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Assessing and Treating Sleep Disturbance in Patients with Dementia (part 1): Assessment

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 […]

Psychiatric Issues Related to Contraceptives

Contraceptives are commonly used in many forms (oral, patch, injection, etc.) in women of childbearing age, many of who also have psychiatric concerns. It is important to be aware of the interactions between contraceptives and certain psychotropic medications as well as the psychiatric side effects of contraceptives themselves. Contraceptives have synthetic estrogen, progesterone or a […]

Insomnia: Assessment and Treatment in Primary Care (Part Two of Two)

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: Assessment and Treatment in Adults (Part I)

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 […]

The Link Between PTSD and ADHD

It has been shown that the risk for Post-Traumatic Stress Disorder (PTSD) is higher in individuals with Attention Deficit Hyperactivity Disorder (ADHD) compared to those without ADHD and the risk for ADHD is higher in individuals with PTSD than those without PTSD. The strongest correlation is for the risk of PTSD in individuals with ADHD […]

How to Assess for ADHD in Adults

  Attention-deficit/hyperactivity disorder (ADHD) affects about 1/3 of adults who had ADHD in childhood. It can be difficult to diagnose because of the overlap in symptoms of adult ADHD with depression, anxiety and substance abuse, and reliance solely on the patient’s self report of symptoms. Studies of self-referral suggest that only 1/3-1/2 of adults who […]

Ways to say “No” to your patients and still keep them smiling.

Telling patients no is not always easy.  Primary care physicians (PCPs) know this all too well. Most providers feel pressure to obtain better patient satisfaction scores and know that their compensation, in part, is linked to this. How do you tell such patients “no” in a nice way that minimizes your risk of being trashed […]

Perchance to Sleep: Cognitive Behavioral Therapy for Insomnia

One of the primary presenting complaints in the primary care setting is insomnia. It can be a solitary presenting symptom or it can be part of a constellation of symptoms related to a medical cause or mood or anxiety disorder. A good assessment of onset, extent, duration, onset, severity, triggers of the sleep problem, in […]