polypharmacy | CARLAT PUBLISHING

Research Update

Antipsychotic Polypharmacy: Maybe Not So Risky After All?

July 1, 2024

Sébastien Hardy, MD. Dr. Hardy has no financial relationships with companies related to this material.

The findings of this large study offer some reassurance about the safety and efficacy of antipsychotic polypharmacy, despite general treatment guidelines cautioning against it.

Expert Q&A

Decoding Drug Promotion Tactics in Geriatric Psychiatry

January 1, 2024

David Healy, MD, FRCPsych

David Healy, MD, FRCPsych. Chief Scientific Officer, Data Based Medicine Ltd, Bangor, Wales, UK.

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

From our evidence base to continuing medical education, Dr. David Healy reveals the vast influence of pharmaceutical marketing and offers tips on how to minimize bias.

Clinical Update

Addressing Polypharmacy in Older Adults

January 1, 2024

Jose Antonio Ribas Roca, MD and Carolyn TK Tran, PhD

Jose Antonio Ribas Roca, MD. Associate Professor, Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Carolyn TK Tran, PhD. Instructor, Psychiatry and Behavioral Sciences Baylor College of Medicine, Houston, TX.

Dr. Ribas Roca and Dr. Tran have no financial relationships with companies related to this material.

Managing polypharmacy in older adults can be tricky, especially when multiple clinicians are involved. We offer tips on how to find the right medication and dose while avoiding prescribing cascades. We also discuss how to use shared decision-making to deprescribe.

Psychopharm Commandments 8A: Polypharmacy Makeover

May 1, 2023

Chris Aiken, MD and Kellie Newsome, PMHNP

How to reduce unnecessary polypharmacy, and when it makes sense to keep it going.

The Evidence Base for Polypharmacy in ADHD

March 24, 2022

Pavan Madan, MD.

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

Often our patients with ADHD do not seem to respond adequately to one medication. We try different medications and we try combining them, but does it work? This study looked at the outcomes for stimulants alone and in combination with central alpha agonists, divalproex, and risperidone. Does polypharmacy work? Read it and see!

EXPERT Q&A

The Schizophrenia-OCD Overlap

September 28, 2021

Michael Poyurovsky, MD

Michael Poyurovsky, MD

Ma’ale HaCarmel Mental Health Center, Tirat Carmel, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. Dr. Poyurovsky has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

OCD and schizophrenia often overlap, but treatment of this comorbidity is risky terrain. Dr. Poyurovsky explains when antidepressants should be avoided and details which antipsychotics are more likely to exacerbate OCD and which ones are more likely to help it.

Are SSRIs Associated With Increased Rates of Violence?

February 3, 2021

Michael Posternak, MD.

Michael Posternak, MD. Dr. Posternak has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

SSRIs are often used to reduce irritability, but questions about they can cause violence have loomed over these antidepressants since the early 1990’s. This new study, with 700,000 patients followed over 7 years, suggests they can.

The “Z-Drugs”: Safety Issues and Misuse Potential

June 10, 2020

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.

Once heralded for their relative safety compared to benzodiazepines, the “Z-drugs” are now known to be one of the most common causes of adverse drug events. Here we review the risks of Z-drugs and highlight updated dosing recommendations for zolpidem.

Muscle Relaxants: Sedatives Often Under the Radar

June 10, 2020

Michael Weaver, MD, FASAM.

Michael Weaver, MD, FASAM. Professor and medical director at the Center for Neurobehavioral Research on Addictions at the University of Texas Medical School. Author of Addiction Treatment (Carlat Publishing, 2017). Dr. Weaver has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Muscle relaxants encompass medications with different mechanisms of action—many of which have been used for decades. Yet most are sedating, can have significant side effects, and can interact with opioids and other substances to worsen CNS and respiratory depression.

Tips for Good Medication Practice

June 28, 2019

The following are some recommendations on good medication practice from child psychiatrist Mark Chenven, MD, who offered his expertise in The Carlat Child Psychiatry Report:Start low, go slow: Most side effects are dose related, so gradual up-titration is simple common sense. This allows for the body’s homeostatic and regulatory mechanisms...