COMMON PSYCHIATRY COMPLAINTS CHEAT SHEET

DEPRESSION (MAJOR DEPRESSIVE DISORDER)

If you suspect any form of depression always ask about:

Revised 2/17/14. Email with any feedback.

-Suicidal Ideation (Plan? Intent?)

-Homicidal Ideation

-Auditory or Visual Hallucinations

-Illicit & Prescription Drug or EtOH Use

-History of a hypomanic/manic episode (bipolar)

-Past mental health hospitalizations

-Past suicide attempts

Revised 2/17/14. Email with any feedback.

*Counsel the patient and tell them if they ever have thoughts of suicide to call 911 or go to the ER immediately.

Two-week continuous history of DEPRESSED MOOD and/or ANHEDONIA plus 4 additional positive complaints of “SIG E CAPS”:

-Sleep problems (insomnia or sleeping all day)

-Interest/pleasure decreased from activities once enjoyed (“anhedonia”)

-Guilt/feelings of worthlessness which is excessive

-Energy loss; fatigue

-Concentration difficulty or more indecisiveness

-Appetite or weight changes (decreased or increased)

-Psychomotor retardation (as observed by physician)

-Suicidal thoughts, recurrent thoughts about death/dying

Classified as single or recurrent episodes. Classified as mild, moderate, and severe based on clinical subjectivity.
If they have psychotic symptoms, it is always severe.

Treatment

1st line: Selective Serotonin Inhibitors (SSRIs) + counseling. SSRIs are very safe & effective.

TTUHSC Free Clinic offers 3 SSRIs:

Fluoxetine (Prozac) – Interacts with other medications via cyp450, which can be problematic. Weight neutral!

Citalopram (Celexa) –Best option if patient is on multiple other medications because it has the fewest cyp450 interactions. Weight neutral!

Paroxetine (Paxil) – Causes weight gain.

General SSRI Side effects: GI upset, sleep changes, headache and decreased libido, and other symptoms. GI upset and headache usually resolve in 1-2 weeks after starting medication.

Counseling referrals: Covenant Counseling (sliding-scale payments based on income)

GENERALIZED ANXIETY DISORDER (GAD)

6 months of excessive worrying, often irrational, difficult to control, interferes with daily living.(Not due to a substance or general medical condition.)
Need 3 or more criteria present most days for the past 6 months:

Revised 2/17/14. Email with any feedback.

  • Restlessness or feeling keyed up/on edge
  • Easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance

Revised 2/17/14. Email with any feedback.

1st line: SSRIs.

BI-POLAR DISORDER

Dx: irritable mood + 4 DIGFAST criteria OR elevated mood + 3 DIGFAST criteria.

Ask about “DIG FAST” symptoms:

Revised 2/17/14. Email with any feedback.

-Distractibility

-Irresponsible/risky behavior (e.g. excessive spending, promiscuity)

-Grandiosity (special abilities, purpose, role)

-Flight of ideas (rapid shifting of ideas in speech)/racing thoughts

-Activity increased

-Sleep decreased

-Talkativeness

Revised 2/17/14. Email with any feedback.

Hypomania: Symptoms last 4 or more days; change in function

Mania: Symptoms last 7 or more days with impaired function orpsychosisor severe enough to need hospitalization

Other Psych medications available at the free clinic:

Amitriptyline– Tricyclic Antidepressant – used for neuropathy and can be used for depression (if failed SSRIs).
Very dangerous / lethal in overdose. – used at low doses for insomnia and neuropathy

Trazodone–weak antidepressant – used at low doses for insomnia. Risk of priapism & orthostatic hypotension.

Buspirone – weak anxiolytic – can be used to treat GAD.

A complete Mental Status Exam (MSE) should be in Progress Note and include:

Revised 2/17/14. Email with any feedback.

-Orientation to person, place and time (“A&Ox3”)

-Attitude: (Un)cooperative, Guarded, Hostile, Suspicious

-Psychomotor activity: Tremor? Slowed? Agitated? WNL?

-Eye contact: good/fair/poor

-Speech: rate, rhythm, volume

-Thought process: Logical & goal-directed? Tangential? Circumstantial? Thought blocking? Flight of ideas? Slowed?

-Thoughtcontent: Delusions? Obsessions?

-Intelligence: above/average/below

-Memory: intact?

-Mood: how patient reportss/he feels

-Affect: emotion displayed by patient (Full/euthymic? Constricted? Labile? Blunted? Flat? Dysphoric?)

-Insight (understands illness)

-Judgment(capacity to make good decisions)

-Suicidal/ homicidal ideation?

Revised 2/17/14. Email with any feedback.

-Auditory or visual hallucinations?

Revised 2/17/14. Email with any feedback.