Impact of Excessive Screen Time in Children 11/29/2018

With the increased use of technology in our everyday lives, it is not surprising that children and adolescents are using screens at higher rates than ever before. Parents estimate that children ages 2-8 spend about 2 hours per day on digital devices, children ages 8-12 spend about 4.5 hours per day on screens and teenagers […]

How to Manage School Refusal 11/15/2018

Families often present to their primary care providers when their children are refusing to go to school. School refusal can happen for a variety of reasons. Some school refusal may be time-limited, but most children who are refusing to go to school on an extended basis have an underlying psychiatric concern such as major depression, […]

Important Drug Interactions with the SSRIs 11/8/2018

Selective serotonin reuptake inhibitors (SSRIs) are commonly used psychotropic medications to treat depression and anxiety. It is important to be aware of common drug interactions between them and other medications, especially because some SSRIs are competitive inhibitors of a variety of cytochrome P450 liver enzymes. Therefore, they can dramatically increase the blood levels of medications […]

Screening for Suicide Risk Among Teens 11/1/2018

Suicide is now the second leading cause of death in adolescents, in the United States, surpassing homicide and second only behind unintentional injuries (motor vehicle accidents, accidental overdose). This switch occurred because of both a reduction in deaths from homicide and a modest increase in deaths from suicide. Deaths from suicide had been decreasing from […]

“I am Concerned About Autism in the This Child”: What are the Next Steps? 10/25/2018

With improved and consistent early screening, increasing awareness and broader definitions of Autism Spectrum Disorders (ASD), it is becoming increasingly common for the question of ASD to come up in the primary care setting. Sometimes parents present with their own concerns or concerns brought up by school or daycare providers about their children. Other times, […]

Post Traumatic Stress Disorder 10/18/2018

Post Traumatic Stress Disorder (PTSD) is a mental disorder than can occur after a person is exposed to a traumatic event. It is classified as a “trauma and stress-related disorder” in the DSM-5. It used to be thought that PTSD only occurred in combat situations but it is now known that it can occur as […]

Co-Morbid Depression and ADHD – Assessment and Treatment Strategies 10/11/2018

Independently, Major Depressive Disorder (MDD) and Attention-Deficit Hyperactivity Disorder (ADHD) are two of the most commonly diagnosed psychiatric conditions. Additionally, many people who have concerns about depression and/or ADHD present first in the primary care setting. It is not uncommon for these disorders to present together, which can have implications for assessment, treatment and outcomes. […]

Evaluation and Management of Perimenopausal Depression 10/4/2018

Perimenopause is defined as the early and late menopause transition stages as well as early menopause. This typically lasts 4-8 years. It has been identified as a vulnerable time for development of depressive symptoms and major depressive episodes. It is therefore important for providers in primary care to be aware of the risk of depressive […]

Maximizing Efficacy of Antidepressants 9/27/2018

Antidepressant medications, most commonly the selective serotonin reuptake inhibitors (SSRIs), are frequently prescribed by primary care providers for depression, anxiety, and impulse control disorders. There are some important guiding principles to keep in mind when prescribing these medications, which can dramatically improve a patient’s response to treatment and ensure ongoing safety. Here is a review […]

Treatment of Insomnia in Anxiety Disorders 9/20/2018

Insomnia is a common symptom in anxiety disorders, in fact it is a criteria for several DSM 5 Anxiety Disorders. It is important to inquire about sleep disturbance as part of the assessment for anxiety disorders, especially because there is clear evidence that the presence of insomnia in anxiety disorders is associated with increased morbidity. […]