When I completed my residency training in 2017 I never imagined so much of my clinical efforts would be directed towards educating patients about controlled substances. As I stepped into clinical practice and took over patients who had long-term relationships with providers that had retired or moved to other positions I began to notice a preponderance of patients, some elderly, taking benzodiazepines daily, frequently at high doses. Often conditions other ...

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Since finishing my medical training recently, many of my friends have embraced their newfound freedom as attendings in traditional ways: reviving long-neglected hobbies, finally exercising regularly, enjoying more time with loved ones. Me? I joined Twitter. It may seem like a strange step, but after years of caution regarding the perils of social media as a physician (and more specifically, as a child, adolescent and adult psychiatrist), it was only once I ...

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I remember Grandpa Larry’s visits remarkably vividly. He would lumber into the house hunched over, grunting loudly and reeking of cigarettes. He was unshaven and haggard, with wild grey-black hair streaking out horizontally from the sides of his head. He would rock and turn uncomfortably until he could find a chair, then once seated would begin rhythmically swaying back and forth. He spoke in a flat, rough voice. He had ...

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"You ever work with vets?" asks the young man sitting across from me in the hospital waiting room. He's been sitting there all morning. So have I. Since 5:30 a.m., my father-in-law, 88, has been undergoing surgery to remove a tumor in his lung. The surgeons just sent word that they've finished, and my wife and her mother have gone to the post-op room to see him. Waiting for them to return, ...

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K: “I was assaulted by an intoxicated female. She punched me and ruptured two discs in my back. I lost my whole self. I could no longer take the CPR course required. I lost my income that was supporting me and my three children. I needed the narcotics — not only to dull the physical pain but to numb the emotions. I found myself taking more than prescribed. I asked the ...

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There are roughly 15 percent of the nation’s children who suffer from a developmental-behavioral condition or about 1 in 6 children. Unfortunately, many of those children often do not get the help they need. Children with developmental and behavioral challenges can easily be missed, especially when the behaviors are more subtle or impacts on function are not evident daily, such as with
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I was standing behind my trolley in our local supermarket when, in my wallet, I came across that drawing of a human heart. In the miniature pen-and-ink composition, the heart is suspended between two birds’ wings. At the bottom is a dateline: Opioid Vigil, October 19, 2012. Memory is a slippery thing, but I recall the 20-something artist as tall and rangy. At that opioid vigil, he sat behind the exhibit table, ...

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Recently, the Food and Drug Administration approved a nasal spray version of the drug Ketamine, named Spravato (esketamine), for use as a supplement to oral antidepressants taken by adults living with treatment-resistant depression. The announcement was accompanied by a flurry of media excitement as Spravato is the first medication for depression with a new mechanism of action since Prozac (fluoxetine hydrochloride) was approved in the late 1980s. The risks ...

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Some children present to me with complex problems or multiple problems that fail to resolve after the typical interventions. I recall a child with severe abdominal pain. He had tried numerous medicines and had had scopes and studies galore. It had reached the point where he was being scheduled for exploratory surgery to try and see the cause of his pain. I lost track of his case when I rotated elsewhere ...

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I found myself in the privileged position recently of participating in the National Stop the Bleed Research Consensus Conference, at the table with an extraordinarily committed and compassionate group of thought leaders exploring the role, challenges and implications of this crucial initiative. My perspective as a consultation-liaison psychiatrist interested in trauma-informed care was aptly described as “a different lens,” though my colleagues appeared to require no convincing of its relevance. When ...

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