PSYCHIATRIC SERVICES & CARE

Norm Jacobowitz, APRN and Mary Fisher, APRN, are licensed to provide Psychiatric Medication Management, Psychotherapy, Psychoeducation, and other behavioral health services. In general, your care will be restricted to Psychiatric Medication Management and Psychoeducation.

While not always required as a condition of receiving services, Norm and Mary believe that you often cannot expect good results in treatment without engaging in psychotherapy. In addition, it is proven that exercise, good sleep hygiene, and avoidance of alcohol and other substances (including cannabis/THC) are important to your recovery. 

COVID-19 Response: Since the COVID-19 Emergency declaration in January of 2020, follow-up visits for existing patients are optionally offered via telemedicine/telepsychiatry.

Norm provides treatment for these and other psychiatric conditions:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Anxiety Disorders
• Panic Symptoms
• Depressive Disorders
• Bipolar & Mood Disorders
• Obsessive-Compulsive Disorders
• Post Traumatic Stress Disorder
• Insomnia / Sleep Disorders
• Schizophrenia Spectrum Disorders & Schizoaffective Disorder
• Other disorders for which psychiatric medications are shown to be beneficial

The following descriptions are brief outlines of the most common psychiatric conditions treated, and should not be considered a diagnostic tool or treatment advice. When you meet with Norm, you’ll discuss your symptoms in detail and develop an individual treatment plan specific to your diagnosis and needs. If you wish to learn more about a specific condition before meeting with Norm, National Alliance on Mental Illness (NAMI) has great information for you. 

Attention Deficit Hyperactivity Disorder, or ADHD, symptoms start before age 12 and include:

• difficulty focusing or staying on task at work, school and home
• being very distractible to the point you cannot complete tasks
• being very disorganized and unable to plan
• severe procrastination or poor time management
• being physically restless and unable to sit still through school or work
• losing things frequently or missing appointments
• difficulty paying attention when reading or in conversations
• interrupting others or talking out of turn

ADHD usually responds to medications to some degree, but for adults, full relief usually requires ADHD coaching or executive functioning training in addition to the medication.

Anxiety disorder symptoms may include:

• excessive worry, fear, dread or always feeling like something bad is about to happen, even if you are not sure what that might be
• feeling nervous, restless “on edge” or jumpy
• unable to get your mind off your worries or fears to the point that your daily life becomes difficult or even unmanageable
• physical symptoms like upset stomach, nausea, diarrhea, racing heart, sweaty palms, headaches, and trouble sleeping

Treating Anxiety can be a challenge. Medications can help, but alone are almost never enough to ease all your symptoms: psychotherapy, regular exercise, stress reduction, good sleep hygiene, and engaging in pleasurable activities (like hobbies) are all part of a complete treatment program. 

Panic symptoms can include:

• severe and intense onset of pounding/racing heartbeat
• rapid shallow breathing or feeling you cannot breathe or are being smothered
• tunnel vision or difficulty hearing
• sensation of doom or that you are actually dying 

Panic symptoms or panic attacks can come out of nowhere, or can be triggered by specific events or fears. Medications can help with sudden symptoms, but reducing the frequency and severity of panic attacks generally requires consistent treatment including psychotherapy.

Depressive Disorders (Major Depressive Disorder or “Unipolar Depression”) symptoms include:

• sadness, feeling blue, or “down”
• lack of pleasure in doing things, even things you used to love like hobbies
• low energy, feeling drained, and/or low motivation to do things
• eating too much or eating too little
• sleeping too much, not wanting to get out of bed, or having difficulty sleeping even though you feel tired
• feeling guilty or hopeless and helpless
• physical aches and pains or other physical symptoms
• inability to concentrate on work or daily affairs
• suicidal thoughts or feeling those you love might be better off without you

Depression can respond to medications, but medications are almost never effective without psychotherapy, regular exercise, or other techniques like meditation. In severe cases, Transcranial Magnetic Stimulation, Ketamine Treatment, or Electroconvulsive Therapy can be used.

Bipolar Disorder and related mood disorder symptoms include discrete episodes of:

• dramatic out of character elevation of mood or self-esteem or even grandiosity
• significant elevation of energy and desire to do or accomplish things
• decreased need for sleep or feeling well-rested with very little sleep
• out of character impulsivity such as spending money, driving recklessly, or doing things you would normally never do
• feeling like your thoughts are racing or like you cannot finish a thought

Usually, bipolar disorder will include the above symptoms alternating with depression symptoms. Bipolar disorder almost always requires medications to treat effectively. Treatment is important because severe mood symptoms can be very disruptive or lead to serious problems for you and those around you. 

Obsessive-Compulsive Disorder (OCD) includes symptoms like:

• uncontrollable, recurring images, or ideas that are unpleasant or disturbing
• intrusive thoughts or worries that you may know are irrational but yet somehow seem true
• repetitive behaviors or actions that you are unable to stop repeating, such as excessive handwashing

OCD can be devastating, with a physical and mental toll on sufferers. OCD can require high dosages of medications in addition to behavioral modifications and psychotherapy to control. 

Post Traumatic Stress Disorder (PTSD) is complex, some symptoms are:

• “flashbacks” or reliving the traumatic experience you suffered
• avoidance of events, people, or places that remind your of a traumatic experience
• being easily frightened, startled, or always being on-guard or overly vigilant
• memory or cognitive problems
• nightmares and other sleep disturbances

PTSD can stem from any form of traumatic experience, such as motor vehicle accidents, physical, emotional or sexual abuse, and combat experience. While medications can help with some symptoms, psychotherapy is the main form of treatment.

Insomnia and sleep disorders can have many forms, including:

• Difficulty falling or staying asleep
• Not feeling rested despite getting enough sleep
• Problems breathing during sleep, like snoring or sleep apnea
• Complex sleep behaviors like sleep walking or engaging in behaviors as if you are awake (like cooking, fighting, having conversations, etc)

Psychiatric medications can help with mild sleep problems related to other psychiatric disorders, but Cognitive Behavioral Therapy for Insomnia (CBT-I) is the best treatment. Primary sleep disorders or parasomnias and sleep apnea are generally treated by a sleep medicine specialist.

Schizophrenia is a serious psychiatric condition with symptoms including:

• Severe disruption of thought processes and cognitive abilities
• Perceptual disturbances like hallucinations
• Delusional or paranoid thoughts
• Flattening of emotions and severely impaired social interaction

Schizophrenia is a devastating illness with poor prognosis if not treated early and correctly. Medications are the main focus of treatment along with lifestyle management and psychoeducation.

This office treats psychiatric conditions only, but sometimes the medications prescribed can help with other conditions, for example:

• If a patient suffers migraines and insomnia, some medications can help with both
• Certain pain conditions are helped by some psychiatric medications
• Some medications for ADHD can help with tics or hypertension
• Mood stabilizers can also help with some neurological conditions

If the underlying medical condition is uncontrolled, you will be referred back to your primary care provider or the appropriate specialist.