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Psychiatric Disorders (Medically Related Disorders (Somatic Symptom…

- - - - Generalized Anxiety Disorder
        
        Diagnostic Keys
        
        Chronic worry about multiple issues
        
        No panic attacks
    - - Panic Disorder
        
        Diagnostic Keys
        
        Recurrent unexpected panic attacks
        
        May restrict activities due to fear of an attack
        
        Some attacks must be spontaneous with no obvious trigger
        
        Management
        
        SSRI/SNRI
        
        CBT
        
        Benzodiazepines for acute stress
        
        Presentation
        
        chest pain
        
        shortness of breath
        
        tachycardia
        
        gi symtpoms
        
        neuro symptoms
        
        Fear of losing control or dying
        
        Repeated Panic Attacks can lead to Anxiety about and Avoidance of Situations where you feel trapped or helpless in the event of a panic attack
        
        Agoraphobia
        Avoidance of public spaces (crowds, enclosed spaces, public transport) where you cannot escape or get away in the event of a panic attack
        
        Patients may restrict their activities to where they never leave home or only leave with a. companion
  - - - More than One Month of:
        
        Insomnia
        
        Nightmares
        
        Flashbacks
        
        Avoidance
        
        Dissociative Symptoms
        
        Emotional Detachment
        
        PTSD
        
        Often exposed to life threatening trauma. Patients will have characteristic intrusive flashbacks, hyperarousal, and avoidance
      - 3 days to 1 month of:
        
        Insomnia
        
        Nightmares
        
        Flashbacks
        
        Avoidance
        
        Dissociative Symptoms
        
        Emotional Detachment
        
        Acute Stress Disorder
        Similar symptoms to PTDS but they last from 3 days to 1 month after trauma
    - - Anxiety and depression that don't meet criteria for another psychiatric disorder
        
        Even if Depressive Symptoms are only present for 15 days, you will have a diagnosis of MDD not Adjustment Disorder
        
        Adjustment Disorder
        
        Stressor of any severity that results in symptoms of anxiety and depression but which don't meet criteria for other disorders
        
        Symptoms must be distressing and impairing but on their own don't meet the criteria for a distinct mental disorder
        
        Timeline
        Develops within 3 months of an identifiable stressor and lasts no longer than 6 months once the stressor has been removed.
- - - - Bulemia
        
        Recurrent binge eating followed by compensatory behavior (purge, exercise, fasting, laxatives)
        
        Normal to increased body weight
        SSRI
        Don't use Buproprion (SNRI)
    - - Binge Eating Disorder
        
        Recurrent episodes of binge eating
        
        No compensatory behaviors
        
        Lack of control when eating
        SSRI or Amphetamine salt
- - - - Manipulative
        
        Less Physically Aggressive
        
        Manipulative because they fear abandonment
        
        Border-Line Personality Disorder
        Transient mood shifts and impulsive behavior in response to environmental triggers
        
        Unstable and intense relationships
        
        Alternate between extremes of idealizing and devaluing others (Splitting)
        
        Impulsivity, drugs, unsafe sex
        
        Self-mutilating behavior
        
        Transient paranoia or dissociation
        
        Attention seeking behavior
        
        Physically Aggressive
        
        Manipulative for Personal Gain
        
        Anti-Social Personality Disorder
        
        Pattern of violating the rights of others
        
        Engaging in unlawful behaviors (physical aggression, illegal occupations)
        
        Lacking remorse for transgressions
        
        Typically have a diagnosis of conduct disorder prior to 15
      - Destructive
        
        Intermittent Explosive Disorder
        
        Recurrent impulsive and destructive outbursts
        
        Outbursts are not premediated nor related to achieving secondary gain
- - - - More than 2 weeks but shorter Than 2 Years
        
        No Psychosis
        
        Major Depressive Disorder
        
        SIGECAPS
        
        Sleep disturbances
        
        Loss of Interest
        
        Excessive Guilt
        
        Impaired Concentration
        
        Appetite disturbance
        
        Pyschomotor agitation/retardation
        
        Suicidal ideation
        
        Significant Functional Impairment
        
        Psychosis only during depressive Episode
        
        Major Depressive Disorder with Psychotic Features
        Similar to MDD except with psychotic features
        
        More than 2 weeks of SIDECAPS criteria
        
        Psychotic symptoms during depressive states only
        
        If psychotic symptoms existed independent of depression then this patient would be diagnosed with Schizoaffective disorder
      - Longer than 2 Years
        
        Persistent Depressive Disorder
        Depressed Mood more days than not for at least 2 years and 2 depressive symptoms
        Chronically depressed mood for longer than 2 years
        Poor appetite/Overeating
        Insomnia/Hypersomnia
        Low Energy/Fatigue
        Low Self-Esteem
        poor Concentration
        Feelings of hopelessness
      - No Functional Impairment
  - - - Normal Stress Response
        
        Not excessive or out of proportion to severity of stressor
        
        No significant functional impairement
    - - Adjustment Disorder with Depressed Mood
        
        Onset within 3 months of stressor
        
        Marked distress and or functional impairment
        
        Doesn't meet criteria for other diagnosis
- - - - More than 1 Month
        
        Less than 6 months
        
        Schizophreniform
        Basically the doctor is waiting to see if you're a full blown schizophrenic yet but has to wait 6 months to make the diagnosis
      - More than 6 Months
        
        Schizophrenia
      - More than 1 Day
        
        Less than 1 Month
        
        Brief Psychotic Disorder
        
        Diagnosis cannot be made when psychotic symptoms occur only in the context of a manic episode - this would be bipolar disorder
    - - Delusional Disorder
        
        Delusions over a month in the absence of other psychotic symptoms
        
        Behavior is not obviously bizarre and functioning is not significantly impaired apart from the direct impact of the delusions
    - - Paranoid Personality Disorder
        
        pervasive pattern of suspiciousness (paranoid)
    - - Schizotypal
    - - Schizoid
        
        Don't like to be social or talk with anyone, but I'm ok with that
  - - - Schizoaffective Disorder
        Patient must be psychotic for at least 2 weeks without any concurrent mania or depression
    - - Major Depression w/ Psychotic Features
- - - - Psychosis ONLY during Manic States
        
        Bipolar I
        
        Special
        
        Diagnostic Factors
        
        Manic Episodes
        
        Depressive Episodes
        + Not required for diagnosis
        
        Mania - 3 or more of the following:
        
        Distractibility
        
        Impulsivity/indiscretion, risk behavior
        
        Grandiosity
        
        Flight of ideas / racing thoughts
        
        Increased Activity/psychomotor Agitation
        
        Decreased need for Sleep
        
        Talkativeness
        DIGFAST
        
        Severity
        
        Impaired psychosocial function
        
        May have psychotic features (hallucinations, delusions)
        
        May require hospitalization
        
        Management
        
        Lithium
      - Psychosis with AND without Mania
    - - Bipolar II
        
        Special
        
        Management
        1.
        2.
        3.
        
        Diagnostic Factors
        
        Hypomanic Episodes
        
        increased energy
        
        activity
        
        confidence
        
        hyposomnia
        
        Major Depressive Episodes
        
        one or more event
        3.
        
        Diseases
        1.
        2.
        3.
        
        Lab Identifiers
        1.
        2.
        3.