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, covering their potential causes, symptoms, and treatment typically involving antipsychotic medications.
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
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