This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of basic psychiatric disorders including Depression, Anxiety, and Bipolar Disorder. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans. These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1. Any and all feedback is very welcomed.

1. Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.
COMMON PSYCHIATRY COMPLAINTS CHEAT SHEET
DEPRESSION (MAJOR DEPRESSIVE DISORDER)
If you suspect any form of depression always ask about:
- 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
*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:
 Restlessness or feeling keyed up/on
edge
 Easily fatigued
 Difficulty concentrating
 Irritability
 Muscle tension
 Sleep disturbance
1st line: SSRIs.

2. Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.
BI-POLAR DISORDER
Dx: irritable mood + 4 DIGFAST criteria OR elevated mood + 3 DIGFAST criteria.
Ask about “DIG FAST” symptoms:
- 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
Hypomania: Symptoms last 4 or more days; change in function
Mania: Symptoms last 7 or more days with impaired function or psychosis or 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:
- 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?
- Thought content: Delusions? Obsessions?
- Intelligence: above/average/below
- Memory: intact?
- Mood: how patient reports s/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?
- Auditory or visual hallucinations?