Mental Health

Mini-Mental State Examination (MMSE) {OMAMLC}

Item	Score
Orientation	10
Memory :: registration	3
Attention	5
Memory :: recall	3
Language	8
Construction	1

Confusion Assessment Method (CAM)

Consciousness
Attention
Mental status
Thinking

Psychiatric Disorders

Neurodevelopmental Disorders

Intellectual disability
Communication disorder
Autism spectrum disorder
Attention-deficit hyperactivity disorder (ADHD)
Motor disorder
- Tic disorder
- Tourette syndrome

Neurocognitive Disorders

Delirium
Dementia due to Parkinson disease
Dementia due to Alzheimer disease
Dementia due to Pick disease
Dementia due to prion disease
Dementia due to Huntington disease

Personality Disorders

Cluster A: Paranoid & Schizoid & Schizotypal
Cluster B: Antisocial & Borderline & Histrionic & Narcissistic
Cluster C: Avoidant & Obsessive-compulsive & Dependent

Psychotic Disorders

Delusional disorder
Brief psychotic disorder: < 1 month
Schizophreniform disorder: 1 ~ 6 months
Schizophrenia: > 6 months
Schizoaffective disorder

Mood Disorders

Bipolar I/II disorder
Cyclothymia: > 2 years
Major depressive disorder: > 2 weeks
Persistent depressive disorder [Dysthymia]: > 2 years
Seasonal affective disorder (SAD)

Anxiety Disorders

Adjustment disorder: < 6 months
Generalized anxiety disorder: > 6 months
Acute stress disorder: < 1 month
Post-traumatic stress disorder (PTSD): > 1 month
Panic disorder: > 1 month
Phobias: > 6 months
- Agoraphobia
- Social anxiety disorder
- Specific phobias
Obsessive-compulsive disorder (OCD)
- Body dysmorphic disorder
Separation anxiety disorder
Selective mutism

Dissociative Disorders

Dissociative amnesia & fugue
Dissociative identity disorder
Depersonalization & Derealization disorder

Somatic Disorders

Malingering
Factitious disorder
Somatic symptom disorder
Conversion disorder
Illness anxiety disorder

Feeding & Eating Disorders

Pica
Anorexia nervosa
Bulimia nervosa

Sexual Dysfunction

Sexual arousal disorder
Sexual desire disorder
Sexual pain disorder
Orgasmic disorder

Sleep-wake Disorders

Insomnia
Hypersomnia
Narcolepsy
Nightmare disorder
Sleepwalking disorder
Sleep terror disorder
Restless legs disorder
Sleep apnea

Disruptive Behavior Disorders

Oppositional defiant disorder
Intermittent explosive disorder
Conduct disorder

Symptom Duration Required for Diagnosis

Types of Delusions

Delusion of control
Delusion of guilt
Delusion of reference
Erotomanic delusion
Grandiose delusion
Jealous delusion
Persecutory delusion
Somatic delusion

Presentation of Schizophrenia

Delusions
Hallucinations
Speech disturbances
Catatonia
Negative symptoms

Antipsychotics

1° [Typical] Antipsychotics

High Potency

Haloperidol
Trifluoperazine
Fluphenazine

Low Potency

Chlorpromazine
Thioridazine

2° [Atypical] Antipsychotics

Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone

Side Effects of Antipsychotics

Anticholinergic symptoms
Antiadrenergic symptoms
Antihistamine symptoms
Cardiac :: QT prolongation
Extrapyramidal symptoms (EPS)
Endocrine :: hyperprolactinemia
Hematologic :: agranulocytosis
Metabolic syndrome
Neuroleptic malignant syndrome (NMS)

Extrapyramidal Symptoms (EPS)

Onset	Symptoms	Treatment
4 hours	Dystonia	1° Antihistamines M antagonists
4 days	Bradykinesia	1° Antihistamines M antagonists
4 weeks	Akathisia	β antagonists Benzodiazepines
4 months	Tardive dyskinesia	VMAT2 inhibitors

Presentation of Neuroleptic Malignant Syndrome (NMS) {FEVER}

Fever
Encephalopathy
Vitals unstable
Enzyme elevation :: creatine kinase (CK)
Rigidity

Medications for Neuroleptic Malignant Syndrome (NMS)

Mechanism	Medication
Ca channel blockers	Dantrolene
D₂ agonists	Bromocriptine
NMDA antagonists	Amantadine
GABA_A agonists	Benzodiazepines

Presentation of Major Depressive Episode {SIG-E-CAPS}

Sleep disturbances :: insomnia & hypersomnia
Interest
Guilt
Energy
Concentration
Appetite changes :: anorexia & hyperphagia
Psychomotor agitation & retardation
Suicidal ideation

Effects of Depression on Sleep-Wake Cycle

↓ REM latency
↑ Total REM sleep

Antidepressants

Mechanism	Medication
Reuptake inhibitors	TCAs SSRIs SNRIs
	NDRI :: Bupropion
MAO inhibitors	Tranylcypromine Phenelzine Isocarboxazid Selegiline
α₂ antagonists	Mirtazapine
5-HT modulators	Trazodone

Side Effects of Antidepressants

Anticholinergic symptoms
Antiadrenergic symptoms
Antihistamine symptoms
Cardiac :: QT prolongation
Serotonin syndrome

Presentation of Serotonin Syndrome

Altered mental status (AMS)
Hyperthermia
Cardiovascular collapse
Hyperreflexia
Myoclonus

Presentation of Manic Episode {DIG-FAST}

Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Agitation
Sleep deprivation
Talkativeness

Medications for Bipolar Disorder

Mechanism	Medication
Mood stabilizer	Lithium
D₂ antagonists	2° Antipsychotics
Na channel blockers	Valproate Carbamazepine Lamotrigine

Clinical Features of Anxiety Disorders

Disorder	Preceding Stressor	Identifiable Trigger	Duration
Adjustment disorder	+	-	< 6 months
Generalized anxiety disorder	±	-	> 6 months
Acute stress disorder	+	+	< 1 month
Post-traumatic stress disorder (PTSD)	+	+	> 1 month
Panic disorder	-	±	> 1 month
Phobias	-	+	> 6 months

Anxiolytics

Mechanism	Medication
Reuptake inhibitors	TCAs SSRIs SNRIs
MAO inhibitors	Tranylcypromine Phenelzine Isocarboxazid Selegiline
β antagonists	Propranolol
5-HT₁ agonists	Buspirone
GABA_A agonists	Benzodiazepines

Medications for Insomnia

Mechanism	Medication
5-HT modulators	Trazodone
GABA_A agonists	Benzodiazepines
	Zolpidem Zaleplon Eszopiclone

Medications for OCD

Mechanism	Medication
Reuptake inhibitors	TCAs SSRIs SNRIs

Medications for ADHD

Mechanism	Medication
Reuptake inhibitors	NRI :: Atomoxetine
	NDRI :: Methylphenidate

Medications for Tourette Syndrome

Mechanism	Medication
VMAT2 inhibitors	Tetrabenazine Valbenazine
α₂ agonists	Clonidine Guanfacine
D₂ antagonists	Antipsychotics

Clinical Features of Somatic Disorders

Disorder	Symptoms	Motivation
Malingering	Conscious	Conscious
Factitious disorder	Conscious	Unconscious
Somatic symptom	Unconscious	Unconscious