As cannabis use increases, with easier access and recent legislation, there has been significant emerging evidence for cannabis-related risks. It is important for primary care providers to be aware of these, because a primary care office may be the place where patients present with these negative effects and educating patients about the potential risks is […]
Author Archive: Shirley Fett
CBT for Insomnia 8/31/2017
Insomnia is one of the primary presenting complaints in the primary care setting. It can be the only symptom the patient is reporting or it can be part of a constellation of symptoms related to a medical cause or mood or anxiety disorder. That, of course, has to be investigated first. Once that has been […]
Interactions: BCP’s and Psychotropic Meds 9/7/2017
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 […]
Pharmacogenetic Testing in Psychiatry 9/14/2017
There has been increasing interest in the use of pharmacogenomic testing to help with medication choice when treating psychiatric conditions. Advocates are claiming they can be helpful for personalizing prescribing, improving outcomes, and reducing costs. Some of these commercial tests are now covered by some insurance companies. While clinicians would love to have a way […]
Premenstrual Dysphoric Disorder (PMDD) 9/21/2017
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 […]
Important Drug Interactions with SSRI’s 9/28/2017
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 […]
Complementary and/or Alternative Medicine Concerns 10/5/2017
Many people are interested in using complementary and/or alternative medicine (CAM) when they are dealing with physical or mental health concerns. This is sometimes because they are worried about side effects from traditional medical treatments. Sometimes it is because they are not seeing the relief they expected from the traditional treatment prescribed by their medical […]
Supported vs. Unsupported Off Label Prescribing 10/12/2017
Off-label prescribing is a central and common source of treatment throughout medicine, particularly psychiatry. Lack of FDA indication does not equate to lack of evidence. It is therefore important to distinguish between supported and unsupported off-label prescribing practices. Supported off-label prescribing is the use of medications for a non-FDA-approved indication with clinical literature to support […]
Rationale for Considering Long-Acting Injectable Antipsychotic Medication 10/19/2017
While schizophrenia is not a common diagnosis treated in the primary care setting, it does come up on occasion, especially when a patient is past the acute phase and in a more “stable” phase of his illness. Medication noncompliance goes hand in hand with the more severe psychiatric disorders, like schizophrenia and bipolar disorder. Really, […]
Positive Mental Health: A Better Outcome Measure for Remission? 10/26/2017
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 […]