Motivational interviewing (MI) is a technique that can be applicable to all clinical settings including primary care. MI is defined as “a person-centered, goal-oriented approach for facilitating change by exploring and resolving ambivalence” (Miller 2006). It can be useful in situations when a patient’s behavioral choices negatively impact his health condition – examples include smoking, […]
CBD Oil: What Do We Know? 4/5/2018
Particularly with legalization of marijuana and increasing use of medical marijuana, a buzz has developed about CBD oil and many patients are asking their primary care providers about using it for various medical conditions. It can be challenging to know how to answer many of the questions, but it helps to be as up-to-date as […]
Guidelines for tapering benzodiazepines 3/29/2018
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 […]
Co-Morbid Depression and Pain 3/22/2018
It is worth spending some time reviewing the complicated relationship between depression and pain. It is easy to see how depression can worsen the experience of pain and pain can worsen the experience of depression. Depression can occur as a result of a poorly treated pain syndrome, especially if a patient’s level of functioning deteriorates […]
Cannabis Use in Adolescents 3/15/2018
There is a complexity when it comes to cannabis – it can be safe and benign, it can have medicinal components, and it can be harmful and dangerous. These are all true. As regulations around cannabis continue to loosen, it is imperative that providers understand that cannabis use will probably increase. It is therefore important […]
Important Monitoring Guideline for Psychotropic Medications 6/29/2017
Important Monitoring Guidelines for Psychotropic Medications There are some important monitoring guidelines to keep in mind when prescribing psychotropic medications, to ensure that the medications are well tolerated and that patients are not developing problematic side effects. Here is a brief review of those guidelines: MEDICATION LAB/MEASUREMENT FREQUENCY Antipsychotics All atypical and typical […]
Is It Late Life Depression or Dementia? 7/6/2017
It is often difficult to differentiate between depression and dementia in older patients, particularly because there is overlap in the presenting symptoms and the two disorders can occur co-morbidly. Population studies have shown that over the age of 85, the two disorders occur co-morbidly in 1 out of 4 people. And late-life depression is a […]
Bipolar Disorder in Primary Care Part 1 7/13/2017
Primary care providers may often be the first point of contact for persons with bipolar disorder, and about 25% of patients with bipolar disorder receive their mental health care predominantly through the primary care setting. PCPs are in a unique position to be the first clinicians to be able to recognize bipolar symptoms early in […]
Bipolar Disorder in Primary Care Part 2: Treatment 7/20/2017
It is important that primary care providers have a basic level of understanding of the medications used to treat bipolar disorder as they may be called upon to help maintain and monitor ongoing medication treatment or they may be the first person to identify the condition in a patient. Regardless of the context, the primary […]
Is This Bipolar Disorder? 7/27/2017
Case Presentation: A 24 year old female who meets criteria for a major depressive episode was started on fluoxetine (Prozac) and titrated up to 20mg per day. Her presenting depressive symptoms included: sad mood, hypersomnia, fatigue, poor concentration, and crying spells for 1 month. Her symptoms were and still are impacting her functioning at work. […]