Useful apps on sale for limited time! English-Spanish Medical Dictionary and iTranslate Voice, both for iOS devices

I recommend grabbing these apps for iOS devices (iPhone, iPad, iPod Touch) as quickly as possible!

medical Spanish app icon#1: English-Spanish Medical Dictionary: FREE for a limited time! Just does English/Spanish, but has a medical focus. Usually costs $4.99.


iTranslate app icon#2: iTranslate Voice: $0.99 (introductory price). Translate among many languages with this app, using a Star Trek-style interface: speak to it in one language, listen to it speak the translation in another language! It uses speech recognition software by Nuance (who make the excellent Dragon Naturally Speaking desktop software), and early reviews are already very positive.

Notes about the above links:

  • If you click the links from an iPhone/iPad, it will take you to the App Store for download. Hopefully the download button will still say the price I stated above (“FREE” for #1, “$0.99” for #2). Just tap that button, which changes to “INSTALL” (then tap that).
  • If you click the links on any other device, it will take you to Apple’s web site where you can read more about it, but you can download it only if you have iTunes installed on that computer.

Good hunting [for low-priced apps]!

Intrigue, suspense, and empathy in Scorsese’s Shutter Island

Shutter IslandI just watched Shutter Island, a suspenseful and beautiful film directed by Martin Scorsese and released in 2010. The story takes place in 1954: a time of change in the ways mentally ill patients were viewed and treated (and, specifically, the year that chlorpromazine was approved by the FDA).

The real value of the film is that watching it ultimately helps one understand the experience of living with a psychotic disorder. It in fact has given me another layer of understanding and empathy for an irascible and accusatory patient I was struggling to help just yesterday.

I don’t want to spoil the experience of watching the movie by elaborating any more. I just recommend that you rent and watch it! (The DVD extras are certainly worth watching as well.)

Family’s struggle to get care for manic father highlights philosophical and practical struggles of mental health system

New York Times Magazine coverIn this thoughtful and riveting article, Jeneen Interlandi chronicles the fear, helplessness, frustration, and double binds that relatives face in a mental health system struggling to navigate civil liberties, public safety, and beneficence. She brings in stories from other families to support the picture of a system so concerned with patients’ rights to be free of detention that other important rights are neglected. I consider two of the most important of these to be:

  • the right to be in one’s sane state, in which one’s actions are governed by his or her true self–not by symptoms; and
  • the right to be taken care of when in an altered state–a state in which one might be victimized, destroy one’s relationships, lose one’s job/housing/savings, and, in extreme circumstances, die or kill someone else

The short hospital stays of today carry a far smaller risk for harm to a patient than decisions not to hospitalize. Putting theoretical concerns about individual liberty above the actual safety and wellbeing of patients will lead to continued suffering, especially as lack of funding for outpatient services continues to drive more patients into crises.

Tale of Two Enantiomers (or, when do we really have to worry about QTc prolongation with citalopram?)

[UPDATE 4/19: The FDA revised the warning discussed in this article. Additions from the revised version are shown in orange text.]

A Dickens classicLike many providers, I have always been skeptical about escitalopram (Lexapro). It seemed to come right when the patent on citalopram (Celexa) was going to expire and thus Forest Pharmaceuticals was going to lose a lot of money to generic citalopram producers.

So Forest gave us escitalopram, or S-citalopram, the “good” enantiomer of citalopram (the original citalopram was a racemic mixture of both S– and R-citalopram). We were to believe that giving S-citalopram alone would be more effective,* have fewer side effects, and have fewer interactions.

So, imagine the skepticism when–after years of citalopram being so mainstream that it was the default medication in the STAR*D trial–we received an FDA warning that citalopram has a problematic risk of QTc prolongation, and a directive that we therefore must stop using doses above 40mg [20mg in some patients per the revised warning]!

One can’t be blamed for wondering whether someone was again trying to push us towards using the fancy-pants S-enantiomer-only version. Particularly frustrating was the FDA’s comment that “studies did not show a benefit in the treatment of depression at doses higher than 40 mg per day [emphasis added],” which does not address the fact that higher doses are required to treat anxiety-spectrum disorders.

However, after doing seem research, I can say that there are some patients in whom to consider potential danger with citalopram:

  1. Patients at risk for overdose
  2. Patients taking 2C19 inhibitors [or otherwise at risk of having impaired 2C19 metabolism]
  3. Patients taking other QTc-prolonging agents
  4. Patients with certain conditions

Read on to learn more… [Continue reading…]

Gratuitous drug interaction metaphor describes website performance improvement

gratuitous use of appealing meta-clockSince changing web hosting services, the speed of went up greater than blood levels of lamotrigine after the addition of divalproex to a drug regimen…and without the possibility of a deadly hemorrhagic rash!

Now that the site is usable (both to readers and authors), soon there will be more content and, eventually, a formal site launch!

[Continue reading…] will soon be moving at the speed of inhibition!

Are you tired of taking as long to load a link as it takes oxcarbazepine to induce CYP3A4? Well, soon, will be on a much faster host and you won’t dread using it! This will also encourage the completion of many half-written posts, so there will be more to click!

PS: I almost wrote “stay tuned!” but then realized how anachronistic this would be. More appropriate would be “check your RSS aggregator regularly…”

Fascinating RadioLab episode explores ideas of good and “bad” in thought and behavior

RadioLab's "The Bad Show" episodeThis thought-provoking series of stories on the WNYC public radio show RadioLab includes an important revisiting the 1960s experiments by Yale psychologist Stanley Milgram which are widely viewed as demonstrating that people will do terrible things if told to do so by authorities. As Alex Haslam (Professor of Social and Organizational Psychology at the University of Exeter) explains in the show, Dr Milgrim’s subsequent experiments actually demonstrated the opposite. I won’t spoil the story, but encourage you to listen to the episode.

Of note, their second story, besides being increasingly fascinating on multiple levels, finds a way to use the phrase “batshit crazy” as a literal adjective.

TO LISTEN: either click “Play” from the episode’s page or stream/download directly the MP3.

You owe it to yourself to get the RadioLab podcast feed. Add to iTunes with this link, or add to another podcatcher or RSS reader from this page. Don’t know what I’m talking about? Come to my Friday conference 2/17/12, Shrinks in the Cloud: Five Heavenly Cloud Resources for Storing, Searching, and Sharing. Eventually I will have an article here explaining how to use podcasts as well (let me know if you want it sooner rather than later).

What does this picture have to do with lithium? AND: new monitoring recommendations for lithium

Do you know what this picture may have to do with lithium and drug interactions? Also, learn of an easy new screening test and other lithium monitoring recommendations from a Lancet review so hot off the press that it’s still in press!

[Continue reading…]

Which mobile drug reference tool (or “app”) should I use?

Micromedex, Medscape, Epocrates, Lexicomp

Icons for major drug reference apps: Micromedex, Medscape, Epocrates, Lexicomp

Trick question! You should have *multiple* apps, especially since so many are free, and different databases have different strong points. For better or worse, you also get different information from each, especially regarding drug interactions, so it can be helpful to get a 3rd or 4th opinion if you’re unsure of the significance of a potential interaction.

In this article, I will cover which tools I think are essential, which I think is “the best” (if you can afford it or have institutional access!), and some pros/cons of each of these excellent apps.  My “Essential” and “Best” picks may surprise you! [Continue reading…] is up!

ddiPad thumbnailAs promised, you can now download the newest version of the ddiPad via the “GET DDIPAD” link here at! If you don’t feel like dragging your pointer all the way up to the menu bar above, you can click the picture on the right instead.

Coming soon will be instructions on using the ddiPad, and an ever-growing body of (hopefully) interesting and useful cases, news, and references!

Feel free to remind me to stop hacking backend code and get back to making content by leaving feedback 🙂