In The News

20% of adults now take at least one psychotropic medication. The largest increases over the last decade have been in the use of antipsychotic drugs (Abilify, Saphris, Seroquel, Zyprexa) across all ages and the adult use of drugs for ADHD (Concerta, Vyvanse) which tripled among those aged 20 to 44 and doubled among women 45 to 65.

Overall use increased 22%, though antidepressant (Lexapro, Cymbalta, Wellbutrin) use decreased in children as did antianxiety drug (Xanax, Valium) use in the elderly.

Psychiatric medications are the most widely prescribed and largest dollar volume class of drugs in the United States. The recognition of depression, psychosis and ADHD as lifelong disorders, as well as marketing and awareness programs have resulted in these increases.

With this extension and proliferation of drug use, a comprehensive evaluation by a board certified psychiatrist has become even more important. Dr. Covert is a Houston, Texas psychiatrist who provides initial psychiatric examinations, combined with computerized psychological testing, to reduce misdiagnoses and to guide your treatment plans. For Dr. Covert and his staff, it’s all about helping you stabilize moods and correct dysfunctional emotional, cognitive and behavioral patterns to maximize your potential and satisfaction.

Posted on 12-17-2011 | Permalink

If you have recently moved to Houston from abroad or from another state and need a Houston psychiatrist, Dr. Charles Covert is a good option.

National mobility has declined in the last few years because of the downturn in the housing industry, making it difficult to sell a home in order to take a new job elsewhere. Also, since January, 2007, United States net nonfarm employment has decreased by 7 million jobs. However, during that time frame, Texas has added almost 400,000 jobs, ¾’s of the new jobs created in the United States! In recent years, 180,000 migrants from other countries and over 1 million people from the other 49 states have migrated to Texas. Of these states, California, Louisiana, Florida, Oklahoma and Illinois out-migrated to Texas the most. About 40% of the total had college degrees. Currently 4% of the United States college graduates are unemployed, compared to about 14% for those without high school diplomas.

Luckily, Texas in general, and Houston in particular, are attracting people who are largely well educated. More than 70% of the heads of incoming households have at least some college, and as Texas and especially Houston lead the nation in employment opportunities, this trend should continue.

Internationally, the United States remains the preferred destination for affluent individuals seeking a better quality of life and good financial prospects. Most migrants come from Canada, Singapore and Europe, and significant numbers originate in Hong Kong and the United Kingdom.

With an office conveniently located in the Galleria area and offering first appointments within 24 hours, immigrating patients often find Dr. Covert’s psychiatric practice a good fit for them.

There are several reasons to relocate to Houston from elsewhere:

1. Texas is leading the nation in the current economic recovery and its economy is big and growing.
2. Houston leads Texas as its most economically robust metropolitan area, ahead of Dallas-Fort Worth and San Antonio and 4th in the nation.
3. Housing and the cost of living are very affordable.
4. The quality of life is high.
5. Texas has a comparatively low tax burden as well as superlative medical and educational availability.
6. Houston’s Texas Medical Center is the world’s largest medical center, home to 49 institutions and the equivalent of the nation’s 11th biggest downtown.
7. Unemployment is 8.6%
8. Houston is home to the 2nd highest number of Fortune 500 companies.
9. Houston’s food scene boasts 10,000 diverse restaurants, topping the list of most eateries per capita in national polls. There are no long lines, no waiting for a table, no Maitre D’s to bribe and unlimited high quality, low cost dining experiences with friendly service.
10. Traffic in Houston is much more manageable and far less congested than Los Angeles, New York, Chicago and California and New Jersey in general.
11. People are friendly and open and appreciate the influx, particularly of young professionals who largely prefer Houston to Austin and elsewhere.

Can 1,000 new Houstonians moving to the city every day be wrong? Could the 6 ½ million people who elect to continue happily living here be wrong?

Dr. Covert can help you after your move to Houston by providing initial or continuing psychiatric care as well as referrals to top medical specialties for your other health care needs and a comfortable integration into Houston – the best in the West!

Posted on 11-06-2011 | Permalink

Dr. Covert was among the Houston psychiatrists invited to attend a scientific presentation by Vivek Singh, M.D., Assistant Professor of Psychiatry at UTHSC in San Antonio and fellowship-trained in psychopharmacology.

The focus of Dr. Singh’s presentation was on the relative attributes of the atypical major tranquilizer, asenapine:

1. Efficacy comparable to olanzapine, the Gold Standard for this class of medications
2. Superior short and long term tolerability, improving patient compliance and adherence
3. Negligible weight gain over 52 weeks
4. The absence of lipid metabolism dysfunction resulting in elevated serum triglyceride and cholesterol levels
5. The absence of prolactin elevation which in female patients can cause osteoporosis and galactorrhea
6. No provocation of diabetes mellitus
7. No negative impact on cognition and executive functioning
8. A .0005 rate of hypersensitivity
9. A 79% rate of patient compliance when provided in a single daily dose, usually at bedtime, which also minimizes problems with somnolence side effects, the most common side effect (24%)
10. No cholinergic properties

Dr. Covert’s participation in continuing educational programs such as this enables his patients to benefit from information from thought leaders in American psychiatry. This correlated with Dr. Covert’s opinion that physicians are measured by their patients according to their ability, their availability, their affability and their willingness to communicate.

On August 30, 2011, Dr. Covert and his staff and other members of the Houston psychiatric community were invited to attend a scientific presentation entitled "Current Issues in Neuropsychiatry." The topics included "Monitoring of Patients with Bipolar I disorder or Schizophrenia."

The two speakers were John Docherty, M.D., Adjunct Professor of Psychiatry, Cornell Medical College and Matthew Byerly, M.D., Associate Professor of Psychiatry, U.T. Southwestern Medical Center, and Director of the Schizophrenic Research Program there.

The focus of the program was to review the use of atypical antipsychotic medications, with comparisons to the relatively newer and novel sublingual medication, Saphris (asenapine). The goal with this medication is to achieve remission in at least 50% of patients. It has an early onset of action. It may have efficacy in acute severe cases, similar to Zyprexa Zydis and shows promise in maintenance studies. It also has minimal drug-drug interactions (mainly with Luvox) and has a very manageable side effect profile. Somnolence is noted in 24% of patients with twice daily dosing, suggesting that a possible off-label single daily dose administration before bedtime may be helpful and may evolve in the future as the preferred approach.

Dr. Covert and his staff frequently participate in continuing psychiatric education events so that they are able to provide patients with the latest information and treatment strategies. Also, they really enjoyed meeting Dr. Docherty and Dr. Byerly.

Posted on 8-31-2011 | Permalink

On August 16, 2011, Dr. Covert and other members of the Houston psychiatric community were invited to an enjoyable scientific presentation by Dr. Larry Ereshefsky, Pharm D and Clinical Professor at the UTHSC San Antonio, TX , and now associated with UCLA Medical School In Los Angeles, California.

Dr. Larry discussed the sublingual neuroleptic medication, Saphris (aserapine), and it’s comparative properties, including:

1. Optimal bioavailability
2. Steady state concentration achieved in 3 days with twice daily administration
3. Minimal drug-drug interactions
4. FDA efficacy in significant mental disorders while minimizing sedation, lipid and weight gain problems and cognitive dulling as compared to other atypical neuroleptics like Seroquel and Zyprexa.

Posted on 8-17-2011 | Permalink

ADHD doctors prescribe stimulants for the treatment of child, adolescent or adult ADHD because it is a neurological disorder caused by the deficiency of the neurotransmitter, epinephrine, in some parts of the brain. After doing a comprehensive psychiatric examination which reveals symptoms of this disorder, standardized tests and questionnaires are administered to confirm and document statistically valid levels of inattentiveness and/or hyperactivity.

The two main classes of medications which "stimulate" production of epinephrine in the brain are methylphenidate and dextro-amphetamine, in use since the 1960’s.

Dr. Covert is an ADHD doctor. The primary Ritalin-based medication prescribed by Dr. Covert for ADHD is Concerta. The main amphetamine-based medication he prescribes is Vyvanse. The benefits of both these medications are that they are effective for 12 hours, they cannot be abused, they have no value on the street and they are the gold standard of psychiatric care for ADHD patients.

Posted on 8-3-2011 | Permalink

There is broad consensus among psychiatrists who treat chronic pain that:

1. Major depression and chronic severe pain are frequently comorbid conditions, and
2. Antidepressants can improve both conditions, when found together, Or separately, and
3. The management of both conditions is complicated by iatrogenic opiate and anxiolytic tolerance and dependency.

Dr. Covert is a psychiatrist in Houston, Texas and a Texas Workman’s Compensation psychiatrist who assists patients with these conditions with cognitive behavioral therapy, outpatient detoxification and treatment for depression with medications which are not habituating, and do not aggravate depression, cognitive functioning and the ability to collaborate in pursuing treatment goals.

Posted on 4-8-2011 | Permalink

On April 5, 2011, Dr. Covert, a psychiatrist in Houston, Texas, attended an important continuing psychiatric education event. The speaker was William M. Glazer, M.D., who has been a member of both the Yale and Harvard Medical School psychiatric faculties.

Dr. Glazer spoke on the topic of "Management of Bipolar I or Schizophrenic Patients." He discussed salience, the ability to focus attention on what is important, often missing in these disorders. The efficacy of asenapine in these disorders was discussed by the local psychiatrists and residents attending. The comparative advantage of this relatively new medication was efficacy, but also a reduced incidence of tardive dyskinesia, hyperlipidemia, weight gain and akasthesia as well as dystonia.

Posted on 4-5-2011 | Permalink

Most of us are patriotic, but we don’t know how to help our military troops in the field. Operation-Helmet.org is the place to find out how to send donations to purchase helmet pad upgrades for combat helmets. Head injury and brain damage are the leading causes (>80%) of death and disability in our combat units, many due to inferior helmet inner liners and padding. $34.00 buys one helmet upgrade!! "THE LIFE YOU SAVE MAY SAVE ANOTHER."

Dr. Covert is a Houston, Texas psychiatrist and USAF Veteran who believes everyone needs the option and a way to help our combat personnel stay as safe as possible in war zones.

Dr. Covert is a Houston, Texas psychiatrist who is also a Texas workers compensation doctor and OWCP psychiatrist who evaluates and participates in the treatment of patients with traumatic brain injury (TBI), particularly in the depressed moods and cognitive impairment that follows. Dr. Covert and his staff and consultants serve patients with severe industrial head injuries as well as those traumatized, either in the military or as civilians in the war zones of Iraq and Afghanistan. He is a Defense Base Act doctor and psychiatrist and an OWCP doctor and psychiatrist.

Posted on 3-18-2011 | Permalink

According to an eight decade research project, the best childhood predictor of longevity is conscientiousness, a complex pattern of persistence, prudence and hard work as well as close involvement with friends and community.

Persistence and the ability to navigate life’s challenges were superior predictors of longevity to higher IQs or achieving advanced degrees.

Believe it or not, cheerful children turned out to be shorter-lived than their more sober compatriots. Also, early parental death was not nearly as devastating as parental divorce during childhood, the strongest predictor of early death in adulthood from all causes, including accidents, violence, cancer, stroke or heart attack. The winners of the longevity race had a fairly high level of physical activity, gave back to the community, had thriving and long running careers and healthy home lives. Thus, parents should encourage their children to be goal oriented and conscientious!

Dr. Covert is a Houston, Texas psychiatrist willing and able to assist you with parenting challenges.

Posted on 3-17-2011 | Permalink

According to a study of nearly one million children born in Denmark between 1988 and 2001, babies born with low Apgar test scores were at higher risk to develop ADHD.  The Apgar is a 10-point scale used by pediatricians worldwide, measuring respiration, reflexes, skin color, pulse and heart rate during the first few minutes of life.  82% of those later diagnosed with ADHD were boys.  Scores between one and 4 had a 75% higher risk of developing ADHD than babies with scores of 9 or 10.  The risk of ADHD was 63% higher with scores of 5 and 6.  Low Apgar scores have also been linked with epilepsy, cerebral palsy and mental retardation.

Doctor Covert is an ADHD psychiatrist in Houston, Texas who comprehensively evaluates for child ADHD and adult ADHD, using both subjective and objective measurement tools, to confirm diagnoses and to guide effective and safe ADHD treatment strategies.

Posted on 3-16-2011 | Permalink

If you search for a Texas Workers’ Compensation psychiatrist or a Houston workers’ compensation psychiatrist, you may not connect with Dr. Covert as one of the very few board certified and experienced psychiatrists still accepting Texas Workers’ Compensation cases, Office of Workers’ Compensation Program (OWCP) Federal Workers’ Compensation cases and Defense Base Act cases.

Some workers’ compensation insurance carriers in association with employers and with the Texas legislature limit your choice of a physician to treat your industrial injuries and the psychological consequences. Victims of rape, robbery, assault and devastating personal injuries (traumatic brain injury, toxic exposures, orthopedic and other industrial injuries) are further traumatized by resistance to or denial of their legitimate Texas Workers’ Compensation claims. The symptoms you may experience as a result of the psychiatric component of your injuries, may include depression, insomnia, severe pain syndromes, habituation to narcotics and PTSD.

Now there are rules requiring that you accept "treating doctors" in your employer’s "network list," doctors that control your care, are copied with correspondence and can make referrals to other specialists you need to see. Network doctors are controlled by employers and can be taken off the list for "non-performance." Ironically, in-network treatment has been found to be more expensive on average than out-of-network treatment.

Dr. Covert, as a Texas Workers’ Compensation psychiatrist and a Houston Workers’ Compensation doctor, is a patient advocate and will help you to make the system work for everyone, including you.

Posted on 2-8-2011 | Permalink

Recent survey finds 20% of Americans experienced mental illness in the past 12 months. In the past year, 45 million individuals developed mental disorders, but less than 40% of these received mental health services. 20% of the 45 million also had a comorbid substance disorder. This rate is about three times higher than the general population. This survey indicates that over 60% of those with mental disorders in any given year go undiagnosed and untreated.

With looming state and local budget cuts, reducing community health and state hospital services, the public and law enforcement officials will need to be more wary and will need to raise their level of awareness about how to deal with symptomatic people in the general population. Unfortunately, many families first access emergency mental health services with a call to 911.

Dr. Covert responds to his patients’ needs by scheduling appointments for evaluation soon after each prospective patient calls. Also, each patient is provided with appropriate objective psychological screening testing to insure accurate diagnosis and effective and timely, evidence-based psychiatric treatment.

Posted on 2-1-2011 | Permalink

Some of the best medications used in general medicine and psychiatry will be cheaper in 2011. Among those losing their patents this year are Lipitor and Plavix, the top selling cholesterol and clot prevention drugs. Also coming off patent protection are the antibiotic Levaquin, Concerta for attention deficit hyperactivity disorder and Zyprexa, for schizophrenia and other major emotional disorders.

In 2009, generic medications cost only 25% of their brand name counterparts. Market share in 2009 for generics was 75%, expected to rise to 85% in the next 3 years. Pharmaceutical companies have blocked the production of generics, keeping prices high, by paying generic drug manufacturers to keep their cheap products off the market—a practice known as “pay for delay”. Under current agreements, generic drugs are delayed entry into the US market by an average of 17 months! Also, drug companies have raised prices of name-brand medications dramatically. Name brand drugs represent 25% of the prescriptions written nationwide, but 80% of the overall prescription costs.

Dr. Covert will work with you to hold your medication costs down, while prescribing the best, but often, least-cost alternatives. If you are uninsured, he will offer you prescription benefit cards for savings at a wide range of pharmacies.

Posted on 1-25-2011 | Permalink

Recent research shows that behavioral addictions are three times more common in people with bipolar disorder than in the general population. These behavioral addictions include pathological gambling, compulsive buying and sexual and word addictions. In one study, one third of bipolar patients had at least one behavioral addiction compared to 13 per cent in the control group.

Results in Dr. Covert’s practice indicate that successful bipolar treatment and management often results in improvement in the related behavioral addictions, reducing or eliminating high-risk activities.

Posted on 1-17-2011 | Permalink

Cannabis use has been linked to earlier onset and poorer treatment outcomes in both bipolar disorder and schizophrenia. Substance abuse, especially of cannabis, is associated with earlier ages of onset in both these patient groups as well as poorer response to treatment and clinical outcomes. Cannabis users developed bipolar disorder nine years earlier than non-users.

Dr. Covert provides urine drug screening and hair sample drug screening services to provide objective documentation of this variable for evidence-based treatment decisions.

Posted on 1-10-2011 | Permalink

On November 16, 2010 in Houston, Texas Dr. Covert attended a scientific presentation by Ontario, Canada based psychiatrist Dr. Michael K.S. Cheng, noted expert and lecturer who has written an article in Psychiatric Clinics of North America on the therapeutic alliance between psychiatrists and their patients. This alliance refers to their collaborative partnership, agreement on goals, the tasks which each have and their bond of trust and mutual acceptance. Dr. Cheng described various interviewing styles and techniques which he has used to overcome reluctance and to keep the doctor-patient interview solution-focused. Dr. Covert enjoyed discussing these issues with Dr. Cheng, as each employ the same patient-friendly and productive therapeutic practices.

The second half of the meeting was conducted by noted psychiatrist, author and psychopharmacologist, Dr. R.J. Baldassarini, who presented the latest information on the diagnosis-specific selection of atypical neuroleptics in the treatment of major emotional disorders, including bipolar disorder and schizophrenia, focusing on side effects, adverse events and metabolic consequences of each choice.

Posted on 12-22-2010 | Permalink

Researchers at Harvard Medical School have reported that conventional magnetic resonance imaging or MRI machines detected 94 percent of individuals with a high-functioning form of autism. This disorder is diagnosed in one in 110 children in the U.S., afflicting four times the number of boys as girls.

Earlier detection may allow earlier intervention to assist in the development of language skills, improved social functioning and resolution of emotional problems in the future. The MRIs were tuned to pick up microscopic features of the brain's wiring – a technique known as "diffusion tensor imaging." MRI machines are widely available around the world.

Dr. Covert has successfully diagnosed and treated individuals with various degrees of autism and is encouraged by this scientific development.

Posted on 12-8-2010 | Permalink

Army General Raymond Odierno, commander of joint forces in Iraq, estimates that 30% of all troops suffer from PTSD. Other military officials say it’s virtually impossible for anyone to emerge unscathed in some way from combat. What is more monolithic than the murderous methods of our adversaries is the incompetent, hostile reception our injured vets and families experience later. Tragic and indefensible.

Posted on 11-19-2010 | Permalink

According to recent CDC&P figures, estimates of the incidence of ADHD have jumped to 9.5%. Nearly 1 in 10 U.S. children has ADHD, based on diagnoses given to parents. It’s hard for some kids to pay attention and to control impulsive behavior. About 2/3 of ADHD kids are on medication.

Call us for a comprehensive evaluation and treatment.

Posted on 11-18-2010 | Permalink

Due to a sharp increase in marijuana as well as surges in ecstasy and methamphetamine use, the Director of National Drug Control recently announced a 9% overall increase in substance abuse. This trend appeared to be linked to changing attitudes regarding the perception of the harm caused by these drugs and the political trend to legalize “medical marijuana” in some states. Marijuana use rose by 8% and remained the most commonly abused drug.

Posted on 11-3-2010 | Permalink

Social media, such as YouTube, Twitter, Facebook, MySpace and blogs are inappropriate for doctor-patient communication because they are too informal and lack the atmosphere of professionalism. They promote casual conversation and blur the boundary between personal and professional relationships.

Accordingly, Dr. Covert does not use the social media to dispense medical advice, respond to clinical questions from patients nor otherwise practice medicine on these sites.

Patients should presume that anything said or posted is in the public domain. These types of media do not use HIPAA-compliant secure networks. Also, remember that anything typed or emailed creates a permanent, indelible record.

Posted on 11-1-2010 | Permalink

Dr. Covert's office policy is that neither he nor his staff communicate with patients by email about any issues related to their psychiatric treatment. The reason is that exchanging emails would circumvent the normal psychotherapeutic process and create the expectation that we would continually monitor for emailed patient messages.

However, we do maintain a 24-hour answering service so that patients can leave messages with a real person who will relay those messages to Dr. Covert and his staff who will respond.

We are available and willing to communicate.

Denial of Mental Illness, or anosognosia, is a physiological syndrome that makes a person unable to understand that they are sick and dysfunctional and that their judgment is impaired.

a) About 50% of people with schizophrenia and bipolar disorder do not believe they are ill

b) About 20% ofU.S. women will have a major depressive episode in their lifetime, and 13% of U.S. men

c) Major depression may present itself as a depressed mood and loss of interest for 2 weeks or more, plus 4 of these symptoms:

(1) Sleep problems-insomnia or day sleeping

(2) Low energy

(3) Significant weight loss or gain

(4) Loss of appetite

(5) Difficulty concentrating

(6) Feelings of worthlessness and hopelessness

(7) Thoughts of death or suicide

(8) Decreased interest in socializing

(9) Morbid or illogical and irrational or delusional thinking

(10) Hearing voices

(11) Odd and peculiar out-of-control behavior, including grandiosity, recklessness, overspending or gambling

d) Anosognosia is an impairment of the frontal lobe of the brain which controls self-awareness, which results in an inability to perceive that person's dysfunctional state.

Solutions to Overcoming the Denial and your loved one's refusal to accept evaluation and treatment:

a) Be kind

b) Share your own problems, but be firm

c) Don't attempt reasoning with an unreasonable person when you can see it doesn't work

d) Make anappointment now with Dr. Covert, with your spouse, to discuss the affect this is having on your family and possible solutions, including involuntary hospitalization

e) Educate yourself beforehand on the provisions of the Texas Mental Health Code and the Probate Code elements of a comprehensive guardianship, for both medical and financial affairs

f) Seek referral from your psychiatrist to an attorney board certified in guardianship matters to discuss your legal options and take action

g) Resolve to stop being held hostage to a mentally disordered family member

Dr. Covert does not believe in sacrificial parenting nor in denial as a means of dealing with your child's or other family member's cognitive, emotional and behavioral dysfunction.

He will support your attempts to reassert appropriate and reasonable parental or family authority in your family member's best interests.

On 9/21/10, Dr. Covert participated in ADHD Live!, Expert Discussions on ADHD in Houston, Texas, for physicians who diagnose and treat ADHD.

The nationally recognized experts on the panel included:

1. Stephen Stahl, M.D., Ph.D, University of California Adjunct Professor of Psychiatry
2. Melvin Oates, M.D., Assistant Professor of Clinical Psychiatry, NYU Child Study Center
3. Theresa Cerulli, M.D., Harvard Medical School

The take home messages were:

A. Clinical Pointers:

1. Clinicians should use DSM-IV criteria, and
2. establish treatment alliance with parents and teachers, and
3. facilitate behavioral modification techniques with rewards and consequences for undesirable behavior across multiple settings by establishing a token economy, and
4. consider both stimulant and non-stimulant options to address inattentiveness, hyperactivity and impulsivity, and
5. understand that patients never outgrow the neurotransmitter imbalances of ADHD, but patients may learn to compensate for ADHD symptoms which are still present and can still affect their lives.

B. There are multiple on-line informational resources available to patients and families, including:

1. addresources.org
2. chadd.org
3. help4adhd.org
4. add.org

C. 9.8 million adults suffer from ADHD

Dr. Covert and his staff are ready to help you evaluate your family’s ADHD issues and to competently address them.