Anxiety disorders are common in young people, affecting 4%–7% of children. It appears that the majority of “adult” anxiety disorders begin in childhood and are stable and often chronic conditions, so an effective intervention can have lifelong benefits.

While there are many different anxiety disorders, the mainstay of treatment for nearly all of them is the same: cognitive behavioral therapy (CBT).

Anxiety disorders, in general, for children and adolescents, can be a very big problem. A big issue is that anxiety disorders are often not the first diagnoses considered and they are often overlooked.

Over the past decade or so, atypical antipsychotic use has exploded, for both FDA approved indications and off-label treatments.

Insomnia is one of the most common comorbidities you’ll see in your depressed and anxious patients. But it is often misunderstood. While the common view is that insomnia is caused by a primary psychiatric or medical condition, it is more accurate to simply say that patients have insomnia and depression at the same time. Insomnia is almost never an isolated problem.

This handy table lists the medications most often used to treat insomnia.

If patients are stable on olanzapine (Zyprexa), quetiapine (Seroquel), or risperidone (Risperdal) but are experiencing adverse metabolic effects, it might make sense to switch to a medication that has a lower risk of causing such effects. But would such a switch reduce obesity and cholesterol at the risk of a relapse?

Using combination antipsychotic treatment has become more common over the years, presumably reflecting a common sense theory that in refractory patients, two medications might be more effective than one. But studies thus far of the practice have been small and inconclusive.

Lurasidone (Latuda) was approved by the FDA for schizophrenia in October 2010 and is the 10th atypical antipsychotic in our toolbox. The key question is: does lurasidone have any advantages over existing agents, or is it just another “me-too” drug?

In what ways, if any, are cognitive problem a distinct feature of schizophrenia? And how can we use this information to guide treatment?