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How Anxiety Can Lead to Disruptive Behavior 3/21/2019

It is common for children and families to present to their primary care providers with concerns about behavioral problems and/or wanting to rule out ADHD. The typical presenting problem is severe temper tantrums or disruptive behavior in school. In some of these cases, the appropriate diagnosis is ADHD or another disruptive behavior disorder and treatment […]

Behavioral Management of Migraines 3/14/2019

While migraines are a medical and not a psychological condition, it is well known that psychological factors can impact a patient’s experience with migraines. It is widely known that migraines can be triggered by psychological stressors. Factors such as work stress, home stress, relationship difficulties, anxiety, depression and other issues can trigger headaches, maintain them, […]

“My Patient is Hearing Voices. What do I do?” 3/7/2019

Case Study: Patient Presenting with Mood and Psychotic Symptoms This article is based on a recent SmartCare consultation with a primary care provider. Case: 36 yo male who is a new patient presents with depressive symptoms since age 14 and previous suicide attempt at age 18. Additionally, he reports voices telling him negative things about […]

Understanding Different Assessments 2/28/2019

Patients will frequently present in the primary care setting asking for an assessment for a mental health or behavioral concern. It can be confusing to know which direction to send a family in and/or what type of assessment to refer for. There are some clarifying questions that a primary care provider can ask to better […]

“High Functioning” Depression 2/21/2019

There are people who have significant symptoms of depression but seem to have an unimpaired level of functioning. Their struggle is more internal and not readily apparent externally. This is sometimes referred to as “high functioning” depression or persistent depressive disorder (PDD) in the DSM V. PDD was referred to dysthymic disorder in the DSM […]

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 […]