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 (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 […]

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 […]

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 […]

Given the increase in prescribing of antipsychotic medication, it is more important than ever for providers to be screening for Tardive Dyskinesia (TD) and other extrapyramidal symptoms (EPS) related to antipsychotic use. Partially, the increase in prescribing of antipsychotic medications is related to their use in non-psychotic disorders, like monotherapy for bipolar disorder and adjunctive […]

Concussion, defined as a head injury with a temporary loss of brain function, is the most common type of traumatic brain injury. There is typically not a loss of consciousness associated with most concussions, and the sequelae are typically temporary. Concussion can cause a variety of physical, cognitive, and emotional symptoms. This article is going […]

Alcohol Use Disorder (AUD) is very common and can lead to medical, social and legal impairments for affected individuals and their families. Despite the high prevalence of AUD and its significant public health consequences, patients with this disorder continue to be under-identified and undertreated. The American Psychiatric Association has recently come out with practice guidelines […]

Type of Treatment Advantages Disadvantages SSRIs*/SNRIs*: paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac),  citalopram (Celexa), venlafaxine(Effexor),  duloxetine (Cymbalta) Recommended first-line treatments in GAD Effective against comorbid depression Slow onset of action Sexual dysfunction, other side effects limit compliance Tolerability/withdrawal issues/”start low, go slow”. Maximize dose over time, as tolerated. Psychological Therapies/Counseling: Concurrent with possible medications; All patients […]

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 […]