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, […]

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 […]

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 […]

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 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 […]

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 […]

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 […]

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 […]

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. […]

A tic is defined as a sudden, rapid, non-rhythmic, repetitive movement. There are motor tics and vocal tics. Examples of motor tics include: eye blinking, grimacing, nose wrinkling, tongue protruding, shoulder shrugging, head rolling and body writhing. Examples of vocal tics include: throat clearing, sighing, smacking sounds, sucking sounds, coughing and hiccupping. Sometimes it can […]