Long acting injectable aripiprazole for bipolar one patients has been shown to significantly reduce the risk of a recurrence of a mood episode in a 52 week placebo controlled clinical trial. Poor adherence to treatment is a significant problem in patients with bipolar disorder, putting patients at increased risk of recurrence of mood episodes, hospitalization, and suicide. One other study …
Fee Increase 2017
We hope 2017 is off to a good start! We look forward to working with and supporting you in your goals toward mental health and wellness. We wanted to get in touch as we enter a new year, as we regularly examine our fee scales during this time. In preparation for this task we reviewed data on health care costs …
TMS for Anxiety
“How effective is TMS for anxiety?” The young woman with a remarkable history of serious adverse effects from multiple trials of psychiatric medications for anxiety recently asked me this question. This post summarizes the results of a thoughtful literature search using the UCSF medical library, data from the Medical Affairs departments for two of the TMS manufacturers, and clinical experience …
Long Term Depression Psychotherapy
Effective psychotherapy for depression that has lasted for years is needed because chronic depression (lasting two years or longer) develops in up to a third of people with an episode of major depression. Chronic depression is associated with more suicidality, more impairment in functioning, and more hospitalizations. Chronic depression psychotherapy is often less effective than therapy for other forms of depression. …
Marijuana Potency and Psychiatric Adverse Effects
The steady increase in THC content raises a question about the relationship between marijuana potency and psychiatric adverse effects which is summarized in an article in Current Psychiatry by Joseph M. Pierre, MD, Health Sciences Clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA in the February 2017 issue. The table below summarizes data about …
Significance of Events and Serotonin 2A
Making sense of the constant bombardment of information and sensory experience that all of us face requires the ability to determine the significance of events, and an elegant study suggests that the serotonin 2A receptor plays a critical role in determining significance. Many psychiatric conditions and human experiences are associated with the misattribution of meaning to events. For example, delusional disorder …
Low Dose Atypical Antipsychotics Are Better for Bipolar Depression
An analysis of several studies comparing low and high doses of atypical antipsychotics finds that low dose atypical antipsychotics are better for bipolar depression. In general, the therapeutic effects are the same, but side effects are significantly less with lower doses. The study reviewed the data from seven clinical trials of high and low doses of quetiapine (4 trials), cariprazine, lurasidone, and …
Poverty and Adversity Changes Brain Function
A remarkable study published in the journal Molecular Psychiatry identifies ways that the experience of poverty and adversity changes brain function. Specifically, the study finds that adolescents growing up in lower socioeconomic environments are more likely to have the gene that codes for the serotonin transporter protein methylated in a region that is associated with increased reactivity of the amygdala to threat. …
Atypical Antipsychotics with Mood Stabilizers
Many people with bipolar receive atypical antipsychotics with mood stabilizers. As in many areas of medicine, we have relatively little data about longer-term outcomes when people receive this combination. If an atypical antipsychotic is added to a mood stabilizer to control a manic episode, how long should that combination be prescribed? A recent study conducted by the Canadian Mood and …
UCSF Bipolar Education Group Starts Again
Dr. Descartes Li, an expert in Bipolar Disorder at UCSF runs an excellent 8 session program for people with bipolar who are interested in learning more. Here is the latest information about the group which starts at the end of February. The UCSF bipolar psychoeducational group starts on February 27, 2017. It runs for 8 sessions, Mondays 12pm to 115pm. …