An Atypical Neuropsychiatric Condition: Anti-NMDA Receptor Encephalitis 3/19/2020

Although not a bread and butter primary care concern, Anti-NMDA Receptor Encephalitis is a recently recognized autoimmune process that can cause significant psychiatric, neurological and medical sequelae and it is an organic systemic disorder that may first present in the primary care setting. (NMDA = N-Methyl-D-Aspartate.) In the last decade, it has been more widely […]

Assessing and Treating Sleep Disturbance in Patients with Dementia (Part 2): Treatment 3/12/2020

There are non-pharmacological and pharmacological options to treat sleep disturbance in patients with dementia. Non-pharmacological approaches include: light therapy, regular exercise, and behavioral treatment/sleep hygiene. In general, evening bright light treatment is helpful for sleep maintenance problems and morning light exposure is helpful for patients whose sleep is phase-delayed or who are suffering from a […]

Assessing and Treating Sleep Disturbance in Patients with Dementia (part 1): Assessment 3/5/2020

Sleep disturbance, including reduced sleep time, fragmented sleep, nighttime wandering, increased sleep latency, and daytime sleepiness and fatigue, are common concerns related to dementia. It is estimated that 1/3 of patients with Alzheimer’s dementia suffer from a sleep disturbance. The goal of this article is to review treatment options for sleep disturbance in patients with […]

Insomnia: Assessment & Treatment in Primary Care (Part 2) 2/27/2020

When efforts to change sleep hygiene profiles prove unsuccessful and other contributing conditions have been examined and ruled out, use of a medication may be appropriate. Both prescribed and over-the-counter options are available and choice can be based on patient preference, clinical symptoms and need for short-term versus long-term treatment. Prescription Meds: In general the […]

INSOMNIA (PART 1): Assessment & Treatment in Adults 2/20/2020

Insomnia is a frequent complaint of patients in both the medical and psychiatric settings. Nearly 30% of adult will have issues with trouble falling or staying asleep at some point, however most of these issues are generally time limited and not impairing. For others, it is a very troubling issue. Insomnia Defined ―trouble with either […]


Women are almost twice as likely to be prescribed psychotropic medication as men. Because women are the primary consumers of psychotropic medications, it is important to pay attention to gender differences in the pharmacology of these medications. Other e-weekly topics have addressed issues related to pregnancy, menopause, and birth control with mental health, so this […]


CLINICAL SITUATION: Your patient is not tolerating or is not responding adequately to an SSRI or SNRI and the dose and duration have been adequate. Symptoms of anxiety or depression persist in spite of optimized psychosocial interventions and therapy and you believe that further psychopharmacologic intervention is required. What to do? There are four strategies […]

How Should We Treat Grief and How to Distinguish it from Depression? 1/16/2020

Grief as a response to significant loss is normal. However, the mourning that occurs during periods of grief has features that overlap with depression and anxiety. This makes it occasionally confusing to distinguish one from the other and to know how to help patients heal appropriately. In previous DSM versions, mental health professionals were to […]

Using Antidepressants to Manage Chronic Pain 9/23/2021

This week’s article summarizes the potential benefits and the limitations of using antidepressant medications as co-analgesic agents along with other pain medication interventions from findings drawn from a recent article of Drs. Leo and Khalid from Current Psychiatry1.   They note the finding that pain syndromes are often associated with significant depressive symptomatology and they further […]

Melatonin 12/19/2019

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 […]