Author name: Emma Samelson-Jones

How do you talk with patients about suicidal thoughts and behaviors?

David is a 60 yo man with chronic pain on opioids, PTSD, alcohol use disorder, and major depression, who was introduced in our last PsychSnap. He calls his primary care clinic every few weeks saying that he is going to kill himself if his pain isn’t better controlled. He now presents to a routine follow-up …

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Can suicide risk assessments prevent your patients from dying by suicide?

David is a 60 yo man with a history of chronic low back from severe disc disease on long-term opioids, PTSD, alcohol use disorder, and major depression. After his husband died 30 years ago, he tried to kill himself twice by hanging and was psychiatrically hospitalized for severe depression after each attempt. Since that time, he …

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How do you navigate chronic delusions to provide effective medical care?

Ms. Wren, an 80-year-old woman with heart failure and diabetes, was recently hospitalized for a heart failure exacerbation. She has been on your panel for a year, but you have not met her. The inpatient notes describe her as having chronic fixed paranoid delusions of a man who follows her and occasionally threatens to kill …

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When should you stop an SSRI trial for depression due to lack of efficacy?

30 yo woman with generalized anxiety disorder presents in her first major depressive episode. She is depressed, hopeless, sleeping poorly, exhausted, and losing weight (6 pounds in the last month). She has never taken psychiatric medications before. She would like to try a medication to treat both depression and anxiety (so bupropion is out).  You prescribe …

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How do you evaluate for bipolar disorder in depressed patients? 

Olivia is a 19 yo woman who presents to primary care during her first major depressive episode. She feels depressed every day with a deep sense that she will always be a failure. She can’t concentrate well enough to read anymore, though she can follow short TV shows. She has low energy and wakes up every morning at …

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How do you taper long-term benzodiazepines?

We return to Mr. Davis, a 75-yo man who has taken temazepam 30mg at bedtime for 15 years for insomnia. He recently fell and fractured his wrist. You discussed the risks and benefits of continuing vs stopping temazepam and the rationale for tapering the medication as described in the prior PsychSnap. Mr. Davis decides to move forward …

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Beyond seasonal depression: how can bright light therapy be used in the management of mood disorders?

Michelle is a 45 yo woman with a history of recurrent major depression. She took several antidepressants in her 20s that were either intolerable (escitalopram) or ineffective (sertraline, venlafaxine). She has been taking fluoxetine 20mg for many years, which she says “puts a floor” on her depression. Higher doses of fluoxetine make her feel too activated. She …

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When a young adult is hearing voices and psychiatry is unavailable for months, how can you help? (part 2)

The initial published case has been modified slightly in response to feedback from colleagues. We return to Juan, the 20 yo man from our last PsychSnap. He started hearing the voice of a little boy saying things like “why won’t you help me” three months ago. He now hears the voice multiple times a day, which …

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When a young adult is hearing voices and psychiatry is unavailable for months, how can you help? (part 1)

The initial published case has been modified slightly in response to feedback from colleagues. Juan is a 20 yo young man who is brought to his PCP’s office by his mother for “hearing voices.” You speak with Juan alone first. For 3 months, he has been hearing the voice of a young boy, talking directly to him, …

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