Psychiatry

Defense Mechanisms

Somatoform Disorders

Illness Anxiety Disorder Previously → Hypochondriasis Preoccupation with an illness Somatic Symptom Disorder Somatization Having 1 or more symptoms that has no correlation to physical findings Conversion Disorder Functional Neurologic Symptom Disorder Factitious Munchausen Munchausen by proxy Malingering

Gender Dysphoria

Dissociative Disorders

Dissociative Identity Disorder Dissociative Amnesia Without Fugue (Travel) With Fugue Depersonalization/Derealisation Disorder

Catatonia

Presentation Stupor → ↓ Alertness and ↓ response to stimuli Catalepsy → Can be put in any position Waxy flexibility → Slight, even no resistance to positioning (and holding) Mutism → No verbal response when once there was Negativism → Motiveless resistance to instructions Stereotypy → Repetitive, non-goal directed...

PTSD

PTSD/Acute Stress Disorder Presentation PTSD → >1m Acute Stress Disorder → 2d-1m after event Treatment Best initial -> Group therapy Best initial med Paroxetine Sertraline Nightmares → Prazosin Relaxation techniques Psychotherapy Reactive Attachment Disorder/DSED Adjustment Disorder

Obsessive Compulsive Disorder

OCD Treatment Best initial → CBT Adjunct → SSRIs Fluoxetine Paroxetine Sertraline Citalopram Fluvoxamine If all choices TCAs → Clomipramine Behavioral → Exposure and response prevention Hoarding Disorder → Treatment → SSRIs, Behavioral modification, Psychotherapy Body Dysmorphic Disorder → Treatment → SSRIs, Psychotherapy

Impulse Control

Intermittent Explosive Disorder Adults with rage out of proportion Disruptive Mood Dysregulation Disorder In kids <18y A kind of moor disorder with frequent outbursts and such Pyromania Urge to put stuff on fire Kleptomania Urge to shoplift and such

Substance Abuse

Alcohol Intoxication Presentation Talkative, Sullen, Gregarious, Moody, Disinhibited Treatment Severe → Mechanical ventilation Withdrawal Presentation 6-12h → Tremors Within 48h Tachycardia Hypertension Agitation Seizure 2-7d Hallucination Delirium Tremens Confusion, Agitation Autonomic instability Fever Tachycardia, HTN Diaphoresis Delirium Hallucinations Lasts 5 days 5% Death Treatment Benzodiazepines Thiamine Multivitamins Folic acid Haloperidol...

Anxiety Disorders

Generalized Anxiety Disorder Treatment SSRI Fluoxetin Paroxetine Sertraline Citalopram Venlafaxine Buspirone Psychotherapy, Behavioral therapy Panic Disorder Treatment SSRIs Fluoxetine Paroxetine Sertraline Benzodiazepines Alprazolam Clonazepam Lorazepam Behavioral/Individual therapy → In conjunction With Agoraphobia → Add CBT Panic attack → First choice → Benzodiazepines → Alprazolam Phobias → Treatment → Behavioral modification, Relaxation techniques Stage fright → Atenolol,...

Psychotic Disorders

Brief Psychotic Disorder → 1d-1m Schizophreniform Disorder → 1m-6m Schizophrenia → >6m Treatment Hospitalize First line → Atypical antipsychotics Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone Asenapine Iloperidone Lurasidone Emergency → IM short-acting meds Olanzapine Ziprasidone Haloperidol → More side effects Non-compiance → Long-acting Risperidone Paliperidone Haloperidol → More side effect Fluphenazine → More side effect No response to...

Mood Disorders

Major Depressive Disorder (MDD) Presentation Depressed mood or anhedonia ≥2w ≥5 SIG E CAPS Sleep Interest Guilt Energy Concentration Appetite Psychomotor → Slow moving Suicidality Treatment First line → SSRIs Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine After 4w No effect → Switch to another SSRI Some improvement → ↑ Dose...