0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

784

SYMPTOMS/EXAM

One or more depressive episodes (at least 2 weeks of depressed mood or loss

of interest, accompanied by four or more additional symptoms of depression).

DIFFERENTIAL

Mood disorder secondary to neurological (Alzheimer disease, multiple sclerosis

(MS), Huntington disease), endocrine (hypothyroidism), metabolic conditions,

substance abuse, dementia, bereavement, adjustment disorder, postoperative/

cardiac patients

DIAGNOSIS

Diagnosis is clinical and by history. Also eliminate potential other medical etio-

logies, eg, check TSH, CBC, etc.

TREATMENT

Admit all suicidal patients and patients at high risk for suicide. Otherwise,

treat with antidepressants (starting them in the ED is controversial) with close

follow-up/therapy.

GRIEFREACTION

■ Bereavement after loss of a loved one is normal.

■ Illusions (seeing loved one briefly), guilt, and weight loss can occur.

■ Severe symptoms typically resolve after 2 months and moderate symp-

toms after 1 year.

■ Prolonged symptoms (>1 year) that include marked functional impair-

ment, morbid preoccupation with worthlessness, suicidal ideation, psy-

chotic symptoms, and psychomotor retardation are abnormal and should

prompt immediate psychiatric evaluation.

Dysthymic Disorder

At least 2 years of depressed mood (1 year for children and adolescents) for

more days than not, and without any 2-month asymptomatic period. Needs

outpatient psychiatric evaluation unless patient is suicidal. Treatment often

involves combination drug therapy along with individual and/or group psy-

chotherapy.

Bipolar Disorder

SYMPTOMS/EXAM

■ Bipolar I: One or more manic episodes or mixed episodes

■ Bipolar II: One or more major depressive episodes accompanied by at

least one hypomanic episode

■ Manic syndrome: Elation or irritability, feels “top of the world” with

decreased need for sleep, increased activity, rapid pressured speech, racing

thoughts,grandiose ideas; patient may quickly become hostile, irritable,

and argumentative

DIFFERENTIAL

Mood disorder secondary to neurological (temporal lobe epilepsy), endocrine

(hyperthyroidism), metabolic conditions, substance abuse, dementia, psychotic

disorders

Symptoms of major

depression—

SIGECAPS

Sleep (hypersomnia or

insomnia)

Interest (lost of interest

or pleasure in

activities)

Guilt (feelings of

worthlessness or

inappropriate guilt)

Energy (decreased)

Concentration

Appetite

Psychomotor agitation

or retardation

Suicidal ideation