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Prazosin for PTSD-Related Nightmares: Rationale and Dosing Strategies for Men and Women

David N. Osser, MD Associate Professor of Psychiatry Harvard Medical School Brockton Division of the VA Boston Healthcare System In this video, Dr. David Osser explains the rationale behind the recommendation of using prazosin as first-line treatment for PTSD-related nightmares and disturbed arousals. He also gives practical advice on different dosing strategies for men and…

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Buprenorphine Formulations: A Practical Summary for Clinicians

Joji Suzuki, MD Director, Division of Addiction Psychiatry Department of Psychiatry, Brigham and Women’s Hospital Assistant Professor of Psychiatry, Harvard Medical School This presentation discusses current buprenorphine formulations available for the treatment of opioid use disorder and the rationale for the buprenorphine/naloxone combination. One important concept to remember is that the combination tablet containing both…

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The Neurobiology of Behavioral and Psychological Symptoms of Dementia: An Illustrated Update

Author: Rajesh Tampi, MD Behavioral and psychological symptoms of dementia (BPSD) include a heterogeneous range of psychological reactions, psychiatric symptoms and behaviors. This presentation discusses the neurobiology of BPSD by addressing anatomical, biochemical and functional changes associated with this group of symptoms. Download PDF BPSD tends to occur because of a complex interaction between anatomical,…

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Psychopharmacology of Sleep and Wakefulness: Understanding Neurotransmitters and Pathways in Clinical Practice

Author: Flavio Guzman, MD This tutorial integrates neurotransmitters involved in sleep and arousal with the pharmacology of specific psychotropic agents. We review neurotransmitters that promote wakefulness (dopamine, norepinephrine, serotonin, acetylcholine, histamine, orexin/hypocretin) and summarize how current drugs influence each system. We also discuss neurotransmitters that promote sleep (adenosine, GABA, melatonin). Download PDF This is an…

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Fluvoxamine Essentials: Mechanism of Action, Indications, Pharmacokinetics and Dosing

Author: Flavio Guzman, MD Besides being a SERT inhibitor, fluvoxamine is an agonist at sigma 1 receptors. The drug is approved in the US for the treatment of OCD but not depression. This is interesting as this is a widely used antidepressant in other countries. Fluvoxamine has the potential for drug-drug interactions through inhibition of…

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Cannabis and Mental Health: 2017 Report of the National Academy of Sciences, Engineering and Medicine

Author: Flavio Guzman, MD The National Academies of Sciences, Engineering, and Medicine published a report on the health effects of cannabis and cannabinoids. Here we reproduce the key points of the mental health chapter. You can access the full publication here. Psychosis and schizophrenia Cannabis use is likely to increase the risk of developing schizophrenia…

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Sertraline Essentials: Mechanism of Action, Indications, Pharmacokinetics and Dosing

Author: Flavio Guzman, MD Sertraline is a moderate inhibitor of CYP2D6. In terms of drug-drug interactions this is not as significant as with fluoxetine or paroxetine. It has a similar side effects profile to other SSRIs. The dosage range goes from 50 to 200 mg/day. Pharmacology and MOA   Sertraline is an inhibitor of the…

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2016 in Review: A Psychopharmacology Update for Clinicians

Author: Flavio Guzman, MD Dr. Guzman has no conflicts of interest to disclose. In this article we take a look back at the most clinically relevant news of 2016 in the field of psychopharmacology. In terms of new drugs, only one new molecular entity of psychiatric interest was approved (Pimavanserin, for Parkinson’s disease psychosis). We…

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Antidepressant Discontinuation Syndrome: Diagnosis, Prevention and Management

Author: Flavio Guzman, MD Discontinuation symptoms can occur with all antidepressant classes, and you will see many articles referring to SSRI discontinuation syndrome. The reason is that SSRIs are by far the most commonly prescribed antidepressant class. This syndrome consists of usually mild and reversible symptoms that can be grouped into six categories. As a…

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Lithium’s Mechanism of Action: An Illustrated Review

Author: Flavio Guzman, MD Lithium’s mechanism involves multiple levels of action, from macroscopic neuroprotective effects to intracellular changes. This tutorial discusses: Brain abnormalities found in patients suffering from bipolar disorder How lithium modulates dopamine, glutamate and GABA Intracellular changes associated with lithium use (effects on proteins such as PKC, MARCKS, GSK-3, IPPase and IMPase) Unravelling…

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