Studies indicate that anxiety conditions are often underdiagnosed and undertreated in primary care. The Ottawa Anxiety Algorithm has been designed to be evidence-based and practical, and contains guidance as to when and how to screen for and diagnose anxiety conditions, self-help resources that can be emailed to patients, links to community resources and treatment algorithms for the commonly used medications for these conditions.
Experience of imposter feelings is linked to poor mental health outcomes such as anxiety, depression, and burnout and results in lower professional fulfillment. There may not be a “cure” for imposter syndrome, but there are strategies available to minimize the onset of it. Addressing symptoms that can have a significant impact on your well-being and those that you care for.
Given the rapidly shifting social, political, and legal contexts surrounding the use of psychedelics, we realized the need to offer an informed opinion on the use of psychedelics in the same way we offer information and harm reduction strategies for substances such as opiates, cannabis, and alcohol.
October is ADHD Awareness Month. Until recently, female presentations of ADHD have been largely overlooked in both clinical and research settings. With increasing awareness and media attention to women and ADHD, adult women are asking if ADHD could explain their longstanding challenges.
A large part of physician’s day is spent on mental health and wait times to see specialists can be very long. In 2022 the BC Government created “Group Medical Visit” (GMV) codes to promote physicians to deliver services to groups of patients as “an effective way of leveraging existing resources; simultaneously improving quality of care and health outcomes, increasing patient access to care and reducing costs” (BC Gov, 2022). Physicians can now refer their patients to the Group Cognitive Behavioral Therapy program via cbtskills.ca or through PathwaysBC fillable PDF and they can also train to facilitate group medical visits.
It has been eighteen months since COVID-19 emerged in Canada. The trajectory of the pandemic has placed a strain on our citizens’ mental health, particularly our frontline workers. While physician well-being has been a longstanding concern, the global pandemic has magnified the daily challenges that clinicians so bravely navigate to safeguard the health of their patients.
The ingredients needed to create a happy workplace also largely reflect the principles of secure attachment. Across all levels within organizations, if people do not feel “safe, seen, soothed, and secure” they are more likely to make errors, breach safety protocols, and struggle working together as a team.
Concussions or mild traumatic brain injury are the most common type of traumatic brain injury. It is estimated that every year in British Columbia (BC), there are approximately 14,500 visits to the emergency department and that this number is most likely an underestimate of the “true burden of concussion”.
As I started to understand that this pandemic would wear on, I had to figure out how to help my patients’ families and my own family navigate our way through this totally new reality. I drew on the science of attachment, resilience and healthy relationships to make a plan. (Please stay tuned for Article #3!)
(Please stay tuned for Article #2: ‘Parenting during a pandemic’. We will expand on how to nurture these secure attachments with our children.) By Dr. Linda Uyeda (biography and disclosures) and Dr. Ashley Miller (biography and disclosures) (Members of the Child and Youth Mental Health and Substance Use Community of Practice and the Working Group […]
Fellow psychiatrists often ask whether their patients with schizophrenia are aging prematurely. They point to the fact that several of their patients seem slowed down, forgetful, fidgety, and that they garble their words and stutter. These are, of course, all side effects of antipsychotic medication.
Now in 2019, we are learning that the incidence in girls is higher than previously thought. The girls are catching up to the boys. What is that about? Turns out that the girls are better at hiding their disability but it is there. So, we have to look harder.
I now ask all patients, young and old, new to my practice and established for years, male and female, to complete an ACEs questionnaire in my clinic. I garner a new level of respect for my patients’ resilience and for the ongoing turmoil many of my young patients face. I make finding supports for these young vulnerable patients one of my top priorities—as important as a referral to a specialist or for diagnostic imaging.
View personality disorder symptoms as important treatment targets in themselves. Be curious about each patient’s story, validate PD symptoms as coping mechanisms, focus on collaborative problem solving, set proactive regular visits, and also be mindful of your own emotional reactions providing compassion and empathy while setting clear boundaries.
What I have found is that while it can sometimes be assumed that motor problems are the patient’s “biggest problem”, this is often not the case; instead, I now make a point of asking the patient, and their family directly: “What is the biggest problem for you right now?”
Unwanted, intrusive thoughts of accidental harm to one’s infant are reported by 100% of new mothers, and unwanted, intrusive thoughts of intentionally harming one’s infant are reported by 50% of new mothers. Ask specifically about unwanted, intrusive thoughts of infant-related harm. Educate pregnant women and normalize the occurrence of the thoughts. Reassure women that, in the absence of any additional risk factors for child abuse, disclosure of these thoughts will not result in any action on the part of the care provider/physician.
I realized that engagement is paramount when working with an ambivalent patient, because the change that they want to make is often important in their life, even if the clinician views it as a problem behavior. Motivational interviewing education has been shown to improve patient alliance and treatment adherence.
What changed our practice was a fundamental recognition of trauma as a determinant of health, and furthermore, that PTSD is only the tip of the iceberg when it comes to trauma. Much lies under the surface for our patients.
When psychiatric patients are treated in an emergency department, they are often hypervigilant, manic, or otherwise in an excited, agitated state. The current standard of care to manage acute agitation in adults is using an antipsychotic medication and a benzodiazepine, often loxapine or haloperidol and lorazepam.
As a general pediatrician, I see many children whose behaviour and/or development is not emerging as expected. A diagnosis such as autism or learning disability may be the obvious explanation; but frequently it is not so straightforward. Parents come armed with questions about ‘processing disorders’ and and they expect their MD to be knowledgeable.
The statistics regarding recovery from concussion indicate that the majority of individuals will be symptom-free at 3 months; within 6 months 70-75% will be symptom free; and within a year 10% will have 1 persisting symptom and 5% will have 4 or more persisting symptoms
Affecting 2-3% of Canadians, intellectual disability (ID) is a lifelong, devastating condition defined by deficits in cognitive functioning (IQ<70) and adaptive skills. It is called global developmental disability (GDD) in children less than 5 years of age; it is defined as deficits in 2 or more developmental domains. In Canada, approximately 7,600-11,500 children are born annually with GDD. Identification of GDD or ID in children is the essential first step and often a task for the primary care practitioner.
Simple use of a self-rated symptom checklist can double the odds of response to antidepressant medication in primary-care patients.
Mental health problems including anxiety, depression and stress make up a large proportion of a typical day in primary care medicine. They also contribute a huge comorbid burden in specialty care. These conditions all require an intense amount of time to help and manage patients.
Often, self-injury is managed and treated in the context of therapy work with a psychologist or psychiatrist. Family physicians, however, are in an excellent position to be first responders, to offer helpful suggestions, and to help refer the patient to appropriate care.
Autism rare? Not so now. The current prevalence is a staggering 1 in 68, about four times as common as type 1 diabetes, with a male to female ratio of 5:1.
Depression can have devastating effects on the elderly and their families. Moreover, it is often under recognized, as it can present atypically, with agitation/ anxiety, somatic symptoms, or cognitive and functional decline rather than sadness and withdrawal.
Innovative forms of service delivery have the potential to greatly expand the scope of depression intervention. Series of self-management workbooks designed to teach depressed individuals evidence-based skills for mood management, available for free download from http://www.comh.ca/selfcare/.
The evidence has become impossible to ignore that people with chronic mental illness are dying from heart attacks and strokes at a higher rate than the general population.
In providing care to frail and severely demented elderly we see many patients with aspiration pneumonia, swallowing problems and failing to eat. We also see many patients fail to get better even when we have adequately addressed their acute medical issues.
Recent Comments