Case Presentation: A 24 year old female who meets criteria for a major depressive episode was started on fluoxetine (Prozac) and titrated up to 20mg per day. Her presenting depressive symptoms included: sad mood, hypersomnia, fatigue, poor concentration, and crying spells for 1 month. Her symptoms were and still are impacting her functioning at work. […]

A tic is defined as a sudden, rapid, non-rhythmic, repetitive movement. There are motor tics and vocal tics. Examples of motor tics include: eye blinking, grimacing, nose wrinkling, tongue protruding, shoulder shrugging, head rolling and body writhing. Examples of vocal tics include: throat clearing, sighing, smacking sounds, sucking sounds, coughing and hiccupping. Sometimes it can […]

Psychotherapy is a mainstay treatment for many mental health conditions. In the primary care setting, it is helpful to have a basic understanding of the common therapies that might be recommended to help guide patients as they are accessing treatment. Cognitive Behavioral Therapy (CBT): This is one of the most common types of psychotherapy and […]

Motivational interviewing (MI) is a technique that can be applicable to all clinical settings including primary care. MI is defined as “a person-centered, goal-oriented approach for facilitating change by exploring and resolving ambivalence” (Miller 2006). It can be useful in situations when a patient’s behavioral choices negatively impact his/her health condition – examples include smoking, […]

As cannabis use increases, with easier access and recent legislation, there has been significant emerging evidence for cannabis-related risks. It is important for primary care providers to be aware of these, because a primary care office may be the place where patients present with these negative effects and educating patients about the potential risks is […]

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 […]

There has been increasing interest in the use of pharmacogenomic testing to help with medication choice when treating psychiatric conditions. Advocates are claiming they can be helpful for personalizing prescribing, improving outcomes, and reducing costs. Some of these commercial tests are now covered by some insurance companies. While clinicians would love to have a way […]

Many people are interested in using complementary and/or alternative medicine (CAM) when they are dealing with physical or mental health concerns. This is sometimes because they are worried about side effects from traditional medical treatments. Sometimes it is because they are not seeing the relief they expected from the traditional treatment prescribed by their medical […]

Off-label prescribing is a central and common source of treatment throughout medicine, particularly psychiatry. Lack of FDA indication does not equate to lack of evidence. It is therefore important to distinguish between supported and unsupported off-label prescribing practices. Supported off-label prescribing is the use of medications for a non-FDA-approved indication with clinical literature to support […]