Melatonin is being increasingly used on an over-the-counter basis by patients, both adult and pediatric, for sleep disturbance, both for difficulty initiating sleep and maintaining sleep. When suggested or prescribed, it is also advisable to incorporate guidance about sleep hygiene habits and to encourage patients to get ample exposure to bright sunlight and appropriate levels […]

San Diego County is home to many refugees. According to the California Department of Social Services, between the year of 1975 to 2017, 86,598 refugees came to San Diego County. The rate of arrival has increased in recent years. In 2017, 1532 individuals arrived. A recent systematic review from a national cohort which included 779 […]

The optimal approach in medicine is to aim for evidence-based treatments that provide reasonable assurance of efficacy and effectiveness along with meaningful evidence of limited potential for serious side effect risk.   With both adult populations but more especially with children and adolescents, there are clinical situations where use of medications that are not FDA approved […]

Anxiety is a normal and adaptive aspect of life for everyone. A little bit helps keep us safe, but excessive anxiety can be harmful. It can be a sign of a psychiatric disorder and/or it can be a trigger for (or a symptom of) an organic illness. Many medications can trigger anxiety symptoms. Understanding how […]

In previous SmartCare Weekly editions, we reviewed the role resiliency-based interventions may play in a comprehensive pediatric Adverse Childhood Experiences (ACEs) screening campaign. According to Masten and Barnes, “Resilience is defined as the capacity of a system to adapt successfully to challenges that threaten the function, survival, or future development of the system.” (2018). Subsequently, […]

Ever since Dr. Vincent Felitti led the 1998 study of adverse childhood experiences (ACEs), the impact of trauma on health outcomes has been more closely studied and more widely appreciated. Of course, in the realm of behavioral health, trauma has long been seen as a factor shaping more often than not a damaged sense of self and provoking deleterious symptoms. Yet, it was not until the lifelong […]

There has long been thought to be an intergenerational component as regards the impacts of maternal depression in leading to emotional and behavioral problems in children.  Youth with depressed mothers are more prone to developing depressive symptom profiles and in boys there are findings that indicate increased incidence of behavioral problems.   Various genetic and environmental […]

Psychotherapy has a rich history and many traditions. Each school of thought draws from generations of theorists and practitioners. Over the past 40 years, there has been a growing movement to evaluate the effectiveness of therapy in general and specific models in particular. The expanding body of evidence has been helpful to confirm the long-standing […]

Insomnia is one of the primary presenting complaints in the primary care setting. It can be the only symptom the patient is reporting or it can be part of a constellation of symptoms related to a medical cause or mood or anxiety disorder. That, of course, has to be investigated first. Once that has been […]

Antipsychotic medication can be delivered through long acting injectable (LAI) formulation. While these treatments are not typically prescribed by primary care doctors, primary care patients, both adolescents and adults, may need them. LAIs play a crucial role in treating psychotic symptoms. They can be used for individuals with schizophrenia, bipolar disorder with psychotic features, or […]