Psychiatry
Mood & Anxiety Disorders
Psychiatry

Mood & Anxiety Disorders

Depression, bipolar, anxiety, PTSD, OCD.

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◆Major depressive disorder

  • •SIGECAPS ≥5 for ≥2 weeks with functional impairment
  • •First-line: SSRI + CBT (combination > either alone)
  • •Black box warning in adolescents: ↑ suicidal ideation
  • •Treatment-resistant + psychotic features → ECT (safe in pregnancy)

◆Bipolar

  • •Mania: ≥1 wk elevated mood + ↑energy + ↓sleep + pressured speech + risky behavior; OR hospitalization
  • •Bipolar I: ≥1 manic episode (± depression). Bipolar II: hypomania + MDE
  • •Acute mania: lithium, valproate, atypicals (quetiapine, olanzapine)
  • •Bipolar depression: mood stabilizer FIRST (lithium, quetiapine) — do NOT use antidepressant monotherapy
  • •Lithium reduces suicide; restart effective agent on relapse

◆Lithium toxicity

  • •Triggered by dehydration, NSAIDs, ACEi, thiazides → ↓ renal clearance
  • •GI (early), neurologic (tremor, ataxia, seizure), cardiac
  • •Dialysis if level >2.5 with symptoms or >4.0
  • •Chronic monitoring: TSH (hypothyroidism), creatinine
  • •Teratogenic: Ebstein anomaly

◆Anxiety disorders

  • •Panic disorder: recurrent unexpected attacks + worry/avoidance → CBT + SSRI/SNRI
  • •GAD: excessive worry ≥6 mo + ≥3 symptoms → CBT and/or SSRI/SNRI; buspirone adjunct
  • •Social anxiety (performance-only): propranolol PRN; generalized: CBT + SSRI
  • •OCD: ERP + high-dose SSRI
  • •PTSD: trauma-focused CBT first; SSRI/SNRI (sertraline, paroxetine, venlafaxine); prazosin for nightmares
  • •Acute stress disorder: 3 days–1 month after trauma → trauma-focused CBT

◆SSRI discontinuation syndrome

  • •Abrupt stop of short t1/2 SSRI (paroxetine) → flu-like + dizziness + paresthesias + irritability
  • •Resume + taper
  • •SSRIs need 4–6 weeks for full effect

High-yield pearls

  • ◆#1 risk factor for suicide: prior attempt
  • ◆#1 risk factor for postpartum depression: history of depression
  • ◆Any eating disorder + bupropion = contraindicated (seizures)
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