenced Article: “Naloxone Prescribing,” The Carlat Addiction Treatment Report, July/August 2021
Noah 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.
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Published On: 03/21/2022
Duration: 15 minutes, 24 seconds
Related Articles: “Mental Illness and Flourishing,” The Carlat Psychiatry Report, March 2022
Chris 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?
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Published On: 03/17/2022
Duration: 11 minutes, 45 seconds
Referenced Article: “Clinical Complexity With Children and Adolescents”, The Child Psychiatry Report, January/February/March 2021
Joshua 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.
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Published On: 03/14/2022
Duration: 30 minutes, 24 seconds
Related Article: “A Prescription App for Insomnia,” The Carlat Psychiatry Report, March 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.
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!
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Published On: 03/10/2022
Duration: 9 minutes, 58 seconds
Related 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 2021
Victoria 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.
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Published On: 03/07/2022
Duration: 22 minutes, 21 seconds
Chris 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.
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Published On: 03/03/2022
Duration: 11 minutes, 21 seconds
Related Article: “Exploring the Potential Neurotoxicity of Antipsychotics in Younger Populations,” The Carlat Child Psychiatry Report, November/December 2019
The American Academy of Child and Adolescent Psychiatry Practice Guidelines for Antipsychotics
Joshua 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.
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Published On: 02/28/2022
Duration: 25 minutes, 03 seconds
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.
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.
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Published On: 02/21/2022
Duration: 20 minutes, 52 seconds
Related 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.
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Published On: 02/14/2022
Duration: 25 minutes, 58 seconds
Related Article: “Raising the Bar in Schizophrenia Treatment,” The Carlat Psychiatry Report, February 2022
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.
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.
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Published On: 02/07/2022
Duration: 17 minutes, 07 seconds
Related Article: “When Further Medication Trials Seem Futile,” The Carlat Psychiatry Report, June/July 2020
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.
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?
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Published On: 01/31/2022
Duration: 22 minutes, 24 seconds
Chris 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.
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Published On: 01/24/2022
Duration: 24 minutes, 09 seconds
Chris 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.
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Published On: 01/17/2022
Duration: 18 minutes, 39 seconds
Related Article: “Working With Severe Personality Disorders,” The Carlat Psychiatry Report, January 2022
Chris 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 emotions
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Published On: 01/10/2022
Duration: 9 minutes, 16 seconds
Chris 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).
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Published On: 01/03/2022
Duration: 16 minutes, 0 seconds
Referenced 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 2021
Chris 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.
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Published On: 12/27/2021
Duration: 24 minutes, 16 seconds
Chris 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.
Gordon Parker suggests changes to the DSM-5 criteria for bipolar disorder, and unveils a new screening instrument that aims to separate hypomania from normal happiness.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/20/2021
Duration: 16 minutes, 07 seconds
Referenced Article: “How to Diagnose Bipolar Disorder,” The Carlat Psychiatry Report, November/December 2021
Chris Aiken, MD, Kellie Newsome, PMHNP, Gordon Parker, MD, PhD, DSc, and have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
You will hear about and read research your entire career. Headlines report on positive treatment results, and families come in asking about them. So how should we evaluate research, and what makes a study good or flawed?
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/17/2021
Duration: 17 minutes, 41 seconds
References: Database for reporting adverse events
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
For years, we have dreaded seeing our patients develop antipsychotic-induced tardive dyskinesia because there was little we could do about these symptoms. Thankfully, we now have new treatments that produce noticeable improvements in tardive dyskinesia.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/15/2021
Duration: 11 minutes, 23 seconds
Referenced Article: “Finally, Effective Treatments for Tardive Dyskinesia,” The Carlat Hospital Psychiatry Report, April/May/June 2021
Victoria Hendrick, MD, and Zachary Davis, BS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Peter Whitehouse on how to prevent dementia and the limits of pharmacotherapy for cognitive decline. And the word of the day: Ultradian cycling.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/13/2021
Duration: 21 minutes, 12 seconds
Referenced Article: “In the News: Aducanumab (Aduhelm),” The Carlat Psychiatry Report, November/December 2021
Chris Aiken, MD, Kellie Newsome, PMHNP, and Peter J. Whitehouse, MD, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Pregnant patients with substance use disorder want to do what’s right for their pregnancy, and as clinicians, we need to be supportive and acknowledge our patients courage and vulnerability to seek help. But, what are the best treatments for the various substance use disorders in pregnant women, and which substances have the highest potential for producing negative pregnancy outcomes?
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/10/2021
Duration: 18 minutes, 2 seconds
Referenced Article: “The Pregnant Patient With Substance Use Disorder,” The Carlat Addiction Treatment Report, July/August 2021
Noah Capurso, MD, MHS, and Ariadna Forray, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
From melatonin for sleep-onset insomnia to electroconvulsive therapy for severe adolescent mood disorder to steroid-induced psychosis to the risk of stimulant-induced psychosis in youth with ADHD, and MORE! In this two-part series, Mara and Dr. Feder will tackle various research topics in the field of child psychiatry.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/9/2021
Duration: 14 minutes, 35 seconds
Referenced Articles:
“Risk of Psychosis With Stimulants in ADHD Patients,” The Carlat Child Psychiatry Report, May/June/July/August 2021
“Vitamin D for ADHD?,” The Carlat Child Psychiatry Report, October/November/December 2020
“Efficacy and Safety of SSRIs and SNRIs for Child and Adolescent Psychiatric Disorders,” The Carlat Child Psychiatry Report, January/February 2018
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Individuals with schizophrenia are at high risk of obesity, elevated lipids, increased insulin resistance, diabetes, and cardiovascular disease. On average, people with schizophrenia die 20–25 years sooner than those without schizophrenia. How can we spot metabolic side effects early in our patients, and what should we be looking for exactly?
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/8/2021
Duration: 16 minutes, 42 seconds
Referenced Article: “Weight Gain and Metabolic Side Effects,” The Carlat Hospital Psychiatry Report, July/August/September 2021
Victoria Hendrick, MD, and Stephen Marder, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
From melatonin for sleep-onset insomnia to electroconvulsive therapy for severe adolescent mood disorder to steroid-induced psychosis to the risk of stimulant-induced psychosis in youth with ADHD, and MORE! In this episode, Mara and Dr. Feder will tackle various research topics in the field of child psychiatry.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/6/2021
Duration: 13 minutes, 20 seconds
Referenced Articles:
“Melatonin for Sleep-Onset Insomnia,” The Carlat Child Psychiatry Report, January/February/March 2021
“Steroid-Induced Psychosis in the Pediatric Population,” The Carlat Child Psychiatry Report, May/June/July/August 2021
“ECT in Severe Adolescent Mood Disorders,” The Carlat Child Psychiatry Report, April/May/June 2021
Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In 2004, the well-known pediatric OCD treatment study also known as POTS study revealed that CBT and sertraline had comparable benefits over 12 weeks of treatment for children with OCD. Yet this study left us with a few unanswered questions. For instance, for those who don't respond to initial CBT therapy, should we continue CBT or switch to an SSRI like sertraline.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 12/2/2021
Duration: 6 minutes, 32 seconds
Referenced Article: “Long-Term Treatment Response in Pediatric OCD,” The Carlat Child Psychiatry Report, March 2021
Joshua Feder, MD, has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Got feedback? Take the podcast survey.
An interview with Drew Ramsey on nutritional psychiatry.
Chris Aiken, MD, Kellie Newsome, PMHNP, and Drew Ramsey, MD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 11/29/2021
Duration: 12 minutes, 13 seconds
Referenced Article: “Nutritional Psychiatry in Practice,” The Carlat Psychiatry Report, November/December 2021
How does schizophrenia differ between men and women? And are there adjunctive treatments that can improve outcomes for female patients with schizophrenia? In this podcast, Dr. Kulkarni and I will tackle these questions.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 11/22/2021
Duration: 23 minutes, 16 seconds
Referenced Article: “Sex-Based Treatment of Schizophrenia,” The Carlat Hospital Psychiatry Report, July 2021
Victoria Hendrick, MD, and Jayashri Kulkarni, MBBS, PhD, FAHMS, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
We break down the three main autism intervention approaches, and provide you with information that will help you improve on your abilities to recognize which particular autism intervention might be best for a specific patient.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 11/17/2021
Duration: 19 minutes, 24 seconds
Related Article: “Approaches to Autism Intervention” The Carlat Child Psychiatry Report, April 2021
Aducanumab (Aduhelm) just got FDA approval in dementia, but many experts think it should not have passed the finish line. We interviewed Peter Whitehouse, professor of neurology at Case Western Reserve University and author of American Dementia, on what went wrong.
CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 11/15/2021
Duration: 12 minutes, 4 seconds
Referenced Article: “In the News: Aducanumab (Aduhelm),” The Carlat Psychiatry Report, November/December 2021
Chris Aiken, MD, Kellie Newsome, PMHNP, and Peter J. Whitehouse, MD, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Patients with repeated deliberate foreign body ingestion (DFBI) are among the most challenging we see. In any given room, there’s bound to be some small object that can be swallowed. So how can we reduce the likelihood of foreign body ingestion in these patients?
CME Credit: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.
Published On: 11/08/2021
Duration: 14 minutes, 32 seconds
Related Article: “Deliberate Foreign Body Ingestions,” The Carlat Hospital Psychiatry Report, January 2021
Victoria Hendrick, MD, and Adrienne Grzenda, MD, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Got feedback? Take the podcast survey.
In this 3-part series, we look at the rise and fall, and rise again of antipsychotics in mania, and sort through which ones work, which we should avoid, and whether their use in mania has gone overboard. Today, we lay out the top 3 antipsychotics for mania, and then throw out the whole idea of a rating system.
Published On: 11/01/2021
Duration: 23 mins, 25 seconds
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On April 30th of this year, the FDA approved Kloxxado, a naloxone nasal spray that contains 8mg of naloxone per dose, which is twice as much as the most common formulation: Narcan. But what distinguishes Kloxxado distinguishes from the many other ways that naloxone is delivered and why was it developed in the first place?
Published On: 8/16/2021
Duration: 21 minutes, 01 seconds
Article Referenced: "A New High-Dose Naloxone: Life Saver or Punishment?," The Carlat Addiction Treatment Report," July/August 2021
"Naloxone Prescribing," The Carlat Addiction Treatment Report," July/August 2021
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In this 3-part series, we look at the rise and fall, and rise again of antipsychotics in mania, and sort through which ones work, which we should avoid, and whether their use in mania has gone overboard. Today, we lay out the top 3 antipsychotics for mania, and then throw out the whole idea of a rating system.
Published On: 10/25/2021
Duration: 15 mins, 58 seconds
Got feedback? Take the podcast survey.
In this 3-part series, we look at the rise and fall, and rise again of antipsychotics in mania, and sort through which ones work, which we should avoid, and whether their use in mania has gone overboard. Today, how an anesthetic agent turned into an antipsychotic, and how Bing Crosby lit a spark that would eventually lead psychiatrists to revise their entire diagnostic system.
Published On: 10/17/2021
Duration: 17 minutes, 3 seconds
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An interview with Michael Poyurovsky, MD, on the paradoxical effects of antipsychotics in OCD and the many ways that OCD symptoms show up in schizophrenia.
Published On: 10/11/2021
Duration: 18 minutes, 3 seconds
Related Article: "Can Antipsychotics Worsen OCD?", The Carlat Psychiatry Report, October 2021
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Genetic testing is all the rage in psychiatry, but the test that might work best is the one that no one is talking about.
Published On: 10/04/2021
Duration: 15 minutes, 29 seconds
Related Article: "Genetic Testing in Depression," The Carlat Psychiatry Report, September 2021
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The 21st Century Cures Act (or the “Cures Act'' for short) was a federal law passed in 2016 that included various mental health provisions. This law has significant implications on the way we share information with our patients and their families.
Published On: 09/27/2021
Duration: 17 minutes, 39 seconds
Related Article: "Welcome to the 21st Century Cures Act Information Sharing Rules," The Carlat Child Psychiatry Report, April 2021
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Is ketamine a glutamate antagonist or a spiritual kindler? Ketamine has two origin stories, each with its own understanding of how it treats depression.
Phase III clinical trials are beginning to roll out for psychedelic medications like like psilocybin and MDMA – also known as magic mushrooms and ecstasy. But this is not the first time these drugs have been used to treat mental illness, and today we take a dive into the clinical reports on psilocybin from half a century ago.
Experts in borderline personality disorder and bipolar disorder reach a consensus about the mercurial temperament that underlies borderline personality. The DSM Committee restores a diagnostic code to recognizes those with a “clean bill of mental health,” and the word of the day goes psychedelic over the 5-HT2A receptor.
Published On: 9/5/2021
Duration: 19 minutes, 50 seconds
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Nortriptyline + lithium is one of the top combos for keeping patients well after ECT, and in this episode we walk you through how to prescribe it, including side effects, dosing, drug levels, and drug interactions. Then, the word of the day: Antisocial personality disorder.
Published On: 8/30/2021
Duration: 28 minutes, 49 seconds
Article Referenced: "ECT Worked: Now What?", The Carlat Psychiatry Report, August 2021
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Barry Krakow, MD has spent his career studying and treating nightmares. In this interview, he shares how nightmares affect mental health, and how they point to more than just PTSD.
Published On: 8/22/2021
Duration: 16 minutes, 23 seconds
Related Article: "Turning Nightmares Into Dreams," The Carlat Psychiatry Report, August 2021
This deep dive podcast breaks through the dogma of autism intervention and helps you to understand the three main branches of autism intervention and their very different mechanisms, the quality of autism research with a huge shift in our understanding of what works, and addresses such questions as how many hours are really needed for intervention?
Published On: 8/19/2021
Duration: 27 minutes, 21 seconds
Related Article: "Effect Size Matters: The Seismic Shift Toward Naturalistic and Developmental Interventions in Autism," The Carlat Child Psychiatry Report, April/May/June 2021
Got feedback? Take the podcast survey.
We break down the three main autism intervention approaches, and provide you with information that will help you improve on your abilities to recognize which particular autism intervention might be best for a specific patient.
Published On: 8/11/21
Duration: 27 minutes, 21 seconds
Related Article: “Effect Size Matters: The Seismic Shift Toward Naturalistic and Developmental Interventions in Autism” The Carlat Child Psychiatry Report, April 2021
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Our top 6 tips for managing nausea on psych meds, and a queasy tale of a tenacious problem to watch for when your patients who get nauseous: Conditioned taste aversion.
Published On: 8/9/2021
Duration: 18 minutes, 16 seconds
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The APA says that genetic testing isn’t ready for prime time, but is there anything worth salvaging in these panels? We get some answers from John Nurnberger, a co-founder of the International Society of Psychiatric Genetics, the founding editor of the International Journal Psychiatric Genetic, and a Distinguished Professor Emeritus at the Indiana University School of Medicine.
Published On: 8/2/2021
Duration: 11 minutes, 22 seconds
Related Article: "Genetic Testing: What You Need to Know in 2021," The Carlat Psychiatry Report, June/July 2021
Guide your patients to light therapy with this tutorial, including how to select a device, what time to use it, and how to position the box.
Published On: 7/26/2021
Duration: 12 minutes, 54 seconds
Related Articles: "Dark and Light Therapy" The Carlat Psychiatry Report, February 2019
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Research updates on mirtazapine in anxiety, insomnia, methamphetamine abuse, and controversial news about the abuse potential of this antidepressant. Also new side effects and withdrawal symptoms discovered.
Published On: 7/19/21
Duration: 16 minutes, 28 seconds
Related Article: "Two Negative Studies of Mirtazapine and Riluzole for PTSD in Veterans," The Carlat Psychiatry Report, June/July 2021
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Antidepressants get people better from depression, but what keeps them better? In this episode, Dr. Giovanni Fava suggests we may need to stop trying to stamp-out pathology and start finding ways to enhance well-being as patients recover.
Published On: 7/12/2021
Duration: 15 minutes, 42 seconds
Related Article: "Psychotherapy and Medication in Recurrent Depression," The Carlat Psychiatry Report, June/July 2021
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We interview Vladimir Maletic about the serotonin transporter gene (SERT). It’s supposed to make people more vulnerable to depression, but there’s a bright side to this gene that rarely gets attention. We talk about the strengths it confers, and whether it can predict which antidepressant a patient will respond to.
Published On: 7/5/2021
Duration: 19 minutes, 24 seconds
Related Article: "Genetic Testing: What You Need to Know in 2021," The Carlat Psychiatry Report, June/July 2021
New analyses rank disulfiram (Antabuse) among the most effective medications for alcohol use disorders. But why is it so underutilized? In this podcast we explore the history of this therapy – the oldest medication that is still in use in psychiatry.
Published On: 6/28/21
Duration: 25 minutes, 23 seconds
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On April 2, 2021, viloxazine, brand name Qelbree, received FDA approval for the treatment of ADHD in children and adolescents ages 6-17 years old. The latest issue of The Carlat Child Psychiatry Report includes a News of Note covering this newly approved medication for ADHD. In this podcast, we discuss the advantages and disadvantages of viloxazine for children and adolescents with ADHD.
Published On: 6/21/2021
Duration: 11 minutes, 55 seconds
Related Article: "Viloxazine (Qelbree): A Faster Strattera?", The Carlat Child Psychiatry Report, April/May/June 2021
Resources:
- Nasser A et al, Clin Ther 2020;42(8):1452–1466
- Johnson JK et al, J Atten Disord 2020;24(2):348-358
- Faraone SV, P T. 2009;34(12):678-683, 694.
- de Silva V et al, BMC Psychiatry 2011;11:176.
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THINC-it is a new app that can help you track and measure your patient’s cognition. This episode includes a special patient edition from the Pocket Psychiatrist that walks patients through the app and offers tips to keep them motivated while they make behavioral changes to improve their cognition. Free download here.
Published On: 6/14/21
Duration: 23 minutes, 28 seconds
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THINC-it is a new app that can help you track and measure your patient’s cognition. This episode includes a special patient edition from the Pocket Psychiatrist that walks patients through the app and offers tips to keep them motivated while they make behavioral changes to improve their cognition. Free download here.
Published On: 6/14/21
Duration: 23 minutes, 28 seconds
Got feedback? Take the podcast survey.
Clinicians are inundated with ads for genetic testing, but is genetic testing currently helpful for informing clinical care? The latest issue of The Carlat Child Psychiatry Report includes an interview with Dr. Aaron Besterman, who’s an adult and child & adolescent psychiatrist at the Rady Children’s Hospital inpatient child and adolescent unit in San Diego. He also conducts psychiatric genetic research as a clinical investigator at the Rady Children’s Institute for Genomic Medicine. In our interview with Dr. Besterman, he broke down the current state of genetic research in psychiatry, explaining how these genetic tests work, and what can be reliably taken away from them. Mara and I will discuss the highlights from our interview with Dr. Besterman in this episode.
Published On: 5/31/2021
Duration: 22 minutes, 4 seconds
Related Article: "Pharmacogenetics: Not Quite Ready for Prime Time?" The Carlat Child Psychiatry Report, January/February/March 2021
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Brian Wilson, Lou Reed, and Ian Curtis all created new music genres, and each of them is reputed to have had bipolar disorder. We look at the evidence behind that, and learn a few things about psychiatry and creativity along the way. But it all starts with Lou Reed’s first Velvet Underground concert, performed – of all places – at a psychiatric convention. Here’s the footage [link].
Published On: 5/31/2021
Duration: 21 minutes, 15 seconds
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The psychiatric syndromes caused by COVID infection may look like commonplace DSM-5 disorders, but the cause and treatment may be different. Reference: Boldrini M, Canoll PD, Klein RS. How COVID-19 Affects the Brain. JAMA Psychiatry. 2021 Mar 26.
Published On: 5/24/2021
Duration: 16 minutes, 11 seconds
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We ask the big questions: Is topiramate a drug or a sugar? Do you need to use the FDA-approved combo pill for weight loss? And which of its 13 off-label psychiatric uses are ready for clinical practice?
Published On: 5/17/2021
Duration: 25 minutes, 58 seconds
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Rusty machinery, forged documents, and monkeys in the manufacturing plants. It’s what happens when the FDA stops checking in on things. Katherine Eban talks to us about the current crisis in generic drug safety that this breakdown in oversight is causing.
Published On: 5/10/2021
Duration: 23 minutes, 24 seconds
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A new study looked at what works best after two antidepressants have failed, and it claims to have found some surprising winners. We take a closer look at the data in the final episode of our two-part series on treatment resistant depression (see March 8 2021 for part 1).
Published on: 3/3/21
Duration: 19 minutes 49 seconds
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We unpack 6 studies of the hypnotic eszopiclone in depressive and anxiety disorders, and conclude that there’s more going on here than a simple benefit in sleep. Our word of the day tells us something about what’s missing in depression: Present moment awareness.
Published On: 4/26/21
Duration: 22 minutes, 52 seconds
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18 experts weigh in on how they use antidepressants in bipolar II. Sleep onset latency is defined, and we uncover the neuropsychiatric effects of marijuana in adults.
Published On: 4/19/2020
Duration: 28 minutes, 11 seconds
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We look at three ways that the body influences psychiatric disorders in the brain – through neurohormones, inflammation, and metabolic health. Dr. Rodrigo Mansur delves into that last one in our expert interview, and we end with a new app – Thinc-IT - that measures cognition in patients. It’s here.
Published On: 4/12/21
Duration: 24 minutes, 10 seconds
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Around 50 controlled trials have tested benzodiazepines in depression, and the results are surprising. They seem to work. In this episode we look at the controversies surrounding this research and what it means for practice.
Published On: 4/5/2021
Duration: 25 minutes, 41 seconds
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Overdose deaths have been rising during COVID, but simply stopping the drug causes problems of its own. In this episde, Ashwin Patkar and Richard Weisler discuss how to reduce the risk of opioid deaths in psychiatric patients. Their Current Psychiatry article on the subject is here.
Published On: 3/28/21
Duration: 26 minutes, 50 seconds
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Swapnil Gupta, author of Deprescribing in Psychiatry, shares tips on how to help patients taper off benzodiazepines and psychostimulants. She adds a special therapeutic ingredient, but it’s not a medication. Then we digress into one of the oldest medications known to humankind: Opium.
Published On: 3/21/2021
Duration: 21 minutes, 34 seconds
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DSM-5 has adopted many of the concepts from Hagop Akiskal’s Bipolar Spectrum, but not in the way he had planned. Here we trace his thinking back to the early 1970’s, when Dr. Akiskal reshaped the way we think about depression by blurring the boundary between stress-induced and biological depression.
Published On: 3/15/2021
Duration: 26 minutes, 19 seconds
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What works best when the first antidepressant fails? And the second? Today, we bring you part 1 in our special series on treatment resistant depression.
Published On: 3/7/21
Duration: 16 minutes, 1 second
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For nearly 17 years, since the FDA black box warning about suicidality with antidepressants, our community has been quoting data that downplays this concern. We were wrong. We were deceived. Antidepressants can be lifesaving, but there really is a duty to warn. In this episode, Doctors Martha Ignaszewski and Glen Spielmans talk with us about what went on and how to talk about it with our families.
Guests:
- Dr. Glen Spielmans, professor of psychology at Metropolitan State University in Saint Paul, Minnesota
- Dr. Martha Ignaszewski, staff psychiatrist at BC Children’s Hospital and a clinical instructor at the University of British Columbia
Published On: 3/1/2021
Duration: 24 minutes, 36 seconds
Related Articles:
- "Duty to Warn? Debating Antidepressant Suicidality," The Carlat Child Psychiatry Report, Oct/Nov/Dec 2020
- Spielmans GI, Spence-Sing T, Parry P. Duty to Warn: Antidepressant Black Box Suicidality Warning Is Empirically Justified. Front Psychiatry. 2020 Feb 13;11:18. doi: 10.3389/fpsyt.2020.00018. PMID: 32116839; PMCID: PMC7031767. [Link]
- Ignaszewski MJ, Waslick B. Update on Randomized Placebo-Controlled Trials in the Past Decade for Treatment of Major Depressive Disorder in Child and Adolescent Patients: A Systematic Review. J Child Adolesc Psychopharmacol. 2018 Dec;28(10):668-675. doi: 10.1089/cap.2017.0174. Epub 2018 Jul 31. PMID: 30063169. [Link]
Links and References:
- Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA, Herings RM, Mann JJ. Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 2007 Sep;164(9):1356-63. doi:" [Link]
- Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry. 2012 Jun;69(6):580-7. doi: 10.1001/archgenpsychiatry.2011.2048. Erratum in: Arch Gen Psychiatry.2013 Aug;70(8):881. PMID: 22309973; PMCID: PMC3367101. [Link]
- Findling RL, Robb A, Bose A. Escitalopram in the treatment of adolescent depression: a randomized, double-blind, placebo-controlled extension trial. J Child Adolesc Psychopharmacol. 2013 Sep;23(7):468-80. doi: 10.1089/cap.2012.0023. PMID: 24041408; PMCID: PMC3779002. [Link]
- Healy D, Cattell D. Interface between authorship, industry and science in the domain of therapeutics. Br J Psychiatry. 2003 Jul;183:22-7. PMID: 12835239. [Link]
- Phase Five Website [Link]
- Phase Five Marketing Document [Link]
In 2012, psychiatrists at Harvard’s Massachusetts General Hospital discovered a novel antidepressant. It seemed to improve depression and cognition without causing any significant side effects. There was only one problem. The ingredients were practically free, and there was no way that was going to sell.
Published On: 2/21/2021
Duration: 19 minutes, 49 seconds
Article Referenced: "Buspirone: Still Effective After All These Years?" The Carlat Psychiatry Report, February 2021
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Bupropion and restless legs syndrome: a randomized controlled trialWhen a patient complains that their mood got worse on an antidepressant, it doesn’t necessarily mean they are sensitive to medications. In this episode, we detail 6 other reasons why depression can get worse on an antidepressant.
Published On: 2/15/21
Duration: 22 minutes, 42 seconds
Article Referenced: "Are SSRIs Associated With Increased Rates of Violence?" The Carlat Psychiatry Report, February 2021
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An interview with Swapnil Gupta on when and how to come off psychiatric medications. Plus, tips on cross-tapering antidepressants, and the word of the day: Ephedra.
Published On: 2/8/2021
Duration: 17 minutes, 1 second
Behavioral activation came about in the 1990’s as a challenge to the CBT model of depression. The basic strategy behind this therapy blends well with brief medication visits, and we explain how to use it in this professional guide. Check out the patient companion to this edition in the Pocket Psychiatrist podcast.
Published On: 2/01/21
Duration: 9 minutes, 21 seconds
Patient Companion: www.pocketpsychpod.com
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Richard Weisler tells the tale of science and serendipity that lead to his discovery of lamotrigine for bipolar depression 30 years ago. He shares a few dosing tips, and touches on how he works with patients and their families. Plus, the word of the day: Gramophone Syndrome.
Published On: 1/25/21
Duration: 23 minutes, 30 seconds
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The gut microbiome influences the brain in numerous ways, but can building a better microbiome treat depression? Dr. Ted Dinan walks us through the science in this interview.
Published On: 1/17/21
Duration: 27 minutes, 50 seconds
Article Referenced: "Probiotics in Psychiatry," The Carlat Psychiatry Report, January 2021
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The Queen’s Gambit is Netflix’s critically acclaimed series about a chess prodigy who gets “a little help from her friends.” In this episode we find out what they got right, and wrong, about psychiatric meds and cognitive enhancement.
Published On: 1/11/2020
Duration: 29 minutes
Article Referenced: "The Queen's Gambit," The Carlat Psychiatry Report, January 2021
Brett Stevens has lived through the worst of bipolar and come out standing. Here’s what he did to get his life back. This is the first edition of The Pocket Psychiatrist, a monthly series you can share with your patients through a separate podcast stream Welcome to the Carlat Psychiatry Podcast, keeping psychiatry honest since […]
A look at the top 10 practice-changing highlights from our 2020 journal. Tardive dyskinesia, inflammation, lumateperone, top first-line medications, trazodone in depression, Silexan for anxiety, excellent lithium responders, hormones and mood, and ramelteon’s generic debut.
Published On: 12/28/2020
Duration: 26 minutes, 30 seconds
Articles Referenced:
- "How to Treat Tardive Dyskinesia," The Carlat Psychiatry Report, January 2020
- "Inflammatory Biomarkers in Depression," The Carlat Psychiatry Report, February 2020
- "Lumateperone and lemborexant," The Carlat Psychiatry Report, March 2020
- "The Psychopharmacology Algorithm Project," The Carlat Psychiatry Report, April 2020
- "Trazodone: The Forgotten Antidepressant," The Carlat Psychiatry Report, May 2020
- "When Further Medication Trials Seem Futile," The Carlat Psychiatry Report, June/July 2020
- "Silexan: A Novel Anxiolytic," The Carlat Psychiatry Report, August 2020
- "Who Should Get Lithium?," The Carlat Psychiatry Report, September 2020
- "Mood and Menopause," The Carlat Psychiatry Report, October 2020
- "Is Ramelteon an Effective Hypnotic?," The Carlat Psychiatry Report, November 2020
Retractions are on the rise in medical research, and we get to the bottom of it with Ivan Oransky, cofounder of RetractionWatch.com.
Published On: 12/21/2020
Duration: 25 minutes, 12 seconds
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Most of the research on melatonin has involved older adults, and there it seems to work pretty well, just a little less effective than most prescription sleep meds. So how well does melatonin work in middle aged adults? This new study is the first to test that out. [Study Link]
Published On: 12/17/2020
Duration: 4 minutes, 5 seconds
Related Article: "Is Ramelteon an Effective Hypnotic?", The Carlat Psychiatry Report, November 2020
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Donna Sudak shares her tips for weaving cognitive behavioral therapy (CBT) into the 30-minute psychotherapy session with medication. The article on rating scales she references - Free, Brief, and Validated - is available here.
Published On: 12/14/2020
Duration: 19 minutes, 49 seconds
Article Referenced: "Brief Therapy During the Medication Visit," The Carlat Psychiatry Report, November/December 2020
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Not only do we get more urges to eat at night, but we tend to overeat and lean more towards junk food. So how does that play out in bipolar disorder? This new study by Francisco Romo-Nava and colleagues at the University of Cincinnati and the Mayo Clinic sought to find out by asking 783 adults with bipolar disorder about their eating habits and circadian patterns of energy and sleep. [Study Link]
Published On: 12/12/20
Duration: 4 minutes, 43 seconds
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There are many reasons why people drink, and one of them is alcohol withdrawal. The withdrawal state causes anxiety, negative mood, and cravings, and these kinds of symptoms lead patients to turn to alcohol once more. Some treatments for alcohol use disorders – like gabapentin – work better in patients with high withdrawal symptoms – and this new study from Rajita Sinha and colleagues at Yale investigated whether that held true for prazosin as well. [Study Link]
Published On: 12/10/2020
Duration: 4 minutes, 9 seconds
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Cognitive behavioral therapy treats insomnia as well as a sleep med, and it also improves depression and immune function. This special patient podcast introduces the first steps of the therapy, and shows you how to find the full therapy if more help is needed. CBT-insomnia resources: Apps: CBT-i Coach, Somyrst. Books: Depression and Bipolar Workbook (C Aiken), Say Good Night to Insomnia (G Jacobs), End the Insomnia Struggle (C Ehrnstrom).
Published On: 12/7/2020
Duration:
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Depression and anxiety improve when healthy bacteria are added – whether through diet or probiotics – according to several dozen small randomized controlled trials. However, only a handful of those trials involved full clinical depression. This study adds to that count, but with a different result. [Link]
The probiotic used in the study was: Omnibiotic Stress Repair 7.5 billion organisms per 1 portion (3 g). Bacterial strains in the capsule were: B. bifidum W23, B. lactis W51, B. lactis W52, L. acidophilus W22, L. casei W56, L. paracasei W20, L. plantarum W62, L. salivarius W24 and L. lactis W19.
Published On: 12/5/2020
Duration: 3 minutes, 13 seconds
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About 1 in 50 US adults use stimulants like amphetamines (Adderall), methylphenidate (Ritalin), and modafinil (Provigil) without a prescription, and 80% of them take the drugs to enhance cognition, not to get high. The ethics of all this are vexing, but putting that aside, how well does the practice work? And how does it compare to drug that most of us ingest everyday: Caffeine. [Study Link]
Published On: 12/2/2020
Duration: 4 minutes, 47 seconds
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While medication is the mainstay of treating symptoms in ADHD, Edward Hallowell, MD, shares a positive, relationship-based approach to ADHD with practical strategies to help children and adolescents manage ADHD.
Published On: 11/30/2020
Duration: 18 minutes, 10 seconds
Related Article: "Reimagining ADHD," The Carlat Child Psychiatry Report, January/February/March 2020
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Schizophrenia, autism, addictions, borderline personality disorder, nearly every psychiatric disorder is associated with disrupted circadian rhythms. All of these disorders are treated from time to time with antipsychotics, so how do antipsychotics affect sleep and circadian rhythms? This new systematic review offers some answers. [Link]
Published On: 11/25/2020
Duration: 2 minutes, 53 seconds
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Can psychotherapy have side effects? Michael Linden believes it can, and he launched some of the key studies that shed light on this under-appreciated phenomenon. [Link]
Published On: 11/23/2020
Duration: 26 minutes, 30 seconds
Related Article: "Side Effects of Psychotherapy," The Carlat Psychiatry Report, November 2020
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If we trust the Catie trial, olanzapine is one the most effective antipsychotics for schizophrenia. Why? Despite its trying side effects – particularly weight gain--patients stuck with it the longest, which means it was doing enough good that patients were willing to stick with it despite any side effects it was causing. [Link]
Published On: 11/21/2020
Duration: 2 minutes, 55 seconds
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In March of 2020 sales of alcohol increased by 54% in stores and 262% in online purchases compared to 2019. But then again people were stocking up on everything last March as they hunkered down for an indeterminate quarantine. But what we need to know is how much of that alcohol are people actually drinking? This study by Michael S. Pollard and colleagues from JAMA Open Network compared rates from May of 2019 to June of 2020 using an online survey. [Link]
Published On: 11/18/2020
Duration: 1 minute, 56 seconds
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How the SSRIs were derived from Benadryl, how a forgotten antidepressant almost brought the serotonergic industry to a halt in the 1980’s, and how this all culminated in a Nobel prize and a new theory of dopamine.
Published On: 11/16/2020
Duration: 23 minutes, 34 seconds
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The FDA issued a warning in September about a dangerous game that teens have been playing with Benadryl during COVID. [FDA Safety Info, Study Link]
Published On: 11/14/20
Duration: 2 minutes, 29 seconds
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We’re hearing a lot about people at risk for death with COVID – the elderly, African Americans, men, those with medical problems or low vitamin D, and this new study adds people with mental illness to the list. [Link]
Published On: 11/11/2020
Duration: 1 minute, 48 seconds
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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. Also, the word of the day: delirium mussitans.
Date Published: 11/9/2020
Duration: 17 minutes, 8 seconds
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This month the first systemic meta-analysis of epidemiologic studies of ultra processed foods has come out, and we have a clearer picture of what poor dietary habits do to 300,000 people. [Link]
Published On: 10/3/2020
Duration: 5 minutes, 34 seconds
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In 2004 Morgan Spurlock decided to see what would happen when he ate a typical McDonald’s meal for breakfast, lunch, and dinner. Over the next 30 days, we watched as he gained 24 pounds and developed high cholesterol, fatty liver, and signs of depression in the now classic documentary Supersize Me. [Study Link]
Published On: 10/7/2020
Duration: 3 minutes, 26 seconds
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The FDA keeps recalling medications for contamination with NDMA, and the contamination was recently found in the first-line antidote for antipsychotic weight gain: metformin.
Published On: 11/2/2020
Duration: 13 minutes, 13 seconds
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Chemicals from plastics, pesticides, and food processing are linked to ADHD, according to a new paper in JAMA Open Network. [Link]
Published On: 10/31/2020
Duration: 3 minutes, 1 second
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Xyrem is a branded form of sodium oxybate, the sodium salt of gamma-hydroxybutyrate, or GHB , to precursor to GABA, glutamate, and glycine which is FDA approved for narcolepsy and cataplexy. The news on Xyrem is that the FDA just approved a new version of it – called Xywav – made by Jazz pharmaceuticals. [FDA Prescribing Information]
Date Published: 10/27/2020
Duration: 2 minutes, 4 seconds
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We take you through the story of rational drug discovery that lead to the approval of guanfacine and clonidine for ADHD, and share some tips on how to use them. And the word of the day: Dyssymbole.
Published On: 10/26/2020
Duration: 19 minutes, 55 seconds
Article Referenced: "Guanfacine ER for Adults With ADHD?" The Carlat Psychiatry Report, October 2020
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The hand eye movements of a prescription video game are thought to exercise circuits involved in attention, and this theory did translate to small but real improvements in attention in 5 clinical trials involving over 600 children with ADHD
Published On: 10/24/2020
Duration: 3 minutes, 4 seconds
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Last April we reported on Pimavenserin – Nuplazid – the novel antipsychotic that’s FDA approved in psychosis related to parkinson’s disease. In that article we mentioned a randomized controlled trial from Mass General – the CLARITY trial - that showed promising augmentation effects when Pimavenserin was added to an antidepressant in major depressive disorder. Now comes a secondary analysis of that study, which found a significant reduction in anxiety symptoms as well. [Link and Link]
Published On: 10/21/2020
Duration: 3 minutes, 9 seconds
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We interview Ruta Nunacs on perimenopausal depression, and our word of the day – processomania – brings us into the crosshairs of politics and psychiatry.
Published On: 10/18/20
Duration: 24 minutes, 42 seconds
Article Referenced: "Mood and Menopause," The Carlat Psychiatry Podcast, October 2020
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New labeling from the FDA requires physicians to discuss naloxone with patients or caregivers they are prescribing opioids to. The new guideline also recommends that we prescribe naloxone to anyone who is at risk for opioid overdose, even if we aren’t prescribing them an opioid. That would include patients with a history of opioid overdose and those who use the drugs recreationally.
Published On: 10/17/20
Duration: 2 minutes, 6 seconds
Episode Notes: Naloxone 2 mg/2 ml pre-filled Luer lock–ready needleless syringes with a mucosal atomizer or Narcan nasal spray 4 mg
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Benzo prescriptions have risen 34% during COVID-19, particularly in women. People are also getting benzos outside of prescriptions. Drs. Islam and Choudhry discussed the emerging trend in a commentary in Clinical Psychiatry News. Specifically, they are concerned that people will obtain benzos over the internet, and that this casual use can raise the risk of overdose deaths.
Published On: 10/14/20
Duration: 5 minutes, 36 seconds
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Trintellix claims to improve cognition in depression, but what does this effect look like in patient’s lives? We speak with Tom Gualtieri about the cognitive side of antidepressants, and show you how to use a 3 minute cognitive test that reveals a lot about how your patients are functioning.
Published On: 10/12/20
Duration: 23 minutes, 30 seconds
Article Referenced: "Keeping Up With Trintellix," The Carlat Psychiatry Report, October 2020
Link: The Digit Symbol Substitution Test
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A special edition for patients. Lithium is one of the most effective medications for bipolar and depression, but many of its marvels have remained obscure. Lithium has never benefited from a pharmaceutical ad (because it’s a mineral, not a medicine), so we’ve stepped in to fill that gap.
Published On: 10/5/20
Duration: 23 minutes, 53 seconds
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This month the first systemic meta-analysis of epidemiologic studies of ultra processed foods has come out, and we have a clearer picture of what poor dietary habits do to 300,000 people. [Link]
Published On: 10/3/2020
Duration: 5 minutes, 34 seconds
Got feedback? Take the podcast survey.