“My child can’t focus. What does that mean?”

Many children and adolescents present to their primary care provider’s office with concerns about inattention, poor focus or poor concentration. Since the primary care provider’s office is typically the first stop, it is important to be comfortable further evaluating the presenting problem, identifying associated symptoms, determining the diagnosis and implementing the best treatment plan. Many […]


It used to be thought that obsessive-compulsive disorder (OCD) was rare, but it is more common than originally thought. The prevalence is between 2-3% worldwide and it affects males and females equally. Symptoms usually present between childhood and early adulthood, with 75% of patients having symptoms before the age of 18. OCD can be a […]

Depression in Adolescents

Major depression affects 6% of adolescents with an additional 5-10% presenting with sub-syndromal symptoms of depression. There is a 2:1 female:male ratio of major depression in adolescents. Teens frequently don’t present with the typical DSM criteria for Major Depressive Disorder (MDD). Common depressive symptoms in adolescents include: irritability (as opposed to reporting a sad mood), […]

Anxiety Disorders

Anxiety disorders are far and away one of the most frequent of mental health disorders. Often they are not recognized and/or treated within the context of the primary care setting, even though they tend to be chronic conditions that have significant impact on patients’ health and well-being. Anxiety is a universal and highly adaptive experience, […]

Nonsuicidal Self-Injury

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 be a cultural component to the self-injury. While NSSI acts are done without suicidal intention, […]

4 Traits That Put Kids at Risk for Addiction

The New York Times had an article in September 2016 (http://www.nytimes.com/2016/10/04/well/family/the-4-traits-that-put-kids-at-risk-for-addiction.html) that discussed the risk factors for addiction. Traditional anti-drug education in schools focuses on scare tactics and the message “Just Say No”, which has been found to be largely ineffective in children and adolescents who at the highest risk for drug abuse. Recent anti-drug […]

Generalized Anxiety Disorder (GAD)

Anxiety disorders are the most prevalent of all psychiatric disorders, with generalized anxiety disorder (GAD) being the most common seen in primary care. Nearly 8% of patients consulting a primary care provider have GAD according to the World Health Organization (WHO). Despite this, it is a diagnosis that can easily be missed. The good news […]

Guidelines for Tapering Benzodiazepines

Psychological and physiological dependence on benzodiazepines can occur in as little as two weeks of daily moderate use. It can occur in the most benign of clinical situations, and it is important for providers to be aware of the risk for dependence when prescribing this class of medications. If a patient has been on a […]

Appropriate Use of Benzodiazepines

Millions of prescriptions are written every year for benzodiazepines. In a large percentage of these cases, the provider is uncomfortable with the prescription. For this reason and many others, it is important to have a good understanding of when it might be appropriate to prescribe a benzodiazepine for a patient. This is also becoming particularly […]

Treatment for Anxiety in Children and Adolescents

The presenting symptoms of anxiety in children and adolescents were discussed in last week’s edition and today’s focuses on treatment in pediatric populations.  Primary care pediatric providers can play a major role in diagnosis, treatment planning, prescribing and, as needed, referring for consultation or specialty intervention. Treatment options include therapy or a combination of therapy […]