Chris Aiken, MD

Editor, Carlat Psychiatry Report.
Assist Prof, NYU & WFU medical schools.
Never received pharma funding.
Posting daily research to learn, discuss, debate.

[Chris Aiken, MD @chrisaikenmd]

A daily dose of practice-changing research from the editor of the Carlat Psychiatry Report

[Chris Aiken, MD @chrisaikenmd]

How to disguise a drug-trafficking ring as a medical practice:
▪ Remove non-ADHD screening questions
▪ Incentivize clinicians with up to $720,000 a year (and fire those who resist)
▪ Advertise rapid #ADHD assessments

It's all in the Done convictions:
https://t.co/FnBYUmxX1v

[Chris Aiken, MD @chrisaikenmd]

Cannabis impairs cognition, but does the brain recover?

Yes, with memory improvements within a week, but heavy users and teens don't rebound as well.

Learn more and meds for cannabis use disorder:
https://t.co/sTBpn904Z4

[Chris Aiken, MD @chrisaikenmd]

Here's why experts recommend lithium/anticonvulsants 1st in bipolar:
▪ Lasting remission
▪ Cognitive/functional outcomes
▪ Lower suicide and mortality rates
▪ Addresses underlying biology

From Rif El-Mallakh et al:
https://t.co/MDjrVi4cGv

[Chris Aiken, MD @chrisaikenmd]

Yes, there are randomized trials of open vs locked wards in psychiatry, and this analysis of 9 in depression finds a meaningful benefit in adherence and a small difference in mood:
https://t.co/uFYVjvYm0W

Paging Dr. Pinel...

[Chris Aiken, MD @chrisaikenmd]

Saffron improved depression, anxiety, self-esteem in new trial of 86 older women with mild symptoms:
https://t.co/Xvoi5ecJ3u

The herb now has 5 large and 27 small RCTs in depression/anxiety, with a few benefits unique to women. Cost is low, side effects few, and blind intact.

[Chris Aiken, MD @chrisaikenmd]

@DrPsiquiatraMx One positive and one negative trial (which is true for most psych uses!) so maybe

[Chris Aiken, MD @chrisaikenmd]

Updates on n-acetylcysteine

1. A positive OCD trial, but past trials are mixed:
https://t.co/uA4YOskOMc

2. Reduced menstrual pain in RCT
https://t.co/WZgYCK9vOJ

3. Summary of its medical benefits
https://t.co/q3xnjnd7nl

[Chris Aiken, MD @chrisaikenmd]

New analysis ranks meds for bipolar depression, homing in on optimal doses for each (on average):
https://t.co/6U7cpOLCrL

Some surprises - pindolol, amisulpride, NAC, inositol, ziprasidone - but not all are ready for practice.

[Chris Aiken, MD @chrisaikenmd]

In the new Carlat Psychiatry Podcast:

▪ 9 ways to treat premenstrual syndrome that aren't SSRIs
▪ Best and worst contraceptives for mood
▪ New use for lavender
▪ New FDA-approved device for PTSD

https://t.co/aNP49EtPss

[Chris Aiken, MD @chrisaikenmd]

@Drsikorav Yes dose is everything. Same with alcohol

[Chris Aiken, MD @chrisaikenmd]

Which benzos are riskiest?

Large cohort study points to alprazolam, clonazepam, multiple benzos, and high doses:
https://t.co/F5J17s6f9c

But other factors (severity) could explain the correlation, despite efforts to control for that.

[Chris Aiken, MD @chrisaikenmd]

This study tested two types of AI therapists for social anxiety, one modeled on CBT and one on psychodynamic. The differences, marginal:
https://t.co/AmDOMcEMYl

[Chris Aiken, MD @chrisaikenmd]

Join me with Joe Goldberg for a Deprescribing Webinar with CME, sponsored by SAMHSA
▪ Thur July 16 3:00-4:30 PM EST
▪ Free

Register here:
https://t.co/9NG2jmzRoi

[Chris Aiken, MD @chrisaikenmd]

Prucalopride (Motegrity) is a gut motility drug approved for chronic constipation that also stimulates serotonin-4 receptors in the brain

In this small RCT, it improved cognition in remitted depression. A start, but more data needed:
https://t.co/RD5RNYfzJ3

[Chris Aiken, MD @chrisaikenmd]

ABA therapy may be evidence based, but critics argue it
▪ Forces conformity
▪ Suppresses adaptive behaviors like stimming
▪ Centers on neurotypical goals rather than well-being

Here, both sides came together to find common ground and new directions:
https://t.co/s8iSPTRWSY

[Chris Aiken, MD @chrisaikenmd]

New prolonged-release oral ketamine dampens the cardiac and dissociative risks, but I'm not sure it worked in this phase II trial.
https://t.co/mSQJZhNfKW

Low bioavailability, but dosed high to account for that.

[Chris Aiken, MD @chrisaikenmd]

@drmanejwala You should write that up in a paper. The time is now.

[Chris Aiken, MD @chrisaikenmd]

A new paper in JAMA asks: "Why did the FDA approve an antidepressant that failed in 11 out of 13 trials?"

Here's a summary:
https://t.co/AydA4dgWj4

#psychiatry #pmhnp #depression

[Chris Aiken, MD @chrisaikenmd]

@BadreNicolas Vyvanse does achieve a larger effect size at a smaller dose equivalence though (likely due to less dose dumping), and less “drug liking” than other amphetamines. The PK graph Bryan posted is more in line with those clinical findings; I’d trust clinical over PK

[Chris Aiken, MD @chrisaikenmd]

What drives psych over-medication?

Intolerance of uncertainty, action bias, fears of legal outcomes if nothing is done, and more, argues new paper. Get the details and key areas where high doses and polypharmacy aren't evidence based:
https://t.co/2lzpIikF9Z

[Chris Aiken, MD @chrisaikenmd]

@CymandeBR Rare is based on number of case reports. I do see it 1-2 times a year

[Chris Aiken, MD @chrisaikenmd]

Has anyone seen antipsychotics trigger mania?

This lurasidone case report and systemic review suggest it's a real but rare possibility:
https://t.co/NDFuqYR4mD

#psychiatry #pmhnp