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 |
| GABAA 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 |
| GABAA agonists | Benzodiazepines |
Medications for Insomnia
| Mechanism | Medication |
|---|---|
| 5-HT modulators | Trazodone |
| GABAA 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 |