DSM-V
What are the DSM-5 Criteria for Somatic Symptom Disorder?
1. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
2. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
a) Disproportionate and persistent thoughts about the seriousness of one's symptoms.
b) Persistently high level of anxiety about health or symptoms.
c) Excessive time and energy devoted to these symptoms or health concerns.
3. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
Name two medical causes of depression.
You are seeing a young female in your family medicine office with depressive symptoms. You notice that her Synthroid has not been refilled in a few weeks.
What laboratory test should you do and why?
Thyroid profile (TSH, T3/T4) - rule-out hyper/hypothyroidism
Other investigations for depression: CBC, Vit B12, Electrolytes, BUN, Cr, LFTs, urine tox, Blood EtOH
Elderly, medically ill patients who present with psychotic symptoms such as hallucinations, confusion, or paranoia should be carefully evaluated for ______, which is a far more common finding in this population.
Elderly, medically ill patients who present with psychotic symptoms such as hallucinations, confusion, or paranoia should be carefully evaluated for delirium, which is a far more common finding in this population.
What are the DSM-5 Criteria for Psychotic Disorder due to Another Medical Condition?
1. Prominent hallucinations or delusions.
2. Symptoms do not occur only during an episode of delirium.
3. Evidence from history, physical, or lab data to support another medical
cause (i.e., not psychiatric).
Name two substances/medications that, when withdrawn, can cause anxiety?
Alcohol
Sedatives/hypnotics/anxiolytics
Opioids
Why and how would you measure metanephrines in a patient who presents with anxiety, headache, diaphoresis, and palpitations?
Rule-out pheochromocytoma. Metanephrines are catecholamine metabolites that are increased in pheochromocytoma, and can be measured in the blood and urine.
Other investigations for anxiety: TSH/T3/T4, urine tox, PFTs, ECG, echo, EEG
___-onset anxiety symptoms without prior or family psychiatric history should increase suspicion of anxiety caused by another medical condition or substance.
Late-onset anxiety symptoms without prior or family psychiatric history should increase suspicion of anxiety caused by another medical condition or substance.
What are the DSM-5 Criteria for Substance/Medication-Induced Psychotic Disorder?
1. Hallucinations and/or delusions.
2. Symptoms do not occur only during episode of delirium.
3. Evidence from history, physical, or lab data to support a medication or
substance-induced cause.
4. Disturbance is not better accounted for by a psychotic disorder that is not
substance/medication-induced.
Name two medical causes of mania.
In patients presenting to the ED with depression-, anxiety-, or psychosis-like symptoms, what is one easy test you can do to rule out a potentially life-threatening medical cause of psychiatric syndrome?
Fingerstick glucose! Rule out hypoglycemia.
Depression is common in patients with _______ cancer.
Depression is common in patients with pancreatic cancer.
What are the DSM-5 Criteria of Psychological Factors Affecting Other Medical Conditions?
1. A medical symptom or condition (other than mental disorder) is present.
2. Psychological or behavioral factors adversely affect the medical condition in
at least one way, such as influencing the course or treatment, constituting
an additional health risk factor, influencing the underlying pathophysiology,
precipitating, or exacerbating symptoms or necessitating medical attention.
3. Psychological or behavioral factors not better explained by another mental
disorder.
Name four medical causes of psychosis.
A dishevelled-looking man presents to the ED in florid psychosis. In a moment of lucidity, he admits to using cocaine daily up until three weeks ago, when he ran out of his supply and was out of money. He denies any other illicit drug use.
If he was telling the truth, what would his urine toxicology screen likely show?
Benzoylecgonine: negative
Cocaine: negative
Benzoylecgonine (BE), the major urinary metabolite of cocaine, is the analyte usually tested for in blood, urine, saliva, hair, and meconium. Cocaine is rapidly metabolized and detectable in blood and urine only briefly (ie, several hours) after use. BE can be detected in the urine for several days following intermittent use and up to 10 days or more after heavy use.
In this man, his last cocaine use was more than 20 days ago. Therefore, both BE and cocaine would be negative.
______ patients are at a significant risk for developing depression, and this is associated with a poorer outcome overall.
Stroke patients are at a significant risk for developing depression, and this is associated with a poorer outcome overall.