DSMIV Diagnostic Criteria for Post Traumatic Stress Disorder

PTSD occurs after an individual has been exposed to a traumatic event that is associated with intense fear or horror. B. The patient persistently reexperiences the event through intrusive recollection or nightmares, reliving of the experience (flashbacks), or intense distress when exposed to reminders of the event. C. The patient may have feelings of detachment (emotional numbing), anhedonia, amnesia, restricted affect, or active avoidance of thoughts or activities that may be reminders of...

Differential Diagnosis of Post Traumatic Stress Disorder

Depression is also associated with insomnia, anhedonia, poor concentration, and feelings of detachment. A stressful event may be associated with the onset of depression. Depression is not commonly associated with nightmares or flashbacks of a traumatic event. B. Obsessive-Compulsive Disorder. OCD is associated with recurrent intrusive ideas. However, these ideas lack a relationship to a specific traumatic event, and they are not usually recollections of past events. C. Malingering. PTSD may...

M Side Effects

Gastrointestinal distress (diarrhea, nausea) may be reduced by giving the medication with meals or by switching to a sustained release preparation. 2. Tremor is most common in the hands. Tremor is treated by lowering the dosage or by adding low dose propranolol (10-40 mg tid-qid). 3. Diabetes insipidus may result from lithium administration. It presents with polyuria and polydipsia. Treatment consists of amiloride administration, in doses of 5-20 mg per day with frequent monitoring of lithium...

Monoamine Oxidase Inhibitors

Contraindications and dietary restriction discourage common use. b. Side Effects. Orthostatic hypotension is common. A tyramine-free diet is required to prevent hypertensive crisis. c. Drug Interactions. Coadministration of epinephrine, meperidine, and SSRIs can be life-threatening. VII. Electroconvulsive Therapy for Depression (also see Electroconvulsive Therapy, page 121). ECT is a safe and effective treatment for depression, especially if there is a high risk for suicide or insufficient...

Opiate Dependence Admitting Orders

Vitals q shift x 3 days, then q day if stable Labs Chem 20, CBC with diff, UA with toxicology screen, urine pregnancy test, RPR, thyroid function, hepatitis panel, HIV. Clonidine (Catapres) 0.1 mg po qid, hold for systolic BP < 90 or diastolic BP < 60). Give 0.1 mg po q 4 hours prn signs and symptoms of opiate withdrawal. Dicyclomine (Bentyl) 20 mg po q 6 hours prn cramping. Ibuprofen (Advil) 600 mg po q 6 hours prn pain headache. Methocarbamol (Robaxin) 500 mg po q 6 hours prn muscle pain....

Psychiatric Progress Note

Subjective A direct quote from the patient should be written in the chart. Information reported by the patient may include complaints, symptoms, side effects, life events, and feelings. Objective Discuss pertinent clinical events and observations of the nursing staff. Affect Flat, blunted, labile, full. Mood Dysphoric, euphoric, angry, euthymic, anxious. Thought Processes Quality and quantity of speech. Tone, associations and fluency of speech and speech abnormalities. Thought Content...

Schizoaffective Disorder Admitting Orders

Diagnosis Schizoaffective disorder, bipolar type, depressed Vitals q shift x 3, then q day if stable Precautions Suicide precautions Diet Regular Labs Chem 20, CBC with diff, UA with toxicology screen, urine pregnancy test, RPR, thyroid function, lithium level Quetiapine (Seroquel) 100 mg po bid x 2 days, then 200 mg po bid Lorazepam (Ativan) 2 mg po q 4 hours prn agitation (not to exceed 8 mg 24 hours). Zolpidem (Ambien) 10 mg po qhs prn insomnia. Tylenol 650 mg po q 4 hours prn pain or fever....

Selective Serotonin Reuptake Inhibitors SSRIs

SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox) and citalopram (Celexa). b. SSRIs are commonly used as first-line agents as well as secondary choices for depression that does not respond to tricyclics. c. SSRIs, with their comparatively benign side-effect profile, allow once daily dosing and present less danger from overdose because they lack the cardiovascular toxicity of the tricyclics. d. Another advantage of SSRIs is that they require less...

Substance Induced Mood Disorder

When the mood disorder is associated with recent or prolonged substance use or withdrawal from a substance and psychotic symptoms, a substance-induced mood should be diagnosed. b. Blood or urine screens may be helpful in establishing this diagnosis. c. Common substances that can cause depressive syndromes include antihypertensives, hormones (cortisone, estrogen, progesterone), antiparkinsonian drugs, benzodiazepines, alcohol, chronic use of sympathomimetics, and withdrawal from...

Treatment of Obsessive Compulsive Disorder

Pharmacotherapy is almost always indicated. B. Clomipramine (Anafranil), sertraline (Zoloft), paroxetine (Paxil) fluoxetine (Prozac), and fluvoxamine (Luvox) are effective. C. Standard antidepressant doses of clomipramine are usually effective, but high doses of SSRIs maybe required, such as fluoxetine (Prozac) 60-80 mg , paroxetine (Paxil) 40-60 mg, or sertraline (Zoloft) 200 mg. D. Behavior therapy like thought stopping, desensitization or flooding may also be effective. Often a...

Antipsychotic Side Effects

Low-potency agents such as chlorpromazine produce a higher incidence of anticholinergic side effects, sedation and orthostatic hypotension compared to high-potency agents such as haloperidol. B. High-potency agents such as haloperidol and fluphenazine produce a high incidence of extrapyramidal symptoms such as acute dystonic reactions, Parkinsonian syndrome, and akathisia. C. Moderate-potency agents include trifluoperazine and thiothixene, and have side effect profiles in between the low-...

Differential Diagnosis of Bipolar II Disorder

These patients will exhibit mood swings that will not meet the criteria for full manic episode or full major depressive episode. B. Substance-Induced Mood Disorder. The effects of medication, drugs of abuse, toxin exposure should be excluded. C. Mood Disorder Due to a General Medical Condition. See explanation for dysthymic disorder and bipolar I. VI.Treatment of Bipolar II Disorder. The treatment of Bipolar II disorder includes a mood stabilizer (and an antidepressant...

Physical Examination

Intranasal cocaine use may cause damaged nasal mucosa. B. IV drug abuse may be associated with injection site scars and bacterial endocarditis. C. Nystagmus is often seen in abusers of sedatives, hypnotics, or cannabis. D. Mydriasis (dilated pupils) is often seen in persons under the influence of stimulants or hallucinogens, or in withdrawal from opiates. Miosis (pinpoint pupils) is a classic sign of opioid intoxication. E. The patient should be assessed for the withdrawal symptoms. F. An...

Differential Diagnosis of Obsessive Compulsive Disorder

Substance-Induced Anxiety Disorder or Anxiety Disorder Due to a Medical Condition. Amphetamines, cocaine, caffeine and other symptomatic agents may mimic some of the anxiety symptoms associated with OCD. On rare occasions a brain tumor or temporal lobe epilepsy can manifest with OCD symptoms. B. Major Depressive Disorder. Major depression may be associated with severe obsessive ruminations (eg, obsessive rumination about finances or a relationship). These obsessive thoughts are usually not...

Narcissistic Personality Disorder

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. The disorder begins by early adulthood and is indicated by at least five of the following 1. An exaggerated sense of self-importance. 2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. Believes he is special and can only be understood by, or should associate with, other special or high-status people (or institutions). 4. Requires excessive...

Agitation and Aggression

Pharmacotherapy The following agents have significant efficacy in reducing agitation and aggression in dementia. a. Buspirone (BuSpar) beginning at 5 mg bid with a final dose of 3050 mg day in bid or tid dosing. Buspirone has few side effects and no significant drug interactions. Several weeks are required to achieve full benefit. b. Trazodone (Desyrel) beginning at 25-50 mg qhs with an average dose of 50-200 mg day. c. Risperidone (Risperdal) beginning at 0.25-0.5 mg qhs with an average dose...

Buspirone BuSpar

Buspirone is a first-line treatment of GAD. Buspirone usually requires 3-6 weeks at a dosage of 10-20 mg tid for efficacy. It lacks sedative effects. Tolerance to the beneficial effects of buspirone does not seem to develop. There is no physiologic dependence or withdrawal syndrome. b. Combined benzodiazepine-buspirone therapy may be used for generalized anxiety disorder, with subsequent tapering of the benzodiazepine after 2-4 weeks. c. Patients who have been previously treated with...

Treatment

Nicorette gum or nicotine transdermal patches relieve withdrawal symptoms. Patients should be prescribed a regimen that provides a tapering dose over a period of weeks. Nicotine patch (Habitrol, Nicoderm CQ) 1 patch d for 6-12 wk, then taper for 4 wk Rapid nicotine delivery nasal irritation initially Mimics smoking behavior provides low doses of nicotine 150 mg day for 3 d, then titrate to 300 mg Treatment initiated 1 wk before quit day contraindicated with seizures, anorexia, heavy alcohol use...

Idsm Iv Diagnostic Criteria

Many periods of depression and hypomania, occurring for at least 2 years. Depressive episodes do not reach severity of major depression. B. During the 2-year period, the patient has not been symptom-free for more than 2 months at a time. C. During the 2-year period, no episodes of major depression, mania or mixed states were present. D. Symptoms are not accounted for by schizoaffective disorder and do not coexist with schizophrenia, schizophreniform disorder, delusional disorder, or any...

Venlafaxine Effexor Effexor XR

Venlafaxine is the first line treatment for GAD. Effexor XR can be started at 75 mg per day however, patients with severe anxiety or panic attacks should be started at 37.5 mg per day. The dose should then be titrated up to a maximum dosage of 225 mg of Effexor XR per day. b. Venlafaxine usually requires several weeks to achieve efficacy and an adequate trial should last for 4-6 weeks. c. The side effect profile for GAD patients is similar to that seen with depressive disorders.

Differential Diagnosis of Hypochondriasis

Major depression, obsessive-compulsive disorder, generalized anxiety disorder, and panic disorder can often cause prominent somatic complaints with no organic basis. B. Medical conditions that can produce varied symptoms, such as AIDS, multiple sclerosis, and systemic lupus erythematosus, must be excluded. C. Body Dysmorphic Disorder. Concerns are limited only to physical appearance, in contrast to the fear of having an illness that occurs in hypochondriasis. D. Factitious Disorder and...

Differential Diagnosis of Social Phobia

Substance-Induced Anxiety Disorder. Substances such as caffeine, amphetamines, cocaine, alcohol or benzodiazepines may cause a withdrawal syndrome that can mimic symptoms of social phobia B. Obsessive-Compulsive Disorder, Specific Phobia, Hypochondriasis, or Anorexia Nervosa. Anxiety symptoms are common to many psychiatric disorders such as depression and the anxiety disorders. The diagnosis of social phobia should be made only if the anxiety is unrelated to another disorder. For example,...

Drug Induced Parkinsonian Syndrome

Patients with Parkinsonian syndrome secondary to neuroleptics present with cogwheel rigidity, mask-like facies, bradykinesia, and shuffling gait. This is similar to patients with idiopathic Parkinson's disease. b. Drug-induced Parkinsonism is treated by adding an anticholinergic agent such as benztropine (Cogentin) or trihexyphenidyl (Artane). c. The dopamine releasing agent, amantadine, is also effective. d. Parkinsonian symptoms may also improve with a lower dose of neuroleptic or after...

Classification of Antidepressant Agents 1 Heterocyclic Antidepressants

Side effects (especially sedation and anticholinergic effects) are worse during the first month of therapy and usually diminish after four weeks. b. Early in the treatment course, patients may sleep better, but patients rarely describe improvement in mood before 3-4 weeks. c. Only minimum quantities should be prescribed because of the potential of tricyclics to cause a fatal overdose in suicide-prone patients. d. Use of heterocyclic antidepressants in the elderly may be limited by the...

Treatment of Avoidant Personality Disorder

Individual psychotherapy, group psychotherapy and behavioral techniques may all be useful. Group therapy may assist in dealing with social anxiety. Behavioral techniques, such as assertiveness training and systematic desensitization, may help the patient to overcome anxiety and shyness. B. Beta-blockers can be useful for situational anxiety. C. Since many of these patients will meet criteria for Social Phobia (generalized) a trial of SSRI medication may prove beneficial. D. Patients are...

Epidemiology of Cyclothymic Disorder

The prevalence is 1 , but cyclothymic disorder constitutes 5-10 of psychiatric outpatients. B. The onset occurs between age 15 and 25, and women are affected more than men by a ratio of 3 2. C. Thirty percent of patients have a family history of bipolar disorder. IV.Differential Diagnosis of Cyclothymic Disorder A. Bipolar II Disorder. Patients with bipolar type II disorder exhibit hypomania and episodes of major depression. B. Substance-Induced Mood Disorder Mood Disorder Due to a General...

Differential Diagnosis of Specific Phobia

Substance-Induced Anxiety Disorder. Substances such as caffeine, amphetamines, and cocaine can mimic phobic symptoms. Alcohol or benzodiazepine withdrawal can also mimic phobic symptoms. B. Panic Disorder, Obsessive-Compulsive Disorder, Social Phobia, Hypochondriasis or Anorexia Nervosa. Many psychiatric disorders present with marked anxiety, and the diagnosis of specific phobia should be made only if the anxiety is unrelated to another disorder. For example, specific phobia should not be...

Major Depressive Disorder

DSM-IV Diagnostic Criteria for Major Depressive Disorders A. History of one or more Major Depressive Episodes B. No history of manic, hypomanic or mixed episodes II. Clinical Features of Major Depressive Disorder A. High mortality 15 suicide rate. Common coexisting diagnoses include panic disorder, eating disorders, substance-related disorders. These disorders should be excluded by the clinical history. B. Major depressive disorder often complicates the presentation and treatment of patients...

Differential Diagnosis of Dysthymic Disorder

Dysthymia leads to chronic less severe depressive symptoms compared to Major Depression which usually has one of more discrete episodes. B. Substance-Induced Mood Disorder. Alcohol, benzodiazepines and other sedative-hypnotics can mimic dysthymia symptoms, as can chronic use of amphetamines or cocaine. Anabolic steroids, oral contraceptives, methyldopa, beta adrenergic blockers and isotretinoin (Accutane) have also been linked to depressive symptoms. Rule out with...

History of present illness HPI

Current symptoms date of onset, duration and course of symptoms. 2. Previous psychiatric symptoms and treatment. 3. Recent psychosocial stressors stressful life events which may have contributed to the patient's current presentation. 4. Reason the patient is presenting now. 5. This section provides evidence that supports or rules out relevant diagnoses. Therefore documenting the absence of pertinent symptoms is also important. 6. Historical evidence in this section should be relevant to the...

Differential Diagnosis of Schizotypal Personality Disorder

Schizoid and Avoidant Personality Disorder. Schizoid and avoidant patients will not display the oddities of behavior, perception, and communication of schizotypal patients. B. Schizophrenia. No formal thought disorder is present in personality disorders. When psychosis is present in schizotypal patients, it is of brief duration. C. Paranoid Personality Disorder. Patients with paranoid personality disorder will not display the oddities of behavior, perception and communication of schizotypal...

Idsm Iv Criteria for Conversion Disorder

The patient complains of symptoms or deficits affecting voluntary muscles, or deficits of sensory function that suggest a neurological or medical condition. B. The temporal relation of symptoms to a stressful event suggests association of psychological factors. C. Symptoms are not intentionally produced. D. Symptoms are not explained by an organic etiology. E. Symptoms result in significant functional impairment. F. Symptoms are not limited to pain or sexual dysfunction, and are not...