Mood Disorders - Psychiatry - Lecture Slides, Slides of Psychology

Download Mood Disorders - Psychiatry - Lecture Slides and more Slides Psychology in PDF only on Docsity! Mood Disorders Docsity.com Goals • Effectively recognize, diagnose and treat mental illness in primary care • Bring the psychiatry skills and knowledge base of the primary care physician on par with other medical specialty knowledge bases Docsity.com “de facto mental health system” Regier,1978 • 54% of people with mental illness who seek treatment are exclusively seen in the “general medical sector” • 25% of patients in primary care setting have a diagnosable mental illness Docsity.com Why Now? • Great scientific evidence – Genetic basis for disease • Twin studies and Human Genome Project – Neuroscience Research • CT to MRI to PET to SPECT scanning • Neurotransmitter basic science • Somatic Therapies – Psychiatric Medication Explosion (“SSRI Surge”) • Economic pressures (Managed Care) Docsity.com PIPC® Interview Docsity.com Example: Chest Pain • Target symptoms – Chest pain, Shortness of Breath • Differential diagnosis – Cardiac (ischemic, valvular, cardiomyopathy) – GI (esophageal spasm, PUD) – Pulmonary (COPD, pleuresy, pneumonia) – Musculoskeletal (intercostal spasm, rib fx) • Further questions – Age, onset, associated symptoms, etc….. Docsity.com Example: Depression • Target symptoms: – Poor sleep, fatigue, isolation (no enjoyment) • Differential diagnosis: – Major Depression (single episode vs recurrent) – Dysthymia (2 year history) – Bipolar (mania/hypomania) – Substance induced mood disorder (mood during periods on abstinence) • Further questions: – Age, onset, associated symptoms, etc… Docsity.com Screening Strategies vs. Case Finding Strategies • High false positives if everyone screened • Practicing physicians think using case- finding strategies • High comorbidity • Different tools: – Interviewing questions – Diagnostic checklists – Disease specific scales Docsity.com CUES HYPOTHESES (MAPSO©) CASE FINDING QUESTIONS DIAGNOSTIC CRITERIA (DSM-IV) Comorbidities (ROS) D A T A G A T H E R I N G Docsity.com DIAGNOSIS TREATMENTS PATIENT PREFERENCE DIAGNOSIS & TREATMENT CHOICE N E G O T I A T I O N E P D A U T C I A E T N I T O N Docsity.com MAPS-O® Docsity.com MAPS-O® Mood Disorders Anxiety Disorders Psychotic Disorders Substance Abuse Other Docsity.com MAPS-O® Mood Disorders Major Depression, Dysthymia, Bipolar Disorder Anxiety Disorders Psychotic Disorders Substance Abuse Other Docsity.com MAPS-O® Mood Disorders Anxiety Disorders GAD, Panic Disorder, PTSD, OCD, Phobias (Social/Specific) Psychotic Disorders Substance Abuse Other Docsity.com MAPS-O® Mood Disorders Anxiety Disorders Psychotic Disorders Substance Abuse Other “Organic”: Stroke, Dementia, HIV, TBI Other Psych: Personality Disorders, ADHD, Somatization,Eating Disorders Docsity.com MOOD DISORDERS Docsity.com Mood Disorders • Major Depression – Single episode – Recurrent • Dysthymia • “Double” Depression • Bipolar Disorder – Mania – Hypomania • Psychotic Depression Docsity.com Major Depression – Questions: • How is your mood? • Have you been feeling sad, blue or depressed? • Have you lost interest in or do you get less pleasure from the things you used to enjoy? • Has there been any change in your appetite? (5% weight change in 1 month) • How have you been sleeping? Docsity.com Major Depression – Questions: • Have you been more fidgety? • Have you felt slowed down, like you were moving in slow motion or stuck in mud? • How has your energy level been? • How have you been feeling about yourself? • Have you been blaming yourself for things? • Have you had problems thinking or concentrating? Docsity.com 2+ years DEPRESSION NORMAL MOOD DYSTHYMIA 5-7 Stahl S M, Essential Psychopharmacology (2000) Docsity.com 6 - 24 months 2+ years DEPRESSION NORMAL MOOD DYSTHYMIA PARTIAL RECOVERY DOUBLE DEPRESSION 5-8 Stahl S M, Essential Psychopharmacology (2000) Docsity.com Mood Disorders – Mania and Hypomania Mania Distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least one week. Hypomania Like mania but less and lasts throughout at least 4 days. Clearly different from the usual nondepressed mood. Docsity.com 5-5 Stahl S M, Essential Psychopharmacology (2000) DEPRESSION NORMAL MOOD MANIA HYPOMANIA MIXED EPISODE Docsity.com SUICIDE Docsity.com Suicide • More common in all psychiatric diagnoses; not just depression • Dispel myths: talking about it probably makes it less likely to happen • Symptom as well as outcome • High risk groups (men, older, past history) • Assess prohibitions to suicide Docsity.com Suicide - Questions: • When things have gotten really bad - • Have you had increased thoughts about death and dying? • Have you thought about hurting yourself? • Have you ever acted on those thoughts? • Do you have access to those means? • What keeps you from doing this? Docsity.com