Medscape Psychiatry 2024 November Issue

5 Minutes with Dr. Joseph Goldberg

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Happy Thanksgiving from all of us at Medscape, Psychiatry Newsletter Readers! We have had an extraordinary year in the field of psychiatry, and it is always interesting to take the pulse of psychiatrists who are on the front lines of research and innovation during times of advancement and upheaval. To that end, this month we are joined by Joseph F. Goldberg, MD. Dr. Goldberg is a Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York. He has given his time as faculty of past meetings and will do so at the upcoming 2025 Psychiatry Update.

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Read on for Dr. Goldberg’s opinions and experience on many topics germane to today’s practicing psychiatrist! Also, scroll down for the Psychiatry Resource Section, in which you will find multiple articles on some of the very topics covered in this month’s exchange.

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Thank you to Dr. Goldberg for his time and effort, especially during the holiday season. Please contact me at colleen@cmhadvisors.com with any comments. –Colleen Hutchinson

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5 Minutes with… Dr. Joseph Goldberg

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Share an issue in psychiatry that needs more attention to solutions.

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Dr. Goldberg: The more judicious use of antipsychotics. They are overpromoted for long-term use in nonpsychotic disorders at expense of generic/nonbranded older non-antipsychotic medicines such as lithium or traditional antidepressants that the younger generation of prescribers is being unduly influenced to think are virtually the universal treatment for all psychiatric maladies.

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What was your most memorable case or patient in the last year or recent past?

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Dr. Joseph Goldberg: Single cases are tough because they don’t really allow for generalizable inferences, but that said, here are two:

A woman with multi-treatment resistant OCD for whom I prescribed Caplyta off label and her symptoms have been in remission for about 9 months for the first time in many years.
Another woman with bipolar disorder and cocaine use disorder unresponsive to numerous pharmacotherapies and ECT for whom TMS (somehow) put her mood symptoms in remission and markedly reduced/eliminated her cocaine use.

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What has been a significant challenge in 2024?

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Dr. Goldberg: Adapting to the post-pandemic preference for telehealth. Pros and cons. It is hard to manage substance use disorder without face-to-face visits, and hard to assess cognitive impairment via Zoom. It is also hard to assess motor symptoms or cardiovascular problems without seeing the patient live.

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What was the best source of education for you this year?

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Dr. Goldberg: Pubmed. Without a doubt, the peer reviewed original literature is where one goes for factually correct medical information that has no commercial influence.

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What are you looking forward to in the field of psychiatry in 2025?

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Dr. Goldberg: Staunch opposition from the medical community to the Trump administration’s disdain for science and potential, through its campaign of misinformation and dangerously wrong ideas, to throw medicine back to the Stone Age.

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What is the best part of caring for your patients?

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Dr. Goldberg: Gratitude when they recognize improvement.

What is one of the biggest advances you have seen in treating your patients?

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Dr. Goldberg: Guidelines for deprescribing and minimizing excessive polypharmacy.

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