In the final episode of our second psychopharmacology series, we will discuss how to manage antipsychotic side effects. Side effects are quite common for patients taking antipsychotics unfortunately. Knowing how to manage common antipsychotic side effects is incredibly valuable for your patients as it can improve tolerability and treatment compliance. We’ll provide a broad overview for how to conceptualize the treatment of side effects based on which receptors are targeted by the drug. We’ll discuss general principles for managing side effects and then review how to manage specific side effects including extrapyramidal symptoms, hyperprolactinemia, metabolic syndrome, orthostatic hypotension, and more!

Photo Credit: Hernan Pinera, “Move,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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In today’s episode of our psychopharmacology series, we will discuss insomnia and treatments for insomnia. Most of the time, sleep medications are not the solution for addressing insomnia! We’ll briefly describe cognitive behavioral therapy for insomnia (CBT-I), which is THE first line treatment for insomnia.  We will then review 6 different classes of medications used to treat insomnia including benzodiazepines, non-benzodiazepine sedative hypnotics (i.e. Z-drugs), melatonin agonists, TCAs, orexin receptor antagonists, and miscellaneous non-FDA approved medications for insomnia. We’ll discuss the evidence base for these medications in treating chronic insomnia (hint: it’s not good) and what factors might make you choose behavioral treatment versus medications. We’ll then review common side effects of sleep medications and test your clinical reasoning with some cases!

Photo Credit: Joao Santos, “Smooth Antelope Canyon b&w,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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In today’s episode, we will discuss benzodiazepines, a commonly used type of sedative-hypnotic medication. We will start by reviewing their mechanism of action, common indications for use, contraindications for use, and side effects. We’ll also discuss how to differentiate benzodiazepines based on their unique pharamacologic properties. Finally, we’ll explore some of the controversy around benzodiazepines, particularly in the treatment of chronic anxiety or insomnia, and provide some general guidelines to consider before prescribing these medications to patients.

Photo Credit: Juan Carlos Molina Gimenez, “Ice and Geometry,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

The Rolling Stones, “Mother’s Little Helper,” Forty Licks

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We are revisiting psychopharmacology in our second psychopharm series. We will kick things off by talking about the “older antidepressants”- tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). While these medications are used less frequently than SSRIs due to their side effect profiles, both TCAs and MAOIs have their select uses in psychiatry (i.e. treatment resistant depression or comorbid pain). We’ll discuss the history behind TCAs and MAOIs, their respective mechanisms of action, common class side effects, and specific medications within each class. We’ll also review unique considerations with MAOIs (including dietary restrictions, hypertensive crisis, and serotonin syndrome) and TCAs (including cardiac toxicity in overdose).

Photo Credit: CiaoHo, “DSC_4598,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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In the second episode of our series on somatic treatments in psychiatry, we will discuss transcranial magnetic stimulation, otherwise known as TMS. TMS is a newer procedure used to treat depression and represents an alternative to medications and ECT. We will review the mechanism of action for TMS, what is entailed in the procedure, indications for TMS, medical contraindications, and potential side effects.

Photo Credit: Jeremy Brooks, “Anti-Mass, Plate 1,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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In the first episode of our series on somatic treatments in psychiatry, we will discuss electroconvulsive therapy, otherwise known as ECT. ECT is one of the few procedures used in psychiatry. Despite its excellent safety record and remarkable efficacy for treating many psychiatric disorders, there is still significant stigma around ECT. We’ll dispel some of the myths around ECT and explain how ECT differs from the sensationalized portrayals of ECT in the media. We’ll discuss its uses in psychiatry, focusing particularly on treatment-resistant depression. We’ll also review the medical evaluation in ECT and side effects of ECT including general medical risks and cognitive side effects.

Photo Credit: Thomas Hawk, “I Think I’ll Park It Here,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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In the final episode of our psychotherapy series, we will discuss cognitive behavioral therapy (CBT).  We’ll review the cognitive triangle and illustrate how our thoughts, behaviors, and feelings influence one another using a hypothetical scenario.  Finally, we’ll discuss the rationale behind key CBT concepts and techniques including monitoring, behavioral activation, relaxation, exposure, cognitive errors, and cognitive restructuring.

Photo Credit: Kaisea, “Retail Therapy,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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In the second episode of our psychotherapy series, we will discuss supportive and psychodynamic therapy. To illustrate principles of supportive and psychodynamic therapy, we will do a role play and then afterward, use the role play to explore the difference between supportive and dynamic approaches to the situation. We will discuss how to use reflections and validations in your interviews with patients, and we will also explore key concepts in psychodynamic therapy including defense mechanisms, transference, countertransference, and more!

Photo Credit: Ming Chun Or, “Or week 2 06–Cut off,” Flickr

Episode Music Credit: Javier Suárez, Tumbling Dishes, Better With Music

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In the first episode of our miniseries on psychotherapy, we will provide an introduction to psychotherapy, one of psychiatry’s most powerful and misunderstood tools. We will discuss common misconceptions about therapy and provide you with a clear picture of what psychotherapy is and what it isn’t. We’ll discuss who goes to therapy, how to access therapy, and the most common therapeutic frameworks used in therapy including supportive/psychodynamic, CBT, DBT and ACT. Finally, we’ll identify common factors that are universal to all psychotherapies.

Photo Credit: micaeh, “sit in,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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Now that we can identify common intoxication/withdrawal syndromes, we will shift our focus to substance use treatment in the second part of our two-part series on substance use. While therapies are a huge part of substance use treatment, we will primarily discuss medication management of withdrawal and relapse prevention. By the end of this episode, you will have a better sense of how to manage withdrawal and prevent relapse for patients with alcohol, benzodiazepine, nicotine, stimulant, opioid, cannabis, and hallucinogen use disorders. We’ll also highlight key medications that have been used to fight the opioid epidemic including suboxone, methadone, naltrexone, and naloxone.

Photo Credit: Curtis Simmons, “the monaco-sails-into sandstorm-burning-man-2014,” Flickr

Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

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