1. Psychiatry for internist
Anxiety disorders
Mood disorders- depression
Psychosis- schizophrenia

2. Anxiety disorders
 Often chronic debilitating conditions
 Frequently accompanied by symptoms
like headache, sweating, palpitation,
hypertension, muscle spasms,
sexual dysfunction
 Aggravated by stress
 ~60% with other mental disorders,
specially depression

3. Classification
 Generalized anxiety disorder-
chronic, common in elderly, not
object/situation specific
 Panic disorder- brief episodic attacks
 Phobia- episodes triggered by specific stimulus/situation
 Obsessive-compulsive disorder-
repetitive intrusive thoughts/images
compelling to perform specific acts/rituals
 Post-traumatic stress disorder
 Separation anxiety disorder
 Childhood anxiety disorder

4. Treatment
 Reassurance
 Reduce caffeine, regular exercise,
improve sleep hygiene
 Cognitive-behavioural therapy
 Drugs-
 Selective serotonin reuptake inhibitors- SSRI-
paroxetine, sertraline, escitalopram
 Benzodiazepines- short-term or prn/sos use
 Other- β-blockers

5. Mood disorders- classification
 Major depressive disorder- unipolar
 Melancholic- loss of pleasure in all activities
 Psychotic- with delusions/hallucinations
 Catatonic- mute, stuporose, immobile
 Post-partum- within 3 months, lasts ~3 months
 Seasonal affective disorder- winter blues
 Bipolar disorder- manic depression
 Substance-induced mood disorders-
 Alcohol induced
 Benzodiazepine induced
 Other- interferon induced

6. Major depression
 Onset- young adults
 Low mood, inability to experience pleasure,
including from food, sleep, sex
 Pre-occupation with thoughts & feeling of
worthlessness, guilt, hopelessness
 Fatigue, headache, GI symptoms are
common presenting problems
 Rule out dementia in elderly-
check CBC, Na, Ca, TSH, MRI

7. Treatment
 Psychotherapy- cognitive-behavioural therapy-
preferred in adolescents, prevents relapse
 Antidepressants- effective in ~2/3rd
, need ~6-8
weeks for remission, given for 6 months-1 year
 SSRI- sertraline, fluoxetine, paroxetine, escitalopram

Tricyclics- nortriptyline, amitriptyline, imipramine
 Electro-convulsive therapy- ECT-
quicker action, preferred in catatonic/suicidal
patients
 Other- exercise, vagus nerve stimulation

8. Psychosis
 Loss of insight & contact with reality
 Characteristic-
 Hallucination- sensory perception in absence of external stimuli-
auditory hallucinations are common
 Delusion- a false belief or opinion, commonly paranoid
 Thought disorder- leads to disconnected &
disorganized speech & writing
 Causes-
 Functional- schizophrenia, severe stress, sleep deprivation
 Organic- dementia, brain tumor, lupus, AIDS, malaria,
hypoglycemia, electrolyte disorder
 Psychoactive substance use- cannabis, cocaine,
methamphetamine

9. Schizophrenia
 Onset in young adults
 Cause-
 Genetic- complex inheritance
 Social- disadvantage/discrimination, child abuse, family discord
 ?substance abuse
 Symptoms- x >6 months
 +ve- hallucinations, delusions, thought disorder
 -ve- blunted affect/emotion, poverty of speech,
lack of motivation, inability to experience pleasure
 Social/occupational dysfunction

10. Treatment
 Drugs- antipsychotics- haloperidol,
resperidon, olanzapine, clozapine
 Cognitive-behavioural therapy
 Family therapy
 ECT- specially for catatonia or
when other Rx has failed