Forest Path - photo by Hein van den Heuvel

Announcing Our New Online Appointment-Scheduling Service:  www.Schedulicity.Com:

We are pleased to announce that, as of July 8th, 2010, we have changed to using an online appointment-scheduling service, Schedulicity.Com.  This service, which is free-of-charge for all patients, allows prospective or established patients to make, cancel, or reschedule appointments at any time of the day or night, thus making it unnecessary to call the doctor or the secretary.  However, please note that our 24-hour cancellation policy remains in effect — if you attempt to cancel an appointment less than 24 hours in advance of your scheduled appointment, Schedulicity will not allow you to do so, and you yourself will be billed for the missed appointment.

To begin use of Schedulicity, go to the CONTACT tab for explicit instructions

Reminder:  Schedule Return Appointments to Avoid Case-Closure:

Patients should recall that their cases will go inactive by default if they are not seen within five months of their last clinic visit.  However, specific cases more become inactive within only a few days or weeks, if the doctor has specifically recommended a return exam within a relatively short time, based upon specific psychiatric needs or situations.

When a case becomes inactive, this means that the doctor will not be able to refill a patient’s prescriptions until the patient is seen again in clinic and the case is then re-opened.  To avoid case-closure, pay attention to the doctor’s recommendations for when you need to be seen again in clinic, and check to make sure you schedule a return appointment within the time-frame which the doctor has recommended.  If you have forgotten the day and time of your next appointment, or need to schedule an appointment, go to the CONTACT tab, read the instructions for making appointments, and go to www.Schedulicity.Com.

Reminder:  Annual Physical Exams:

Every prospective or established psychiatric patient should get a physical exam once a year to detect general medical illnesses which can masquerade as primary psychiatric illnesses, or complicate existing ones.  See the essay, “Importance of Annual Physical Exams for Your Psychiatric Treatment,” located under the Educational Seminars tab.

Important Tips for Optimizing Your Psychiatric Care:

Dr. Firnberg has compiled a list of a number of important tips, gleaned from years of experience in the field, for improving your psychiatric care — tips such as bringing your medication bottles in with you at clinic visits, keeping a note pad with you at all times to write down questions or problems to discuss at your next clinic visit.  For a complete list of these suggestions, go to the EDUCATIONAL SEMINARS tab.

New Medications Recently Approved by FDA:

New medications recently approved by FDA are now available for depressive and anxiety disorders.  These include Cymbalta (duloxetine) and Pristiq (desvenlafaxine).  Each is an improvement over older medications such as venlafaxine XR (Effexor XR), since these newer medications do not generally cause the weight gain and reduced libido that venlafaxine does.

Another new medication approved by FDA for ADHD is Vyvanse (lisdexamfetamine).  Vyvanse has a novel mechanism of delivery which reduces the usual side effects from stimulants such as anxiety, irritability, or insomnia.  As a result, Vyvanse seems to be better tolerated.  Ask Dr. Firnberg for more details.

Medications Which Have Become Generic:

Zaleplon (Sonata), an ultra-short half-life medication for insomnia has recently become available in generic form.  This is welcome news for patients on insurance plans which would not cover it previously.  Also, zaleplon’s short half-life has meant:  a) it wears off by morning so that no a.m. grogginess persists; b) even though it is ‘first-cousin’ to Valium-class medications, addictions are rare to non-existent, since it is not around long enough for the body to develop an addiction to it; c) it can be taken when one awakens halfway through the night without worry that a.m. grogginess will occur.

Another medication which recently went to generic form is risperidone (brandname was Risperdal).  Although FDA-approved for psychotic disorders and bipolar mood disorders, it is also commonly used in low-doses as augmentation with standard antidepressants/antianxiety agents for treatment-resistant or more severe cases of depression or anxiety.  Talk with Dr. Firnberg about this very helpful option for treatment.

Warnings About Some Herbal Products:

The Dietary Supplement Health and Education Act (DSHEA) of 1994 removed food and nutritional supplements (including herbs) from regulation by the FDA.  As a result herbal supplement manufacturers are not required to publicize evidence of efficacy, or possible adverse effects, of their products.

Torres del Paine, Patagonia, Chil

The April 2009 issue of Psychopharm Review (vol. 44, no. 4, www.LWW.com), lists four common herbal products, some of which have questionable efficacy and some of which must be taken with care because of possible adverse effects.  To review these products, go to the EDUCATIONAL SEMINARS tab. Anyone considering taking the herbal products above should consult with the doctor prior to doing so.

New Developments in Psychotherapy: Benefits of Long-term Psychotherapy:

In the most recent issue of American Psychiatry News (Jan./Feb. 2009, vol. 2, no. 1), emerging empirical research has begun to confirm the benefits of long-term (“psychodynamic”) psychotherapy for patients, compared to shorter-term (or “cognitive-behavioral”) psychotherapy.  For more information, go to the essay on this topic under the EDUCATIONAL SEMINARS tab.

Other New Developments In Psychotherapy:  Saying Goodbye to ”Blank Screen” Therapies:

One relic of older, Fredian-style psychotherapies which is gradually being discredited is the “blank screen” technique.  New research has found that this technique increases anxiety in patients and actually makes them worse.  For more information, go to the essay on this subject under the EDUCATIONAL SEMINARS tab.

Off-Label Use of Psychiatric Medications: Is it advisable, safe, or even legal?

Patients often have questions about whether their psychiatrist should use medications for their condition when the FDA has not approved that medication for such a use.  However, the facts are that such “off-label” use is safe and often represent the cutting edge of current psychiatric practice.  To see why, go to the essay on this topic under the EDUCATIONAL SEMINARS tab.

New in Philosophical Counseling: Deus Absconditus aut Deus Intelligibilis?

Tired of the traditional discursive arguments for or against divine existence?  Walk in the footsteps of great thinkers such as Plato, Plotinus, and Augustine, and consider  ‘exemplarism‘ in classical metaphysics, an ancient methodology which eschews syllogistic ‘proofs’ in favor of a methodology of direct apprehension with the mind of universal givens.

For more information on exemplarism, please see the essay on this subject found under the EDUCATIONAL SEMINARS tab.  Come find a lost world of truth and knowledge — your own!

Obstructive Sleep Apnea — The Silent Killer II

Obstructive Sleep Apnea (OSA), involves the collapse of the tongue, soft palate, and other structures of the throat during sleep, leading to risk of sudden death, stroke, heart attack, and psychiatric disorders, such as depression, anxiety, bipolar mood disorder, and even schizophrenia.

Unfortunately, like high blood pressure, OSA is often ‘silent’ in that the patient may not even know he has the disorder until it is too late.  For more information, go to the essay on this topic under EDUCATIONAL SEMINARS tab.