This document provides an overview of psychiatry for internists, summarizing key information about anxiety disorders, mood disorders like depression, and psychosis/schizophrenia. It describes the common symptoms and classifications of anxiety disorders, as well as their treatment with SSRIs, benzodiazepines, or cognitive-behavioral therapy. Major depression is outlined, including its presentation and treatment with antidepressants like SSRIs or therapy. Psychosis and schizophrenia are also summarized, explaining their symptoms, potential causes, and treatment typically involving antipsychotic medications.

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