PSYCHOBEHAVIORAL DISORDERSDIAGNOSIS
Diagnosis is clinical and by history. Also eliminate potential other medical
etiologies (see above).
TREATMENT
Admit patients with suicidality and acute psychosis; mood stabilizers (lithium,
select anticonvulsants), antipsychotics if indicated. Outpatient therapy.
Anxiety Disorders
See Table 16.6.
TABLE 16.6. Anxiety Disorders
DISORDER SYMPTOMS/EXAM DIFFERENTIAL DIAGNOSIS TREATMENTGeneralized Six months of Rule out: Diagnosis is Cognitive behavioral
anxiety disorder persistent/excessive 1. Organic causes such as clinical. Rule out therapy (CBT), group
(GAD) anxiety and worry hyperthyroidism, other causes! therapy, long-acting
about a broad range hyperparathyroidism, Rule out all likely benzodiazepines,
of topics pheochromocytoma, medical etiologies anxiolytic agents (eg,
vestibular dysfunction, (eg, check Flonazepam) selective
seizure disorder, acute ECG, lytes, CXR). serotonin reuptake
coronary syndrome inhibitor (SSRI)- CNS stimulants such as
caffeine, cocaine,
amphetamines - Other psychiatric
condition (depression,
psychosis, schizophrenia,
bipolar disorder, or
other anxiety disorder)
Panic disorder Recurrent, unexpected Endocrine:Hypoglycemia, Same as for GAD SSRI, short-acting
panic attacks followed hypo/hyperthyroidism, benzodiazepines,
by at least 1 mo of hyperparathyroidism, anxiolytic agents,
persistent concern pheochromocytoma β-blockers, desensitization,
about having another Neurologic:Seizure “flooding” therapy (CBT)
panic attack disorders, vestibular
dysfunction, neoplasms
Pharmacologic:Acute
intoxication, medication-
induced symptoms
Cardiovascular:
Arrhythmias, MI
Psychiatric:GAD, obsessive-
compulsive disorder (OCD),
posttraumatic stress disorder
(PTSD)Onset after age 45 or presence
of atypical symptoms during an
episode of anxiety (loss of
consciousness, loss of bowel or
bladder control, headache,
altered speech, focal neurologic
symptoms, amnesia) suggest
an organic cause!