There is a complexity when it comes to cannabis – it can be safe and benign, it can have medicinal components, and it can be harmful and dangerous. These are all true. As regulations around cannabis continue to loosen, it is imperative that providers understand that cannabis use will probably increase. It is therefore important […]

30-50% of adults report transient concerns with insomnia and about 5-10% of adults have chronic problems with insomnia. Insomnia is defined as a subjective difficulty with initiating or maintaining sleep that results in daytime impairment. It can occur as a primary disorder or as a secondary disorder related to another medical condition, medication side effect, […]

It is common for children and families to present to their primary care providers with concerns about behavioral problems and/or wanting to rule out ADHD. The typical presenting problem is severe temper tantrums or disruptive behavior in school. In some of these cases, the appropriate diagnosis is ADHD or another disruptive behavior disorder and treatment […]

While migraines are a medical and not a psychological condition, it is well known that psychological factors can impact a patient’s experience with migraines. It is widely known that migraines can be triggered by psychological stressors. Factors such as work stress, home stress, relationship difficulties, anxiety, depression and other issues can trigger headaches, maintain them, […]

Case Study: Patient Presenting with Mood and Psychotic Symptoms This article is based on a recent SmartCare consultation with a primary care provider. Case: 36 yo male who is a new patient presents with depressive symptoms since age 14 and previous suicide attempt at age 18. Additionally, he reports voices telling him negative things about […]

Patients will frequently present in the primary care setting asking for an assessment for a mental health or behavioral concern. It can be confusing to know which direction to send a family in and/or what type of assessment to refer for. There are some clarifying questions that a primary care provider can ask to better […]

There are people who have significant symptoms of depression but seem to have an unimpaired level of functioning. Their struggle is more internal and not readily apparent externally. This is sometimes referred to as “high functioning” depression or persistent depressive disorder (PDD) in the DSM V. PDD was referred to dysthymic disorder in the DSM […]

While the rate of corporal punishment is lessening over time, many parents continue to use spanking as a discipline tool. There is growing evidence on its limited efficacy and harmful effects. Parents often look to their children’s primary care providers for guidance on discipline. In fact, parents trust their doctors’ recommendations on parenting as much […]

Approximately 75% of women experience premenstrual changes – increased irritability, tension, depressed mood, breast tenderness and bloating – commonly referred to as premenstrual syndrome (PMS). About 5-10% of women experience moderate to severe premenstrual mood symptoms known as premenstrual dysphoric disorder (PMDD). PMDD includes depressed mood, irritability, mood lability, anxiety, anger, difficulty concentrating, and insomnia […]

Case Summary 15yo girl with symptoms of depression and slightly elevated PHQ-9 who is engaging in non-suicidal self-injury. She denies active SI and is currently doing well academically and socially with family and peers. The question that was posed is about treatment – should medication automatically be considered because of the self harm? What is […]