In this newsletter, we look into how COVID-19 has influenced telepsychiatry. We also share the latest information on perinatal psychopharmacology, key points from a presentation on sleep issues in psychiatry, our practical research summaries (Quick Takes), and our new live webinars.
What’s New: Telepsychiatry: “The Genie Is Out of the Bottle”
“The genie is out of the bottle on this,” said Dr. Jay Shore, Director of Telemedicine at the Helen and Arthur E. Johnson Depression Center and Director of Telemedicine Programming for the department of psychiatry at the University of Colorado at Denver, Aurora.
How will medical practices return to pre-COVID-19 ways? We don’t know yet, but telepsychiatry is clearly an option. Patients and clinicians alike have learned that it is possible and sometimes even preferable to offer services through telepsychiatry.
Some tips for successful telepsychiatry:
- Work out the technical issues before the first patient appointment.
- Keep an on-screen professional environment, with privacy and no interruptions.
- Use the “share screen” feature for interactive activities.
Click here and here to learn more.
Expert Consultations: Perinatal Psychopharmacology—Helping Patients Make Decisions in Pregnancy—With Dr. Vivien Burt
In this interview, Dr. Vivien Burt discusses the use of antidepressants, stimulants, and insomnia medications in pregnancy and the postpartum. She also guides clinicians on how to talk to patients about their best options and possible nonpharmacologic strategies.
Interview highlights:
- Avoid paroxetine in pregnancy.
- Stimulant use during pregnancy and breastfeeding is not absolutely contraindicated but will affect the infant.
- Zolpidem is not associated with congenital malformations, according to the available data.
Learn more, and earn 0.5 CME credits here.
Podcast: Clinical Pearls in Perinatal Psychiatry
Continuing the theme of perinatal psychiatry, listen to our open podcast episode where we explore the case of Rosa, a 36-year-old pregnant woman with a history of depression. Learn how to discuss and adjust pharmacotherapy, psychotherapy, and other factors in this clinical scenario.
Podcast key points:
- “Satisficing” means to choose among treatment options that will safeguard the mother’s health and optimize the health of her baby in a way that she can live with.
- Psychotherapy should be an integral part of the treatment plan.
- Depression in pregnancy is associated with an increased risk for poor obstetric outcomes.
- Transient neonatal adaptive difficulties may occur with antenatal antidepressant exposure; it is, however, transient and has no long-term implications.
- Breastfeeding is a choice, and conversations about sleep deprivation and pharmacotherapy during this time are important.
Video Lecture: The Clinical Guide to Sleep Issues in Psychiatry
Insomnia and other sleep-wake disorders are common in psychiatry practice and need to be adequately recognized and treated. Treatments include nonpharmacologic approaches, like BBTI, and pharmacologic ones, like benzodiazepines, hypnotics, and sedating antidepressants and antipsychotics.
You can earn 1.0 CME credit here.
Pharmacotherapy for Insomnia
- Ramelteon may be useful in patients with difficulty falling asleep.
- Suvorexant is an orexin receptor antagonist that reduces intermittent wakefulness and wake time after sleep onset.
- Sedative antipsychotics are not recommended in older adults. Learn more.
Quick Takes: Informing Your Practice
Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression
- Nasal esketamine, administered twice a week for 3+ weeks, was superior to nasal saline—but only up to 2 weeks. After that, placebo caught up. At an 81-day follow-up, remission was 50% for placebo and 60% for esketamine (p = 0.8). Learn more.
Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial
- Cannabidiol reduced craving for heroin when long-time users were faced with strong use-related cues but had minimal impact on craving in the absence of those cues. This article teaches us about the endocannabinoid reward pathway and cannabidiol’s subtle effects there. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
Behind the Scenes: New Developments on the Platform
We want to interact more with our subscribers! In our trial live webinar with Dr. Michael Thase, 160 premium members enrolled and had the opportunity to ask clinically focused questions on anxiety and depression.
We are working on possible future live webinars on a number of interesting topics, such as OCD during COVID-19 times. Stay tuned!
References
1. Society of Hospital Medicine. (April 9, 2020). COVID-19: A guide to making telepsychiatry work. The Hospitalist. Retrieved from https://www.the-hospitalist.org/hospitalist/article/220510/business-medicine/covid-19-guide-making-telepsychiatry-work/page/0/1
2. Caudill, R. (May 11, 2020). We’re All Telepsychiatrists Now. Psychiatric News. Retrieved from https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2020.5b33
