Chapter 11 of 157% of exam

Psychiatry/Behavioral Science

Psychiatry items test diagnostic criteria, time thresholds and first-line treatment. The blueprint lists mood, anxiety, trauma, psychotic, neurodevelopmental, substance-related and personality disorders, plus abuse and neglect.

Mood and anxiety disorders

Duration thresholds and the number of symptoms separate many of these diagnoses. First-line treatment is usually psychotherapy, an SSRI, or both. Symptoms must cause distress or impairment to meet criteria.

Major depressive disorder

Five or more symptoms including depressed mood or anhedonia nearly every day for 2 weeks.

Merck Manual Professional Edition, Depressive Disorders

Generalized anxiety disorder

Excessive, hard-to-control worry more days than not for at least 6 months.

Merck Manual Professional Edition, Generalized Anxiety Disorder

Panic disorder

Recurrent unexpected attacks with at least 1 month of worry or behavior change; SSRIs and CBT.

Merck Manual Professional Edition, Panic Attacks and Panic Disorder

Trauma, OCD and neurodevelopment

Timing after trauma and age of onset are built into the diagnostic criteria. Specific psychotherapies are first-line for several of these conditions. Neurodevelopmental disorders begin in childhood even when diagnosed later.

Acute stress disorder vs PTSD

Within the first month it is acute stress disorder; PTSD requires more than 1 month.

Merck Manual Professional Edition, Posttraumatic Stress Disorder

OCD

Exposure and response prevention, SSRIs or clomipramine.

Merck Manual Professional Edition, Obsessive-Compulsive Disorder

ADHD

Some symptoms present before age 12 and in more than one setting.

Merck Manual Professional Edition, Attention-Deficit/Hyperactivity Disorder

Substances and medication toxicity

Withdrawal syndromes and drug reactions can be fatal. They are usually treated by substituting a cross-tolerant drug or stopping the offending one. Psychotic disorders are classified partly by duration.

Alcohol withdrawal

Benzodiazepines, guided by the CIWA-Ar score.

Merck Manual Professional Edition, Alcohol Toxicity and Withdrawal

Neuroleptic malignant syndrome

Rigidity, hyperthermia, autonomic instability and high CK; stop the antipsychotic and cool.

Merck Manual Professional Edition, Antipsychotic Medications

Schizophrenia

Symptoms must persist at least 6 months.

Merck Manual Professional Edition, Schizophrenia

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