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Psychotropics and Gastrointestinal Conditions: Prescribe with the Gut in Mind

Here is a summary of this episode: Always ask about over-the-counter drugs like antacids, antiemetics, and spasmolytics as they may interfere with drug absorption. In patients who have undergone gastric bypass, use immediate release formulations, or give liquid form of drugs. There is evidence to suggest that IBS-constipation responds better to SSRIs and IBS-diarrhea to TCAs. The risk of GIT bleeding with SSRIs is 1.5 to 2 times greater. Patients with a defect in platelet number or function...


Clinical Pearls in Geriatric Psychopharmacology

Here is a summary of this episode: Geriatric Psychopharmacology Today’s topic is geriatric psychopharmacology. Do one thing at a time. Start low and go slow with medication titration and avoid PRN prescribing. Avoid medications on the Beers list like antihistamines, anticholinergics, and tricyclic antidepressants. In patients with diabetes or those prone to orthostasis, consider ziprasidone or aripiprazole. For glaucoma, consider aripiprazole, risperidone, and quetiapine. For those with...


Treatment-Resistant Depression: Clinical Conundrum

Today’s question is: How to manage treatment-resistant depression? Here is a summary of this episode: The first step in the management of treatment-resistant depression (TRD) is adequate history taking and assessment for comorbidities and bipolar depression. Augmentation is more effective than switching. Adding lithium is effective particularly in suicidal patients. Modafinil and T3 have been shown to be good add-ons in patients with fatigue. Psychosocial interventions such as mindfulness...


How to Manage an Agitated Patient?

Today’s question is: How to manage an agitated patient? Here is a summary of this episode: Antipsychotics are the mainstay of treatment; addressing psychotic agitation as well as treating delirium. Haloperidol is best combined with a benzodiazepine, showing both high efficacy and low side effect profile. There are currently no FDA-approved oral regimens for agitation. However, there are orally disintegrating formulations of olanzapine, aripiprazole and risperidone. Asenapine is available in...


When to Discontinue Antipsychotics? Reviewing the Evidence

Today’s question is: When is the right time to discontinue an antipsychotic in the treatment of schizophrenia? We reviewed the evidence as well as consulting Dr. Ira Glick to help us answer this question. Here is the summary of the podcast: The APA guidelines (2004, updated 2009) recommend indefinite antipsychotics for patients with multiple episodes or two episodes within 5 years. The WFSBP 2013 guidelines recommend antipsychotic maintenance for least 1 year in first-episode psychosis and 2...


Are Drug Interaction Warnings Influenced by Drug Company Promotion? An Interview with Dr. Jeffery Mattes

Dr. Jeffrey Mattes, psychiatrist in Princeton, New Jersey speaks about drug interaction warnings that appear during electronic prescribing and how these warnings may be influenced by drug company promotion. This interview is part of a series covering the 2018 ASCP Annual Meeting. Here is the summary of this interview: Drug interaction warnings are issued by drug compendia, which claim to be independent of drug company influence. However, this has been recently questioned and there are...


Psilocybin for Treatment-Resistant Depression - Dr. Robin Carhart-Harris

Dr. Robin Carhart-Harris speaks about the use of psilocybin for treatment-resistant depression. Here are some key points from this interview: - Psilocybin, a psychedelic, is a 5-HT2A agonist. Stimulation of the 5-HT2A receptor promotes neural plasticity -A potential mechanism of action of psilocybin in treatment-resistant depression involves “brain resetting” - Psilocybin has a good safety profile. However, patients may experience challenging psychological experiences that may turn out to be...


Are Psychopharm Algorithms Bad for You?

At the 2018 Annual Meeting of the American Psychiatric Association, Dr. Robert Patterson (psychiatrist at McLean Hospital Boston) spoke about the benefits of following a structured approach to psychopharmacology. In this episode, Dr. Patterson explains why algorithms are good for patient outcomes and how they support clear decision making. Get our key points from the 2018 APA Annual Meeting here