Vitamin B12 deficiency and psychiatric symptoms

Psychiatric symptoms of Vitamin B12 deficiency can be wide-spread but also non-specific. In my practice I have seen several people who ultimately had a Vitamin B12 deficiency who presented with psychiatric symptoms, no signs of anemia (which is a common lab finding but is not necessarily always present) and who otherwise had been undiagnosed. It is especially important in geriatric patients with any early signs of cognitive decline since Vitamin B12 is a reversible medical cause of cognitive impairment. The following symptoms are important findings but keep in mind, most people present with a more subtle picture that is slow and progressive in nature. A few groups are especially at risk: Gastric bypass surgery history, long-history of antacid medications, Crohn’s history, Celiac disease and people who do not eat meat products. Some of the findings are outlined below: Neurologic changes — Neurologic problems, when present, consist of the classic picture of subacute combined degeneration of the dorsal (posterior) and lateral...
Read More

Treatment of Frontotemporal Dementia with Depakote

Treatment of Frontotemporal Dementia with Depakote Frontotemporal dementia can be a devastating disease, especially for family members watching their loved one have drastic swings in their behaviors, personality and ability to function on a day to day basis. Frontotemporal dementia is a specific type of dementia referring to a degeneration of the frontal and/or temporal lobe’s. In short, the frontal lobe controls out behavior, speech, impulse control and overall personality. Our temporal lobe is a language center crucial for understanding language. Deficits in one or both of these can lead to Frontotemporal dementia. Whereas memory is often the major problem in other dementia subtypes, it is often the severe personality change, aggression and disinhibited behaviors that are most problematic in Frontotemporal dementia. While a key piece of treatment is working with families on how to understand and interact with their loved one, there is an important role for pharmacological treatment. Traditional medications used for Alzheimer’s such as Aricept (a Cholinesterase inhibitor) or...
Read More

Phoenix psychiatrist offers the addition of office appointments

Phoenix psychiatrist Michael Yasinski MD adds office appointments As a Phoenix psychiatrist who has focused predominantly on house-call appointments to provide the best possible psychiatry care amongst all Phoenix psychiatrists, I strive to create the best experience possible for my patient’s. With the demand for the best psychiatry services valley-wide, I have implemented office days into my practice which is now located in the central Scottsdale area. I am still one of the only Phoenix psychiatrists who offer house-calls but now for people living outside of my house-call area, or prefer to be in an office setting, I can accommodate them. My philosophy still differs than any other Phoenix psychiatrist even in the way I provide office based care. I still offer only 1 hour long appointments and never “med-check” visits. I feel strongly that it is crucial to spend time with my patients, whether we visit once a week or once a month. I often take people who wish to...
Read More

Antipsychotic use in breast cancer patients

Antipsychotic use and the risk fo breast cancer in women Antipsychotic use with medications such as Abilify, Seroquel and Risperdal are increasing in popularity among depressed patients in conjunction with traditional antidepressants. Although efficacy is debated in unipolar major depression, they are a popular choice, especially among primary care doctors. A growing trend however is unfamiliarity with the risks of using antipsychotics in women with breast cancer. They even may increase the risk of developing breast cancer, although no data is available to know for sure. Antipsychotics act on the central nervous system to block dopamine in several different neuro-circuits. They regulate other neurotransmitters such as serotonin and regular areas of the brain involving mood control. They also however act on several other regions such as the tuburoinfundibular pathway. This pathways regulates the release of prolactin in the central nervous system by regulating how the hypothalamic-pituitary tract regulates and releases prolactin. Dopamine regulates the release and production of prolactin in this circuit...
Read More

Damentia and geriatric patients being scammed

Dementia patients and geriatric elderly getting scammed Geriatric patients and elderly people with dementia are extremely susceptible to being taken advantage of. Over the past year there has been a surge of scammers who drain their entire bank accounts over the course of months by sucking them into a variety of scams. Geriatric patients and elderly patients with dementia are lacking some of the insight and reasoning abilities that the normal person has which is why they are especially targeted by these scam artists. This month I helped a family who had been scammed out of close to a million dollars due to their father with dementia had been sending thousands of dollars to the scammers for almost a year until the family became aware. So how does the scam work to trick the elderly dementia and geriatric patients? The latest scam originates from foreign countries and follows a “winning” prize claim ticket in the mail that someone receives. They get sucked into believing...
Read More

Agorophobia treatment programs: Treating the most severe

Agorophobia treatment programs option for the most severe Agoraphobia treatment programs exist all over the country, albeit in small numbers but for the most severe patients who are disabled by their agoraphobia and panic or those house-bound, the programs do not address the severity of symptoms in an effective way. I have been treating specifically severe agoraphobia and largely house-bound patients for 2 years and although trained in traditional CBT and exposure treatment and medication utilization, I learned quickly that extremely severe panic and agoraphobia takes some modification for an agoraphobia treatment program to be effective. My agoraphobia treatment program is reviewed below, highlighting  key differences which make my program successful for the most severe panic disorder sufferers.  I am a psychiatrist trained in medication utilization, CBT and in-person exposure where I drive, accompany patients to any anxiety provoking situation and in real-time we disrupt the fear-panic cycle by confronting the negative irrational automatic thoughts that dominate during a panic attack.  I couple...
Read More

Role of medication in agorophobia treatment

Medications for agorophobia treatment Medications for agoraphobia treatment include benzodiazepine’s (klonopin, Ativan, valium, Xanax), SSRI’s (Prozac, celexa, Zoloft, paxil), Tricyclic anti-depressants (clomipramine, nortriptyline , Elavil), MAOI’s (parnate, nardil) and anti-psychotics (ability, Risperdal, Seroquel).  Using medication for agoraphobia and panic is an important piece of treatment in severe forms of the disorder, especially in agoraphobia house-bound patients. Exposure therapy is necessary for resolution of panic and agoraphobia but in house-bound folks and debilitated people with panic, exposure therapy and proper extinction is impossible without toning down their baseline level of anxiety and panic. Benzodiazepine’s are used short-term in order to make exposure tolerable for the initial part of therapy. A person needs to be able to tolerate leaving the house for the first time or getting in the car for the first time in order to begin the desensitization process and de-conditioning of the fear. They need to build confidence by successfully proving they can complete their fear-task and tolerate it by seeing...
Read More

Instagram addiction causes anxiety and depression

Instagram addiction causes anxiety, depression and is the worst drug epidemic in women's history Modern day crack: Turn on the computer, log in to Instagram and lose yourself in the site’s black hole of interest, hope, inspiration, jealousy, desperation, despair and depression. Instragram is the latest social media of choice and it is essentially another flavor digital crack. Joining the ranks of Pinterest, facebook and twitter.  It causes high’s low’s and withdrawal symptoms.  Sound familiar to a drug addiction? Its reach into society is huge, with about 11 million unique visitors last month, according to Forbes. Frankly, I doubted any men used Instagram, however a surge of young male users shows technologies newest guilty pleasure is not exclusive to women.  Young men and teens are using it to rise to digital popularity to the detriment of their real life school and relationships. Yet another downfall of the digital wasteland.  Men and women alike beware: You have been warned. Pictures of food, crafts, travel spots, home remodeling and docor, hairstyles,...
Read More

Low dose Naltrexone treatment for resistant psychopathology

Low dose Naltrexone therapy for psychiatric conditions Low-dose Naltrexone therapy is an exciting, relatively new concept being used for a variety of treatment resistant psychopathology. There is data that it is effective for a range of psychiatric diseases including major depression, Bipolar disorder, panic/anxiety, OCD, opiate/alcohol post-withdrawal symptoms and cravings and eating disorders. Usually treatments with such a broad range of effectiveness are suspect, however the unique nature of this treatment makes this treatment able to cast such a wide net in an efficacious fashion. Naltrexone is an opiate receptor antagonist which blocks both ingested opiates (heroin or pain pills) and endogenous opiates better known as “Endorphins” from binding to our own receptors and having an effect. Naltrexone has been traditionally used in full dose strength at 50mg per day to treat cravings in alcohol addiction and opiate addiction.  It has however been extremely disappointing in terms of its benefit when used in these modalities. It enjoys great success also as a reversal for heroin and...
Read More

Vitamin D: The forgotten panacea

Vitamin D-are you getting enough? Nobody in the valley of the Sun should have a reason for being low on Vitamin D, however it is actually quite common, even here in the valley.  What exactly makes vitamin D so important to our health? Quite simply, it directly and indirectly influences most of what happens in our bodies every second of every day. First, Vitamin D isn’t actually a vitamin. Rather, it’s a hormone precursor that our biological ancestors made from being in the sun. When exposed to UV rays, a chemical reaction in the skin creates vitamin D, which travels to the liver and is changed to the active form of Vitamin D which then plays a key role in the activation of thousands of genes involved in keeping both the mind and body operating at peak health. In addition to the well-known benefits on bone health, the evidence is particularly strong when it comes to vitamin D’s role in treating depression, strengthening...
Read More
12