Ask A Psychiatrist

著者： Erik Messamore
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  • Ask a Psychiatrist is a podcast where a real psychiatrist answers real questions about health, illness, recovery, and well-being. The host of Ask a Psychiatrist is Dr. Erik Messamore, a board-certified psychiatric physician and PhD-level pharmacologist. He is a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar. Dr. Messamore is joined on the podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate. Ask a Psychiatrist is driven by the philosophy that giving people accurate and complete information about the causes of illness and suffering – and the full range of tools for wellness and recovery – will help people ask the right questions of their therapists and doctors. This kind of knowledge will make them better negotiators at getting the right kinds of care. They’ll get better results. And they’ll drive the profession toward better practice. - Sign up for news about the podcast launch. - Send us a question. - And tell your friends about Ask A Psychiatrist. Let’s spread useful knowledge far and wide.
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  • Ep. 012 - How to reverse weight gain from antipsychotic medication?

    Ep. 012 - How to reverse weight gain from antipsychotic medication?
    2021/11/12
    This episode deals with the question of weight gain from antipsychotic medication: I'm on 20 milligrams of olanzapine. It's helping me and I don't want to change it. The only thing is that I've gained a lot of weight that makes me feel very unattractive. I’ve spoken to my psychiatrist about it, but I haven't gotten any guidance on the matter. Are there any solutions to weight gain from this kind of medicine? Modern antipsychotic medications can be very helpful for some people. And they are less likely to cause neurological side effects, compared to their first-generation predecessors. However, many of these newer medicines can cause someone to gain significant amounts of weight. This is a serious problem that the psychiatric profession (in my view) has been very slow to address. In this episode, Dr. Erik Messamore describes several strategies that can reduce the risk of medication-related weight gain or that can reverse weight gain once it has started.   Strategy 1. Choose antipsychotic medications with low weight gain risk Different antipsychotic medications come with different degrees of weight gain risk. Table 1 in this open-access medical journal article lists medications with higher or lower risk of weight gain. The graph in this article also illustrates the differences in weight gain risk among the various antipsychotic medications.   Strategy 2. Switch to an antipsychotic medication with lower weight gain risk People who have gained weight from higher-risk medications – like quetiapine (Seroquel) or olanzapine (Zyprexa), for example – may lose weight after switching to a lower-risk medication. On the other hand, some people (like the person who sent in today’s question) might mostly like their current medication, or may not want to take the risks involved in medication switching (e.g., the switched-to medication might not work as well, or might have other side effects). In situations like these, there are several weight loss options worth considering.   Strategy 3. Diet and exercise to reduce weight from antipsychotic medication Many studies show that antipsychotic-induced weight gain does respond to standard diet or exercise interventions. A relatively small reduction of 150 calories per day can lead to about 16 pounds of weight loss over a year. For many people, that can be achieved by sticking to natural, whole foods and avoiding processed foods with a lot of carbohydrates or added sugars. Exercise and physical activity can enhance weight loss. And numerous studies show that exercise can improve mood, reduce anxiety, increase cognitive performance, and reduce symptoms of psychosis. Very low carbohydrate diets like the ketogenic diet are popular these days. These diets are designed to reduce insulin levels, which can make it easier to lose weight (because insulin is a fat-storage signal). Many people who undertake these diets can maintain calorie deficits without feeling hungry. Several case reports and a small clinical study suggest that the low-carb/ketogenic diet might help some people with schizophrenia, psychosis, or bipolar disorder to experience fewer symptoms.   Strategy 4. Metformin to reduce weight from antipsychotic medication Metformin is a widely-used treatment for type-2 diabetes. It improves the body’s insulin signals and reduces spikes in blood sugar. Metformin can also help people without diabetes to lose weight. And there are many studies showing the metformin can reduce weight in people who have gained weight from antipsychotic medications.   Strategy 5. GLP-1 Agonists to reduce weight from antipsychotic medication GLP-1 is an abbreviation for glucagon-like peptide 1. The GLP-1 agonist drugs mimic the action of natural GLP-1. They optimize the body’s insulin responses and reduce appetite. Some of these medications – liraglutide (Victoza, Saxenda); semaglutide (Ozempic, Rybelsus, Wegovy) – even have FDA approval for treating obesity. Lirgalutide has been studied in weight gain from antipsychotic medication and appears to produce more weight loss than metformin.   Strategy 6. Melatonin might reduce weight gain from antipsychotic medications This episode mentions that some studies show that melatonin might reduce the amount of weight gained from antipsychotic medication, while at the same time helping to further reduce symptoms of psychosis. The studies referred to are: Romo-Nava F et al. (2014) Melatonin attenuates antipsychotic metabolic effects: an eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trialModabbernia A et al. (2014) Melatonin for prevention of metabolic side-effects of olanzapine in patients with first-episode schizophrenia: randomized double-blind placebo-controlled study.Mostafavi A et al. (2014) Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial.   Summary and suggestions Although the psychiatric ...
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    31 分
  • Ep. 011 - What is akathisia, and how to stop it?

    Ep. 011 - What is akathisia, and how to stop it?
    2021/10/27

    What is akathisia?

    Akathisia is a relatively common medication side effect. Akathisia is a feeling of restlessness that many people find difficult to describe. Many people with akathisia say that it makes them feel like they would like to crawl out of their skin.

     

    What does akathisia feel like?

    Akathisia can be just an uncomfortable feeling. But for many people that feeling of restlessness translates into not being able to sit still. (Akathisia comes from Greek words that mean “not able to sit down”). It can involve fidgeting, or not being able to sit down or lie down for very long without having to move. Akathisia can manifest as walking or pacing as well.

     

    What causes akathisia?

    Akathisia is sometimes a symptom of neurological illnesses (like Parkinson’s disease), but most of the time akathisia is a medication side effect.

    Medications used to treat psychosis or schizophrenia are the most common cause of akathisia. But antidepressants can cause akathisia. So can some treatments for nausea or vomiting.

     

    Akathisia treatment

     

    Akathisia is relatively easy to treat. The most common treatments for akathisia are: reducing the dose of the medication that’s causing it, or getting rid of the medication and switching to a different one. The most common medication treatments for akathisia are propranolol or lorazepam. Other treatment options that have been studied include: cyproheptadine, vitamin B6, benztropine (Cogentin), or diphenhydramine (Benadryl).

     

    In this week's episode, Melissa and Dr. Erik answer questions like:

    • What is akathisia?
    • What causes akathisia?
    • What are the best treatments for akathisia?

     

     

    Topics covered:

    0:44

    What is Akathisia?

     

    02:11

    Akathisia can consist of feelings or of movements.

     

    3:32

    What causes Akathisia?

     

    6:36

    Akathisia is a frequently missed or unrecognized side effect.

     

    7:59

    Why is Akathisia an often-unrecognized side effect?

     

    10:40

    The feeling of Akathisia is hard to express

     

    14:25

    A description of what Akathisia looks like

     

    20:20

    What to do when a medical problem does not respond to textbook solutions?

     

    23:59

    Antidepressant medications can cause Akathisia

     

    26:17

    Some medications for nausea or vomiting can cause Akathisia.

     

    28:25

    A tragic story of missed Akathisia in the emergency department

     

    30:18

    Advice and possible solutions for someone who might be experiencing restlessness

     

    33:07

    Weighing your options and choosing the right medications

     

     

     

     

    About the Podcast:

    Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He’s a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.

    Send us a question

    Useful Links

    Dr. Erik’s website and blog

    Podcast website

    Ask A Psychiatrist YouTube Channel
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    38 分
  • Ep. 010 - Lack of insight into mental illness: Are there any new leads?

    Ep. 010 - Lack of insight into mental illness: Are there any new leads?
    2021/10/12
    This week’s listener question was “is there any new research about curing anosognosia?” Anosognosia is a medical term derived from Greek root words that mean “lack of disease knowledge.” Although anosognosia started off as a neurological concept, it's also very common for people with psychiatric conditions to have no awareness that their symptoms are unusual, or that they could indicate the presence of a mental illness. Emerging data suggest that impaired insight in mental illness might -- like neurological anosognosia -- involve those outer layers of the right side of the brain. It turns out that a unique form of brain stimulation that activates the right brain can temporarily reverse anosognosia in people who have had strokes... and in people with insight-impairing bipolar disorder or schizophrenia. The studies are small. And the findings are preliminary. But the results open the possibility of treating bipolar disorder or schizophrenia without medications. And the data also suggests very strongly that insight impairment in psychosis is more like the anosognosia typically seen in neurological disorders than the commonly assumed psychological denial or willful disregard. Companion YouTube video about vestibular stimulation as a possible mania-reducing, psychosis-reducing, and insight-improving treatment in bipolar disorder or schizophrenia.   Topics covered 1:01 – What is anosognosia? 1:45 – Is anosognosia a form of psychological denial? 3:19 – Psychological defense mechanisms versus willful denial of illness? 4:15 – The difference between denial and anosognosia 4:40 – History of the anosognosia concept 7:28 – What types of brain injury can cause anosognosia? 10:05 – What are some functions of the cerebral cortex? 12:03 – Can anosognosia be a feature of psychiatric conditions? 12:30 – Lack of illness awareness is common in psychiatric conditions 15:08 – An example of insight impairment in schizophrenia 18:26 – Can psychiatric treatment improve insight or illness awareness? 22:36 – What can family or friends do? 22:52 – The controversy of involuntary treatment 26:00 – Strong caring relationships are better than strong logical arguments 28:23 – Do neurological factors contribute to lack of illness awareness in psychiatric conditions? 29:45 – A simple procedure that can temporarily reduce symptoms and improve insight 34:13 – The possibly paradigm-shifting significance of vestibular stimulation studies   Quotes It's been said that people are persuaded by the strength of relationships more so than by the strength of logic.If you look at people that have had bipolar mania or manic episodes because of brain injuries, then you'll find that about 60% of those individuals have brain damage to the right side of the brain only, and about 10% have brain damage to the left side of the brain.We can temporarily create small windows of insight or temporarily eradicate anosognosia in stroke victims by this cold-water simulation in the left eardrum. And we can do the same thing with schizophrenia and mania, apparently.   Resources The book I Am Not Sick, I Don't Need Help! How to Help Someone Accept Treatment by Xavier Amador is one of the most helpful resources for friends or family members to understand anosognosia/illness unawareness and how to befriend, support, and effectively encourage someone to accept treatment.   About the Podcast: Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He’s a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.   Send us a question   Useful Links Dr. Erik’s website and blog Podcast website Ask A Psychiatrist YouTube Channel
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    38 分

あらすじ・解説

Ask a Psychiatrist is a podcast where a real psychiatrist answers real questions about health, illness, recovery, and well-being. The host of Ask a Psychiatrist is Dr. Erik Messamore, a board-certified psychiatric physician and PhD-level pharmacologist. He is a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar. Dr. Messamore is joined on the podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate. Ask a Psychiatrist is driven by the philosophy that giving people accurate and complete information about the causes of illness and suffering – and the full range of tools for wellness and recovery – will help people ask the right questions of their therapists and doctors. This kind of knowledge will make them better negotiators at getting the right kinds of care. They’ll get better results. And they’ll drive the profession toward better practice. - Sign up for news about the podcast launch. - Send us a question. - And tell your friends about Ask A Psychiatrist. Let’s spread useful knowledge far and wide.
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