Psychiatric Consultation to Primary Care Call or email PC2 at (858) 880-6405 , or contact us at eConsultSD.com A behavioral health integration partnership program of Vista Hill, funded by San Diego County Department of Behavioral Health Services May 22, 2012
Disorder (OCD) Obsessive-compulsive disorder (OCD) can be a debilitating disorder. The term “obsessive-compulsive” is loosely used in everyday jargon, so it is important to be able to detect clinically significant OCD. Consultee question: OCD as defined in DSM-IV entails obsessions (intrusive, A 13 year old male is being seen in his primary care provider’s unwanted, excessive worrisome thoughts) and/or compulsions office-- his mother reports: frequent hand washing, flushing (rituals or forced habits) that impair everyday life that demand the toilet repeatedly, opening and closing doors and repeating time, interfere with daily living, and alienate people. the same phrase over and over. As a young child, he was seen Obsessions and compulsions can involve: preoccupation with by a psychiatrist for conduct issues and, anger management sexual, violent or religious thoughts; preoccupation with problems in school. Mother may also have mental health contamination, cleaning; checking for symmetry and order; problems, stating there is a stalker watching the family—she and hoarding. has made police reports but these have not been substantiated. Maternal grandmother had a history of mental illness of Patient are typically aware that their symptoms are irrational unknown nature. and excessive but feel compelled to do them anyways. Rarely, they have poor insight, making treatment more difficult. Some Consultant response: patients present with psychotic delusions. The prevalence of It is wise to speak with the youth without the mother present to OCD is 2% in the adult population. Since 3 of 4 patients have clarify the reported symptoms and assess for other concerns. symptoms before adulthood, it is good to inquire about onset. . A referral for counseling is usually indicated. Medication such as fluoxetine or citalopram may be offered using a slow OCD co-morbidities include anxiety, depressive, and eating titration of 10mg. every two weeks to a target dose of 40mg., disorders in adults. Comorbidities in childhood include ADHD with monitoring for physiological side effects and mental status and tic disorders. changes. A simple informational feedback loop with the therapist is most desirable. The YBOCS is a diagnostic tool that delineates symptoms and rates the level of severity and insight of a patient. www.stlocd.org/handouts/YBOC-Symptom-Checklist.pdf Treatment options include psychotherapies such as Exposure When you contact PC2 about a patient with behavioral health Response Prevention (ERP), a cognitive behavior therapy, and concerns, your question goes first to Bella Montgomery, RNP, medications. ERP involves repeat exposure to triggers with support and redirection from the patient’s ri our triage clinician, who then contacts one of the PC2 psychiatrists: Mark Chenven, M.D., Charmi Patel Rao, M.D., or Will Connor, M.D. Medication options include the SSRIs (Prozac, Paxil, Lexapro, Celexa, Zoloft, Luvox) and Anafranil (an older tricyclic Callers to PC2 receive a time-sensitive response, followed by a antidepressant). Slow titration is used to avoid worsening the written note faxed to you for inclusion in the medical record. anxiety, and patients often need higher doses for longer periods Emailed questions and eConsultSD.com consults are answered of time for a full effect. within 24 hours. Patience and persistence are needed. Periodic re- PC2 consults are a no cost service,. PC2 is a component of administration of the YBOCS tool may assist in monitoring Vista Hill’s SmartCare Integrated Behavioral Healthcare progress and can be useful in demonstrating clinical response. Community Clinic Partnership Program, with funding from As with most behavioral health problems, most patients do Mental Health Services Act provided by San Diego Behavioral better with a combination of medication and therapy. Health Services.
An In-depth Look at Children with IC "I think it's important for people to know that kids can get IC." That's what 10-year-old JT McNeil told the ICA Update and all the legislators and aides who would listen when he joined the ICA's Capitol Hill Walk last June at age 9. But not all physicians or even pediatric urologists know that. JT's mom, the ICA's Children's Advocate Merri M
Case #205 (2/24/09) BIONEURIX CORPORATION Amoryn Dietary Supplement Direct response advertising for the Amoryn dietary supplement, marketed by the BioNeurix Corporation came to the attention of the National Advertising Review Council’s Electronic Retailing Self-Regulation Program (“ERSP”) pursuant to ERSPs ongoing monitoring program. Following ERSP’s initial review of online advertising