MDOCC

For Primary Care Providers

Common Questions from PCPs

I have a 19-year-old patient that has Seasonal Affective Disorder who I’m wondering about. She complained of some depressive symptoms a few weeks ago but attributed them to stress from finals at community college. Now that finals are over, she is still not feeling “like herself.” She endorses the following symptoms: tiredness even after sleeping 9-10 hours, difficulty concentrating, weight gain, lack of interest in normal activities, and social withdrawal. After reviewing her chart, she did endorse a few of these symptoms around the same time last year. Is there anything different in treating SAD versus MDD?

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I am working with a 13 year old patient who sees a specialist for ADHD and co-morbid diagnoses. The patient’s parent reported to me that their child is being prescribed an experimental dose of Ketamine (150mg/ml) 2 sprays every 7 days for mood by the specialist. I am not really comfortable with this, but I’m also not too familiar with the off-label use of Ketamine for ADHD.

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I am working with an adolescent male with obesity & Major Depressive Disorder. After several weeks increasing his SSRI medications, he’s not responding. Suggestions?

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I have a 5 year old patient that appears to be selectively mute. He will talk with parents and grandparents, and peers that are his same age. However, he will hide and cry when other adults try to speak to him. He won’t talk at school and will not interact with teacher verbally. Teacher is not able to do any verbal assessments. The patient is learning, at or above grade level in reading, writing, and above grade level in math. He will point to things he wants. Parents are worried about him, especially as he gets older and will inevitably have to interact with other adults. What type of treatment would be helpful?

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I have a patient who is experiencing severe Cymbalta discontinuation symptoms despite a very slow taper (going from Cymbalta 60mg to 50 mg). I’ve tried adding a low dose Prozac but it doesn’t seem to help. Any other ideas how to help manage the discontinuation?

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I’m having a hard time conveying to my patients and their caregivers the importance of starting an SSRI when it’s needed for depression. Often, I find my patients “tune out” after I discuss the black box warning. Any words of wisdom?

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I’m seeing a new mom whose baby is one week old. She is currently on Vyvanse for her ADHD. Is it ok for her to nurse while she’s taking Vyvanse?

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I’m treating a child with self-injurious behaviors, who has cognitive impairment due to severe neglect and drug exposure in utero. Patient is responding positively to Risperdal for violence and aggression. However, I need some suggestions on treating the self-injurious behaviors.

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I’m treating a young teenager with autism. The patient is functioning rather well, in special education services and in ABA. However, there has been a recent increase in irritability. What is the approach for treating irritability in autism?

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Is it ok to “double-up” on the Daytrana patch? I have a few patients who tolerate the patch quite well, but there are certain days that they could certainly use a bit more assistance in treating their ADHD.

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How do I apply for a new or replacement Social Security number card?

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