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Supported vs. Unsupported Off Label Prescribing 10/12/2017
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 […]
Rationale for Considering Long-Acting Injectable Antipsychotic Medication 10/19/2017
While schizophrenia is not a common diagnosis treated in the primary care setting, it does come up on occasion, especially when a patient is past the acute phase and in a more “stable” phase of his illness. Medication noncompliance goes hand in hand with the more severe psychiatric disorders, like schizophrenia and bipolar disorder. Really, […]
Positive Mental Health: A Better Outcome Measure for Remission? 10/26/2017
Symptom remission has been traditionally used as the outcome measure for remission in mental health disorders. This is how remission is defined in clinical trials. But is that what patients actually perceive as remission or what they want from treatment? When this has been assessed further, patients indicate what they are looking for with remission […]
Prazosin: Effective or Not? 2/22/2018
Prazosin (brand name = Minipress) is an alpha agonist medication that has long been used for hypertension and benign prostatic hyperplasia (BPH). It has anecdotally been found to be helpful for nightmares and sleep disturbance in patients with Post Traumatic Stress Disorder (PTSD) and has become increasingly used in veterans with PTSD. The starting dose […]
Non-Suicidal Self Injury 11/2/2017
Also known as self-injury and self-harm, nonsuicidal self-injury (NSSI) refers to the deliberate and direct alteration or destruction of healthy body tissue without suicidal intent. This can range from skin cutting or burning to amputation of body parts. There can also be a significant cultural component to the self-injury. While NSSI acts are done without […]
Learning From Behavioral Health Screening Tools: SPANISH VERSIONS 11/9/2017
Patients, pediatric and adult commonly present to primary care offices with symptoms and concerns related to their mental health or substance use problems. Sometimes they come in with that as part of their chief complaint, but often a PCP will have a concern that a behavioral health issue is present, either based on the physical […]
Learning From Behavioral Health Screening Tools 11/9/2017
Patients, pediatric and adult commonly present to primary care offices with symptoms and concerns related to their mental health or substance use problems. Sometimes they come in with that as part of their chief complaint, but often a PCP will have a concern that a behavioral health issue is present, either based on the physical […]
Treatment of Insomnia in Anxiety Disorders 11/16/2017
Insomnia is a common symptom in anxiety disorders, in fact it is a criteria for several DSM-IV Anxiety Disorders. It is important to inquire about sleep disturbance as part of the assessment for anxiety disorders, especially because there is clear evidence that the presence of insomnia in anxiety disorders is associated with increased morbidity. It […]
Treating Co-Morbid ADHD and Tic Disorders 11/30/2017
A recent SmartCare case consultation highlights an important clinical situation regarding co-morbid ADHD and tics. Case Presentation: 10 yo boy with history of motor tic disorder (eye blinking, shoulder shrugging) who was then diagnosed with ADHD combined type. He was started on Concerta and titrated to 36 mg qAM, which has been helpful for his […]
Depression in Older Adults 12/7/2017
Depression is not an inevitable part of growing older, but there are factors that come with aging that can increase the risk of developing depression, even for a person who does not have a history of depression. These include retiring and losing one’s professional identity, increased medical problems, losing loved ones, and increased isolation. It […]