Helping Parents Understand Why Spanking is not Effective 2/14/2019

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 […]

Premenstrual Dysphoric Disorder (PMDD) 2/7/2019

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 […]

Nonsuicidal Self Injury (NSSI) 1/31/2019

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 […]

Psychotropic Medications and Birth Control Chart 1/24/2019

Medication No Known Effect Increases metabolism/decreases effectiveness of contraceptive Increases metabolism/decreases effectiveness of psychotropic medication Decreases metabolism/concerns about toxicity from psychotropic medication SSRIs X       Tricyclic antidepressants       X 2nd generation antipsychotics X       1st generation antipsychotics       ? Lithium X       valproate   X […]

Important Drug Interactions Between Psychotropic Medications and Contraceptives 1/24/2019

Contraceptives are commonly used in women of childbearing age, many of who are also taking psychotropic medications for mental health 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 combination of […]

Sleep Apnea and Psychiatric Illness 1/17/2019

There is an interesting relationship between obstructive sleep apnea (OSA) and psychiatric disorders, particularly major depressive disorder (MDD). Given that both are commonly seen in the primary care setting, it is important for providers to understand that relationship in more detail. OSA can play a role in exacerbating medical problems in people with mental health […]

Treatment Resistant OCD

In a previous e-weekly, we discussed assessment and treatment of obsessive-compulsive disorder (OCD). It is well known that OCD is a chronic waxing and waning disorder. The hidden nature of symptoms and the reinforcement provided by the reduction in anxiety after performing a compulsion contribute to sustained illness. Once the diagnosis of OCD is made, […]

What happens first—depression or chronic illness? 12/20/2018

Both mental health disorders and chronic diseases are common and disabling. These conditions can affect anyone, regardless of age, culture, race/ethnicity, gender, or income. The cause is not entirely clear, but it is believed to be a combination of changes in the brain and other neurobiochemical reactions, lack of functionality, and medication related side effects. […]

Treating Neuropsychiatric Symptoms related to Dementia 12/13/2018

More than 5 million older adults in the United States are living with Alzheimer’s disease and other dementias. Although dementia is viewed as a memory loss disorder, neuropsychiatric symptoms (NPS) are common features. NPS can include aggression, agitation, wandering, depression, anxiety, sleep disturbance and paranoia. Nearly all patients with dementia will develop at least one […]

Mental Health Concerns in Adults with Autism Spectrum Disorders 12/6/2018

As the Autism Spectrum Disorders (ASD) are being better recognized and identified, both in early childhood and even in later childhood and adolescence, this is leading to better awareness of the impact of autism on some of our adult patients. As we know, ASD is a lifetime condition. Patients with ASD are at higher risk […]