April 2026 – Gator Psychiatry

Therapeutic Questioning

I wanted to send an email on something I’ve been thinking about sporadically for the past year. That is, “therapeutic questioning”. I haven’t come across this in any textbooks, but I find that gentle exploratory questions that get a patient to reflect and share their feelings can be helpful. It helps a patient feel seen andContinue reading “Therapeutic Questioning”

Dysautonomia

The topic of this page is Dysautonomia/POTS, a condition we see occasionally at Shands. This is quite disabling and misunderstood, so I wanted to provide a brief overview. What is Dysautonomia? It’s an umbrella term for disorders of the Autonomic Nervous System (ANS). What is POTS? How common is dysautonomia? POTS? What are are the symptoms of dysautonomia? Continue reading “Dysautonomia”

Avoidant/Restrictive Food Intake Disorder

We often see patients with feeding difficulties that don’t fit with anorexia nervosa, but are more attributable to food aversion/sensory issues. This is known as ARFID or avoidant/restrictive food intake disorder. Here is some background info.

Benzodiazepine Tapering

One common issue on consult service is patients taking chronic benzodiazepines. A few practical principles are helpful when thinking about tapering. 1️⃣ Short-Term Use Patients on a benzodiazepine (except alprazolam) for: Usually do not require a taper. 2️⃣ Longer-Term Use at Standard Doses Patients on a benzodiazepine (except alprazolam) for: ➡️ Can typically be tapered over ~4Continue reading “Benzodiazepine Tapering”

Case Formulation

I want to highlight a skill that can significantly elevate your clinical reasoning and deepen your understanding of patients: formulation. We all want to understand patients better. How do we deeply get to know patients? Formulation is a great way, and we can document this understanding clearly in our assessments. While we may not always pauseContinue reading “Case Formulation”

Carbamazepine: Details

Carbamazepine. If we find a patient on this medicine at Shands, there are several key factors to be familiar with. I will also try to find time to later review oxcarbazepine and topiramate. Dose Starting dose: 200mg BID Titration: Increase by 200mg/day until response Maximum dose: 1600mg total/day -When tapering off, go slowly to avoid the risk of seizure. (Reduce dose every 2Continue reading “Carbamazepine: Details”

Akinetic Mutism

We received a consult to evaluate for “abulia vs akinetic mutism”. You may be unfamiliar with these terms. Here is a brief overview: Definition Akinetic mutism is the most severe presentation along a spectrum of disorders affecting motivation and initiation. Least severe Apathy –> Abulia –> Akinetic mutism Most severe These patients have theContinue reading “Akinetic Mutism”

Agitation as Unmet Needs

We get a TON of consults for agitation in delirium and dementia. Our treatment plan often involves prescription of one or more medications. But an often underappreciated aspect in care is behavioral interventions. Agitation in a delirious patient or patient with dementia often reflects an unmet need. They do not have the ability to communicate their need, so theirContinue reading “Agitation as Unmet Needs”