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 […]
Author Archive: Shirley Fett
Non-Suicidal Self Injury 11/2/2017
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 […]
Learning From Behavioral Health Screening Tools: SPANISH VERSIONS 11/9/2017
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 […]
Learning From Behavioral Health Screening Tools 11/9/2017
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 […]
Treatment of Insomnia in Anxiety Disorders 11/16/2017
Insomnia is a common symptom in anxiety disorders, in fact it is a criteria for several DSM-IV 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. It […]
Treating Co-Morbid ADHD and Tic Disorders 11/30/2017
A recent SmartCare case consultation highlights an important clinical situation regarding co-morbid ADHD and tics. Case Presentation: 10 yo boy with history of motor tic disorder (eye blinking, shoulder shrugging) who was then diagnosed with ADHD combined type. He was started on Concerta and titrated to 36 mg qAM, which has been helpful for his […]
Depression in Older Adults 12/7/2017
Depression is not an inevitable part of growing older, but there are factors that come with aging that can increase the risk of developing depression, even for a person who does not have a history of depression. These include retiring and losing one’s professional identity, increased medical problems, losing loved ones, and increased isolation. It […]
Improving Detection of Postpartum Depression 12/14/2017
Postpartum depression is fairly common, with a prevalence of 10-15%. PPD can occur anytime in the first year after delivery. The postpartum year is one of the highest risk periods for first-onset depression for women with approximately 50% of women who will have a depressive disorder in their lifetime experiencing their first episode of depression […]
Primer on the Opioid Epidemic 12/21/2017
The opioid epidemic is all over the news, and has become both a national political football and a health care crisis. It might be worthwhile to look at some of the factors that got us here. The opioid epidemic has become a national emergency because of multiple factors: deaths related to overdose, lost employment, harm […]
Assessing and Treating Tardive Dyskinesia 1/4/2018
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 […]