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Maximizing Efficacy of Antidepressants

Antidepressant medications, most commonly the selective serotonin reuptake inhibitors (SSRIs), are frequently prescribed by primary care providers for depression, anxiety, and impulse control disorders. There are some important guiding principles to keep in mind when prescribing these medications, which can dramatically improve a patient’s response to treatment and ensure ongoing safety. Here is a review […]

Treating Co-Morbid Depression and Coronary Artery Disease

Coronary artery disease is the leading cause of death in the United States and is one of the main contributors for the global burden of disease. One in four patients with coronary artery disease also suffer from depression, which adds to the risk of recurrent myocardial infarction and death. Guidelines exist to urge primary care […]

Crisis Intervention for Aggressive Patients

As health care professionals, we are sometimes faced with patients in crisis. An estimated 4 percent of visits to primary care physicians involve psychiatric or social crises. Proper assessment and intervention are essential to ensure the safety of the patient and others. For purposes of this article, crisis moments refer to those points in time […]

Psychiatry and Chronic Pain

Pain affects nearly 100 million people and is one of the most common complaints made to primary care providers by their patients. More than 20% of all medical visits are pain-related. Consistent with a biopsychosocial model of illness, individuals with chronic pain often report that the pain interferes with their ability to engage in occupational […]

Medical Differential for Patient Presenting with Depressive Symptoms

When a patient, especially one without a history of depression, presents with depressive symptoms, it is important to consider if those symptoms are a result of another medical condition. Depressive symptoms that are more likely to be in this category include:  Fatigue/low energy  Trouble initiating or maintaining sleep  Hypersomnia  Significant change in […]

“Hallucinations” in Children

Hallucinations in children can be a confounding symptom and it is important to evaluate further if a child is presenting with concerns about hallucinations. It is important to distinguish among true hallucinations (false auditory, visual or other sensory perceptions that are not associated with real external stimuli), illusions (misperceptions of actual stimuli), imaginary friends, fantasies […]

Breaking Confidentiality with Confidence

While privacy and confidentiality issues are paramount parameters in all healthcare interactions, it is not uncommon for providers to feel constrained at critical moments by these concerns. A recent consult received on our provider triage line [(858) 880-6405] involved a single, middle aged gentleman who had presented on his own steam to a clinic with […]

Extra-Pyramidal Symptoms (EPS)

Extra-Pyramidal Symptoms (EPS) refers to involuntary motor movement side effects that can result from antipsychotic use. EPS is generally less likely to occur with second generation antipsychotic medications (Risperdal, Seroquel, Abilify, Geodon, Zyprexa, Latuda) compared to first generation antipsychotic medications, especially the high potency ones (Haldol, Prolixin, Trilafon). It is important to monitor for EPS, […]

Tips to Reduce the Side Effects of ADHD Medications

Medications for Attention Deficit Hyperactivity Disorder (ADHD) can be very helpful for children who struggle with hyperactivity, impulsivity, and inattention so that they can be more successful in the home and school environments. Often these medications can lead to problematic side effects such as decreased appetite, stomach pain, sleep problems, and moodiness, that can make […]