Who We Are
The Practice
Any provider can prescribe psychiatric medications - but there is considerable skill involved in creating a thoughtful and effective regimen tailored to each patient and their specific needs.
Dr. Beth Gabriel is a doctorally prepared, ANCC board certified psychiatric mental health nurse practitioner with experience treating a wide variety of psychiatric illnesses in children and adults. She holds doctoral and master’s degrees from Florida International University. She has experience practicing psychiatry in a variety of settings including inpatient, outpatient and rehabilitation.
The Team
Collaborating / Supervising physician Shlomo Pascal, MD is an adult and child psychiatrist with over 30 years of experience in the field. Bernadette Ranieri PMHNP-BC is a great new addition to our staff!
The Treatment Focus
Expert assessment, medication titration, and prescribing. Online Psychiatry
The Goal
Thoughtful, comprehensive care grounded in evidenced based practice and treatment planning reflective of personal treatment goals.
For Children & Adolescents
Psychiatric evaluation of children and adolescents incorporates a parental interview in order to obtain the most information possible. Prescribing medication to children should not be taken lightly and we must ensure medication therapy is necessary before it is prescribed.
Some disorders we treat
Major Depressive Disorder (MDD)
MDD (a type of severe depression) is a mental illness characterized by a person experiencing depressed mood nearly every day all day for at least two weeks and a loss of interest or pleasure in doing things they once enjoyed. Other common symptoms include: insomnia or hypersomnia, significant weight loss or gain, psychomotor agitation or retardation, impaired concentration or difficulty making decisions, fatigue, feeling worthless or excessively guilty, and recurrent thoughts of death or suicide. There are many medications that are available to treat MDD. The most common are the antidepressants including: escitalopram, sertraline, and fluoxetine.
Generalized Anxiety Disorder (GAD)
GAD is a type of anxiety disorder that is based on a person experiencing excessive anxiety and worry that is difficult to control, occurring more days than not, for at least six months. Some common symptoms of this disorder are restlessness, fatigue, difficulty concentrating, irritability, muscle tension and insomnia. GAD is commonly treated with antidepressants like fluoxetine, sertraline, and escitalopram.
Panic Disorder
Panic disorder is characterized by repeated, unexpected, and unprovoked panic attacks. These attacks are extremely intense and short in duration. Some of the expected symptoms are: palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, fear of losing control or going crazy, and fear of dying. The criteria that must be met in order to be diagnosed with panic disorder are that these panic attacks must create significant and impairing worry that another panic attack will occur and/or a significant change in behavior in relation to fear that a panic attack will occur. A person can have panic attacks and not have panic disorder. Panic disorder is usually treated with SSRI medications and sometimes with the short term addition of benzodiazepines (like alprazolam or clonazepam), and therapy.
Social Anxiety Disorder (SAD)
Social anxiety disorder is a disorder characterized by intense fear or anxiety related to participation in social situations. People with SAD fear that they will act in a manner that will lead them to be criticized by others. Because of this fear and anxiety, people with SAD tend to avoid social situations all together. When avoidance is not possible, the social situation is usually endured with intense anxiety. The best treatments for SAD are antidepressants, CBT, and exposure therapy.
Post Traumatic Stress Disorder (PTSD)
PTSD is very complex. To simplify, sometimes when people experience a traumatic event it can trigger PTSD symptoms including: routine distressing dreams or night terrors, flashbacks or intrusive thoughts. Some other things to watch out for are an inability to feel positive emotions and feeling separated or alienated from others. There are actually medications we can prescribe that can help reduce the nightmares, flashbacks, and exaggerated startle response that can occur with PTSD. EMDR is a type of therapy we recommend as well. .
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is neuro-developmental disorder characterized by inattention, difficulty concentrating, difficulty with sustained attention and impulse control. It is most commonly diagnosed in childhood but can be diagnosed well into adulthood. ADHD can be very impairing in adults and cause difficulties in functioning socially and in the workplace. In children it can manifest itself as: hyperactivity, difficulty sitting still, difficulty waiting their turn, and having explosive outbursts. The best treatments we have for ADHD are medications. One class is called the stimulants, They work on a neurotransmitter called dopamine. Some common medications in this class are dexedrine, methylphenidate and dextroamphetamine. There is also a medication called atamoxetine that is not a stimulant medication; it works primarily on norepinephrine and has shown to be efficacious in treating ADHD.
Bipolar 1 Disorder
Bipolar 1 disorder is a disorder characterized by periods of abnormally elevated mood in which a person finds themselves having symptoms like a decreased need for sleep, an increase in risk taking behaviors, impulsivity, grandiosity, or rapid speech. This period of elevated mood is called 'mania' and can only be diagnosed if these symptoms are significantly impairing, last for more than a week, or lead to hospitalization.
Bipolar 2 Disorder
Bipolar 2 disorder differs from bipolar one in that the patient never meets criteria for a full manic episode. People with bipolar 2 have episodes called hypomanic episodes that are similar to mania but are not nearly as impairing. They do not negatively impact a person's life like a manic episode.
Bipolar Disorder Overview & Treatment
People with bipolar 1 and bipolar 2 disorders both experience bouts of depression as part of their illness. These episodes usually follow the manic or hypomanic episodes. It is not uncommon to see a person 'crash' into depression after several days of mood elevation. People with bipolar disorder tend to spend most of their time in the depressive phase of the illness.
The first line medications we use to treat bipolar disorder are called mood stabilizers. Some examples of mood stabilizers are lamotrigine, valproic acid, and carbamazepine. It is also common to use antipsychotic medications that can provide mood stabilization and an antidepressant effect. The 'gold standard' treatment for bipolar disorder is lithium, however it is not frequently a first choicer as it has many side effects and requires blood levels.
Insomnia
Whether it is getting to sleep or staying asleep, insomnia can really take a toll on a person. There are some great medications out there that can really help people sleep better depending on what their exact sleep issue is. Sleep hygiene (a fancy way of saying your bedtime routine) is also an important part of treatment and something we would discuss at your psychiatric evaluation and follow up visits.