withdrawal | CARLAT PUBLISHING

Expert Q&A

Alcohol Withdrawal: What to Watch For on the Psychiatric Inpatient Unit

January 31, 2024

Caridad Ponce Martinez, MD, FAPA, FASAM.

Assistant professor of psychiatry, UMass Chan Medical School, Worcester, MA.

Dr. Ponce Martinez has no financial relationships with companies related to this material.

Dr. Ponce Martinez highlights the need to identify and manage alcohol withdrawal in psychiatric settings, underscoring the use of the CIWA-Ar scale for monitoring symptom progression. While benzodiazepines remain the primary treatment, she reviews alternative treatment strategies and tells us which patients are so high risk that they must be transferred to a medical unit for care.

RESEARCH UPDATE

Is Ibogaine Safe for Opioid Detox?

January 30, 2023

Richard Moldawsky, MD

Richard Moldawsky, MD. Dr. Moldawsky has no financial relationships with companies related to this material.

Ibogaine is being promoted as a natural and safe way to detox from
opioids. Researchers here find that ibogaine is not quite as benign as some might believe.

EXPERT Q&A

Managing Alcohol Withdrawal in the Emergency Department

January 30, 2023

Brian Fuehrlein, MD, PhD

Brian Fuehrlein, MD, PhD.

Addiction psychiatrist. Associate professor of psychiatry, Yale University. Director of the psychiatric emergency department at VA Connecticut. West Haven, CT.

Dr. Fuehrlein has no financial relationships with companies related to this material.

Alcohol withdrawal is among the most commonly encountered scenarios managed by psychiatrists in the ED. Here, Dr. Fuehrlein discusses the natural history of alcohol withdrawal, how best to assess withdrawal risk, and choose between treatment options.

RESEARCH UPDATE

Phenobarbital vs Lorazepam in Alcohol Withdrawal

October 31, 2022

Clayton Barnes, MD

Barnes Clayton, MD. Dr. Barnes, author of this educational activity, has no relevant financial relationship(s) with ineligible companies to disclose.

Barbiturates and benzodiazepines are both commonly used for alcohol detoxification. But how do they compare to one another? Here, researchers found some intriguing benefits of phenobarbital.

10 Psychopharm Commandments: Med Withdrawal

September 26, 2022

Chris Aiken, MD and Kellie Newsome, PMHNP

When to stop meds quickly, and when to do it slowly, in #2 of our 10 Commandment series.

Treating Agitation in ICU Patients with AUD?

May 1, 2022

Jedidiah Perdue, MD, MPH

Jedidiah Perdue, MD. Dr. Perdue has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Patients with AUD who are hospitalized in ICUs have high rates of agitation. Researchers here investigate whether treatment with baclofen might improve outcomes.

Nicotine Patch for Cannabis Withdrawal?

July 3, 2021

John O’Neal, MD.

John O’Neal, MD. Dr. O’Neal has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

As cannabis use becomes more widespread, treaters will inevitably see increases in patients reporting symptoms of cannabis withdrawal. Researchers in this study investigated whether a nicotine patch might help mitigate some of these symptoms. Results were not particularly promising, and should only be considered for patients who also use tobacco.

Management of Opioid Withdrawal in the Emergency Setting

March 19, 2021

Rehan Aziz, MD.

Rehan Aziz, MD. Associate Professor of Psychiatry and Neurology, Rutgers Robert Wood Johnson Medical School. Dr. Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

An emergency department visit can be a “reachable moment” for people with unhealthy opioid use. Here, we review pharmacologic and harm-reduction strategies for use in those settings—and how to advocate for your patients when consulting with emergency clinicians.

How to Come Off a Psych Med Part 2: Antidepressants, Stimulants, and Benzos

March 11, 2021

Swapnil Gupta, MD

Swapnil Gupta, MD

Associate Professor at Icahn School of Medicine at Mount Sinai. Co-author of Deprescribing in Psychiatry (Oxford, 2019). Dr. Gupta has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

What do you do when a patient comes to you on a high dose of Adderall and Klonopin without any clear reason to be on them? Swapnil Gupta tackles this in part II of our interview on deprescribing, and describes how to fine-tune and microdose antidepressants and benzodiazepines to manage withdrawal symptoms.

Kratom: A Primer

February 3, 2021

Alison Knopf

Alison Knopf Editor, Alcoholism & Drug Abuse Weekly Ms. Knopf has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

With opioid-like properties, kratom’s recreational use is increasingly reported among those seeking pain relief or a high. This primer reviews what’s known about this unregulated substance, how to talk about it in the clinic, and early evidence on how to treat its withdrawal syndrome.