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Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2018). Current medical diagnosis & treatment (57th ed.). New York, NY: McGraw Hill. Chapter 25, “Psychiatric Disorders†(pp. 1059-1116) • Evaluate patients with psychosocial health conditions • Develop differential diagnoses for patients with psychosocial health conditions • Develop treatment plans for patients with psychosocial health conditions Generalized anxiety disorder diagnosis criteria- Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The person finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children. (1) restlessness or feeling keyed up or on edge (2) being easily fatigued (3) difficulty concentrating or mind going blank (4) irritability (5) muscle tension (6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) Primary neurotransmitter in PTSD- Due to the traumatic stress of PTSD victims, the neurotransmitters that fuel the sympathetic versus parasympathetic system get out of balance. As a Yale University journal review states, “It has been suggested that alterations in NE [norepinephrine], E [epinephrine], and 5-HT [5HTP] may have relevance for symptoms commonly seen in survivors with PTSD * PTSD diagnosis and treatment-assessing history of exposure to a perceived or actual life threatening event, serious injury or sexual violence, symptoms lasting more than 1 month. Disturbance causes clinically significant distress or impairment in functioning H) The disturbance is not attributable to the physiological effects of a substance or other medical condition DSM-5 recognizes a “with dissociative symptom†specifier when the PTSD symptoms are accompanied by persistent or recurrent depersonalization or derealization. The specifier “with delayed expression†should be included if the full criteria for PTSD are not met for more than 6 months following the trauma. The traumatic event is persistently re-experienced: • Nightmares • Intrusive thoughts of the traumatic event • Flashbacks • Marked emotional distress when exposed to traumatic reminders • Strong physiologic reaction when exposed to traumatic reminders Treatment psychotherapy (cognitive processing, prolonged exposure therapy, eyemovement desensitizing) . SSRIs (sertraline, paroxetine) clonidine 0.1mg at bed time, prazosin 2-10mg for nightmare, antiseizure meds for anger management (carbamazepine 400-800mg daily), clonazepam 1-4mg daily for anxiety, Trazodone 25-100mg for sleep. Treatment of acute panic attacks- What are the medications for initial/first line therapy- SL 0.5-1 mg alprazolam, clonazepam 0.5-1mg, antidepressants, SSRIs (sertraline 25mg/day for 1 week, then 50mg) Inpatient treatment of depression- ECT o What are the therapies for patient’s that won’t eat, take meds, etc. When is serotonin norepinephrine reuptake inhibitor indicated, when is it contraindicated? For pain neuropathy/fibromyalgia Venlafaxine dosing, when is follow up? What are you monitoring? - Blood pressure monitoring, arrhythmias DOSE is 150-225 mg daily. Patients should be cautioned about the concomitant use of Venlafaxine tabletsand NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since combined use of psychotropic drugs that interfere with serotonin
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