Psych Diagnoses
This patient knows it all and is very important. He is angry that he is being seen by "just" a resident today and that he had to wait 6 minutes past the scheduled appointment time.
What is Narcissistic Personality Disorder -grandiose sense of self importance, need for admiration and lack of empathy for others
The two most commonly reported side effects of SSRI's.
What is GI distress and sexual side effects
Least for sexual SE? probably Lexapro
When found on a patient's med list, Bipolar Disorder is a likely guess.
What is Lithium (or Depakote)
Based on the true story of John Nash, Russell Crow portrays the story of living with this serious mental illness in "A Beautiful Mind."
What is Schizophrenia
When initiating a medication for patient reported depression, screening for Bipolar Disorder is important and can by done by querying for a history of these symptoms.
What is 1) Periods of abnormally elevated or irritable mood and increased activity or energy lasting a week; 2) Decreased need for sleep; 3) Thinking or speaking too fast; 4) Risk taking or unwise behaviors that occur within period of mood changes. Why is this important to query?
Described by many as one of the most challenging of the heartsinks. This patient is chronically unstable. Their relationships are a mess, they are emotionally all over the place, and I never know if they're going to love me or hate me. The scars up and down their arms are very sad, but it's still hard to like them.
What is Borderline Personality Disorder
Considered the first line treatment for depression in adolescents.
What is fluoxetine (Prozac) Black box warning? (strongest in paroxetine (Paxil))
A new male patient presents with significant depression but is afraid to consider medications due history of erectile dysfunction and fear of further sexual side effects. You feel a medication could benefit this patient and discuss with him these options that are less likely to worsen ED.
bupropion (Wellbutrin) or mirtazapine (Remeron)
This person, the most decorated Olympian in history with 28 total medals, also suffered from ADHD as a child.
Who is Michael Phelps
I am referring to psychiatry for this suspected diagnosis when my patient reports that someone is poisoning their food, and they have stopped watching Comedy Central because the comedians are making jokes about him.
What is Schizophrenia
This patient "needs" a prescription for hydrocodone. He states that doctors here told him last year that he "wouldn't be able to function without it." There is no record of him being seen here previously. He hasn't had pain medication in 6 months because they wouldn't give him any in jail. I know hydrocodone isn't indicated here, but he scares me.
What is Antisocial Personality Disorder
Of this SSRI's, this one has been associated with the highest risk for QT prolongation.
What is Citalopram (Celexa)
These would be some medication options for consideration of a patient reporting issues with insomnia.
What is trazadone, mirtazapine (Remeron), zolpidem (Ambien), zalepion (Sonata), eszopiclone (Lunesta), amitriptyline. * What are other recommendations?
Winona Ryder depicts a woman suffering from what diagnosis characterized by emotional intensity and suicidality in "Girl Interrupted."
What is Borderline Personality Disorder
My patient was recently in the ED because she thought she was having a heart attack. Cardiac workup was normal. She continues with episodes of anxiousness, racing heart, rapid breathing and feeling out of control. What diagnosis and treatment options would be considered?
What is Panic Disorder; SSRI (Lexapro, Celexa, Paxil would be good choices); Brief instruction on importance of relaxed breathing and offer of therapy.
Benzos?
This patient presents to the ED feeling unable to sit still and noting rapid heart rate. While taking the history, they tell you that their psychiatrist increased their Prozac earlier this week. Wondering about serotonin syndrome, you do a quick scan for these signs/symptoms.
What is fever, rapid pulse, high blood pressure, GI issues, confusion, dilated pupils, headache, shivering.
When I see these medications on the med list for a patient, I suspect that they have been diagnosed with dementia.
What is donepezil (Aricept), memantine (Namenda), rivastigmine (Exelon), galantamine (Razadyne)
This diagnosis is depicted in "Silver Linings Playbook," in which ballroom dancing becomes part of Bradley Cooper's character's recovery plan after being discharged from a psychiatric facility.
What is Bipolar Disorder
A parent presents with concerns regarding their child's maturity level and ability to pay attention in school. They would like to discuss medications for ADHD. After observing the child lining up dinosaur figures very methodically, avoiding all eye contact and cringing when touched, we need further evaluation related to this possible diagnosis.
What is Autism Spectrum Disorder
My patient has been tried on a number of SSRI's without much response and would like to try something different. I am considering one of these SNRI's.
What is venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta)
These medications are considered first line treatment for diagnosed ADHD.
What are stimulants?
Concerta 18 mg or Vyvanse 30 mg (typical starting dosages unless very young)
Most common side effect?
Non-stimulant option?
Popular Netflix drama series (based on a novel) about teen suicide.
What is 13 Reasons Why?