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Psychotherapy
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| Substance Use and Addictive Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance Use and Addictive Disorders
Primer
Substance Use Disorders and Addictive Disorders are mental disorders in the DSM-5 broadly divided into 10 classes of drugs for which substance-related disorders can apply: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Addiction Medicine Primer Addiction Medicine is a branch of medicine involved in the diagnosis, treatment, and prevention of substance use disorders. This article will address basic concepts related to addictions, substance use disorders, and the DSM-5's conceptualization of these disorders. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alcohol-Related Disorders Primer Alcohol-Related Disorders are a group of substance use disorders related to the use of alcohol. In the DSM-5, alcohol-related disorders comprise of alcohol use disorder, alcohol intoxication, alcohol withdrawal, and other alcohol-induced disorders. Alcohol use is a leading risk factor for premature death and disability worldwide and remains the leading cause of mortality for people aged 15-49 years old worldwide. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alcohol Use Disorder (AUD)
Primer
Alcohol Use Disorder (AUD) is a substance use disorder characterized by repeated use of alcohol despite significant problems associated with its use.
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| Alcohol Intoxication
Primer
Alcohol Intoxication occurs when there is a clinically significant problematic behavioural or psychological change (e.g. - inappropriate sexual or aggressive behavior, impaired social or occupational functioning, mood lability, impaired judgment) that develops during, or shortly after ingestion. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alcohol Withdrawal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alcohol Withdrawal
Primer
Alcohol Withdrawal is a withdrawal syndrome that occurs within several hours to a few days of stopping heavy and prolonged alcohol use. The withdrawal syndrome includes autonomic hyperactivity, anxiety, and gastrointestinal symptoms. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Alcohol-Induced Disorders Primer Other Alcohol-Induced Disorders are mental disorders induced by alcohol use. This includes alcohol-induced psychotic disorder, alcohol-induced bipolar disorder, alcohol-induced depressive disorder, alcohol-induced anxiety disorder, alcohol-induced sleep disorder, alcohol-induced sexual dysfunction, and alcohol-induced major or mild neurocognitive disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Caffeine-Related Disorders Primer Caffeine-Related Disorders are a group of substance use disorders related to the use of caffeine, a psychoactive substance. In the DSM-5, caffeine-related disorders comprise of caffeine intoxication, caffeine withdrawal, and other caffeine-induced disorders. Importantly, the DSM-5 does not have a diagnosis of caffeine use disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Caffeine Intoxication Primer Caffeine Intoxication occurs when there is recent consumption of caffeine and five or more signs or symptoms that develop during or shortly after caffeine use, and causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Caffeine Withdrawal Primer Caffeine Withdrawal is a withdrawal syndrome that occurs after the abrupt cessation of (or substantial reduction in) prolonged daily caffeine use. The withdrawal syndrome includes headaches, fatigue or drowsiness, depressed mood, irritability, poor concentration, and flu-like symptoms (nausea, vomiting, or muscle pain/stiffness). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cannabis-Related Disorders Primer Cannabis-Related Disorders are a group of substance use disorders related to the use of cannabis (marijuana), a genus of flowering plant in the family Cannabaceae. In the DSM-5, cannabis-related disorders comprise of cannabis use disorder, cannabis intoxication, cannabis withdrawal, and other cannabis-induced disorders. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cannabis Use Disorder
Primer
Cannabis Use Disorder is a substance use disorder characterized by a problematic pattern of cannabis (marijuana) use leading to clinically significant impairment or distress.
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| Cannabis Intoxication Primer Cannabis Intoxication occurs when there is a clinically significant problematic behavioural or psychological change (e.g. - impaired motor coordination, sensation of slowed time, impaired judgment, social withdrawal, euphoria, anxiety) that develops during, or shortly after ingestion. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cannabis Withdrawal Primer Cannabis Withdrawal is a withdrawal syndrome that develops after the cessation of or substantial reduction in heavy and prolonged cannabis use. The withdrawal syndrome can include irritability, anger, anxiety, insomnia, restlessness, decreased appetite/weight loss, and dysphoria. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hallucinogen-Related Disorders Primer Hallucinogen-Related Disorders are a group of substance use disorders related to the use of hallucinogens. In the DSM-5, hallucinogen-related disorders comprise of phencyclidine (PCP) use disorder, phencyclidine (PCP) intoxication, other hallucinogen (e.g. - LSD, MDMA) use disorder , other hallucinogen (e.g. - LSD, MDMA) intoxication, hallucinogen persisting perception disorder (HPPD), other phencyclidine-induced disorders, other hallucinogen-induced disor… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phencyclidine (PCP, Ketamine) Use Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phencyclidine (PCP, Ketamine) Use Disorder
Primer
Phencyclidine (PCP) Use Disorder is a substance use disorder characterized by a problematic pattern of PCP (or PCP-like substances such as ketamine) leading to clinically significant impairment or distress.
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| Phencyclidine (PCP, Ketamine) Intoxication Primer Phencyclidine (PCP) Intoxication occurs when there is a clinically significant problematic physiological, behavioural or psychological change (e.g. - disorientation, confusion without hallucinations, hallucinations or delusions, a catatonic-like syndrome, and/or coma) that develops during, or shortly after ingestion. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Hallucinogen (LSD, MDMA) Use Disorder Primer Other Hallucinogen Use Disorder is a substance use disorder characterized by a problematic pattern of hallucinogen use (not phencyclidine or phencyclidine-like substances) use leading to clinically significant impairment or distress. Of the other hallucinogens, MDMA is thought to have the greatest risk in terms of withdrawal symptoms and neurological impairment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Hallucinogen (LSD, MDMA) Intoxication Primer Other Hallucinogen Intoxication occurs when there is a clinically significant problematic physiological, behavioural or psychological change that develops during, or shortly after ingestion of a hallucinogen. Depending on the specific hallucinogen, the episode of intoxication can last from minutes, to hours, or longer. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hallucinogen Persisting Perception Disorder (HPPD)
Primer
Hallucinogen Persisting Perception Disorder (HPPD) is a mental disorder where a sober, non-intoxicated individual reexperiences the perceptual disturbances that were experienced while they were | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inhalant-Related Disorders
Primer
Inhalant-Related Disorders are a group of substance use disorders related to the use of inhalant (volatile hydrocarbons/gases from glues, fuels, paints, and other volatile compounds). In the DSM-5, inhalant-related disorders comprise of | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inhalant Use Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inhalant Use Disorder
Primer
Inhalant Use Disorder is a substance use disorder characterized by a problematic pattern of inhalant (volatile hydrocarbons/gases from glues, fuels, paints, and other volatile compounds) use leading to clinically significant impairment or distress. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inhalant Intoxication Primer Inhalant Intoxication occurs when there is a clinically significant problematic behavioural or psychological change that develops during, or immediately after, intended or unintended inhalation of a volatile hydrocarbon substance. Volatile hydrocarbons include toxic gases from glues, fuels, paints, and other volatile compounds. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tobacco (Nicotine)-Related Disorders
Primer
Tobacco (Nicotine)-Related Disorders are a group of substance use disorders related to the use of tobacco (nicotine). In the DSM-5, tobacco-related disorders comprise of tobacco use disorder, tobacco withdrawal, other tobacco-induced disorders, and unspecified tobacco-related disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tobacco (Nicotine) Use Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tobacco (Nicotine) Use Disorder Primer Tobacco (Nicotine) Use Disorder is a substance use disorder characterized by a problematic pattern of tobacco (nicotine) use leading to clinically significant impairment or distress. Like with all substance use disorders, there is a complex interplay between biological, social, psychological, and cultural factors. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tobacco (Nicotine) Withdrawal Primer Tobacco Withdrawal is a withdrawal syndrome that occurs when individuals stop tobacco/nicotine use. The withdrawal syndrome consists of irritability, anxiety, poor concentration, restlessness, poor focus, low mood, and insomnia. The syndrome is usually most intense in individuals who smoke cigarettes or use smokeless tobacco, due to the more rapid onset and higher levels of nicotine. Tobacco withdrawal can also produce clinically significant mood changes an… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-Substance-Related Addictive Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-Substance-Related Addictive Disorders
Primer
Non-Substance-Related Disorders are addiction disorders not related to substance use. This includes the DSM-5 diagnosis of gambling disorder, and other disorders under investigation, such as internet gaming disorder.
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| Behavioural Addictions | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Behavioural Addictions
Primer
Behavioural Addictions are mental disorders that cause problematic pattern of behaviours (e.g. - gambling, technology use) that lead to clinically significant impairment or distress.
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| Gambling Disorder
Primer
Gambling Disorder is a mental disorder characterized by persistent and recurrent maladaptive gambling behavior that disrupts personal, family, and/or vocational pursuits. It is the only non-substance addictive disorder endorsed as a diagnosis in the DSM-5. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Opioid-Related Disorders Primer Opioid-Related Disorders are a group of substance use disorders related to the use of opioids. In the DSM-5, opioid-related disorders comprise of opioid use disorder, opioid intoxication, opioid withdrawal, other opioid-induced disorders, and unspecified opioid-related disorder.American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Opioid Use Disorder (OUD)
Primer
Opioid Use Disorder (OUD) is a substance use disorder characterized by a problematic pattern of opioid use leading to clinically significant impairment or distress.
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| Opioid Intoxication | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Opioid Intoxication
Primer
Opioid Intoxication occurs when there is a clinically significant problematic behavioural or psychological change (e.g. - initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that develops during, or shortly after ingestion.
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| Opioid Withdrawal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Opioid Withdrawal
Primer
Opioid Withdrawal is a withdrawal syndrome that develops after stopping or reducing opioid use that has been heavy and prolonged. Opioid withdrawal can also be triggered by administration of an opioid antagonist (e.g. - naloxone or | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sedative-, Hypnotic-, or Anxiolytic-Related Disorders Primer Sedative-, Hypnotic-, or Anxiolytic-Related Disorders are a group of substance use disorders related to the use of substances including benzodiazepines, benzodiazepine-like drugs (e.g. - zolpidem, zaleplon), carbamates (e.g. - glutethimide, meprobamate), barbiturates (e.g. - phenobarbital, secobarbital), and barbiturate-like hypnotics (e.g. - glutethimide, methaqualone). This class also includes all prescription sleeping medications … | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sedative, Hypnotic, or Anxiolytic (Benzodiazepine) Use Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sedative, Hypnotic, or Anxiolytic (Benzodiazepine) Use Disorder Primer Sedative, Hypnotic, or Anxiolytic Use Disorder is a substance use disorder characterized by repeated use of substances including benzodiazepines, benzodiazepine-like drugs (e.g. - zolpidem, zaleplon), carbamates (e.g. - glutethimide, meprobamate), barbiturates (e.g. - phenobarbital, secobarbital), and barbiturate-like hypnotics (e.g. - glutethimide, methaqualone) despite significant problems associated with its use. This cl… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sedative, Hypnotic, or Anxiolytic (Benzodiazepine) Intoxication | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sedative, Hypnotic, or Anxiolytic (Benzodiazepine) Intoxication Primer Sedative, Hypnotic, or Anxiolytic Intoxication occurs when there is a clinically significant problematic behavioural or psychological change (e.g. - inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that develops during, or shortly after ingestion of substances including | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sedative, Hypnotic, or Anxiolytic (Benzodiazepine) Withdrawal
Primer
Sedative, Hypnotic, or Anxiolytic Withdrawal is a withdrawal syndrome that occurs after a marked decrease in or cessation of intake after several weeks or more of regular use of substances such as | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stimulant-Related Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stimulant-Related Disorders Primer Stimulant-Related Disorders are a group of substance use disorders related to the use of stimulants. In the DSM-5, stimulant-related disorders comprise of stimulant use disorder, stimulant intoxication, stimulant withdrawal, other stimulant-induced disorders, and unspecified stimulant-related disorder. Stimulants include cocaine, methamphetamine, and other similar drugs within this class. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stimulant Use Disorder
Primer
Stimulant Use Disorder is a substance use disorder characterized by a problematic pattern of stimulant use leading to clinically significant impairment or distress.
For a pharmacological review of prescribed stimulants, see: Introduction to Stimulants
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| Stimulant Intoxication Primer Stimulant Intoxication occurs when there is a clinically significant problematic behavioural or psychological change (e.g. - “high” feeling, euphoria with enhanced vigour, gregariousness, hyperactivity, restlessness, hypervigilance, interpersonal sensitivity, talkativeness, anxiety, tension, alertness, grandiosity, stereotyped and repetitive behaviour, anger, impaired judgment) that develops during, or shortly after use of stimulants. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stimulant Withdrawal
Primer
Stimulant Withdrawal is a withdrawal syndrome that develops within a few hours to several days after the cessation of (or marked reduction in) stimulant use (generally high dose) that has been prolonged.
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| Anxiety Disorders
Primer
Anxiety Disorders are a group of mental disorders characterized by significant feelings of anxiety and fear, including generalized anxiety disorders, specific phobias, panic disorder, and posttraumatic stress disorder. Anxiety is a worry about future events, and fear is a reaction to current events. These feelings may cause significant somatic symptoms as well. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Agoraphobia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Agoraphobia Primer Agoraphobia is an anxiety disorder where an individual has intense fears about at least two different types of situations, with the fear being that escape may be difficult or help may be unavailable if panic-like symptoms occur. Epidemiology * | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Generalized Anxiety Disorder (GAD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Generalized Anxiety Disorder (GAD) Primer Generalized Anxiety Disorder (GAD) is mental disorder characterized by excessive anxiety and worry about multiple events or activities (e.g. - school or work difficulties, relationships, finances) on a majority of days over at least half a year. There are also associated symptoms, such as restlessness, muscle tension, fatigue, poor concentration, irritability, and sleep changes. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Panic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Panic Disorder Primer Panic disorder is a condition where there are recurrent unexpected panic attacks, in the absence of triggers. It is marked by persistent concern about additional panic attacks and/or maladaptive change in behaviour related to the attacks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Specific Phobia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Specific Phobia Primer Specific Phobia is an anxiety disorder characterized by intense fear or anxiety in the presence of a particular situation or object (phobic stimulus). The four major types of fear are animals, environments, medical procedures, and situations (e.g. - elevators, planes, enclosed spaces). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Selective Mutism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Selective Mutism Primer Selective Mutism is a mental disorder where individuals (most commonly children) do not initiate speech or reciprocally respond when spoken to by others. This lack of speech occurs in both social interactions with children or adults. Children will however, speak in their home in the presence of immediate family members. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Separation Anxiety Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Separation Anxiety Disorder Primer Separation anxiety disorder is a mental disorder characterized by an excessive fear or anxiety concerning separation from a home or attachment figure(s). The anxiety exceeds what is expected at the individual's developmental level. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Social Anxiety Disorder (Social Phobia) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Social Anxiety Disorder (Social Phobia) Primer Social Anxiety Disorder (also known as social phobia), is an anxiety disorder characterized by a significant amount of fear in one or more social situations, causing significant distress and impaired ability to function in some aspects of daily life. These fears can be triggered by perceived or actual scrutiny, or negative evaluation from others. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Anxiety Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Anxiety Disorder Primer Substance/medication-induced anxiety disorder is diagnosed after an individual uses a substance (e.g., a drug of abuse, a medication, or a toxin exposure) that leads to prominent symptoms of panic or anxiety. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Anxiety Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Anxiety Disorders Primer Other Specified Anxiety Disorders is a category of DSM-5 diagnoses that applies to individuals who have symptoms characteristic of an anxiety disorder but do not meet the full criteria for any of them. This category in anxiety disorders also includes disorders with cultural components. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bipolar Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bipolar Disorders
Primer
Bipolar Disorders are a group of mental disorders characterized by prolonged periods of excessive elevation in mood with/without depressive episodes. It can be considered as a group of disorders that bridge between the depressive and psychotic disorders.
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| Bipolar I Disorder Primer Bipolar I Disorder is a mental disorder characterized by episodes of highly elevated or irritable mood, known as mania. Individuals may also present with decreased sleep, grandiosity, talkativeness, racing thoughts, and indiscretion or risk-taking behaviours. In some presentations, one's mood can shift very quickly between mania, anger, irritability, and/or depression, indicating a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bipolar II Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bipolar II Disorder Primer Bipolar II Disorder is a mental disorder characterized by a clinical course of recurring mood episodes consisting of at least one major depressive episode and at least one hypomanic episode. The depressive episode must last at least 2 weeks, and the hypomanic episode must last at least 4 days. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cyclothymic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cyclothymic Disorder Primer Cyclothymic disorder is a mood disorder characterized by chronic, fluctuating mood disturbances that consist of numerous hypomanic symptoms (not a hypomanic episode) and depressive symptoms (not a depressive episode), that are chronologically distinct from each other. It is best conceptualized as | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Bipolar and Related Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Bipolar and Related Disorder Primer Substance/Medication-Induced Bipolar and Related Disorder is diagnosed when a substance (alcohol, illicit drugs, or prescribed medication) causes manic/hypomanic and/or depressive symptoms while an individual is using the substance or during a withdrawal syndrome associated with the substance. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bipolar and Related Disorder Due to Another Medical Condition | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bipolar and Related Disorder Due to Another Medical Condition Primer Bipolar and Related Disorder Due to Another Medical Condition is a mood disorder diagnosis given when there is a prominent and persistent period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy that is attributable to another medical condition. Medical conditions commonly known to cause bipolar mania or hypomania include Cushing's disease, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Bipolar and Related Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Bipolar and Related Disorders Primer Other Specified Bipolar and Related Disorders is a category of DSM-5 diagnoses that applies to individuals who have symptoms characteristic of a bipolar and related disorder (e.g. - bipolar I, bipolar II, cyclothymic disorder) but do not meet the full criteria for any of them. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Brain Stimulation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Brain Stimulation Primer Brain stimulation therapies (Neurostimulation, neuromodulation) are a type of intervention used to treat psychiatric and neuropsychiatric disorders. Neurostimulation involve activating or inhibiting the areas of the brain directly via electricity or magnetic stimulus. The electricity can be delivered in various ways, including via electrodes implanted in the brain (e.g. - deep brain stimulation), or non-invasively through electrodes on the scalp (e.g. - electroconvulsi… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Deep Brain Stimulation (DBS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Deep Brain Stimulation (DBS) Primer Deep Brain Stimulation (DBS) is a form of brain stimulation that involves invasive neurosurgical intervention and implantation of electrodes under MRI guidance into specific brain regions.Milev, R. V., Giacobbe, P., Kennedy, S. H., Blumberger, D. M., Daskalakis, Z. J., Downar, J., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive di… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Electroconvulsive Therapy (ECT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Electroconvulsive Therapy (ECT) Primer Electroconvulsive Therapy (ECT) is a form of brain stimulation performed under general anesthesia, in which electrical currents are passed through the brain, intentionally triggering a brief seizure. The indications for treatment with ECT are numerous, including for | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Magnetic Seizure Therapy (MST) Primer Magnetic Seizure Therapy (MST) is a form of brain stimulation performed under general anesthesia, where electromagnetic induction to is used to induce an electric field in the brain strong enough to elicit a generalized tonic-clonic seizure. MST is currently an investigative therapy, and being explored as an alternative to ECT. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Repetitive Transcranial Magnetic Stimulation (rTMS)
Primer
Repetitive Transcranial Magnetic Stimulation (rTMS) is a form of brain stimulation that uses focused magnetic field pulses to induce electrical currents in neural tissue non-invasively, via an inductor coil positioned against the scalp. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Transcranial Direct-Current Stimulation (tDCS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Transcranial Direct-Current Stimulation (tDCS) Primer Transcranial Direct-Current Stimulation (tDCS) is a form of brain stimulation that delivers a continuous low-amplitude electrical current to a specified cortical region using scalp electrodes. Stimulation over the cortex increases cortical excitability through depolarization of neuronal membrane potential. By contrast, cathodal stimulation decreases cortical excitability through hyperpolarization of the membrane potential. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Child and Adolescent Psychiatry Primer Child and Adolescent Mental Disorders are an important part of psychiatry. Half of all mental illnesses begin by age 14 and this increases to more than 75% by the mid-20s.Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., ... & Rahman, A. (2011). Child and adolescent mental health worldwide: evidence for action. The Lancet, 378(9801), 1515-1525. Neuropsychiatric conditions are the leading cause of disability in children an… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Attachment Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Attachment Disorders
Primer
Attachment Disorders are a diagnostic category that describe disorders of mood, behaviour, and social relationships due to a failure to form normal attachments to primary care giving figures in early childhood.
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| Attachment Theory | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Attachment Theory Primer Attachment Theory is a psychological model that states strong emotional and physical attachment to at least one primary caregiver is critical in development during childhood. The theory posits that children are motivated to seek protective contact with caregivers, and if a parent responds sensitively to a child's distress, then the child feels secure enough to explore their environment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disinhibited Social Engagement Disorder (DSED) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disinhibited Social Engagement Disorder (DSED) Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Signs and Symptoms | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reactive Attachment Disorder (RAD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reactive Attachment Disorder (RAD) Primer Reactive Attachment Disorder (RAD) is a disorder of infancy and early childhood, characterized by a pattern of significant disturbance and developmentally inappropriate attachment behaviors. The infant or child will rarely or minimally turn preferentially to an attachment figure for comfort, support, protection, and/or nurturance. At its core, there is an absent or severely underdeveloped | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Communication Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Communication Disorders Primer Communication Disorders are disorders that result in deficits in language, speech, and communication. There are five communication disorders in the DSM-5: Language Disorder, Speech Sound Disorder (previously Phonological Disorder), Childhood-Onset Fluency Disorder (Stuttering), Social (Pragmatic) Communication Disorder, and Unspecified Communication Disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Childhood-Onset Fluency Disorder (Stuttering) Primer Childhood-Onset Fluency Disorder (more commonly known as Stuttering) is a communication disorder characterized by a disturbance in the normal fluency and time patterning of speech that is inappropriate for an individual's age. The disorder is characterized by frequent repetitions or prolongations of sounds or syllables. Other speech deficits include: (1) single words that are broken up (e.g. - pauses within a word), (2) audible or silent blo… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Language Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Language Disorder Primer Language Disorder is a disorder characterized by difficulties in the acquisition and use of language, due to deficits in the production or comprehension of vocabulary, discourse, and sentence structure. These deficits will be apparent in spoken communication, written communication, or sign language. These deficits can either be in receptive and/or expressive skills. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Social (Pragmatic) Communication Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Social (Pragmatic) Communication Disorder Primer Social (Pragmatic) Communication Disorder (SCD) is a disorder characterized by difficulty with pragmatics, or the social use of language and communication. This seen through deficits in understanding and following social rules of verbal and nonverbal communication in day-to-day contexts, an inability to change language according to the needs of the listener or situation, and difficulty following rules for conversations and storytelling. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Speech Sound Disorder (Phonological Disorder) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Speech Sound Disorder (Phonological Disorder) Primer Speech Sound Disorder (also known as Phonological Disorder) is a disorder where speech sound production is not consistent with what is expected based on the child's developmental stage and age. Additionally, the speech production deficits must not be due to a physical, structural, neurological, or hearing impairment. Children with the disorder may not have knowledge of phonological speech sounds, or be unable to coordinate movements (i.e. - … | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disruptive, Impulse-Control, and Conduct Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disruptive, Impulse-Control, and Conduct Disorders Primer Disruptive, Impulse-Control, and Conduct Disorders include conditions involving problems in the self-control of emotions and behaviours. While other disorders in DSM-5 may also involve problems in emotional and/or behavioral regulation, the disorders in this category are unique in that these problems are manifested in behaviours that violate the rights of others (e.g., aggression, destruction of property) and/or that bring the individua… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Parent Management Training (Parent Training) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Parent Management Training (Parent Training) Primer Parent training, also known as parent management training (PMT) or behavioural parent training (BPT), are training programs that aim to change parenting behaviors and teach positive reinforcement methods for improving children and adolescent behaviour problems. It is commonly used for | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conduct Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conduct Disorder Primer Conduct Disorder is a mental disorder characterized by a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated. These behaviours fall into four main categories: aggressive conduct that causes or threatens physical harm to other people or animals, non-aggressive conduct that causes property loss or damage, deceitfulness or theft, and serious violations of rules. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disruptive Mood Dysregulation Disorder (DMDD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disruptive Mood Dysregulation Disorder (DMDD) Primer Disruptive Mood Dysregulation Disorder (DMDD) is a new controversial DSM-5 diagnosis for children with chronic and severe persistent irritability and severe anger outbursts. DMDD was created for patients previously diagnosed with the also controversial diagnosis of childhood (pediatric) bipolar disorder and concerns about over-diagnosis and over-treatment with | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intermittent Explosive Disorder (IED) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intermittent Explosive Disorder (IED) Primer Intermittent Explosive Disorder (IED) is an impulse control disorder characterized by aggressive outbursts that has a rapid onset and, typically, with little to no warning.American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Kleptomania | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Kleptomania Primer Kleptomania is characterized by the recurrent failure to resist impulses to steal items even though the items are not required for personal use or are of little value to the individual. Epidemiology * The prevalence of kleptomania in the general population is very rare, and thought to be between 0.3 to 0.6%. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Oppositional Defiant Disorder (ODD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Oppositional Defiant Disorder (ODD) Primer Oppositional Defiant Disorder (ODD) is a mental disorder characterized by frequent and persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness.American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pyromania | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pyromania Primer Pyromania is an impulse-control disorder, characterized by multiple episodes of deliberate and purposeful fire setting associated with tension or affective arousal.American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Genetic Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Genetic Disorders Primer Genetic Disorders (also called Genetic Diseases and Syndromes) are conditions caused by an abnormality in an individual's DNA. These abnormalities can be as little as a single-base mutation, all the way to single gene defects, multi-gene defects, teratogenic problems, or chromosomal abnormalities. Many genetic conditions can cause significant neuropsychiatric disorders and symptoms. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Angelman Syndrome (AS) Primer Angelman Syndrome (AS) (pejoratively referred to in the past as “Happy Puppet Syndrome”)is a genetic disorder that results in microcephaly, facial dysmorphia, severe intellectual disability, developmental disability, limited speech, balance and movement problems, seizures, and sleep difficulties. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DiGeorge (22q11.2 Deletion) Syndrome | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DiGeorge (22q11.2 Deletion) Syndrome Primer DiGeorge Syndrome (also known as 22q11.2 Deletion Syndrome, and formerly Velocardiofacial Syndrome) is a syndrome caused by the deletion of a small segment (microdeletion) of chromosome 22. It is the most common microdeletion syndrome in humans. This microdeletion is also responsible for a 20 to 30 times increased risk for | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Down Syndrome (Trisomy 21) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Down Syndrome (Trisomy 21) Primer Down Syndrome (Trisomy 21) is the most common identifiable genetic cause of intellectual disability. It is due to the presence of all or part of a third copy of chromosome 21. Individuals with Down syndrome have a characteristic facial appearance and hypotonia in infancy. About half are born with a heart defect. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fragile X Syndrome (FXS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fragile X Syndrome (FXS) Primer Fragile X Syndrome (FXS) is an X chromosome-linked dominant disorder caused by the amplification of a CGG repeat in the 5′ untranslated region of the fragile X mental retardation gene 1 (FMR1). It is the most common | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Prader-Willi Syndrome (PWS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Prader-Willi Syndrome (PWS) Primer Prader–Willi Syndrome (PWS) a is genetic disorder caused by a loss of function of specific genes on chromosome 15. At birth, individuals will have muscle weakness, failure to feed, and slowed development. Characteristic hyperphagia begins in childhood, and children become at high risk for obesity and type 2 diabetes. Individuals have marked mild to moderate intellectual impairment and behavioural difficulties throughout the lifespan. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rett Syndrome | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rett Syndrome Primer Rett Syndrome is a genetic disorder that usually becomes apparent after 6 to 18 months of age in females. Symptoms include problems with language, coordination, and repetitive movements that can resemble autism spectrum disorder. Often there is slower growth, problems walking, and a smaller head size. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Williams Syndrome | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Williams Syndrome Primer Williams Syndrome is a genetic disorder characterized by mild to moderate intellectual disability, facial dysmorphia, hypercalcemia, and cardiac defects. Individuals have an outgoing personality, and interact readily with strangers. Psychiatric Symptoms The most common psychiatric disorders found in Williams syndrome have been reported mainly in children and include | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Specific Learning Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Specific Learning Disorder Primer Specific Learning Disorder (also known as learning disorder or learning disability) is a neurodevelopmental disorder that begins during school-age, but may not be recognized until adulthood. Learning disabilities affect one of three areas: reading, writing and/or math. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychoeducational and Intelligence Assessments | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychoeducational and Intelligence Assessments Primer A Psychoeducational Assessment identifies factors that may have an impact on any aspect of an individual's learning. This assessment is used to determine the individual's learning profile. Factors that can affect an individual's profile includes their ability to process, retain, or output information. These factors can either have a positive impact (in the case of giftedness) or a negative impact (in the case of a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Motor Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Motor Disorders
Primer
Motor Disorders are disorders of the nervous system that cause abnormal and involuntary movements. They can result from damage to the motor system.
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| Developmental Coordination Disorder DSM-5 Diagnostic Criteria Criterion A The acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g. - dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g. - catching an object, using scissors or cutlery, handwriting, riding a bike, or partici… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stereotypic Movement Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stereotypic Movement Disorder DSM-5 Diagnostic Criteria Criterion A Repetitive, seemingly driven, and apparently purposeless motor behaviour (e.g. - hand shaking or waving, body rocking, head banging, self-biting, hitting own body). Criterion B | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tic Disorders (Tics) and Tourette's | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tic Disorders (Tics) and Tourette's Primer Tics are sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations. Individuals with tics experience a feeling of a mounting inner tension or urge (known as a premonitory urge), which is transiently relieved by tic expression. Tics will wax and wane with time, and can be worsened with stress, fatigue, or excitement. Although tics can include almost any muscle group or vocalization, certain tic symptoms, such as eye blinking or throat cle… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Attention-Deficit/Hyperactivity Disorder (ADHD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Attention-Deficit/Hyperactivity Disorder (ADHD) Primer Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, usually first diagnosed in childhood, characterized by inattention, impulsivity, and/or hyperactivity. Epidemiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Autism Spectrum Disorder (ASD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Autism Spectrum Disorder (ASD) Primer Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by: (1) persistent impairments in reciprocal social communication and social interaction, and (2) restricted, repetitive patterns of behaviour, interests, or activities. The manifestations and functional impact of the disorder vary greatly depending on the severity of the autistic symptoms, developmental level, and chronological age. Thus, the term | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intellectual Disability (ID) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intellectual Disability (ID) Primer Intellectual Disability (ID) (also known as Intellectual Developmental Disorder, and previously Mental Retardation) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in 3 domains: (1) conceptual, (2) social, and (3) practical domains. Intellectual disability is a heterogeneous condition with many different etiologies. Two other diagnoses exist under the intellectual disability diagnosti… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) Primer Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is the presence of Obsessive-Compulsive Disorder (OCD) and/or tic disorder at prepubertal age of onset with abrupt onset and relapsing-remitting symptom course. The defining features are a temporal association between symptom exacerbations and a Group-A beta-hemolytic streptococcal (GAS) infectio… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical Psychiatry | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical Psychiatry
Primer
Medical Psychiatry (also known as Psychosomatic Medicine and Consultation-Liaison Psychiatry) is a branch of psychiatry that focuses on the psychiatric manifestations of medical and neurologic disorders, especially in acute medical settings. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Autoimmune Encephalitis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Autoimmune Encephalitis Primer Autoimmune Encephalitis (AE) is a broad term that encompasses a group of autoimmune inflammatory brain disorders. AE is increasingly being recognized as a unique, unrecognized type of encephalitis that affects all age-ranges, often with significant neuropsychiatric symptoms. The course of AE is usually (but not always) subacute. The timeline of symptom onset to clinical attention is usually over the course of several weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| anti-NMDA Receptor Encephalitis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| anti-NMDA Receptor Encephalitis Primer anti-NMDA (N-methyl-D-aspartate) Receptor Encephalitis is an autoimmune encephalitis that is initially characterized by prominent psychiatric symptoms, then progressing to seizures, movement disorders, autonomic dysfunction, and hypoventilation. The prominent psychiatric symptoms often results in initial hospitalization in psychiatric units, and delays in diagnosis and treatment. It is associated with CSF IgG antibodies against the GluN1 subunit of the NM… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hashimoto's Encephalitis (Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hashimoto's Encephalitis (Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]) Primer Hashimoto's Encephalopathy (HE) (also known as Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis [SREAT]), is a rare, clinically heterogeneous neurological disorder associated with | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| home | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hashimoto's Disease | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hashimoto's Disease Primer Hashimoto's Disease (Hashimoto's Thyroiditis) is an autoimmune thyroiditis (AIT) that is a common cause of hypothyroidism. Epidemiology * Hashimoto's is the most common cause of hypothyroidism in the United States and in those areas of the world where iodine intake is adequate. The incidence is 0.8 per 1000 per year in men, and 3.5 per 1000 per year in women. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperthyroidism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperthyroidism Primer Hyperthyroidism is an autoimmune disorder of the endocrine system where the thyroid gland produces excess thyroid hormone. Hyperthyroidism can accelerate the body's metabolism, and can cause unintentional weight loss and systemic symptoms and changes. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypothyroidism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypothyroidism Primer Hypothyroidism is a disorder of the endocrine system where the thyroid gland does not produce enough thyroid hormone. Hypothyroidism can be due to various etiologies including Hashimoto thyroiditis, postpartum thyroiditis, and congenital hypothyroidism. Hypothyroidism can result in a spectrum of neuropsychiatric symptoms, and can also be caused by psychotropic medications such as lithium. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Catatonia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Catatonia Primer Catatonia is a severe heterogeneous neuropsychiatric and medical syndrome with motor and/or behavioural signs. At times, it can be life-threatening, especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia is not just a psychiatric syndrome and can accompany both psychiatric and medical illnesses. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delirium | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delirium Primer Delirium is a serious neuropsychiatric syndrome characterized by an acute confusional state with global impairments in attention and cognition.Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Nature reviews neurology, 5(4), 210. Delirium is often associated with a disturbance in the sleep-wake cycle, including daytime sleepiness, nighttime agitation, insomnia, excessive sleepiness, or wakefulness throughout t… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Major Neurocognitive Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Major Neurocognitive Disorder Primer Major neurocognitive disorder (and mild neurocognitive disorder) exists on a spectrum of cognitive and functional impairment. The term major neurocognitive disorder corresponds to the condition referred to what was previously referred to in the DSM-IV as | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mild Neurocognitive Disorder / Mild Cognitive Impairment (MCI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mild Neurocognitive Disorder / Mild Cognitive Impairment (MCI) Primer Mild Neurocognitive Disorder (also known as Mild Cognitive Impairment, or MCI) is a condition in which individuals demonstrate cognitive impairment with minimal impairment of instrumental activities of daily living (IADLs). Although it can be the first cognitive sign of | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Major/Mild Neurocognitive Disorder Due to Another Medical Condition | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Major/Mild Neurocognitive Disorder Due to Another Medical Condition Primer Medical conditions can cause major or mild neurocognitive disorders. DSM-5 Diagnostic Criteria Criterion A The criteria are met for major or mild neurocognitive disorder. Criterion B There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is the pathophysiological consequence of another medical condition. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cryptococcal Meningitis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cryptococcal Meningitis Primer Cryptococcal Meningitis is meningeal infection that commonly affects patients with HIV but can also occur in patients who are immunosuppressed by other means. Individuals who are not immunocompromised can also develop this infection. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Epilepsy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Epilepsy Primer Epilepsy is a group of neurological disorders characterized by epileptic seizures characterized by anywhere from brief and nearly undetectable periods to long periods of vigorous shaking. Epilepsy has significant psychiatric implications, in particular with psychosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hepatic Encephalopathy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hepatic Encephalopathy Primer Hepatic encephalopathy (HE) or Portosystemic Encephalopathy (PSE) is a neuropsychiatric syndrome that can develop in patients with liver disease. Symptoms Cognitive impairment, altered level of consciousness, ataxia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Human Immunodeficiency Virus (HIV) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Human Immunodeficiency Virus (HIV) Primer Human Immunodeficiency Virus (HIV) is a lentivirus that causes HIV infection in humans, and over time develops into acquired immunodeficiency syndrome (AIDS). AIDS leads to progressive failure of the immune system and life-threatening opportunistic infections/cancers. HIV has numerous neuropsychiatric considerations, which are detailed below. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Huntington's Disease (HD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Huntington's Disease (HD) Primer Huntington's Disease (HD) is a hereditary, neurodegenerative illness characterized by a triad of symptoms including motor disturbance, cognitive impairment, and psychiatric symptoms. It is an autosomal dominant disorder caused by an expanded trinucleotide repeat (CAG) mutation in the coding region of the | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypercalcemia and Hyperparathyroidism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypercalcemia and Hyperparathyroidism Primer Hypercalcemia and hyperparathyroidism are frequently under-diagnosed in psychiatric practice and there are recommendations that calcium levels should be monitored in patients on long‐term treatment.Shapiro, H. I., & Davis, K. A. (2014). Hypercalcemia and “primary” hyperparathyroidism during lithium therapy. American Journal of Psychiatry, 172(1), 12-15. Like with other electrolyte and fluid imbalances (see: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypocalcemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypocalcemia Primer Hypocalcaemia is low serum calcium levels. Like with other electrolyte and fluid imbalances (see also: hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia),Webb Jr, W. L., & Gehi, M. (1981). Electrolyte and fluid imbalance: neuropsychiatric manifestations. Psychosomatics, 22(3), 199-203. hypocalcemia can cause neuropsychiatric symptoms. Comparison Hypo (Low Concentration) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypokalemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypokalemia Primer Hypokalemia is an electrolyte disturbance of low serum postassium. Like with other electrolyte and fluid imbalances (see also: hyponatremia, hypomagnesemia, hypocalcemia, hypercalcemia),Webb Jr, W. L., & Gehi, M. (1981). Electrolyte and fluid imbalance: neuropsychiatric manifestations. Psychosomatics, 22(3), 199-203. hypokalemia can cause neuropsychiatric symptoms. Neuropsychiatric * Hong, E. (2016). Hypokalemia and Psychosis: A Forgotten Association. American Journal of… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypomagnesemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypomagnesemia Primer Hypomagnesemia is an electrolyte disturbance with low levels of serum magnesium. Normal magnesium levels are between 1.46–2.68 mg/dL (0.6-1.1 mmol/L) with levels less than 1.46 mg/dL (0.6 mmol/L) defining hypomagnesemia. Like with other electrolyte and fluid imbalances (see also: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyponatremia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyponatremia Primer Hyponatremia is an electrolyte disturbance of low serum sodium that can result in neuropsychiatric symptoms. In psychiatric patients, the cause of hyponatremia is most commonly secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) from psychotropics medications including | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Kleine–Levin Syndrome (KLS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Kleine–Levin Syndrome (KLS) Primer Kleine–Levin Syndrome (KLS) is a rare neuropsychiatric disorder characterized by persistent episodic hypersomnia, hyperphagia, cognitive impairment, and mood changes. Individuals can also experience hypersexuality, personality changes, and behavioural changes. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Kluver-Bucy Syndrome (KBS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Kluver-Bucy Syndrome (KBS) Primer Kluver-Bucy Syndrome (KBS) is a neuropsychiatric syndrome caused by lesions of the bilateral temporal lobes, in particular with lesion of the hippocampus and amygdala. KBS is characterized by hyperorality, sexual hyperactivity, changes in dietary behavior, hypermetamorphosis, visual agnosia, and placidity. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lyme Disease | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lyme Disease Primer Resources Articles * The Atlantic: Lyme Disease Is Baffling, Even to Experts | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Moyamoya Disease | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Moyamoya Disease Primer Moyamoya Disease (Japanese: “puff of smoke”) is a cerebrovascular disorder characterized by progressive unilateral or bilateral stenosis of the distal internal carotid arteries (often extending to the anterior and middle cerebral arteries). Up to a quarter of patients may present with heterogenous psychiatric symptoms that may be misdiagnosed as a behavioural (especially in children), mood, or psychotic disorder. The etiology of Moyamoya is unknown. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multiple Sclerosis (MS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multiple Sclerosis (MS) Primer Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system, and associated with neuropsychiatric symptoms including depression. Epidemiology * MS affects more than 2 million people worldwide | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Myocardial Infarction (MI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Myocardial Infarction (MI) Primer A myocardial infarction (MI), also known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Depression Sertraline has been shown to be effective in post-MI depression. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neurosyphilis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neurosyphilis Primer Neurosyphilis is the infection of the central nervous system in a patient with syphilis that can occur during any stage of the infection. Neurosyphilis can present with a wide spectrum of neuropsychiatric symptoms that are non-specific and can resemble many neurologic and psychiatric disorders (hence its historical name | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Niemann-Pick Type C Disease (NPC) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Niemann-Pick Type C Disease (NPC) Primer Niemann-Pick Type C Disease (NPC) is a rare, neurodegenerative, autosomal recessive disease, with an extremely heterogeneous clinical presentation. NPC may initially present in adulthood with psychosis, and when psychosis is associated with a vertical supranuclear gaze palsy, various dyskinesias, and seizures, NPC should be suspected. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatric Manifestations of Paraneoplastic Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatric Manifestations of Paraneoplastic Disorders Primer Paraneoplastic disorders can lead to severe psychiatric and behavioural symptoms. Paraneoplastic limbic encephalitis (PLE) is a rare neurological syndrome associated with cancer, and selectively affects limbic system structures, including the hippocampus, hypothalamus, and amygdala. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Porphyria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Porphyria Primer The porphyrias are a group of inherited disorders characterized by an enzyme deficiency in the heme biosynthetic pathway. Porphyrias can present with neuropsychiatric symptoms, and can be misdiagnosed as a primary psychiatric disorder (e.g. - anxiety disorders or psychotic disorders). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatric Side Effects of Medications and Substances | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatric Side Effects of Medications and Substances Primer Medications and recreational substances can sometimes induce psychiatric syndromes, including depression, anxiety, mania/hypomania, sleep, and cognitive impairment. Thus, it is important to ensure that these iatrogenic effects are not mistaken for a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Systemic Lupus Erythematosus (SLE) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Systemic Lupus Erythematosus (SLE) Primer Systemic Lupus Erythematosus (SLE) can prevent with significant neuropsychiatric symptoms include depression and psychosis.Popescu, A., & H Kao, A. (2011). Neuropsychiatric systemic lupus erythematosus. Current neuropharmacology, 9(3), 449-457. Review of Symptoms A comprehensive review of systems should be done, including asking about rashes, skin changes other than acne, ulcers, joint pain, joint swelling, hair loss, dry eyes, dry mouth, muscle pain… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Traumatic Brain Injury (TBI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Traumatic Brain Injury (TBI) Primer Traumatic Brain Injury (TBI) is an intracranial injury that occurs when an external force injures the brain. When clinically significant, the DSM-5 diagnoses are major neurocognitive disorder or mild neurocognitive disorder due to Traumatic Brain Injury.Wortzel, H. S., & Arciniegas, D. B. (2014). The DSM-5 approach to the evaluation of traumatic brain injury and its neuropsychiatric sequelae. NeuroRehabilitation, 34(4), 613-623. Epidemiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Thyroid Disorders and Diseases | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Thyroid Disorders and Diseases
Primer
Thyroid Disorders and Diseases are a group of medical conditions that affect the function of the thyroid gland.
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| Vitamin B12 (Cobalamin) Deficiency Primer Vitamin B12 (also referred to as cobalamin, cyanocobalamin) is a coenzyme required for various metabolic functions in the body, including fat metabolism, carbohydrate metabolism, and protein synthesis. It plays an additional critical roles in hematopoiesis and a major role synthesizing and maintaining myelin in the central and peripheral nervous system. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Wernicke Encephalopathy and Korsakoff Syndrome | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Wernicke Encephalopathy and Korsakoff Syndrome Primer Wernicke-Korsakoff Syndrome (WKS) is a neuropsychiatric syndrome caused by thiamine (vitamin B1) deficiency, commonly found in chronic alcoholism. This primarily alcohol-induced disorder is characterized by amnesia, confabulation, disorientation, and neurological findings. WKS occurs due to necrotic lesions to the mammillary bodies, thalamus, and brainstem. The syndrome itself consists of 2 components: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Wilson's Disease | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Wilson's Disease Primer Wilson's Disease is a rare autosomal recessive disorder that results in copper build up in the brain and liver. There are both neuropsychiatric and GI/hepatic signs and symptoms. Epidemiology * Wilson's disease occurs in about 1 in 30,000 people. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Clock-Drawing Test (CDT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The CDT evaluates general executive functioning of the frontal lobe and visuospatial abilities. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Frontal Assessment Battery (FAB) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The FAB is a brief battery of neuropsychological tasks designed to assess frontal lobe function and screens for frontotemporal dementia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Cognitive Testing | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Cognitive Testing Primer Cognitive Testing is an exam to localize possible areas of the brain that may be causing a cognitive impairment. Cognitive testing also helps inform diagnosis and gives clinicians a sense of a patient's overall level of function. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Memory and Cognition | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Memory and Cognition Primer Memory and Cognition complaints are some of the most common symptoms in psychiatric and neurologic practice. Terminology * Retrograde amnesia: inability to remember things that occured prior to a central nervous system injury | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mini-Cog | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Mini-Cog is a rapid 3-minute instrument that can increase detection of cognitive impairment in older adults. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mini-Mental Status Exam (MMSE) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The MMSE is the most commonly used cognitive test. It is more geared towards detecting memory, attention, construction, orientation, and language deficits, and is less sensitive to executive dysfunction. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Montreal Cognitive Assessment (MoCA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The MoCA is a cognitive test used for screening mild cognitive impairment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rowland Universal Dementia Assessment Scale (RUDAS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The RUDAS is a short cognitive screen that minimizes the effects of culture and language on assessment, and is useful for patients whose first language is not English. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stroop Test | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Stroop Test is used to screen and diagnose patients with covert/minimal hepatic encephalopathy (CHE/MHE). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Dissociative Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dissociative Disorders
Primer
Dissociative disorders are a group of mental disorders characterized by disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dissociative Amnesia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dissociative Amnesia Primer Dissociative amnesia is a disorder characterized by an inability to recall important autobiographical information that is successfully stored in memory and ordinarily would be readily remembered. Dissociative amnesia differs from the permanent amnesias due to neurological damage that prevent memory storage or retrieval in that it is always potentially reversible. This is because the memory remains successfully stored. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Depersonalization/Derealization Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Depersonalization/Derealization Disorder Primer Depersonalization/derealization disorder are persistent or recurrent episodes of depersonalization, derealization, or both. Episodes of depersonalization are characterized by a feeling of unreality or detachment from, or unfamiliarity with, one's whole self or from aspects of the self. The individual often feels completely detached from their own being, and their may be a diminished sense of agency. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dissociative Identity Disorder (DID) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dissociative Identity Disorder (DID) Primer Dissociative Identity Disorder (DID) (also previously known as multiple personality disorder), is a mental disorder characterized by at least two distinct and relatively enduring personality states. Individuals with DID may report they have suddenly become depersonalized observers of their | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Feeding and Eating Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Feeding and Eating Disorders Primer Feeding and Eating Disorders are mental disorders that involve a persistent disturbance of eating or eating-related behaviours that cause a change in consumption or absorption of food. Additionally, this change significantly impacts the individual's physical health and/or psychosocial functioning. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Anorexia Nervosa Primer Anorexia nervosa (AN) is an eating disorder characterized by a fear of gaining weight, strong desire to be thin, and food restriction, which results in low weight. It is the highest mortality psychiatric illness with a mortality rate of 10%. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Avoidant/Restrictive Food Intake Disorder (ARFID) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Avoidant/Restrictive Food Intake Disorder (ARFID) Primer Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder characterized by avoidance or restriction of food intake, resulting in clinically significant failure to meet requirements for nutrition or insufficient energy intake through oral intake of food. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Binge-Eating Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Binge-Eating Disorder Primer Binge Eating Disorder (BED) is a feeding and eating disorder characterized by episodes of consuming food in a larger amount than is normal in a short time. Epidemiology * In the United States, the 12-month prevalence is 1.6% for females and 0.8% for males. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bulimia Nervosa | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bulimia Nervosa Primer Bulimia Nervosa is an eating disorder characterized by recurrent episodes of binge eating, compensatory behaviors to prevent weight gain, and self-evaluation that is significantly influenced by body shape and weight. Epidemiology * The 12-month prevalence in young females is 1 to 1.5%, with a peak in older adolescence and young adulthood. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pica | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pica Primer Pica is an eating disorder characterized by the eating of one or more non-nutritive, non-food substances on a persistent basis over a period of at least one month that is severe enough to warrant clinical attention. Epidemiology * The prevalence of pica is unclear, but is higher in individuals with severe intellectual disability (up to 9 to 25% in institutionalized populations | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rumination Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rumination Disorder Primer Rumination Disorder is a feeding and eating disorder characterized by repeated regurgitation of food occurring after feeding or eating over a period of at least one month. Epidemiology * The prevalence is not well understood, but is most common in those with intellectual disability. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Feeding or Eating Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Feeding or Eating Disorders Primer Other Specified Feeding or Eating Disorders is a category of DSM-5 diagnoses that applies to individuals who have symptoms characteristic of an eating or feeding disorder (e.g. - Anorexia Nervosa, Bulimia Nervosa) but do not meet the full criteria for any of them. The other specified feeding or eating disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet t… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Elimination Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Elimination Disorders
Primer
Elimination disorders are mental disorders that involve the inappropriate elimination of urine or feces, and are usually diagnosed in childhood or adolescence.
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| Encopresis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Encopresis Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology Differential Diagnosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Enuresis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Enuresis Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology Differential Diagnosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gender Dysphoria | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gender Dysphoria Primer Epidemiology Prognosis Comorbidity Comorbid disorders include anxiety and depressive disorders.American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. Risk Factors In children with gender dysphoria, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Psychiatry | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Psychiatry
Primer
Geriatric Psychiatry is the branch of psychiatry involved in older adult mental health with a particular focus on the neuropsychiatric aspects of neurocognitive disorders (such as dementias) and late-life mental disorders. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Dementia Primer Dementia is a syndrome characterized by progressive neurocognitive decline of sufficient magnitude to interfere with normal social or occupational functions, or with usual daily activities. It is a broad diagnostic category that includes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rapidly Progressive Dementias (RPDs) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rapidly Progressive Dementias (RPDs) Primer Rapidly Progressive Dementias (RPDs) are dementias that progress quickly -- over the course of weeks to months. In some cases, it may be over a period of 1-2 years.Paterson, R. W., Takada, L. T., & Geschwind, M. D. (2012). Diagnosis and treatment of rapidly progressive dementias. Neurology: Clinical Practice, 2(3), 187-200. Treatment of an RPD is dependent on the etiology of the dementia, some of which are fully treatable. This makes early recognitio… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Behavioural and Psychological Symptoms of Dementia (BPSD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Behavioural and Psychological Symptoms of Dementia (BPSD) Primer Behavioural and Psychological Symptoms of Dementia (BPSD) will develop in more than 90% of individuals diagnosed with dementia.Steinberg, M., Shao, H., Zandi, P., Lyketsos, C. G., Welsh‐Bohmer, K. A., Norton, M. C., ... & Tschanz, J. T. (2008). Point and 5‐year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amyotrophic Lateral Sclerosis (ALS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amyotrophic Lateral Sclerosis (ALS) Primer Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's Disease is a progressive upper and lower motor neuron disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alzheimer's Disease (AD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alzheimer's Disease (AD) Primer Alzheimer's Disease (AD) is the most common type of dementia in the world, characterized by gradual progressive memory loss and behavioural changes. Different subtypes of Alzheimer's can have memory, visual, language, or frontal lobe deficit involvement. AD is associated with accumulation of amyloid and tau depositions in the brain. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Corticobasal Degeneration (CBD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Corticobasal Degeneration (CBD) Primer Corticobasal Degeneration (CBD) is an neurodegenerative disorder, classified as an atypical parkinsonian syndrome (also known as one of the Parkinson's-plus syndromes). CBD was previously classified as a progressive asymmetric movement disorder characterized by akinesia, rigidity, dystonia, focal myoclonus, ideomotor apraxia, and/or alien-limb phenomena. However, it is increasingly seen as a disorder with cognitive and behavioural disturbances as well. Th… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Creutzfeldt-Jakob Disease (CJD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Creutzfeldt-Jakob Disease (CJD) Primer Creutzfeldt-Jakob Disease (CJD) is a rare, fatal, rapidly progressive dementia. It affects about 1 in every 1 million people per year worldwide. CJD has a rapid course and usually appears in late life. There is a very short survival time, death usually occurs within one year of symptom onset. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Frontotemporal Dementia (FTD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Frontotemporal Dementia (FTD) Primer Frontotemporal dementia (FTD), also known as frontotemporal lobar degeneration (FTLD), or less commonly, Pick's disease, is one of the most common causes of dementia in adults younger than 60 years. FTD is actually an umbrella clinical term that encompasses a group of neurodegenerative diseases (behavioural-variant frontotemporal dementia, non-fluent variant | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Limbic-predominant Age-related TDP-43 Encephalopathy (LATE) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Limbic-predominant Age-related TDP-43 Encephalopathy (LATE) Primer Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a proposed neurodegenerative disorder of older adults (typically >80 years old). It presents primarily as an amnestic dementia and is thought to be due to a TDP-43 proteinopathy in limbic system structures, including the hippocampus. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dementia with Lewy Bodies (DLB) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dementia with Lewy Bodies (DLB) Primer Dementia with Lewy Bodies (DLB), is a neurodegenerative disorder associated with abnormal deposits of alpha-synuclein in the brain. It is characterized by progressive cognitive impairment (with early changes in complex attention and executive function rather than learning and memory), recurrent complex visual hallucinations, rapid eye movement (REM) sleep behavior disorder, depression, and/or delusions. DLB is one of the most common causes of dementia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multiple System Atrophy (MSA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multiple System Atrophy (MSA) Primer Multiple System Atrophy (MSA) is a rapidly progressive neurodegenerative disorder characterized by any combination of Parkinsonism, cerebellar ataxia, and autonomic failure. The autonomic failure can include severe impairments such as orthostatic hypotension, post-prandial hypotension, postural instability, falls, and constipation. It is also the only neurodegenerative disorder with cerebellar dysfunction (ataxia, kinetic tremors). Although more typically c… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Parkinsons's Disease Dementia (PDD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Parkinsons's Disease Dementia (PDD) Primer Parkinson’s Disease Dementia (PDD) is a form of dementia that develops after the diagnosis of Parkinson's Disease. Patients with PD have an almost six-fold increased risk of developing dementia. By definition, Parkinson's disease dementia is cognitive decline that occurs | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Posterior Cortical Atrophy (PCA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Posterior Cortical Atrophy (PCA) Primer Posterior Cortical Atrophy (PCA) (also known as Benson’s Syndrome), is a rare, visual variant of Alzheimer’s disease. The disease primarily affects areas in the posterior regions of the brain (parietal, occipital, and occipitotemporal cortex) responsible for complex visual processing, spatial perception, spelling, and calculation. Unlike in typical Alzheimer’s, memory and insight are usually preserved in the early stages of the disease. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary Progressive Aphasia (PPA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary Progressive Aphasia (PPA) Primer Primary Progressive Aphasia (PPA) is a clinically diverse neurological syndrome most commonly associated with Alzheimer’s Disease or frontotemporal dementia. It can also rarely occur in Parkinson's-plus disorders. PPA typically begins with gradual, subtle language deficits that progresses to a nearly complete inability to speak. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Progressive Supranuclear Palsy (PSP) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Progressive Supranuclear Palsy (PSP) Primer Progressive Supranuclear Palsy (PSP) is a rare neurodegenerative disorder characterized by early postural instability, leading to falls, and a characteristic vertical supranuclear-gaze palsy on physical exam. It is classified as an atypical parkinsonian syndrome (or | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vascular Dementia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vascular Dementia Primer Vascular dementia is a neurodegenerative disorder (dementia) that occurs due to cerebrovascular disease and hypoperfusion. This can range from large vessel stroke to microvascular disease. The symptoms and presentation can be heterogenous, depending on the extent of vascular lesions and the anatomical location. Lesions can be limited to a single site, multifocal, or diffusely distributed. As such, there are also varied definitions and criteria for the diagnosis of vasc… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Giants | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Giants Primer Geriatric Giants is a term coined by geriatrician Bernard Isaacs, and the expression refers to the principal chronic disabilities of old age that impact on the physical, mental and social domains of older adults.Independent: OBITUARY: Professor Bernard Isaacs Many of these conditions, commonly misperceived to be an unavoidable part of old age, can in fact be improved. These include: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Parkinson's Disease (PD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Parkinson's Disease (PD) Primer Parkinson's disease (PD) is a progressive neurodegenerative disease characterized by a loss of dopaminergic innervation in the basal ganglia leading to motor and non-motor symptoms. Although historically considered a motor disorder, there are many neuropsychiatric symptoms associated with the disease, and the majority of diagnoses will progress to | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stroke | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stroke Primer A stroke (also called a cerebrovascular accident, CVA) is an acute disturbance of the cerebral perfusion or vasculature. Approximately 85% of strokes are ischemic (blockage of a vessel) and remainder are hemorrhagic. Post-stroke, individuals are at risk for developing neuropsychiatric syndromes such as | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Introduction to the Autonomic Nervous System | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to the Autonomic Nervous System Primer The Autonomic Nervous System (ANS) plays a significant role in unconscious and automatic processes in the human body. As prescribers of medications, what you prescribe can have profound impacts on the ANS, and it is important to be aware of how and | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Neurotransmitters and Receptors | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Neurotransmitters and Receptors Primer Understanding Neurotransmitters and Receptors is important due to the frequent use of psychotropic medications in psychiatry. Receptors Evolution of Neuroceptors The dopamine, muscarinic, adrenergic, serotonin, opiate, and histamine receptors are all evolutionarily related to a common ancestor. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alcohol-related Medications | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alcohol-related Medications | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acamprosate | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acamprosate Primer Acamprosate (Trade name: Campral), is a medication used along with psychotherapy to treat alcohol use disorder. Efficacy There is considerable difference in the efficacy of acamprosate between the US and Europe. Numerous European trials have found acamprosate significantly more effective than placebo in reducing drinking days, increasing complete abstinence, and lengthening time to relapse. Evidence from U.S. studies has been mixed. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disulfiram | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disulfiram Primer Disulfiram is a drug used in the treatment of alcohol use disorder, by producing an acute sensitivity to drinking alcohol. Mechanism of Action * Disulfiram works by inhibiting the enzyme aldehyde dehydrogenase (ALDH), causing many of the effects of a hangover to be felt immediately following alcohol consumption. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Topiramate (Topamax) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Topiramate (Topamax) Primer Topiramate (Trade name: Topamax) is an anticonvulsant used to treat epilepsy and prevent migraines. It is also used in the treatment of alcohol use disorder. Pharmacokinetics See also article: Introduction to Pharmacology Absorption Distribution Metabolism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Prazosin | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Prazosin Primer Prazosin is an alpha-1 blocker primarily used in the treatment of hypertension, benign prostate hypertrophy, and posttraumatic stress disorder. Dosing * Initial: 1 mg PO qHS * Maintenance: 1 mg PO qHS initially; may increase dose to 2 mg qHS; adjust dose based on response and tolerability in 1-2 mg increments q7days; not to exceed 15 mg/day | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alpha 2-adrenergic Agonists | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alpha 2-adrenergic Agonists
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Alpha-adrenergic agonists are a class of sympathomimetic medications that selectively stimulate the alpha adrenergic receptors.
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Clonidine
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Clonidine is an alpha 2-adrenergic agonist used in the treatment of attention-deficit/hyperactivity disorder (ADHD).
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| Guanfacine (Intuniv) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Guanfacine (Intuniv)
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Guanfacine (Trade name: Intuniv) is an alpha 2-adrenergic agonist most commonly used in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD).
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| Anticholinergics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Benztropine (Cogentin) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Benztropine (Cogentin) Primer Benztropine, also spelled Benzatropine (Tradename: Cogentin) is an anticholinergic marketed under the trade name Cogentin. It is used for the treatment of Parkinson's disease, Parkinsonism, and acute dystonia. Mechanism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diphenhydramine (Benadryl) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diphenhydramine (Benadryl) Primer Diphenhydramine (Tradename: Benadryl) is an antihistamine mainly used to treat allergies. It is also used for insomnia, symptoms of the common cold, tremor in parkinsonism, and nausea. It is used by mouth, injection into a vein, and injection into a muscle. Maximal effect is typically around two hours after a dose and effects can last for up to 7 hours. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Procyclidine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Procyclidine Primer Procyclidine is an anticholinergic medication used in the treatment of Parkinson's Disease (PD) and extrapyramidal symptoms from antipsychotic use. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trihexyphenidyl (Artane) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trihexyphenidyl (Artane) Primer Trihexyphenidyl (Tradename: Artane) is an anticholinergic (specifically, an antimuscarinic) used in the treatment of Parkinson's Disease (PD) and extrapyramidal symptoms from antipsychotic use. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Antidepressants | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Antidepressants Primer Antidepressants are a class of medications used primarily in the treatment of mood disorders (e.g. - major depressive disorder) and anxiety disorders. Its use has expanded to neurodegenerative and neuropsychiatric disorders in recent years. History * The development and history of antidepressants began in the 1950s, with the clinical use of two antidepressant drugs: iproniazid (a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Monoamine Oxidase Inhibitors (MAOI)
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Monoamine Oxidase Inhibitors (MAOIs) are antidepressants most commonly used in the treatment of major depressive disorder.
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| Moclobemide (Manerix)
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Moclobemide (Tradename: Manerix) is a reversible inhibitor of monoamine oxidase A (RIMA) used in the treatment of major depressive disorder and social anxiety.
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| Phenelzine (Nardil) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Phenelzine (Nardil)
Primer
Phenelzine (Tradename: Nardil) is a non-selective and irreversible monoamine oxidase inhibitor (MAOI)
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| Rasagiline (Azilect) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rasagiline (Azilect)
Primer
Rasagiline is a monoamine oxidase inhibitor (MAOI). It is used in the treatment of Parkinson's disease.
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| Selegiline (Eldepryl) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Selegiline (Eldepryl)
Primer
Selegiline (Tradename: Eldepryl) is a monoamine oxidase inhibitor (MAOI) used in the treatment of Parkinson's disease and depression.
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| Tranylcypromine (Parnate)
Primer
Tranylcypromine (Trade name: Parnate), also known as trans-2-phenylcyclopropylamine, is an antidepressant in the irreversible monoamine oxidase inhibitor (MAOI) class used in the treatment of major depressive disorder.
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| Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mirtazapine (Remeron) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mirtazapine (Remeron)
Primer
Mirtazapine (Trade name: Remeron) is an antidepressant in the noradrenergic and specific serotonergic antidepressant (NaSSA) class. It has potent histaminergic blockade which gives it sedative and appetite stimulant properties. It is commonly used in the treatment of major depressive disorder and anxiety disorders.
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| Norepinephrine Dopamine Reuptake Inhibitor (NDRI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Norepinephrine Dopamine Reuptake Inhibitor (NDRI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bupropion (Wellbutrin) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bupropion (Wellbutrin)
Primer
Bupropion (Trade name: Wellbutrin) is an antidepressant in the norepinephrine dopamine reuptake inhibitor (NDRI) class used in the treatment of major depressive disorder and as a smoking cessation agent in tobacco use disorder (Bupropion SR [Trade name: Zyban]).
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| Serotonin Antagonist and Reuptake Inhibitors (SARI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Serotonin Antagonist and Reuptake Inhibitors (SARI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trazodone (Desyrel) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trazodone (Desyrel) Primer Trazodone (Tradename: Desyrel) is a Serotonin Antagonist and Reuptake Inhibitor (SARI). History * Trazodone is a close relative of nefazodone (Serzone), a medication that was discontinued due to hepatoxicity. Mechanism of Action | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Selective Norepinephrine Reuptake Inhibitor (Selective NRI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Selective Norepinephrine Reuptake Inhibitor (Selective NRI)
Primer
Selective Norepinephrine Reuptake Inhibitor (Selective NRI) are a class of medications that increases intrasynaptic norepinephrine levels in the brain.
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| Atomoxetine (Strattera) Primer Atomoxetine (Trade name: Strattera) is a selective norepinephrine reuptake inhibitor (selective NRI) used in the treatment of attention-deficit/hyperactivity disorder. Pharmacokinetics See also article: Introduction to Pharmacology Absorption Rapid and is not affected by food (Tmax=1-2 hrs) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Serotonin Modulator and Stimulators | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Serotonin Modulator and Stimulators | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vortioxetine (Trintellix/Brintillex) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vortioxetine (Trintellix/Brintillex)
Primer
Vortioxetine (Trade name: Trintellix/Brintillex) is an antidepressant in the serotonin modulator and stimulator class used in the treatment of major depressive disorder.
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| Serotonin Norepinephrine Reuptake Inhibitors (SNRI)
Primer
Serotonin Norepinephrine Reuptake Inhibitor (SNRIs) are first-line agents for treatment of mood disorders and anxiety disorders. The exact agent chosen will vary depending on prescriber comfort and specific patient factors including gender, diagnosis, symptoms, and patient preference. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Duloxetine (Cymbalta) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Duloxetine (Cymbalta)
Primer
Duloxetine (Trade name: Cymbalta) is an antidepressant in the serotonin norepinephrine reuptake inhibitor (SNRI) class used in the treatment of major depressive disorder and neuropathic pain..
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| Levomilnacipran (Fetzima)
Primer
Levomilnacipran (Trade name: Fetzima) is an antidepressant in the serotonin norepinephrine reuptake inhibitor (SNRI) class used in the treatment of major depressive disorder.
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| Desvenlafaxine (Pristiq)
Primer
Desvenlafaxine (Trade name: Pristiq) is an antidepressant in the serotonin norepinephrine reuptake inhibitor (SNRI) class used in the treatment of major depressive disorder.
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| Venlafaxine (Effexor)
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Venlafaxine (Trade name: Effexor) is an antidepressant in the serotonin norepinephrine reuptake inhibitor (SNRI) class used in the treatment of major depressive disorder and anxiety disorders.
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| Serotonin 1A Partial Agonist and Reuptake Inhibitor (SPARI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vilazodone (Viibryd) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Vilazodone (Viibryd)
Primer
Vilazodone (Trade name: Viibryd) is an antidepressant in the serotonin 1A partial agonist and reuptake inhibitor (SPARI) used in the treatment of major depressive disorder.
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| Selective Serotonin Reuptake Inhibitors (SSRI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Selective Serotonin Reuptake Inhibitors (SSRI) Primer Selective Serotonin Reuptake Inhibitors (SSRI) are first-line agents for treatment of mood disorders and anxiety disorders. The exact agent chosen will vary depending on prescriber comfort and specific patient factors including gender, diagnosis, symptoms, and patient preference. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Citalopram (Celexa)
Primer
Citalopram (Trade name: Celexa) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class commonly used in the treatment of major depressive disorder.
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| Escitalopram (Cipralex/Lexapro) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Escitalopram (Cipralex/Lexapro)
Primer
Escitalopram (Trade name: Cipralex/Lexapro) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class commonly used in the treatment of major depressive disorder.
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| Fluoxetine (Prozac)
Primer
Fluoxetine (Trade name: Prozac) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class commonly used in the treatment of major depressive disorder, anxiety disorders, and eating disorders.
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| Fluvoxamine (Luvox) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fluvoxamine (Luvox)
Primer
Fluvoxamine (Trade name: Luvox) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class commonly used in the treatment of major depressive disorder and obsessive-compulsive disorder.
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Paroxetine (Paxil)
Primer
Paroxetine (Trade name: Paxil) is an antidepressant in the selective seronin reuptake inhibitor (SSRI) class used in the treatment various psychiatric disorders including: major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, social anxiety disorder, and obsessive compulsive disorder.
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| Sertraline (Zoloft) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sertraline (Zoloft)
Primer
Sertraline (Tradename: Zoloft) is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of psychiatric disorders such as major depressive disorder and generalized anxiety disorder.
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| Tricyclic Antidepressants (TCA) Primer Tricyclic Antidepressants (TCAs) are named after their chemical structure, which contains three rings of atoms (“tricyclic ring system”). TCAs are most commonly used as antidepressants, but also have a role in the treatment of neuropathic pain, chronic pain, migraines, and headaches. TCAs are highly protein bound and therefore interact with medications that are also highly protein bound. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Amitriptyline (Elavil)
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Amitriptyline (Trade name: Elavil) is a tricyclic antidepressant.
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| Clomipramine (Anafranil) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clomipramine (Anafranil)
Primer
Clomipramine (Trade name: Anafranil) is a tricyclic antidepressant used in the treatment of obsessive compulsive disorder.
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Desipramine (Norpramin)
Primer
Desipramine (Trade name: Norpramin) is a tricyclic antidepressant. It is a more activating TCA.
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| Doxepin (Sinequan) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Doxepin (Sinequan)
Primer
Doxepin (Trade name: Sinequan, Silenor) is a tricyclic antidepressant.
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| Imipramine (Tofranil) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Imipramine (Tofranil)
Primer
Imipramine (Trade name: Tofranil) is a tricyclic antidepressant.
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| Nortriptyline (Pamelor/Aventyl) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Nortriptyline (Pamelor/Aventyl) Primer Nortriptyline (Trade names: Pamelor, Aventyl) is a tricyclic antidepressant. It has the lowest anticholinergic (and least hypotensive) burden of the TCA class, and is therefore useful in geriatric depression.Frank, C. (2014). Pharmacologic treatment of depression in the elderly. Canadian Family Physician, 60(2), 121-126. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Serotonin Syndrome Primer Serotonin syndrome (SS) is a clinical triad of mental status changes, autonomic hyperactivity, and neuromuscular changes (hyperreflexia and clonus) due to excess serotonin. Patient's symptoms can vary significantly, from mild symptoms such as tremor and diarrhea to delirium, neuromuscular rigidity, and hyperthermia in life-threatening cases. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antidepressant-induced Sexual Dysfunction | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antidepressant-induced Sexual Dysfunction Primer Antidepressant-induced Sexual Dysfunctions are a very common side effect that is often under-recognized, and for some individuals can be protracted even after antidepressant discontinuation. There are unfortunately few well-designed studies to address this problem, and there are also high placebo-response rates for treatments. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antidepressant Withdrawal (Discontinuation) Syndrome | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antidepressant Withdrawal (Discontinuation) Syndrome Primer Antidepressant Withdrawal (Discontinuation) Syndrome is a clinically important phenomenon to monitor for. Different antidepressants will have different discontinuation side effects.Shelton, R. C. (2001). Steps following attainment of remission: discontinuation of antidepressant therapy. Primary care companion to the Journal of clinical psychiatry, 3(4), 168. Psychiatric symptoms of discontinuation such as anxiety and agitation, crying… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| SSRI and SNRI Bleeding Risks | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| SSRI and SNRI Bleeding Risks Primer Bleeding risks (e.g. - GI bleeding and intracranial bleeding) are associated with selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in individuals with risk factors. This risk is primarily due the effect of SSRIs inhibiting serotonin uptake in platelets. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tapering/Switching Antidepressants | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tapering/Switching Antidepressants Primer When a patient does not respond to an initial antidepressant, there are several switching strategies that can be used. Alternatively, if a diagnostic clarification is needed and a patient does not respond on an antidepressant, tapering should also be considered. Choosing the right strategy depends on patient preference, antidepressant profile, and patient response/side effects: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Antipsychotics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Antipsychotics
Primer
Antipsychotics (also known as neuroleptics or major tranquilizers) are a class of medications mainly used in the treatment of psychosis in schizophrenia and psychosis/mania in bipolar disorder. Its use has expanded to neurodevelopmental, neurodegenerative, and neuropsychiatric disorders in recent years. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| First-Generation (Typical) Antipsychotics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| First-Generation (Typical) Antipsychotics
Primer
First-Generation (Typical) Antipsychotics are a class of antipsychotic medications first developed in the 1950s.
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| Haloperidol (Haldol)
Primer
Haloperidol (Trade name: Haldol) is a first-generation antipsychotic used in the treatment of psychiatric disorders such as schizophrenia.
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Flupentixol (Fluanxol)
Primer
Flupentixol (Tradename: Fluanxol) is a typical antipsychotic.
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| Loxapine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Loxapine
Primer
Loxapine (Trade names: Loxitane, Loxapac, Adasuve) is a typical antipsychotic.
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| Zuclopenthixol (Clopixol-Depot, Clopixol-Acuphase) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Zuclopenthixol (Clopixol-Depot, Clopixol-Acuphase)
Primer
Zuclopenthixol (Tradename: Clopixol) is a typical antipsychotic that comes in two formulations. Zuclopenthixol decanoate (Cloxpiol Depot) is for long-term treatment of schizophrenia, while zuclopenthixol acetate | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Chlorpromazine (Thorazine) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Chlorpromazine (Thorazine)
Primer
Chlorpromazine (Trade name: Thorazine) is a typical antipsychotic. Chlorpromazine was developed in 1950s and was the first antipsychotic.
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Methotrimeprazine (Nozinan)
Primer
Methotrimeprazine, also known as Levomepromazine (Trade name: Nozinan) is a typical antipsychotic.
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| Fluphenazine (Modecate/Prolixin) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fluphenazine (Modecate/Prolixin)
Primer
Fluphenazine (Trade names: Modecate, Prolixin) is a typical antipsychotic.
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| Perphenazine (Trilafon) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Perphenazine (Trilafon)
Primer
Perphenazine (Trade name: Trilafon) is a typical antipsychotic.
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| Second-Generation (Atypical) Antipsychotics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Second-Generation (Atypical) Antipsychotics
Primer
Second-Generation (Atypical) Antipsychotics are a class of antipsychotic medications released in the early late 1990s to 2000s.
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| Risperidone (Risperdal)
Primer
Risperidone (Trade name: Risperdal) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia, bipolar disorder, and major depressive disorder. It has indications for various others psychiatric disorders, including | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paliperidone (Invega)
Primer
Paliperidone (Trade name: Invega) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia and bipolar disorder. It is the primary active metabolite (paliperidone is also known as 9-hydroxyrisperidone) of risperidone.
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| Aripiprazole (Abilify) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Aripiprazole (Abilify)
Primer
Aripiprazole (Trade name: Abilify) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia and bipolar disorder. It is also used as an adjunctive medication in major depressive disorder.
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| Brexpiprazole (Rexulti) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Brexpiprazole (Rexulti) Primer Brexpiprazole (Trade name: Rexulti) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia. It is also used as an adjunctive medication in major depressive disorder. History Brexpiprazole has features that both overlap and contrast with an older medication, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cariprazine (Vraylar)
Primer
Cariprazine (Trade name: Vraylar) is a an antipsychotic in the atypical antipsychotic class used in the treatment of schizophrenia.
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| Olanzapine (Zyprexa)
Primer
Olanzapine (Trade name: Zyprexa) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia and bipolar disorder.
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| Ziprasidone (Zeldox/Geodon)
Primer
Ziprasidone (Trade name: Zeldox in Canada, and Geodon in the United States) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia.
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| Lurasidone (Latuda) Primer Lurasidone (Trade name: Latuda) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia and bipolar depression. See also: Kane, J. M. (2011). Lurasidone: a clinical overview. The Journal of Clinical Psychiatry, 72(suppl 1), 10930. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Quetiapine (Seroquel)
Primer
Quetiapine (Trade name: Seroquel) is an antipsychotic in the atypical antipsychotic class used in the treatment of schizophrenia, bipolar disorder, and major depressive disorder. It is also commonly used off-label for numerous other indications and psychiatric disorders.
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| Clozapine (Clozaril) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clozapine (Clozaril) Primer Clozapine (Trade name: Clozaril) is a an antipsychotic in the atypical antipsychotic class used in the treatment of schizophrenia, especially in patients who are resistant to other antipsychotics. It is commonly referred to as a “last-line antipsychotic.” It is a low potency antipsychotic and highly anticholingeric, which gives it a very low incidence of extrapyramidal side effects. However, it carries a risk of neutropenia and agranulocytosis, which requires intens… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amisulpride (Solian) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amisulpride (Solian)
Primer
Amisulpride (Trade name: Solian) is a an antipsychotic in the atypical antipsychotic class used in the treatment of schizophrenia.
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| Pimavanserin (Nuplazid)
Primer
Pimavanserin (Tradename: Nuplazid) is an antipsychotic in the atypical antipsychotic class used in the treatment of Parkinson's disease psychosis in the United States. It is not yet approved in Canada.
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| Asenapine (Saphris)
Primer
Asenapine (Tradename: Saphris) is an antipsychotic in the atypical antipsychotic class used in the treatment of schizophrenia and bipolar disorder.
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| Long-Acting Injectable Antipsychotics (LAIs) Primer Long-Acting Injectable (LAI) Antipsychotics are antipsychotics delivered via intramuscular injection that can provide medication coverage from a period of weeks to months. Once stabilized on an LAI, patients rarely will need oral antipsychotic supplementation. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antipsychotic‐related Constipation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antipsychotic‐related Constipation Primer Antipsychotic‐related Constipation is a common and a potentially serious side-effect from antipsychotic use, but has received little attention in recent literature. It is particularly relevant in individuals on | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neuroleptic-Induced Dopamine Supersensitivity Psychosis (DSP) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neuroleptic-Induced Dopamine Supersensitivity Psychosis (DSP) Primer Neuroleptic-Induced Dopamine Supersensitivity Psychosis (DSP) was a concept first introduced by psychiatrist Guy Chouinard in 1980.Chouinard, G., & Jones, B. D. (1980). Neuroleptic-induced supersensitivity psychosis: clinical and pharmacologic characteristics. Am J Psychiatry, 137(1), 16-21. Hypothesis * The hypothesis is that chronic antipsychotic use leads to the upregulation of dopamine (D2) receptors in the basal gang… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Extrapyramidal Symptoms (EPS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Extrapyramidal Symptoms (EPS) Primer Extrapyramidal Symptoms (EPS) are drug-induced movement disorders that occur due to antipsychotic blockade of the nigrostriatal dopamine tracts. These blockades can lead to increased cholinergic activity, resulting in acute dystonia, acute akathisia, antipsychotic-induced parkinsonism, tardive dyskinesia (TD), tardive dystonia, and tardive akathisia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperprolactinemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperprolactinemia Primer Hyperprolactinemia is a side effect most commonly associated with antipsychotic use. Hyperprolactinemia can be completely asymptomatic or be very distressing to patients when they experience associated symptoms such as amenorrhea, galactorrhea, infertility, or sexual dysfunction. The most significant consequence of hyperprolactinemia is hypogonadism that results in estrogen or testosterone deficiency. Elevation of prolactin levels can occur as soon as 6 days after ini… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Metabolic Syndrome | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Metabolic Syndrome Primer Metabolic Syndrome is a group of conditions (including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) that occur together. This increases the risk of heart disease, stroke and diabetes. Of psychotropic medications, the risk is greatest with | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neuroleptic Malignant Syndrome (NMS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Neuroleptic Malignant Syndrome (NMS) Primer Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic reaction to dopamine antagonists (most commonly, but not always, antipsychotics) characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tapering/Switching Antipsychotics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tapering/Switching Antipsychotics Primer Antipsychotics may be tapered or switched due to clinical reasons. There are no published controlled trials on switching antipsychotics, guidelines therefore are only an aid and not necessarily supported by evidence. The risk of antipsychotic discontinuation is significant in primary psychotic disorders (See: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Benzodiazepines | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Benzodiazepines Primer Benzodiazepines are a class of psychotropic medications with sedative-hypnotic, anxiolytic, anticonvulsant, and muscle relaxant effects. Benzodiazepines are among the most misused and misprescribed medications in the world. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diazepam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diazepam Primer Diazepam is a medication in the benzodiazepine class. Onset Diazepam is highly lipophilic and has a fast onset of action Metabolites Metabolism of diazepam results in the active metabolites oxazepam, desmethyldiazepam, and temazepam. These metabolites increase the duration of drug action and can have an impact in older adults and in those with extensive hepatic disease. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clonazepam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clonazepam benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alprazolam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alprazolam benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lorazepam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lorazepam benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Oxazepam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Oxazepam benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Temazepam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Temazepam Primer * Trade name: Restoril * Half-life: 8-20 hours * Tmax = 2-3 hours Indications * Insomnia: 7.5mg-30mg benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Triazolam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Triazolam Primer * Trade name: Halcion * Half-life: 2-4 hours Indications * Insomnia: 0.125mg, 0.25mg benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Midazolam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Midazolam Primer benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clobazam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clobazam Primer benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Deprescribing and Tapering Benzodiazepines | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Deprescribing and Tapering Benzodiazepines Primer Deprescribing (or tapering) benzodiazepines is an important clinical skill. While there may be some indication for long-term use of benzodiazepines for certain individuals, most individuals on benzodiazepines do not need to be on it long-term! Studies showing the long-term efficacy of benzodiazepines are lacking. When tapering benzodiazepines, consider the duration of treatment, the dose, and the half-life of the benzodiazepine. If the patient … | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Estazolam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Estazolam Primer * Trade name: ProSom * Half-life: 8-24 hours Indications * Insomnia: 1-2mg benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Flurazepam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Flurazepam Primer * Trade name: Dalmane * Half-life: 48-120 hours Indications * Insomnia: 15mg, 30mg benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Midazolam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Midazolam Primer Midazolam is a short-acting injectable benzodiazepine with rapid onset that is commonly used in seizures, anesthesia, and acute agitation. Indications * Acute agitation * Behavioural and psychological symptoms of dementiaPassmore, M. J., Sheldon, L., Lax, S., Wilkins‐Ho, M., & Illing, M. (2009). Oral Midazolam for dementia‐related response agitation. Journal of the American Geriatrics Society, 57(3), 561-562. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Quazepam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Quazepam Primer * Trade name: Doral * Half-life: 48-120 hours Indications * Insomnia: 7.5mg, 15mg benzo-drug | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cannabinoids | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cannabinoids | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cannabidiol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cannabidiol Primer Cannabidiol (CBD), a non-tetrahydrocannabinol (THC) cannabinoid in Cannabis sativa, has previously been shown to attenuate tetrahydrocannabinol-induced psychotic symptoms and cognitive decline in healthy volunteers and may reduce psychotic symptoms in small studies of patients with schizophrenia and Parkinson disease. However, although CBD seems benign, its clinical effectiveness appears to be minimal and limited to a few patients, at least in this study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acetylcholinesterase Inhibitors and Dementia-Related Medications | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acetylcholinesterase Inhibitors and Dementia-Related Medications
Primer
Acetylcholinesterase Inhibitors and Related Medications are commonly used in the treatment of neurodegenerative disorders.
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| Aducanumab | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Aducanumab Primer Aducanumab is a human monoclonal immunoglobulin (Ig) G1 antibody that selectively targets amyloid-β aggregates and clears amyloid plaques from the brain via a microglia-mediated phagocytic process, indicated in the treatment of Alzheimer's disease. The medication was controversially approved by the FDA in 2021 despite concerns about the questionable study outcomes. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Donepezil (Aricept) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Donepezil (Aricept) Primer Donepezil (Tradename: Aricept) is an acetylcholinesterase inhibitor and cognitive-enhancing medication. It is used in the treatment of dementias and neurodegenerative disorders. Indications Acetylcholinesterase inhibitors are indicated in: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Galantamine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Galantamine Primer Galantamine (Tradename: Razadyne) is an acetylcholinesterase inhibitor and cognitive-enhancing medication. It is used in the treatment of dementias and neurodegenerative disorders. Indications Acetylcholinesterase inhibitors are indicated in: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Memantine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Memantine Primer Memantine is used to treat moderate to severe Alzheimer's disease. It acts on the glutamatergic system by blocking NMDA receptors. Indications * Memantine is indicated for the treatment of patients with moderate to severe AD (i.e. - the | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rivastigmine (Exelon) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rivastigmine (Exelon) Primer Rivastigmine (Tradename: Exelon and Exelon Patch) is an acetylcholinesterase inhibitor and cognitive-enhancing medication. It is used in the treatment of dementias and neurodegenerative disorders. Indications Acetylcholinesterase inhibitors are indicated in: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dopamine Agonists and Related Medications | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dopamine Agonists and Related Medications
Primer
Dopamine agonists can be either:
* Ergot
* Bromocriptine
* Non-ergot (preferred class of medications)
* Pramipexole
* Ropinirole
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| Amantadine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amantadine Primer Amantadine is a medication used to increase dopamine release and decreases dopamine reuptake. Amantadine is not a dopamine agonist, but rather enhances dopamine availability though other mechanisms. Indications * Parkinson's Disease, to enhance dopamine release | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bromocriptine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bromocriptine Primer Bromocriptine is an ergoline derivative and dopamine agonist that is used in the treatment of pituitary tumors, Parkinson's disease, hyperprolactinaemia, neuroleptic malignant syndrome, and type 2 diabetes Adverse Events Impulse-Control Disorders (ICDs) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Carbidopa-Levodopa (Sinemet) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Carbidopa-Levodopa (Sinemet) Primer Carbidopa-Levodopa (Tradename: Sinemet), also known as levocarb, is a combination drug of carbidopa and levodopa used in the treatment of Parkinson's Disease (PD). Mechanism of Action Levodopa (a dihydroxyphenylalanine) is the immediate precursor of dopamine. Unlike dopamine, it can be taken orally and can cross the blood-brain barrier. When ingested alone, levodopa is rapidly converted to dopamine outside the CNS. Thus carbidopa, a DOPA decarboxylase inhi… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Entacapone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Entacapone Primer Entacapone is an inhibitor of catechol-O-methyltransferase (COMT). It is used in combination with levodopa/carbidopa (Sinemet) to treat the end-of-dose wearing-off effects of Parkinson's disease. Entacapone helps to increase levodopa and carbidopa levels. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pramipexole | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pramipexole Primer Pramipexole (Tradename: Mirapex) is a dopamine agonist used in the treatment of Parkinson's Disease (PD) and restless legs syndrome. Mechanism of Action * It is a D2 receptor agonist and also has receptor selectivity for the D3 receptor subtype of the D2 subfamily of receptors. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ropinirole | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ropinirole Primer Ropinirole is a medication in a class known as dopamine agonists. It is used in the treatment of Parkinson's disease and restless leg syndrome (RLS). Adverse Events Impulse-Control Disorders (ICDs) * Impulse-control disorders (ICDs) such as compulsive gambling, buying, sexual, and eating behaviours, are a serious and increasingly recognized complication in Parkinson's disease (PD), occurring in up to 20% of PD patients over the course of their illness. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| GABA Receptor Agonists | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| GABA Receptor Agonists | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Baclofen | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Baclofen Primer Baclofen produces its effects by activating the GABAB | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Histamine 3 (H3) Receptor antagonist/Inverse Agonist | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Histamine 3 (H3) Receptor antagonist/Inverse Agonist
Primer
Histamine 3 (H3) Receptor antagonist/Inverse Agonist are a new class of medications used for the treatment of excessive daytime sleepiness in adults with narcolepsy.
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| Pitolisant (Wakix)
Primer
Pitolisant (Trade name: Wakix) is a histamine 3 (H3) receptor antagonist/inverse agonist used in the treatment of excessive daytime sleepiness in narcolepsy.
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Non-Benzodiazepine Hypnotics ("Z-drugs")
Primer
Non-Benzodiazepine Hypnotics (“Z-drugs”) include eszopiclone, zolpidem, and zopiclone.
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| Eszopiclone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Eszopiclone Primer * Trade name: Lunesta * Half-life: 5-7 hours Indications * Insomnia: 1mg, 2mg, 3mg | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Zaleplon | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Zaleplon Primer * Trade name: Sonata * Half-life: 1 hour Indications * Insomnia: 5mg, 10mg | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Zolpidem | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Zolpidem Primer * Trade name: Ambien * Half-life: 1.5-2.4 hours * Tmax = 30 minutes to 1.4 hours Indications * Insomnia: 5mg, 10mg | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Zopiclone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Zopiclone Primer * Trade name: Imovane * Half-life: 5-7 hours * Tmax = ~30 minutes (<2 hours) Indications * Insomnia: 5mg, 7.5mg | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Melatonin Receptor Agonists | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Melatonin Receptor Agonists | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Agomelatine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Agomelatine
Primer
Agomelatine is an atypical antidepressant melatonin receptor agonist and a serotonin 5-HT2C receptor antagonist.
AgoMELatine is a MELatonin receptor agonist.
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| Melatonin
Primer
Melatonin is a hormone produced by the pineal gland. It has daily and seasonal rhythms that are synchronize physiological processes in the body.
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| Ramelteon (Rozerem)
Primer
Ramelteon (Trade name: Rozerem) is nelatonin receptor agonist use in the treatment of insomnia disorder.
RaMELteon is a MELatonin receptor agonist.
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| Introduction to Mood Stabilizers and Anticonvulsants
Primer
Mood Stabilizers and Anticonvulsants (Antiepileptics) are used to treat both epileptic and nonepileptic disorders such as bipolar disorder. Lithium is considered the gold standard mood stabilizer for bipolar disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lithium
Primer
Lithium is an alkalai metal and mood stabilizer used in the treatment of all phases (manic, maintenance, and depressive) of bipolar I disorder. It is the gold standard treatment for bipolar I disorder and mania.
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| Valproic Acid (VPA) / Divalproex (DVP) (Epival)
Primer
Valproic Acid (VPA) (Trade name: Epival) and Divalproex (DVP) are mood stabilizers and anti-epileptics used primarily to treat epilepsy and bipolar disorder. Divalproex (DVP) is converted to valproic acid (VPA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Carbamazepine (Tegretol) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Carbamazepine (Tegretol)
Primer
Carbamazepine (Trade name: Tegretol) is a mood stabilizer and antiepileptic used in the treatment of epilepsy and bipolar disorder. It is used in the treatment of acute mania and mixed episodes of bipolar I disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Gabapentin (Neurontin)
Primer
Gabapentin (Trade name: Neurontin) is an anticonvulsant. It is commonly also used off-label for anxiety disorders, restless leg syndrome, and in alcohol use disorder. It is structurally similar to GABA but does not directly bind to GABA receptors.
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| Lamotrigine (Lamictal)
Primer
Lamotrigine (Trade name: Lamictal) an antiepileptic and mood stabilizer used in the treatment of bipolar disorder. It is more effective for the treatment/prevention of depression than mania in bipolar disorder.
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| Levetiracetam (Keppra) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Levetiracetam (Keppra)
Primer
Levetiracetam (Trade name: Keppra) is an anticonvulsant medication used in the treatment of seizures. There is also preliminary evidence for its use in psychiatric disorders such as anxiety and mood disorders. It is also known to cause neuropsychiatric side effects. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phenytoin (Dilantin) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Phenytoin (Dilantin)
Primer
Phenytoin (Trade name: Dilantin) is an antiepileptic used in the treatment of seizure disorder.
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| Pregabalin (Lyrica) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pregabalin (Lyrica)
Primer
Pregabalin (Trade name: Lyrica) is anticonvulsant and anxiolytic medication used in the treatment of epilepsy, neuropathic pain, fibromyalgia, restless leg syndrome, and generalized anxiety disorder.
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| Oxcarbazepine (Trileptal)
Primer
Oxcarbazepine (Trade name: Trileptal) is a mood stabilizer and antiepileptic used in the treatment of epilepsy and bipolar disorder. It is generally better tolerated than carbamazepine.
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| Nicotinic Receptor-Related Medications | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Varenicline | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Varenicline Primer Varenicline (Tradename: Champix) is a partial nicotine receptor agonist and antagonist, used for smoking cessation. Mechanism of Action * Varenicline is a partial agonist and antagonist at the alpha-4 beta-2 nicotinic receptor (α4β2 or a4b2) nicotinic acetylcholine receptor (nAChR) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| NMDA Receptor Antagonist | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| NMDA Receptor Antagonist | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ketamine and Esketamine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ketamine and Esketamine Primer Ketamine is a non-competitive NMDA receptor antagonist with a potent anesthetic effect. Esketamine is the S(+) enantiomer of ketamine. Mechanism of Action * Esketamine also acts to some extent as a dopamine reuptake inhibitor but, unlike ketamine, does not interact with the sigma receptors. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-Benzodiazepine Anxiolytics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-Benzodiazepine Anxiolytics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buspirone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buspirone Primer Buspirone (Trade name: Buspar) is an psychotropic medication that stimulates 5-HT1A receptors used in the treatment of generalized anxiety disorder. Mechanism of Action * Serotonin 1A (5HT1A) partial agonist Clinical Pearls * Does not cause sedation, addiction, or tolerance. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hydroxyzine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hydroxyzine Primer Hydroxyzine is a first-generation antihistamine (and anticholingeric) with a variety of uses and indications, including uses as an anxiolytic. Mechanism of Action * Hydroxyzine's predominant mechanism of action is as a potent and selective histamine (H1) receptor inverse agonist. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Propranolol (Inderal) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Propranolol (Inderal) Primer Propranolol (Tradename: Inderal) is a medication of the beta blocker class. Indications * If social anxiety is present during performance-type activities, (like singing or performing onstage) propranolol can be an effective adjunct medication. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Opioids | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Opioids | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buprenorphine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buprenorphine Primer See main article: Buprenorphine/Naloxone (Suboxone) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Codeine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Codeine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Methadone (Methadose) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Methadone (Methadose)
Primer
Methadone (Trade name: Methadose) is a synthetic mu-opioid agonist, similar to morphine. Methadone is used in the treatment opioid use disorder, but prolonged use of methadone itself can also result in dependence.
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| Morphine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Morphine Primer Formulations * Sustained oral-release moprhine (SROM) * Does not require a wash out period * Can be used in patients with prolonged QtC * Treatment requires ongoing urine drug screening | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Naloxone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Naloxone Primer Naloxone (Brandname: Narcan) is an opioid antagonist used to block the effects of opioid agonists. It is most commonly used in opioid overdoses. Naloxone is also commonly combined with buprenorphine to form the combination medication Suboxone to decrease the risk of misuse. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Naltrexone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Naltrexone Primer Naltrexone is a competitive opioid antagonist, similar to naloxone. It blocks the action of opioids and thus may help to prevent relapse in some patients. Alcohol Use Disorder Naltrexone has been shown to be the most efficacious amongst the available pharmacotherapies for alcohol use disorder, although more recent research is showing less of a difference. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buprenorphine Extended-Release Injection (Sublocade) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buprenorphine Extended-Release Injection (Sublocade) Primer Buprenorphine Extended-Release Injection (Tradename: Sublocade) is a long acting monthly subcutaneous injectable opioid for use in patients with moderate to severe opioid use disorder. It is the long-acting form of sublingual | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buprenorphine/Naloxone (Suboxone) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Buprenorphine/Naloxone (Suboxone) Primer Buprenorphine/Naloxone (Trade name: Suboxone) is a combination medication used in opioid replacement therapy in opioid use disorder, and chronic pain management. Buprenorphine is a partial opioid agonist, while naloxone is a competitive opioid antagonist added to prevent misuse. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tramadol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tramadol Primer Tramadol is an opioid used to treat moderate to moderately severe pain. There are many good reasons to not prescribe tramadol, owning to its pharmacokinetic profile. Formulations * Tramadol Extended Release (ER) (Tridural) * Tramadol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Orexin Antagonists | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Orexin Antagonists
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| Daridorexant (Quviviq)
Primer
Daridorexant (Trade name: Quviviq) is a dual orexin receptor antagonist (DORA) used in the treatment of insomnia disorder.
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Lemborexant (Dayvigo)
Primer
Lemborexant (Trade name: Dayvigo) is a dual orexin receptor antagonist (DORA) used in the treatment of insomnia.
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| Suvorexant (Belsomra) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suvorexant (Belsomra)
Primer
Suvorexant (Trade name: Belsomra) is a dual orexin receptor antagonist (DORA) used in the treatment of insomnia disorder.
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| Introduction to Pharmacology Primer To prescribe medications, you must understand how drugs work and have a basic understanding of pharmacology. The two principle ideas in pharmacology are pharmacokinetics and pharmacodynamics: * Pharmacokinetics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Pharmacology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Pharmacology Primer Geriatric patients have many pharmacokinetic and pharmacodynamic changes, due to the aging process. This includes changes in body weight, body composition, volume of distribution, and renal clearance. A 'start low and go slow' approach is recommended. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obstetric and Fetal Pharmacology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obstetric and Fetal Pharmacology Primer Obstetric and Fetal Pharmacology is an important clinical issue for physicians and patients because of the potential for teratogenic risk, perinatal syndromes, and effect on neonatal development. This page focuses specifically on ( | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pediatric Pharmacology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pediatric Pharmacology Primer Pediatric patients have very different pharmacokinetic and pharmacodynamic profiles compared to adults. When considering psychotropic medication for a child or adolescent, be cautious about extrapolating from adult studies or practices. Always remember, children are not small adults! | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Placebo Effect | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Placebo Effect Primer The Placebo Effect is the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work. Placebo Response Rates * The response rates for placebo in antidepressant clinical trials ranges between 30% to 40%. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychology of Psychopharmacology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychology of Psychopharmacology Primer The Psychology of Psychopharmacology plays a huge role on patient and provider expectations of medications. This goes beyond the placebo effect, and there is strong evidence that shows psychological and interpersonal factors have a significant effect in psychopharmacology. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychotropic Dosing in the Medically Ill | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychotropic Dosing in the Medically Ill Primer Psychotropic Dosing in the Medically Ill requires different prescribing principles and considerations compared to healthy individuals. Individuals with cardiac, central nervous system, respiratory, gastrointestinal, and renal impairments all have different dosing considerations. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychedelics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychedelics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dimethyltryptamine (DMT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dimethyltryptamine (DMT) Resources For Patients For Providers Articles * VICE: America Is Getting Its First Legal Ayahuasca Church Research | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lysergic Acid Diethylamide (LSD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lysergic Acid Diethylamide (LSD) Primer Lysergic acid diethylamide (LSD) was first synthesized in 1938 by Swiss chemist Albert Hofmann, and its psychoactive effects were accidentally discovered by him in 1943. It was then used during the 1950s and 1960s as an experimental drug in psychiatric research for producing so-called | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mescaline | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mescaline | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psilocybin | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psilocybin | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Stimulants | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Stimulants Primer Stimulants (prescription, not recreational) are a class of medications commonly used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Class effects include increased alertness, attention, and energy. Stimulant Classes There are two main classes of stimulant medications: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Methylphenidate Primer Methylphenidate (Trade names: Ritalin, Biphentin, Concerta) is a central nervous system (CNS) stimulant of the phenethylamine and piperidine class used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It blocks dopamine and norepinephrine transporters in the presynaptic neuron, thus inhibiting reuptake and resulting in increased synaptic concentrations of these neurotransmitters. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Biphentin® (methylphenidate)
Primer
Biphentin® (methylphenidate) is a stimulant medication in the methylphenidate class used primarily in the treatment of attention-deficit/hyperactivity disorder (ADHD).
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Concerta® (methylphenidate)
Primer
Concerta® (methylphenidate) is a stimulant medication in the methylphenidate class used primarily in the treatment of attention-deficit/hyperactivity disorder (ADHD).
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| Ritalin® (methylphenidate) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ritalin® (methylphenidate)
Primer
Ritalin® (methylphenidate) is a stimulant medication in the methylphenidate class used primarily in the treatment of attention-deficit/hyperactivity disorder (ADHD).
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| Amphetamine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amphetamine
Primer
Amphetamines (Trade names: Adderall, Vyvanse, Dexedrine) are a class of medications that stimulate release of dopamine and, to a lesser extent, norepinephrine from presynaptic sites in neurons. It is used in the treatment of attention-deficit/hyperactivity disorder.
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| Adderall® (mixed amphetamine salts)
Primer
Adderall® (mixed amphetamine salts) is a stimulant medication in the amphetamine class primarily used in the treatment of attention-deficit/hyperactivity disorder (ADHD).
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| Dexedrine® (dextroamphetamine)
Primer
Dexedrine® (dextroamphetamine) is a stimulant medication in the amphetamine class primarily used in the treatment of attention-deficit/hyperactivity disorder (ADHD).
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Vyvanse® (lisdexamfetamine)
Primer
Lisdexamfetamine (Trade name: Vyvanse®) is a stimulant medication in the amphetamine class primarily used in the treatment of attention-deficit/hyperactivity disorder (ADHD). Lisdexamfetamine is a substituted amphetamine and an inactive prodrug of dextroamphetamine.
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| Prescription Stimulant Misuse and Diversion | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Prescription Stimulant Misuse and Diversion Primer Prescription stimulant misuse and diversion is an increasing issue of public health and ethical concern, but not often addressed by clinicians. Individuals who abuse stimulants may achieve a “high | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| MDMA (3,4-Methylenedioxymethamphetamine) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| MDMA (3,4-Methylenedioxymethamphetamine) Primer 3,4-Methylenedioxymethamphetamine (MDMA) commonly known as ecstasy (E), is a psychoactive drug in the amphetamine classes of drugs with both stimulant and hallucinogenic properties. Under the DSM-5, it is officially classified as a hallucinogen. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Modafinil (Provigil) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Modafinil (Provigil) Primer Modafinil (Trade name: Provigil) is a/an wakefulness-promoting agent and CNS stimulant. It is commonly used in the treatment of sleep disorders such as narcolepsy and daytime fatigue in obstructive sleep apnea. Pharmacokinetics See also article: Introduction to Pharmacology Absorption | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Supplements | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Supplements | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Omega-3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Omega-3 Primer Omega-3 fatty acids (ω-3 fatty acids) are polyunsaturated fatty acids that are primarily found in oily fish and certain nuts and seeds. It is also added as a supplement to other foods such as egg products. Indications * Major depressive disorderCarney, R. M., Freedland, K. E., Rubin, E. H., Rich, M. W., Steinmeyer, B. C., & Harris, W. S. (2009). Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: a randomized controlled tria… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| St. John's Wort | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| St. John's Wort Primer St. John's Wort (SJW) (Hypericum perforatum) is a plant used as a herbal medicine for many centuries in the treatment of mood disorders. The active ingredient is thought to be from hypericin/hyperforin and other flavonoids. Pharmacokinetics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tryptophan | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tryptophan Primer Clinical Pearls * Tryptophan + SSRIs = Serotonin Syndrome * If on long-term therapy, need to also take vitamin D6 to neutralize Resources * Richard, D. M., Dawes, M. A., Mathias, C. W., Acheson, A., Hill-Kapturczak, N., & Dougherty, D. M. (2009). L-tryptophan: basic metabolic functions, behavioral research and therapeutic indications. International journal of tryptophan research: IJTR, 2, 45. * Jenkins, T. A., Nguyen, J. C., Polglaze, K. E., & Bertrand, P. P. (2016… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Valerian Root | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Valerian Root Primer Valerian is a herb native to Europe and parts of Asia. Resources * HealthLinkBC: Valerian | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vitamin B | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vitamin B Primer Vitamin B6, B9, B12 help in the creation of serotonin, through metabolizing tryptophan. Vitamins are either water-soluble (vitamins B and C), or fat-soluble (vitamins A, D, E, K) * Fat-soluble vitamins are dependent on absorption from the ileum and pancreas. Toxicity is easier with fat soluble vitamins because these vitamins accumulate in fat. Malabsorption syndromes such as cystic fibrosis and/or celiac disease) can result in fat-soluble vitamin deficiencies. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vitamin D | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vitamin D Primer Vitamin D is a group of fat-soluble secosteroids, of which vitamin D3 and D2 are the most important. Vitamin D3 (cholecalciferol) is generated from exposure of the skin to sunlight, and from ingestion of fish, milk, plants. Vitamin D2 (ergocalciferol) comes from eating plants, fungi, and yeasts. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Thyroid Hormone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Thyroid Hormone | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Levothyroxine (T4) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Levothyroxine (T4) Primer Levothyroxine (L-thyroxine, tradename: Synthroid), is a manufactured form of the thyroid hormone thyroxine (T4). See main article: Triiodothyronine (T3) Levothyroxine should only ever be prescribed in micrograms (mcg) to reduce the risk of prescription error. Common calculation errors when converting from mcg to mg (e.g. - 0.025mg to 25mcg (correct), may sometimes be mistakenly converted to 250mcg (a 10-fold dose increase error). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Triiodothyronine (T3) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Triiodothyronine (T3) Primer Triiodothyronine (T3) (also known as liothyronine) is the active form of the thyroid hormone, thyroxine. Approximately 20% of T3 is secreted into the bloodstream directly by the thyroid gland. The remaining 80% is produced from conversion of thyroxine by organs such as the liver and kidneys. In psychiatry, liothyronine is sometimes used as an augmentation medication for depression in combination with antidepressants. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Toxidromes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Toxidromes Primer Toxidromes (portmanteau of toxic + syndrome) are a medical syndrome caused by a elevated levels of a substance in the body, and often secondary to a drug overdose or adverse drug reaction. Approach See also: YouTube: Toxidromes - Rutgers RWJMS Neurology Physical Exam Comparison | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Anticholinergic and Cholingeric Toxicity | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Anticholinergic and Cholingeric Toxicity Primer Anticholinergic and Cholinergic Drugs are commonly used in medicine and prescribed for many conditions. These medications work on the parasympathetic nervous system (PNS). Remember that the PNS compliments the sympathetic nervous system (SNS), and this combines to make up the | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vesicular Monoamine Transporter 2 (VMAT2) Inhibitor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Vesicular Monoamine Transporter 2 (VMAT2) Inhibitor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tetrabenazine (Nitoman/Xenazine) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tetrabenazine (Nitoman/Xenazine)
Primer
Tetrabenazine (Trade name: Nitoman/Xenazine) is a vesicular monoamine transporter 2 (VMAT2) inhibitor used in the treatment of Huntington's Disease and tardive dyskinesia.
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| Valbenazine (Ingrezza)
Primer
Valbenazine (Trade name: Ingrezza), is used to treat tardive dyskinesia. It acts as a vesicular monoamine transporter 2 (VMAT2) inhibitor.
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| Introduction to Prescribing Medication Primer Medication prescription is cornerstone of psychiatric practice, and indeed for many areas and specialties of medicine. Understanding principles of prescribing and being a thoughtful and careful prescriber is critically important. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pharmacological Management of Acute Behavioural Agitation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pharmacological Management of Acute Behavioural Agitation Primer Acute agitation (a “Code White”) in the medical setting can present as a challenge for both patients and health care providers. When using medications to manage acute agitation, there are several key concepts to consider, including the route of administration, onset of action, absorption, half-life, and the risk of adverse events. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alpha-1 Blockers | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Alpha-1 Blockers | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cytochrome (CYP) P450 Metabolism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cytochrome (CYP) P450 Metabolism Primer The Cytochrome P450 System (CYP) is a family of heme-containing mono-oxygenases enzymes that detoxify foreign compounds (i.e. - medications and drugs) in the liver. Cytochrome P450 enzymes are responsible for most phase I reactions in the liver. Understanding the role of CYP enzymes is vital in the prescribing of psychotropic medications. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inpatient PRN Overuse | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inpatient PRN Overuse Primer PRNs (from the Latin pro re nata: for an occasion that has arisen) are a typical prescribing practice in most in-patient psychiatric units. There is limited evidence for the clinical effectiveness of as needed medications. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Measurement-Based Care (MBC) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Measurement-Based Care (MBC) Primer * Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2016). A tipping point for measurement-based care. Psychiatric Services, 68(2), 179-188. * Guo, T., Xiang, Y. T., Xiao, L., Hu, C. Q., Chiu, H. F., Ungvari, G. S., ... & Feng, Y. (2015). Measurement-based care versus standard care for major depression: a randomized controlled trial with blind raters. American Journal of Psychiatry, 172(10), 1004-1013. *… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paradoxical Reactions | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paradoxical Reactions Primer Paradoxical Reactions are an unintended, paradoxical response to a medication. In the case of benzodiazepines, it can result in excessive movements, agitation, talkativeness, impulsivity, irritability, and/or excitement (the opposite of a benzodiazepine's intended effect). The incidence of paradoxical reactions are rare, at less than 1%. However, the | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pharmacogenetic Testing | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pharmacogenetic Testing Primer Pharmacogenetics is the study of inherited genetic differences in drug metabolic pathways which can affect individual responses to drugs, both in terms of therapeutic effect as well as adverse effects. There is increasing interest in trying to use pharmacogenetics to understand which patients will respond best to which psychotropic medications. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Drug Plasma Levels | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Drug Plasma Levels Primer Drug Plasma Levels may be helpful to determine if a patient is adherent to medication, or has the appropriate serum levels of medications for a response. Tips * First of all, consider is there a clinically useful assay to measure this drug? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| QT (QTc) Prolongation and Monitoring | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| QT (QTc) Prolongation and Monitoring Primer QT (QTc) Prolongation is associated with many psychotropic medications (especially antipsychotics) and some are linked to serious ventricular arrhythmias (e.g. - Torsades de Pointes) and sudden cardiac death. The risk of QT prolongation is likely dose-related, but the overall absolute risk is low. ECG monitoring is recommended for all patients on QT-prolonging agents, especially those taking medications long-term. There are few guidelines on the moni… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tachyphylaxis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tachyphylaxis Primer Tachyphylaxis is the continued or repeated exposure to a drug that may lead to a weakened pharmacological response. This thought to be due to diminished receptor sensitivity in response to the persistent stimulation by an agonist drug, which produces a diminished pharmacological response. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Urine Drug Screen | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Urine Drug Screen Primer The Urine Drug Screen (UDS) has several limitations, including only testing for a limited for a number of drugs, plus false positives/negatives are common. There can be a lack of temporal correlation with the UDS result and the clinical presentation. Urine drug screens at one hospital are also not always the same at another site. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Depressive Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Depressive Disorders Primer Depressive Disorders are a group of mental disorders characterized by prolonged periods of low mood. Bipolar disorders are related to depressive disorders as well in that there are also episodes of low mood, but is now considered as a separate diagnostic category due to different treatments and prognosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Major Depressive Disorder (MDD) Primer Major Depressive Disorder (MDD) is a mental disorder characterized by persistent, often daily, low mood and/or decreased interest (anhedonia). There are also associated neurovegetative symptoms, such as a change in sleep, appetite, cognition, and energy levels. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Atypical Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Atypical Depression Primer Atypical Depression (also known as Major Depressive Disorder with atypical features in the DSM-5) is a subtype of depression characterized by mood reactivity (moods that are strongly reactive to environmental circumstances, and feeling extremely sensitive - this is a must have feature), hypersomnia, carbohydrate craving/increased appetite, leaden paralysis (profound fatigue), and chronic rejection sensitivity. Atypical depression results in more disability than | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Late-life Depression (Geriatric Depression) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Late-life Depression (Geriatric Depression) Primer Geriatric Depression (also known as Late-Life Depression, or LLD) is a subtype of depression characterized by changes in mood, lack of pleasure, and often somatic symptoms in older adults. It is one of the major | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Melancholic Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Melancholic Depression Primer Melancholic Depression (also known as Major Depressive Disorder with melancholic features in the DSM-5, and previously as “endogenous depression”) is a subtype of depression characterized by a severe loss of pleasure and prominent physical symptoms. Classic melancholic depression features include insomnia, weight loss, and psychomotor changes. The DSM-5 specifier | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Childhood and Adolescent (Pediatric) Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Childhood and Adolescent (Pediatric) Depression Primer Childhood and Adolescent Depression is a subtype of depression characterized by low mood, anxiety, and irritability in children and youth. Epidemiology * The prevalence of major depressive disorder among adolescents was reported to be about 15%. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perimenopausal Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perimenopausal Depression Primer Perimenopausal Depression (also known as Major Depressive Disorder with peripartum onset in the DSM-5) is a subtype of depression experienced by women during the perimenopausal period, defined as the interval when a women’s menstrual cycles become irregular, usually between ages of 45 and 49. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Post-Stroke Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Post-Stroke Depression Primer Epidemiology * Following a stroke, the onset of depression is acute, usually occurring within 1 day or a few days of the cerebrovascular accident (CVA).American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Peripartum and Postpartum Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Peripartum and Postpartum Depression Primer Postpartum Depression (PPD) (also known as Peripartum Depression, or Major Depressive Disorder with peripartum onset in the DSM-5) is a subtype of depression that occurs during pregnancy or in the first 4 weeks after delivery. However, women remain at risk for developing depression up to several months following delivery. PPD is the most common psychiatric complication related to child-bearing. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychotic Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychotic Depression Primer Psychotic Depression (also known as Major Depressive Disorder with psychotic features in the DSM-5) is a subtype of depression characterized by psychosis (delusions, hallucinations) in addition to mood changes. It requires the treatment of the underlying mood disorder first to resolve the psychosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Seasonal Affective Disorder (SAD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Seasonal Affective Disorder (SAD) Primer Seasonal Affective Disorder (SAD) (also known as Major Depressive Disorder with seasonal pattern in the DSM-5) is a subtype of depression related to mood changes that are linked to seasonal changes. The diagnostic specifier | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Situational (Reactive/Exogenous) Depression | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Situational (Reactive/Exogenous) Depression Primer Situational Depression (also known as Reactive Depression, Exogenous Depression, and Adjustment Disorder) are depressive symptoms that occur when an individual is unable to adjust to or cope with a particular stress or a major life event. This was a previously historical diagnosis that has fallen out of clinical use. Its close counterpart is now called | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Persistent Depressive Disorder (Dysthymia) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Persistent Depressive Disorder (Dysthymia) Primer Persistent Depressive Disorder (PDD) is a mood disorder characterized by a depressed mood that occurs for most of the day, for more days than not, for at least two years (one year for children and adolescents). PDD is a consolidation of DSM-IV diagnosis of chronic major depressive disorder and dysthymic disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Premenstrual Dysphoric Disorder (PMDD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Premenstrual Dysphoric Disorder (PMDD) Primer Premenstrual Dysphoric Disorder (PMDD) is a mood disorder characterized by dysphoria, mood lability, irritability, and anxiety that occur repeatedly during the premenstrual phase of the cycle and resolve around the time of (or after) menses. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Depressive Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Depressive Disorder Primer Substance/Medication-Induced Depressive Disorder is diagnosed when a substance (alcohol, illicit drugs, or prescribed medication) causes depressive symptoms while an individual is using the substance or during a withdrawal syndrome associated with the substance. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Depressive Disorder Due to Another Medical Condition | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Depressive Disorder Due to Another Medical Condition Primer Depressive Disorder Due to Another Medical Condition is a mood disorder diagnosis where there is a prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the direct physiological effects of another medical condition. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Depressive Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Depressive Disorders Primer Other Specified Depressive Disorders is a category of DSM-5 diagnoses that applies to individuals who have symptoms characteristic of a depressive disorder (e.g. - major depressive disorder), but do not meet the full criteria for any of them. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| home | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Neurological Exam | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Neurological Exam Primer The Neurological Exam is an important physical examination for not just neurologists, but also psychiatrists. This is particularly important to rule out neurological causes of psychiatric disorders, and in even more so in older adults, where | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Go-No-Go Test | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Go-No-Go Test Primer The Go-No-Go test is a neurological exam that tests for frontal lobe pathology. This test is a component of the Frontal Assessment Battery (FAB) Exam The examiner instructs the patient to tap once in response to a single tap, and to withhold a response for two taps. This test can be made more difficult by changing the initial rule after several trials (for example, ‘‘tap once when I tap twice, and not at all when I tap once’’). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Luria Sequence (Luria's Test) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Luria Sequence (Luria's Test) Primer Luria's Test (“fist-edge-palm” test or Luria Sequence) is a task that requires a patient to imitate three hand motions performed by a clinician. Luria's test is part of the Frontal Assessment Battery (FAB) battery of tests. Luria's test assesses for frontal lobe (i.e. - executive) dysfunction or damage, as patients will often have difficulty with fine motor skills and sequencing motor skills. Specifically, it is designed to assess different aspects of execu… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Neurologic Emergencies | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Neurologic Emergencies Primer Neurologic Emergencies must be managed efficiently and quickly, and several common presentations occur in the emergency setting. Common neurological emergencies include stroke, transient ischemic attacks (TIAs), altered level of consciousness, subarachnoid bleeding, seizures, and cauda equina syndrome. An approach to each emergency is briefly described below. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Aphasia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Aphasia Primer Aphasia is a disturbance of language due to brain damage. This damage can affect comprehension (listening and reading) and/or expression (speaking and writing). In aphasia, the ability is name objects is always impaired to some degree. Aphasia most commonly develops after a brain injury, such as a stroke or head trauma. However, it can also develop due to neurodegenerative diseases, such as | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Apraxia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Apraxia Primer Apraxia is the inability to perform a previously learned, purposeful motor task -- despite having the desire and physical ability to do so. Apraxia can commonly affect the performance of activities of daily living such as brushing teeth and dressing. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Dizziness and Vertigo | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Dizziness and Vertigo Primer Dizziness and Vertigo are common neurologic symptoms reported by patients, but the terminology can often be misused or misinterpreted by patients (or even medical professionals!). Vertigo Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Ménière’s disease are the most common causes of vertigo. However, cerebrovascular disease, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Headaches | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Headaches Primer See also: Hainer, B. L., & Matheson, E. (2013). Approach to acute headache in adults. American family physician, 87(10), 682-687. History * Where does it start? * How long does it last? (Minutes, hours?) * Photophobia (light sensitivity)? Phonophobia (Sound sensitivity)? * Are there auras? * Does it worsen with movement, and is there associated nausea or vomitting? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Normal Pressure Hydrocephalus (NPH) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Normal Pressure Hydrocephalus (NPH) Primer Normal-pressure hydrocephalus (NPH) is a neurological condition in which excess cerebrospinal fluid (CSF) occurs in the ventricles, and with normal or slightly elevated cerebrospinal fluid pressure. As the fluid builds up, it causes the ventricles to enlarge and the pressure inside the head to increase, compressing surrounding brain tissue and leading to neurologic and psychiatric symptoms. The etiology of NPH remains poorly understand and… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Seizures | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Seizures Primer Seizures are sudden, uncontrolled electrical disturbances in the brain. The presentation can vary from uncontrolled jerking movement (tonic-clonic seizures) to something as subtle as a momentary loss of awareness (absence seizure). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Stroke | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Stroke Primer A stroke (also called a cerebrovascular accident, CVA) is an acute disturbance of the cerebral perfusion or vasculature. Approximately 85% of strokes are ischemic (blockage of a vessel) and remainder are hemorrhagic. Risk Factors | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Tremors | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to Tremors Primer Tremors are rhythmical, involuntary oscillatory movements of a body part. The most common tremors are enhanced physiologic tremors, followed by essential tremor, and parkinsonian tremors. Tremors also become more common with age. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Computed Tomography (CT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Computed Tomography (CT) Primer Computed Tomography (CT) uses a series of x-rays of the head taken from many different directions. CT scanning requires the use of a computer that performs a numerical integral calculation (the inverse Radon transform) on the measured X-ray series to estimate how much of an X-ray beam is absorbed in a small volume of the brain. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Electroencephalogram (EEG) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Electroencephalogram (EEG) Primer Electroencephalogram (EEG) is a diagnostic test that involves applying electrodes to the scalp’s surface to measure electricity generated by neural activity. EEG is most commonly used in investigation of seizures and sleep disorders. The brain functions primarily via action potentials that lead to the release of neurotransmitters into synaptic clefts. Although an EEG cannot detect the tiny amount of electricity produced by individual neurons, visible waves or … | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Functional Magnetic Resonance Imaging (fMRI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Functional Magnetic Resonance Imaging (fMRI) Primer Functional magnetic resonance imaging (fMRI) is a neuroimaging modality that measures brain activity by detecting changes associated with blood flow. This technique is based on the fact that cerebral blood flow and neuronal activation are coupled. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lumbar Puncture (LP) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lumbar Puncture (LP) Primer A lumbar puncture (LP), or spinal tap, is a procedure where a needle is inserted into the spinal canal to collect cerebrospinal fluid (CSF) for diagnostic testing. neuro-investigations | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Magnetic Resonance Imaging (MRI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Magnetic Resonance Imaging (MRI) Primer Magnetic Resonance Imaging (MRI) is a neuroimaging technique that uses strong magnetic fields, magnetic field gradients, and radio waves to generate anatomical images. MRI is particularly useful at looking for white matter and subcortical changes. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positron Emission Tomography (PET) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positron Emission Tomography (PET) Primer Positron emission tomography (PET) is a functional imaging technique that uses radioactive radiotracers to visualize and measure changes in metabolic processes in the brain. Indications * Alzheimer's Disease (AD). PET amyloid scans visualize amyloid plaques in the brain (which previously could only be visualized on autopsy) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Polysomnography (PSG) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Polysomnography (PSG) Primer Polysomnography (PSG) is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. See also main section: Sleep Medicine Indications * PSGs should be ordered if there is clinical suspicion for obstructive sleep apnea, parasomnias, periodic limb movements, narcolepsy, or REM sleep behaviour disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Single-Photon Emission Computed Tomography (SPECT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Single-Photon Emission Computed Tomography (SPECT) Primer Single Photon Emission Computed Tomography (SPECT) is a neuroimaging technique that uses a combination of computed tomography (CT) and a radioactive material (tracer) to measure regional cerebral blood flow in the brain. SPECT are typically ordered to look for areas of hypoperfusion in the brain. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-Compulsive and Related Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-Compulsive and Related Disorders Primer Obsessive-Compulsive and Related Disorders are a group of mental disorders including obsessive-compulsive disorder (OCD), body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, substance/medication-induced obsessive-compulsive and related disorder, obsessive-compulsive and related disorder due to another medical condition, and other specified obsessive-compulsive and related d… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-Compulsive Disorder (OCD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-Compulsive Disorder (OCD) Primer Obsessive-Compulsive Disorder (OCD) is an obsessive-compulsive and related disorder that consists of (1) obsessions (intrusive, unwanted, and repetitive thoughts, urges, or images that don’t go away and are generally unwanted, or ego-dystonic) and/or (2) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Body Dysmorphic Disorder (BDD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Body Dysmorphic Disorder (BDD) Primer Body Dysmorphic Disorder (BDD) (formerly known as dysmorphophobia) is an obsessive-compulsive and related disorder characterized by the obsessive idea that an aspect of one's own body part or appearance is severely flawed and warrants exceptional measures to hide or fix the dysmorphic part. Individuals are preoccupied with perceived flaws in their physical appearance that are not observable (or appear only slight to others). In addition, there are repetiti… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Excoriation (Skin Picking) Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Excoriation (Skin Picking) Disorder Primer Excoriation (Skin-Picking) Disorder is an obsessive-compulsive and related disorder characterized by the repeated urge to pick at one's own skin, often to the extent that significant skin damage is caused. Epidemiology * Prevalence is 1-2% in the general population. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hoarding Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hoarding Disorder Primer Hoarding Disorder is an obsessive-compulsive and related disorder characterized by persistent difficulty discarding or parting with possessions (regardless of their actual value) due to a strong perceived need to save the items. There is also associated distress associated with discarding these items. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trichotillomania | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trichotillomania Primer Trichotillomania (also known as hair-pulling disorder) is an obsessive-compulsive and related disorder characterized by a long term, irresistible urge to pull out one's hair. The hair pulling occurs to the degree that significant hair loss occurs. Epidemiology * | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Obsessive-Compulsive and Related Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Obsessive-Compulsive and Related Disorders Primer Other specified Obsessive-Compulsive and Related Disorder is a category of DSM-5 diagnoses that applies to individuals who have symptoms characteristic of obsessive compulsive disorders (e.g. - | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-Compulsive and Related Disorder Due to Another Medical Condition | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-Compulsive and Related Disorder Due to Another Medical Condition Primer Obsessive-Compulsive and Related Disorder Due to Another Medical Condition is an obsessive-compulsive and related disorder diagnosis where there is a prominent and persistent period of obsessive-compulsive symptoms thought to be related to the direct physiological effects of another medical condition. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Obsessive-Compulsive and Related Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Obsessive-Compulsive and Related Disorder Primer Substance/Medication-Induced Obsessive-Compulsive and Related Disorder is an obsessive-compulsive and related disorder that is diagnosed after an individual uses a substance (e.g. - a drug of abuse, a medication, or a toxin exposure) that leads to prominent symptoms of an obsessive-compulsive and related disorder. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| CAMH On-Call | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| CAMH On-Call CAMH Orientation Documents * MUST-READ [Resident On-Call/ED Manual (2017)] / [(2016)] * [Billing Form] * [CAMH ED Powerpoint (Dr. Zaheer)] * [CAMH Resident General Manual] * [Patient Safety Planning Template] * [Suicide Risk Assessment Template] * [CAMH Outpatient Lab Ordering Instructions] * [I-CARE Outpatient Booking Instructions] * [CAMH Partial Hospital Program] * [CAMH Social Determinants of Health Resources] * [Diet Orders Reference Card] * [Bridging… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Download | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Download [Approaching Capacity and Certification Issues at the Medical/Psychiatric Interface by Dr. Lesley Wiesenfeld] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to On-Call Internal Medicine Emergencies and Issues | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Approach to On-Call Internal Medicine Emergencies and Issues Primer Common Internal Medicine issues and emergencies for psychiatric patients may occur. It is important for any psychiatrist to have a good approach to these issues and to direct the right work up and medical care and not confound psychiatric symptoms with acute medical issues. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Basic Life Support (BLS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Basic Life Support (BLS) Primer Basic Life Support (BLS) is the basic foundation for single-rescuer and team basic life support skills for use in both pre-hospital and in-facility environments. Adult | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pain Medicine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pain Medicine
Primer
Pain Medicine is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain.
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| Complex Regional Pain Syndrome (CRPS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Complex Regional Pain Syndrome (CRPS) Reflex sympathetic dystrophy (RSD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paraphilic Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paraphilic Disorders
Primer
Paraphilic disorders are a group of mental disorders that involve intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners. Paraphilic disorders specifically cause either distress/impairment or results in risk to self or others. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Exhibitionistic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Exhibitionistic Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fetishistic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fetishistic Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Frotteuristic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Frotteuristic Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pedophilic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pedophilic Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Signs and Symptoms * The likelihood of pedophilic disorder is diagnosed if there are multiple victims (likelihood increases with each victim), male victim (almost all pedophilic), non-cohabiting victims, pre-pubescent victims, child pornography offences, and/or positive phallometric te… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sexual Masochism Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sexual Masochism Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sexual Sadism Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sexual Sadism Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Transvestic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Transvestic Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Voyeuristic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Voyeuristic Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Antisocial Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antisocial personality disorder is characterized by a pattern of disregard for the rights of others and engagement in unlawful activities. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Avoidant Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Avoidant personality disorder is characterized by being timid and shy, but wishing to have friends. Due to fears of being uncomfortable and afraid of rejection or criticism, they avoid social contact. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Borderline Personality Disorder (BPD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Borderline personality disorder is characterized by emotional dysregulation, patterns of unstable interpersonal relationships and high impulsivity. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dependent Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dependent personality disorder is characterized by fear separation and a tendency to be indecisive and unable to take initiative. They have difficulty expressing disagreement because they fear abandonment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Histrionic Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Histrionic personality disorder is characterized by flamboyant behaviour, attention-seeking, and displays of excessive emotions (may be shallow or shift rapidly). May use physical appearance or sexuality to draw attention, and also concerned with appearance. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Personality Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Personality Disorders Primer Personality disorders are enduring patterns of behaviours and inner experiences that deviates significantly from the expectations of an individual's culture. These patterns begin in adolescence or early adulthood, are pervasive | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Personality Change Due to Another Medical Condition | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Personality Change Due to Another Medical Condition is a diagnosis used to identify a persistent personality change caused by medical condition | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Narcissistic Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Narcissistic personality disorder is characterized by a grand sense of own importance and are very sensitive to criticism. Rarely able to empathize with others. Characterized by arrogance, need for admiration, and tendency to exploit others. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-Compulsive Personality Disorder (OCPD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obsessive-compulsive personality disorder is characterized by being perfectionistic, inflexible, and unable to express warm, tender feelings. They are preoccupied with details and rules and do not appreciate changes in routine. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paranoid Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paranoid personality disorder is characterized by pervasive distrust or suspiciousness of others such that their motives are interpreted as malevolent. It is characterized by a pattern of distrust and suspiciousness of others. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizoid Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizoid personality disorder is characterized by a lack of interest in social relationships (and happy about it), a tendency towards a solitary or sheltered lifestyle, secretiveness, emotional coldness, and apathy. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizotypal Personality Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizotypal personality disorder is characterized by pervasive patterns of “strange” or “odd” behavior, appearance, or “magical” thinking. There is no history of psychosis or schizophrenia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychotic Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychotic Disorders
Primer
Psychotic disorders are a group of severe mental disorders are characterized by changes in thought, reality-testing, and perception.
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| Brief Psychotic Disorder Primer Brief Psychotic Disorder is a psychotic disorder that involves at least one positive psychotic symptom (delusions, hallucinations, disorganized speech), and/or grossly abnormal psychomotor behaviour, including catatonia. The symptoms must characteristically last for at least 1 day but no longer than 1 month. Individuals with brief psychotic disorder typically experience emotional turmoil or overwhelming confusion, and the although the duration can be brief, the … | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delusional Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delusional Disorder Primer Delusional disorder is a mental disorder characterized by the presence of one or more delusions that persist for at least 1 month. A diagnosis of delusional disorder is not given if an individual has ever had symptoms that meet criteria for | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delusional Parasitosis (Morgellons Disease) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delusional Parasitosis (Morgellons Disease) Primer Delusional Parasitosis (Ekbom Syndrome, Morgellons Disease) is a psychodermatological disorderKoo, J., & Lebwohl, A. (2001). Psychodermatology: the mind and skin connection. American family physician, 64(11), 1873. characterized by the recurrent and fixed beliefs they are infested by small organisms or even unanimated materials such as fibres (Morgellons disease), without any objective evidence of infestation/parasitosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizoaffective Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizoaffective Disorder Primer Schizoaffective disorder is a mental disorder characterized by a major mood episode (either manic or depressive) that co-occurs at the same time with symptoms of schizophrenia. Epidemiology There are limited studies on the prevalence of schizoaffective disorder. It is estimated that 30% of cases occur between the ages of 25 and 35, and it occurs more frequently in women than men. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizophrenia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizophrenia Primer Schizophrenia is a mental disorder characterized by the presence of positive symptoms (delusions, hallucinations), disorganization, and negative symptoms (poverty of thought, amotivation). Epidemiology * The prevalence is the same between men and women, but differs in the course and onset of illness. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizophreniform Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schizophreniform Disorder Primer Prevalence * Incidence of schizophreniform disorder across sociocultural settings is likely similar to that observed in schizophrenia. In the United States and other developed countries, the incidence is low, possibly fivefold less than that of schizophrenia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Psychotic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Psychotic Disorder Primer Substance/medication-induced psychotic disorder is a psychotic disorder diagnosed after an individual uses a substance (e.g. - a drug of abuse, a medication, or a toxin exposure) that leads to prominent symptoms of psychosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Postpartum Psychosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Postpartum Psychosis Primer Postpartum psychosis is a perinatal mental disorder that begins exclusively after childbirth. It is a disorder linked closely with postpartum depression. Epidemiology * PPP affects affects 1-2 per 1,000 women.Osborne, L. M. (2018). Recognizing and managing postpartum psychosis: a clinical guide for obstetric providers. Obstetrics and Gynecology Clinics, 45(3), 455-468.American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Homework in CBT | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Homework in CBT Why do homework in CBT? Homework assignments in Cognitive Behavioural Therapy (CBT) can help your patients educate themselves further, collect thoughts, and modify their thinking. How to deliver homework Homework is not something that you just assign randomly. You should make sure you: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychodynamic Psychotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Explores unconscious conflicts that cause symptoms and explores past relationships, transference, and defense mechanisms. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Defenses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Defenses Primer Defense Mechanisms (also known as defences) are unconscious psychological mechanisms that reduces anxiety arising from unacceptable or potentially harmful stimuli. Defences can be adaptive or maladaptive. Learning to identify and understand defenses is important in | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acceptance and Commitment Therapy (ACT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Uses commitment and behaviour change strategies to increase psychological flexibility. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Biofeedback | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| A treatment modality where patients use signals from the body (e.g. - heart rate, muscle tension, skin temperature, blood pressure) as a guide. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Brief (Short-term) Psychodynamic Psychotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Brief (short-term) psychodynamic psychotherapy is a time-limited psychotherapy that focuses on troubling feelings or thoughts that interfere with relationships, communication, and/or functioning. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cognitive Behavioural Therapy for Insomnia (CBT-I) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Identifies and replace thoughts and behaviors that cause or worsen insomnia with habits that promote improved sleep. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cognitive Behavioural Therapy (CBT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Challenges maladaptive thinking patterns and changes emotions/behaviour coming from those thoughts. Indicated in: depression, anxiety, and psychosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cognitive Processing Therapy (CPT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Challenges and changes unhelpful beliefs related to trauma to create a new conceptualization of traumatic events. Indicated in: PTSD. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Community Reinforcement Approach (CRA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Uses familial, recreational, occupational, and social events to support a change in substance use behaviours. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dialectical Behavioural Therapy (DBT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Focuses on acceptance and change, emotional regulation, mindfulness, and distress tolerance. Indicated in: borderline personality and self-harm behaviours. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Eye Movement Desensitization and Reprocessing (EMDR) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Involves the use of a patient's own rhythmic, rapid eye movements. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Family Therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multi-person therapy for when symptoms are exacerbated by interpersonal interactions within the family. Indicated in: disruptive behaviour in children, eating disorders, and schizophrenia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Group Therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| One or more therapists work with several individuals simultaneously in a group setting, working through both the process and content of the group. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Psychotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Psychotherapy Primer Psychotherapy (psychological therapy or talking therapy) is the use of psychological methods with regular therapeutic interactions to help an individual change behaviours or overcome symptoms. There are many types of psychotherapies, but at its core the therapist-patient relationship and therapeutic alliance is the most important. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Interpersonal Therapy (IPT) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Focuses on relationship conflicts, life-role transitions, and grief. Indicated in: depression. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Karpman's Drama Triangle | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Karpman's Drama Triangle Primer The Karpman's Drama Triangle (or the “drama triangle”) is a social model of human interaction. The triangle is a prototype of a type of destructive interaction that can occur between people in conflict. The model is a tool used in psychotherapy to understand conflicts. The actors that make up the corners of the triangle are (1) oppressors, (2) victims, and (3) rescuers. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Motivational Interviewing (MI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Addresses ambivalence to change using a non-judgmental stance, enhances motivation to change, and acknowledges resistance. Indicated in: substance use disorders. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mindfulness-Based Therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Focusing on and noticing the present as it is using breathing and relaxation techniques. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Supportive Psychotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The therapist is the guide, listens, understands, and reinforces coping skills and adaptive defense mechanisms. Indicated in: lower cognitive function, crisis, schizophrenia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Theories of Development and Stages of Development | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Theories of Development and Stages of Development Primer Understanding Theories of Development and Stages of Development in psychotherapy through different different developmental frameworks (e.g. - Freudian, Eriksonian, Piaget) can be helpful to structure your understanding of a patient's symptoms and psychopathology, depending on their age. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trauma-Informed Care | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| An approach to therapy that takes into account the impacts of trauma in all aspects of a patient's care. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| home | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sexual Dysfunctions | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sexual Dysfunctions Primer Sexual dysfunctions are a heterogeneous group of disorders that are characterized by clinically significant disturbance in a person's ability to respond sexually or to experience sexual pleasure. The DSM-5 groups these disorders broadly as: delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual interest/arousal disorder, genito–pelvic pain/penetration disorder, male hypoactive sexual desire disorder, premature (early) ejaculation, substance/m… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delayed Ejaculation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delayed Ejaculation Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Erectile Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Erectile Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Female Orgasmic Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Female Orgasmic Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Female Sexual Interest/Arousal Disorder (FSIAD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Female Sexual Interest/Arousal Disorder (FSIAD) Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Genito-Pelvic Pain/Penetration Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Genito-Pelvic Pain/Penetration Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Male Hypoactive Sexual Desire Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Male Hypoactive Sexual Desire Disorder Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Premature (Early) Ejaculation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Premature (Early) Ejaculation Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales Pathophysiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Sexual Dysfunction | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Sexual Dysfunction Primer Epidemiology Prognosis Comorbidity Risk Factors DSM-5 Diagnostic Criteria Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Specifiers Specify if: Screening Tools and Scales | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep Disorders Primer Sleep Disorders include insomnia disorder, hypersomnolence disorder, narcolepsy, non-rapid eye movement (NREM) sleep arousal disorders, nightmare disorder, rapid eye movement (REM) sleep behavior disorder, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, restless legs syndrome, and substance/medication-induced sleep disorder. These disorders all result in daytime distress and impairment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Sleep Medicine Primer Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, inhibition of nearly all voluntary muscles, and reduced interactions with surroundings. Adequate sleep is vital for good mental health, and there is a bidirectional relationship between neuropsychiatric disorders and sleep. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Circadian Rhythm Sleep-Wake Disorders
Primer
Circadian Rhythm Sleep-Wake Disorders are sleep disorders that involve a change in the timing of when an individual sleeps and is awake. The human body has a master circadian clock in a control centre of the brain known as the suprachiasmatic nucleus (SCN).
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| Advanced Sleep Phase Type | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Circadian Rhythm Sleep-Wake Disorder, Advanced Sleep Phase Type
Primer
Circadian Rhythm Sleep-Wake Disorders, Advanced Sleep Phase Type is a circadian rhythm sleep-wake disorder characterized by sleep-wake times that are several hours earlier than desired or conventional times.
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| Circadian Rhythm Sleep-Wake Disorder, Delayed Sleep Phase Type Primer Circadian Rhythm Sleep-Wake Disorder, Delayed Sleep Phase Type (also known as Delayed Sleep Phase Syndrome [DSPS]) is a circadian rhythm sleep-wake disorder characterized by a delay in the timing of the major sleep period (usually more than 2 hours) in relation to the desired sleep and wake-up time, resulting in symptoms of insomnia and excessive sleepiness. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Circadian Rhythm Sleep-Wake Disorder, Irregular Sleep-Wake Type Primer Circadian Rhythm Sleep-Wake Disorder, Irregular Sleep-Wake Type is a circadian rhythm sleep-wake disorder characterized by symptoms of insomnia at night (during the usual sleep period) and excessive sleepiness (napping) during the day. Additionally, there is no discernable sleep-wake circadian rhythm, no major sleep period, and sleep is fragmented into at least three periods during a 24-hour day. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Circadian Rhythm Sleep-Wake Disorder, Non-24-Hour Sleep-Wake Type
Primer
Circadian Rhythm Sleep-Wake Disorder, Non-24-Hour Sleep-Wake Type is a circadian rhythm sleep-wake disorder characterized by symptoms of insomnia or excessive sleepiness due to abnormal synchronization between the 24-hour light-dark cycle and the individual's endogenous circadian rhythm. Non-24-hour sleep-wake type is most common among individuals who are blind, are visually impaired, or have decreased light perception. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shift Work Type | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Circadian Rhythm Sleep-Wake Disorder, Shift Work Type
Primer
Circadian Rhythm Sleep-Wake Disorder, Shift Work Type is a circadian rhythm sleep-wake disorder characterized by a history of an individual working outside of the normal hours (i.e. - 8:00 A.M. to 6:00 P.M) on a regular schedule. Individuals will have symptoms of excessive sleepiness at work, and sleep impairment at home. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep-Related Breathing Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep-Related Breathing Disorders
Primer
Sleep-Related Breathing Disorders (ICSD-3), also called Breathing-Related Sleep Disorder in the DSM-5, include 3 relatively distinct disorders: obstructive sleep apnea (OSA), central sleep apnea (CSA), and sleep-related hypoventilation. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Obstructive Sleep Apnea (OSA) Primer Obstructive Sleep Apnea (OSA) is a sleeping disorder characterized by multiple episodes of cessation of breathing, lasting at least 10 seconds with desaturations and arousals. OSA also involves episodes of upper (pharyngeal) airway obstruction (apneas and hypopneas) during sleep. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Central Sleep Apnea (CSA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Central Sleep Apnea (CSA) Primer Central Sleep Apnea (CSA) is a sleep disorder characterized by episodes of apnea (cessation of breathing) during sleep because the brain does not cue the body to continue breathing. Cheyne-Stokes breathing is a subtype of CSA, seen in patients with severe cardiac, neurologic, or renal impairment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep-Related Hypoventilation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep-Related Hypoventilation Primer Sleep-related hypoventilation is a sleep disorder related to progressive respiratory impairment. When this disorder occurs comorbidly with other disorders (e.g., COPD, neuromuscular disorders, obesity), disease severity reflects the severity of the underlying condition, and the disorder progresses as the condition worsens. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep-Related Movement Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep-Related Movement Disorders Primer Sleep-Related Movement Disorders are relatively simple, usually stereotyped, movements that disturb sleep or its onset (with the exception of restless legs syndrome where individuals typically engage in walking or non-stereotypic limb movement to reduce leg discomfort). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Periodic Limb Movement Disorder (PLMD)
Primer
Periodic Limb Movement Disorder (PLMD), sometimes called nocturnal myoclonus, is a common parasomnia that affects up to 40% of people older than 65 years of age and 11% of sleep disorder clinic patients who complain of insomnia.
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| Restless Legs Syndrome (RLS) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Restless Legs Syndrome (RLS) Primer Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disorder (WED) is a motor-sensory neurological sleep disorder characterized by uncomfortable sensations in the lower extremities that are accompanied by an almost irresistible urge to move the legs or arms. These uncomfortable experiences are typically described as creeping, crawling, tingling, burning, or itching sensations. Symptoms typically occur at night and are relieved by movement. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Parasomnias
Primer
Parasomnias (also known as disorders of arousal) are a group of sleep disorders characterized by abnormal behavioral, experiential, or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-REM Parasomnias (Non-REM Sleep Arousal Disorders) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-REM Parasomnias (Non-REM Sleep Arousal Disorders) Primer Non-Rapid Eye Movement (NREM) Parasomnias (ICSD-3), also referred to as NREM Sleep Arousal Disorders (DSM-5) includes sleepwalking and sleep terrors (night terrors). Both of these conditions consist of repeated occurrence of incomplete arousals, usually beginning during the first third of the major sleep episode, that typically are brief, lasting 1-10 minutes, but may be protracted, lasting up to 1 hour. The maximum duration of an ev… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep Terrors | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleep Terrors Primer Sleep Terrors (also known as Night Terrors) are a non-rapid eye movement sleep disorder characterized by the repeated occurrence of precipitous awakenings from sleep, usually beginning with a panicky scream or cry. Sleep terrors usually begin during the first third of the major sleep episode and last 1-10 minutes, but they may last considerably longer, particularly in children. The episodes are accompanied by impressive autonomic arousal and behavioral manifestations of in… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleepwalking | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sleepwalking Primer Sleepwalking is a non-rapid eye movement sleep disorder characterized by repeated episodes of complex motor behavior initiated during sleep, including rising from bed and walking about. Sleep walking episodes begin during any stage of NREM sleep, most commonly during slow-wave sleep and therefore most often occurring during the first third of the night. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rapid Eye Movement (REM) Sleep Behaviour Disorder Primer Rapid Eye Movement (REM) Sleep Behaviour Disorder is a sleep disorder characterized by repeated episodes of arousal, often associated with vocalizations and/or complex motor behaviours arising during REM sleep. These behaviours often reflect motor responses to the content of action-filled or violent dreams of being attacked or trying to escape from a threatening situation, called | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Nightmare Disorder Primer Nightmare disorder is a sleep disorder characterized by typically lengthy, elaborate, story-like sequences of dream imagery that seem real and that incite anxiety, fear, or other dysphoric emotions. Nightmare content typically focuses on attempts to avoid or cope with imminent danger but may involve themes that evoke other negative emotions. Nightmares occurring after traumatic experiences may replicate the threatening situation ( | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Benign Sleep Phenomena Primer Benign Sleep Phenomena includes sleep paralysis, hypnagogic hallucinations, hypnopompic hallucinations, and hypnagogic jerks. In isolation, these occurrences are benign and not pathological. Hypnagogic and Hypnopompic Hallucinations | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Insomnia Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Insomnia Disorder Primer Insomnia Disorder is the dissatisfaction with sleep quantity or quality, with complaints of difficulty initiating or maintaining sleep. Put simply, insomnia is defined as difficulty falling asleep or staying asleep, even when a person has the chance to do so | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Idiopathic Hypersomnia (Hypersomnolence Disorder) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Idiopathic Hypersomnia (Hypersomnolence Disorder) Primer Idiopathic Hypersomnia (ICSD-3) or Hypersomnolence Disorder (DSM-5), is a broad diagnosis and includes symptoms of excessive quantity of sleep, deteriorated quality of wakefulness, and sleep inertia. Individuals with this disorder fall asleep quickly and have a high sleep efficiency (>90%). They may have difficulty waking up in the morning, sometimes appearing confused, combative, or ataxic. This prolonged impairment of alertness during … | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Narcolepsy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Narcolepsy Primer Narcolepsy is a sleep disorder characterized by sleepiness with recurrent daytime naps or lapses into sleep. Sleepiness typically occurs daily. Narcolepsy also generally produces cataplexy, which most commonly presents as brief episodes (seconds to minutes) of sudden, bilateral loss of muscle tone precipitated by emotions, typically laughing and joking. Narcolepsy-cataplexy is almost always due to loss of hypothalamic hypocretin (orexin)-producing cells, causing hypocretin de… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Sleep Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Substance/Medication-Induced Sleep Disorder Primer Substance/medication-induced sleep disorder is a sleep disorder characterized by a severe change to sleeping patterns enough to warrant independent clinical attention and judged to be primarily caused by the pharmacological effects of a substance (i.e., a drug of abuse, a medication, toxin exposure). Depending on the substance involved, one of four types of sleep disturbances is reported. Insomnia type and day time sleepiness type are most com… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Somatic Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Somatic Disorders Primer Somatic Disorders (formerly Somatoform Disorders) are mental health disorders characterized by prominent somatic symptoms associated with significant distress and impairment. These disorders have undergone significant revisions in the DSM-5. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DSM-5 Somatic Symptom and Related Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DSM-5 Somatic Symptom and Related Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conversion Disorder (Functional Neurological Disorder) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conversion Disorder (Functional Neurological Disorder) Primer Conversion Disorder (also known as Functional Neurological Symptom Disorder or Functional Neurological Disorder [FND]) is a mental disorder characterized by neurologic symptoms (either motor or sensory) that is incompatible with any known neurologic disease. Common symptoms include weakness and/or paralysis, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Factitious Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Factitious Disorder Primer Factitious Disorder (also known as Munchausen Syndrome -- named after Baron von Munchausen, an 18th-century German officer known for embellishing the stories of his life) involves the falsification of physical or psychological signs or symptoms with no obvious reward. Factitious disorder is different from | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Illness Anxiety Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Illness Anxiety Disorder Primer Illness anxiety disorder is a mental disorder characterized by a preoccupation with having or acquiring a serious, undiagnosed medical illness. Somatic symptoms are either not present or mild in intensity. Illness anxiety can be thought of as a generalized anxiety disorder that focuses exclusively on health concerns. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychological Factors Affecting Other Medical Conditions (PFAOMC/PFAMC) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychological Factors Affecting Other Medical Conditions (PFAOMC/PFAMC) Primer Psychological Factors Affecting Other Medical Conditions (PFAOMC/PFAMC) is a mental disorder that is diagnosed when clinically significant psychological or behavioural factors adversely affects an individual's medical condition and increases their risk for suffering, death, or disability. These factors include psychological distress, patterns of interpersonal interaction, coping styles, and maladaptive health behavi… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Somatic Symptom Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Somatic Symptom Disorder Primer Somatic Symptom Disorder is a mental disorder characterized by multiple, current, somatic symptoms that are distressing or result in significant disruption of daily life. Commonly, only one severe symptom, pain is present. The individual's suffering is authentic, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Somatic Symptom and Related Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Other Specified Somatic Symptom and Related Disorders Primer Other Specified Somatic Symptom Disorders is a category of DSM-5 diagnoses that applies to individuals who have symptoms characteristic of somatic symptom and related disorder (e.g. - somatic symptom disorder, illness anxiety disorder) but do not meet the full criteria for any of them. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DSM-IV Somatoform Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DSM-IV Somatoform Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypochondriasis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypochondriasis Primer Hypochondriasis is a mental disorder characterized by preoccupation or fears of having a serious disease based on misinterpretation of bodily symptoms, in the DSM-IV-TR. Approximately 75% of individuals previously diagnosed with hypochondriasis are subsumed under the new diagnosis of | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pain Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pain Disorder Primer This diagnosis no longer exists in the DSM-5. It has been replaced by Somatic Symptom Disorder. Diagnostic Criteria Criterion A Pain in 1 or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Somatisation Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Somatisation Disorder Primer This diagnosis no longer exists in the DSM-5. It has been replaced with Somatic Symptom Disorder. Diagnostic Criteria Criterion A A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Undifferentiated Somatoform Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Undifferentiated Somatoform Disorder Primer This diagnosis no longer exists in the DSM-5. It has been replaced with Somatic Symptom Disorder. Diagnostic Criteria Criterion A 1 or more physical complaints (e.g. - fatigue, loss of appetite, gastrointestinal or urinary complaints). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pseudocyesis (False Pregnancy) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pseudocyesis (False Pregnancy) Primer Pseudocyesis (from the Greek: pseudes [false] and kyesis [pregnancy]), also known as false, imaginary, simulated, phantom, hysterical or spurious pregnancy is a rare mental/psychosomatic disorder characterized by a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy. This may include abdominal enlargement, reduced menstrual flow, amenorrhea, subjective sensation of fetal movement, nausea, breast engorge… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pseudoseizures and Psychogenic Non-Epileptic Seizures (PNES) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pseudoseizures and Psychogenic Non-Epileptic Seizures (PNES) Primer Psychogenic Non-Epileptic Seizures (PNES), also known as pseudoseizures are episodes of movement, sensation, or behaviours that are similar to epileptic seizures but with no neurologic origins. It is considered a form of | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Introduction to British Columbia's Health Care Laws | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to British Columbia's Health Care Laws
Primer
In the province of British Columbia, Canada, there are several laws that guide the process for for medical treatment, consent, capacity, voluntary/involuntary admissions to hospital, and protection and treatment of individuals with medical and psychiatric disorders in British Columbia: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mental Health Act (BC) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mental Health Act (BC)
Primer
The British Columbia Mental Health Act (MHA) provides physicians and hospitals with the legal authority to admit and detain patients with a mental disorder (which may include primary psychiatric disorders such as bipolar disorder, depression, schizophrenia, and neuropsychiatric disorders such as | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 1 (British Columbia - Request for Admission [Voluntary Patients]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 1 (British Columbia - Request for Admission [Voluntary Patients]) Primer A Form 1 (Request for Admission [Voluntary Patients]), is a form under the British Columbia Mental Health Act that is completed when a patient (or their guardian, if the patient is under age 16) is voluntarily requesting to be admitted for psychiatric treatment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 2 (British Columbia - Consent for Treatment [Voluntary Patient]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 2 (British Columbia - Consent for Treatment [Voluntary Patient]) Primer A Form 2 (Consent for Treatment [Voluntary Patient]), is a form under the British Columbia Mental Health Act that is filled out by a patient (or their guardian, if the patient is under age 16) to consent to voluntary psychiatric treatment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 3 (British Columbia - Medical Report [Under 16 Years of Age]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 3 (British Columbia - Medical Report [Under 16 Years of Age]) Primer A Form 3 (Medical Report) (Examination of a Person Under 16 Years of Age, Admitted at the Request of Parent or Guardian - [Renewal Certificate]), is a form under the British Columbia Mental Health Act that is completed by a physician. Form 3s are completed if a patient under the age of 16 is being admitted against their wishes (but their guardian wishes for admission/treatment). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 4 (British Columbia - Medical Certificate for Involuntary Admission) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 4 (British Columbia - Medical Certificate for Involuntary Admission) Primer A Form 4 (Medical Certificate for Involuntary Admission), is a form under the British Columbia Mental Health Act that allows a person to be apprehended, transported, admitted, treated, and detained as an involuntary patient for up to 48 hours. A second Form 4 (Form 4.2) can be completed to extend the involuntary hospitalization for up to 1 calendar month starting from the date of involuntary admissio… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 5 (British Columbia - Consent for Treatment [Involuntary Patient]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 5 (British Columbia - Consent for Treatment [Involuntary Patient]) Primer A Form 5 (Consent for Treatment), is a form under the British Columbia Mental Health Act that details the consent process for mental health treatment if a patient is involuntarily admitted on a Form 4 or Form 6. The Form 5 requires that either patient consent to treatment, or the director’s authorization (if the patient does not consent), be documented. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 6 (British Columbia - Renewal Certificate for Involuntary Admission) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 6 (British Columbia - Renewal Certificate for Involuntary Admission) Primer A Form 6 (Medical Report on Examination of Involuntary Patient Renewal Certificate) also known as a Renewal Certificate, is a form under the British Columbia Mental Health Act that allows a person's involuntary hospitalization to be extended beyond the first month (i.e. - after two | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 7 (British Columbia - Application for Review Panel Hearing) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 7 (British Columbia - Application for Review Panel Hearing) Primer A Form 7 (Application for Review Panel Hearing), is a form under the British Columbia Mental Health Act that is completed when a patient or someone acting on their behalf (e.g. - a family member) applies for a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 9 (British Columbia - Application for Warrant and Warrant) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 9 (British Columbia - Application for Warrant and Warrant) Primer A Form 9 (Application for Warrant [Apprehension of Person with Apparent Mental Disorder for Purpose of Examination]), is a form under the British Columbia Mental Health Act that anyone in British Columbia complete and apply to a Provincial Court Judge or Justice of the Peace (JP) for. A Form 9 is used when an individual (e.g. - a family member or friend) believes another person has a mental disorder and apparently meets the… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 11 (British Columbia - Request for Second Medical Opinion) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 11 (British Columbia - Request for Second Medical Opinion) Primer A Form 11 (Request for Second Medical Opinion), is a form completed under the British Columbia Mental Health Act when a patient wants a second opinion on the appropriateness of their medical treatment. [Download] Tips | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 13 (British Columbia - Notification to Involuntary Patient of Rights) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 13 (British Columbia - Notification to Involuntary Patient of Rights) Primer A Form 13 (Notification to Involuntary Patient of Rights Under the Mental Health Act), is a form under the British Columbia Mental Health Act that is given to a patient to explain to their rights under the Act. This Form notifies the patient that they are being involuntarily detained/treated, and advises the patient of their rights under British Columbia's Mental Health Act and their rights under s… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 15 (British Columbia - Nomination of Near Relative) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 15 (British Columbia - Nomination of Near Relative) Primer A Form 15 (Nomination of Near Relative), is a form under the British Columbia Mental Health Act that allows a patient to nominate someone to receive notice of the their admission, discharge and any application they make to the review panel. Once nominated, the near relative is notified of the patients admission using a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 16 (British Columbia - Notification to Near Relative) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 16 (British Columbia - Notification to Near Relative) Primer A Form 16 (Notification to Near Relative [Admission of Involuntary Patient or Patient Under Age 16]), is a form under the British Columbia Mental Health Act that informs the near relative of the patient’s admission and rights under the Act and the Charter. A | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 17 (British Columbia - Notification to Near Relative [Discharge of Involuntary Patient]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 17 (British Columbia - Notification to Near Relative [Discharge of Involuntary Patient]) Primer A Form 17 (Notification to Near Relative [Discharge of Involuntary Patient]), is a form under the British Columbia Mental Health Act that is completed when an involuntary patient is discharged from their involuntary status and leaves hospital. The purpose is to notify the patient's near relative that they are not longer involuntary. A | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 18 (British Columbia - Notification to Near Relative [Request for a Review Panel Hearing]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 18 (British Columbia - Notification to Near Relative [Request for a Review Panel Hearing]) Primer A Form 18 (Notification to Near Relative [Request for a Review Panel Hearing]), is a form under the British Columbia Mental Health Act that is completed when an involuntary patient applies for a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 19 (British Columbia - Certificate of Discharge) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 19 (British Columbia - Certificate of Discharge) Primer A Form 19 (Certificate of Discharge), is a form under the British Columbia Mental Health Act that is completed when an involuntary patient is discharged from their involuntary status. Keep in mind that this Form is not completed if a patient is discharged on Extended Leave (i.e. - | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 20 (British Columbia - Leave Authorization), Extended Leave, and Recalls | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 20 (British Columbia - Leave Authorization), Extended Leave, and Recalls Primer A Form 20 (Leave Authorization), also known as Extended Leave (EL), is a form under the British Columbia Mental Health Act that is completed and allows an involuntary patient to leave the hospital and live in the community. Under this Form, a patient will return to live in the community (i.e. - home), but are still legally considered an admitted and involuntary patient. Note that Extended Leave i… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 21 (British Columbia - Director's Warrant [Apprehension of Patient]) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-forms Form 21 (British Columbia - Director's Warrant [Apprehension of Patient]) Primer A Form 21 (Director's Warrant [Apprehension of Patient]), is a form under the British Columbia Mental Health Act that is completed and allows a director (or designate) to issue a form to recall a patient if an involuntary patient leaves the hospital without permission (i.e. - absconds). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mental Health Review Board (British Columbia) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-capacity Mental Health Review Board (British Columbia) Primer The Mental Health Review Board (also sometimes called Review Panel) is an independent tribunal under the Mental Health Act in British Columbia. Its members include physicians, lawyers, and members of the community. Any involuntarily admitted patient, or an individual acting on behalf of a patient has a right to ask for and receive a review panel hearing. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Advanced Care Planning (ACP) Primer Advanced Care Planning is the process of thinking about, and writing down, one's wishes or instructions for future health care treatment in the event they become incapable of deciding for themselves. ACP includes the use of legal tools such as Power of Attorney or POA, representation agreements, and advance directives (AD) (ADs became a new legal option in 2011 for capable adults). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adult Guardianship Act (AGA) (BC)
Primer
The Adult Guardianship Act (AGA) is a law in British Columbia for protecting adults with an illness, disease, injury, or condition that makes them vulnerable to abuse, neglect, and/or self-neglect.
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| Consent to Care Facility Admission & Long-Term Care Capacity Assessment (BC) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Consent to Care Facility Admission & Long-Term Care Capacity Assessment (BC) Primer In British Columbia, consent is required before one can be admitted to a care facility. Cognitive impairment or dementia, may cause a decline in memory, reasoning, planning and judgement, and make one incapable to decide if they require such an admission. Thus, if incapacity is suspected, a patient's capacity for consent to a care facility needs to be assessed. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| bc-mha-capacity Financial Capacity Assessment (BC) Primer In British Columbia, a Financial Capacity Assessment should be done when there is concern that an individual could be incapable of managing their finances in the context of a psychiatric (e.g. - spending during a manic episode in bipolar I disorder) or | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Health Care (Consent) and Care Facility (Admission) Act (HCCCFAA) (BC) Primer See main article: Informed Consent and Capacity Assessment (BC) The British Columbia Health Care (Consent) and Care Facility (Admission) Act, or HCCCFAA contains the laws for medical treatment, and consent for health care (excluding mental health care) in British Columbia. The | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Informed Consent and Capacity Assessment (BC)
Primer
Consent and Capacity are two central tenets in modern medicine and critical to patient autonomy, the respect for personal dignity, and the delivery of ethical care by physicians. This page focuses specifically on | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Ontario's Health Care Laws | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Ontario's Health Care Laws Primer Ontario's Mental Health Act (MHA) and Health Care Consent Act (HCCA) are two pieces of legislation that guide mental health care and health care in the province of Ontario, Canada. The Mental Health Act (MHA) applies to psychiatric care, and provides rules and a legal process for voluntary, informal, and involuntary admissions. The Health Care Consent Act (HCCA) applies to all aspects of health care (both medical and psychiatric) and provides r… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mental Health Act (ON) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mental Health Act (ON) Primer The Ontario Mental Health Act (MHA) applies to psychiatric care, and provides rules and a legal process for voluntary, informal, and involuntary admissions. Note that the Health Care Consent Act (HCCA) applies to all aspects of health care (both medical and psychiatric) and provides rules for obtaining informed, voluntary consent for treatment, and involvement from substitute decision makers. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 1 and Form 42 (Ontario - Psychiatric Assessment) Primer A Form 1 (Application by Physician for Psychiatric Assessment) is a provision under the Ontario Mental Health Act that allows a physician to detain a patient for a psychiatric assessment for up to 72 hours at a Schedule 1 Facility. A | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 2 (Ontario - Order For Examination) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 2 (Ontario - Order For Examination) Primer A Form 2, or Order For Examination, under the Ontario Mental Health Act is a form that any member of the public (or family member) can fill out when they are concerned about the mental well-being of an individual. A Justice of the Peace is required to initiate the process, and the member of the public must contact them to issue the Form 2. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 3 (Ontario - Involuntary Admission) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 3 (Ontario - Involuntary Admission) Primer A Form 3 (Certificate of Involuntary Admission) under the Ontario Mental Health Act is a form filled out when a patient meets criteria for an involuntary admission under either Box A, or Box B criteria. A Form 3 lasts 2 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 4 (Ontario - Certificate of Renewal) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 4 (Ontario - Certificate of Renewal) Primer A Form 4 (Certificate of Renewal) under the Ontario Mental Health Act is a form issued when a patient continues to meet criteria for an involuntary admission after a Form 3 expires. * The first Form 4 lasts one month (add one month, minus a day) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 21 (Ontario - Incapacity to Manage One’s Property) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 21 (Ontario - Incapacity to Manage One’s Property) Primer A Form 21 (Certificate of Incapacity to Manage One’s Property under Subsection 54(4) of the Act) under the Ontario Mental Health Act is a form issued when a physician determines a patient in an inpatient psychiatric facility is incapable to their own property (i.e. - finances). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 27 (Ontario - Right to Notice of Admission as an Informal Patient) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 27 (Ontario - Right to Notice of Admission as an Informal Patient) Primer A Form 27 (Right to Notice of Admission as an Informal Patient) under the Ontario Mental Health Act is a form issued when a physician deems a patient is not mentally capable of consenting to or refusing a particular treatment, and requires observation, care, and treatment. In the case of a Form 27, an informal patient is either a child under the age of 16, or someone who is permanently incapable of making treatment … | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 30 (Ontario - Notice to Patient - Involuntary Admission) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 30 (Ontario - Notice to Patient - Involuntary Admission) Primer A Form 30 (Notice to Patient under Subsection 38(1) of the Act) under the Ontario Mental Health Act is a form given to a patient any time you issue a Form 3, Form 4, or Form 4A. Essentially, think of it as a formal notice you give to a patient to let them know they are being involuntarily admitted. The patient must have the | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 33 (Ontario - Notice to Patient - Incapacity) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 33 (Ontario - Notice to Patient - Incapacity) Primer A Form 33 (Notice to Patient under Subsection 59(1) of the Act and under Clause 15(1) (a) and 15.1 (a) of Regulation 741) under the Ontario Mental Health Act is a form given to a patient anytime a physician deems them incapable to consent to treatment, manage their own property, and/or manage the collection/release/use of their health information. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 45, 47, and 49 (Ontario - Community Treatment Order - CTO) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 45, 47, and 49 (Ontario - Community Treatment Order - CTO) Primer A Community Treatment Order (CTO), is a provision under the Ontario Mental Health Act that allows a physician to mandate supervised treatment on a patient when they are discharged from hospital. The overall goal of CTOs is to prevent mental health deterioration due to medication non-compliance. This is especially applicable in patients with a history of deteriorating when off medication, and show improvement when they are b… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 49 (Ontario - Warrant of Committal) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Form 49 (Ontario - Warrant of Committal) Primer A Form 49 (Warrant of Committal, specifically, Section 672.57 of the Criminal Code of Canada) under the Ontario Mental Health Act is a court action that allows a judge to enforce a judgment or order against a person that has refused or neglected to comply with a known court ruling or order. The term | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Consent and Capacity Board (CCB) Hearings (ON) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Consent and Capacity Board (CCB) Hearings (ON) Primer In the province of Ontario, the Consent and Capacity Board (CCB) is an independent, government review panel that holds hearings to determine whether a patient meets the criteria for incapacity to treatment and/or involuntary hospitalization. The CCB is independent of the physician and the hospital, and is a quasi-judicial body. The CCB also maintains independence from the Ministry of Health and Long-Term Care. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Informed Consent and Capacity Assessment (ON)
Primer
Consent and Capacity are two central tenets in modern medicine and critical to patient autonomy, the respect for personal dignity, and the delivery of ethical care by physicians. This page focuses specifically on | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Emergency Capacity Assessments (ON) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Emergency Capacity Assessments (ON)
Primer
Sometimes, you may be paged about an urgent capacity issue while on call, and a patient wants to leave. The following 2×2 table can help guide your decisions on whether a patient should leave. When in doubt, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Long-Term Care Capacity Assessment (ON) Primer In Ontario, the law requires the consent of a patient before admission to a care facility such as a long-term care (LTC) home. However, one may not recognize his or her need for placement into a long-term care home, even when this placement is important to their health. Cognitive impairment or dementia, may cause a decline in memory, reasoning, planning and judgement, and make one incapable to decide if they need LTC. Thus, if incapacity is suspec… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Financial Capacity Assessment (ON) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Financial Capacity Assessment (ON) Primer A Financial Capacity Assessment should be done when there is concern that an individual could be incapable of managing their finances in the context of a psychiatric (e.g. - spending during a manic episode in bipolar I disorder) or neurocognitive disorder (e.g. - dementia). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Health Care Consent Act (HCCA) (ON) Primer The Health Care Consent Act (HCCA) applies to all aspects of health care in Ontario and provides rules for obtaining informed, voluntary consent from a substitute decision maker. Section 4 of the HCCA outlines the guidelines for consent and capacity (one shall not administer treatment without a patient's consent - otherwise it is battery or assault). The HCCA is what allows you to determine whether treatment can be imposed on an individual if you do n… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Power of Attorney (POA) (Ontario) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Power of Attorney (POA) (Ontario) Primer In Ontario, Power of Attorney (POA) is a legal document which allows an individual to transfer the right to make decisions (medical and financial) to a trusted individual (the “attorney”), should they become incapable to make their own decisions either due to physical or mental incapacity. Medical POA and financial POA are separately designated, but a single individual can be POA for both. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History of the DSM Primer The DSM (Diagnostic and Statistical Manual of Mental Disorders) has a long and storied role in the history of psychiatry. As the cornerstone of Western psychiatry and guide for millions of clinicians and healthcare providers, it has been the most significant advance in the diagnosis and treatment of mental disorders. However, in the midst of its success, important criticisms of its role have also arisen. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Statistics and Epidemiology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Introduction to Statistics and Epidemiology Primer Statistics and Epidemiology in Medicine is important for clinicians to understand. There can often be a difference in clinical outcomes seen in patients in clinical trials, compared to real-world, community settings. Clinical trials usually exclude patients with multiple diagnoses or comorbidities, whereas in the real world, patients have multiple diagnoses and conditions all the time. This disconnect means it can be challenging for clinicians… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Psychiatric Interview | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Psychiatric Interview Primer The Psychiatric Interview involves a balance of being empathetic, asking the right questions, and thinking about the diagnostic criteria carefully for psychiatric disorders. Remember, everyone has a different way of interviewing, but every question you ask should have a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diagnosing Psychiatric Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diagnosing Psychiatric Disorders Primer Diagnosing psychiatric disorders can be challenging, and below are some practical approaches for beginners. Anxiety See main section: Anxiety Disorders Is the anxiety in the background of euthymia (normal mood)? If so, then it is likely a primary anxiety disorder, such as generalized anxiety disorder. If the anxiety is in the background of a depressed mood, then depression with anxious features should override a primary anxiety disorder diagnosis. Anot… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Critical Appraisal and Statistics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Critical Appraisal and Statistics Primer Critical Appraisal is the process of carefully and systematically assessing the outcome of scientific research (evidence) to judge its trustworthiness, value, and relevance in a particular clinical context. When critically appraising a research study, you want to think about and comment on: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Physical Exam in Psychiatry and "Medical Clearance" | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Physical Exam in Psychiatry and "Medical Clearance" Primer The Physical Exam (and its associated investigations) is an important part of a psychiatrist's assessment -- a psychiatrist is a physician after all! Thus psychiatrists must play some role in assessing or diagnosing both psychiatric, | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Artificial Intelligence and Big Data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Artificial Intelligence and Big Data Primer * BIDMC DIGITAL PSYCH * Bhugra, D., Tasman, A., Pathare, S., Priebe, S., Smith, S., Torous, J., ... & First, M. B. (2017). The WPA-Lancet Psychiatry Commission on the Future of psychiatry. The Lancet Psychiatry, 4(10), 775-818. (see Part 5: Digital Psychiatry) * Liu, F., Allan, G. M., Korownyk, C., Kolber, M., Flook, N., Sternberg, H., & Garrison, S. (2016). Seasonality of ankle swelling: population symptom reporting using Google Trends. The An… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Apathy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Apathy Primer Apathy is a distinct neuropsychiatric syndrome that has various clinical definitions, which makes it difficult to study and examine clinically. It can be thought of as diminished cognitive plus emotional goal-directed behaviour.Marin, R. S., & Wilkosz, P. A. (2005). Disorders of diminished motivation. The Journal of head trauma rehabilitation, 20(4), 377-388. Apathy is not the same as depression. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Behavioural Modification | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Behavioural Modification Primer Behavioural Modification is a therapeutic and treatment approach designed to change a undesirable negative behaviour. By using a system of positive or negative consequences, an individual learns the correct set of responses for any given stimulus. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History of Psychiatric Biomarkers | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History of Psychiatric Biomarkers Primer Biomarkers in psychiatric disorders long been the “holy grail” of psychiatry. What is the status of the research and where are we now? The advent of the DSM-5 was suppose to be a new chapter in psychiatry where biomarkers and lab tests would aid in the diagnosis and treatment. However, that has not panned out. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Biopsychosocial Model and Case Formulation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Biopsychosocial Model and Case Formulation Primer The Biopsychosocial Model and Case Formulation (also known as the Biopsychosocial Formulation) in psychiatry is a way of understanding a patient as more than a diagnostic label. Hypotheses are generated about the origins and causes of a patient's symptoms. The most common and clinically practical way to formulate is through the biopsychosocial approach, first described in 1980 by George Engel. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Child and Adolescent Psychiatry Interview | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Child and Adolescent Psychiatry Interview Primer The Child and Adolescent Psychiatry Interview is a specialized psychiatric interview tailored to children and adolescents. It requires a particular focus on psychosocial factors. Timeline of Childhood Disorders When doing a child and adolescent assessment, it is very important to keep in mind the age of the child, and the likelihood disorders occurring at that particular age. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adverse Childhood Experiences (ACEs) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adverse Childhood Experiences (ACEs) Primer Adverse Childhood Experiences (ACEs) are traumatic events that occur during childhood (from age 0 to 17 years), these events range from experiencing abuse and witnessing violence to growing up in a household with substance and mental health problems. ACEs are strongly linked to risky health behaviours, chronic physical and mental health conditions, low life potential, and early mortality. There is a direct correlation between the number of ACEs and t… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clerkship Survival Guide | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Clerkship Survival Guide Primer Clerkship is tough! The following are some tips on surviving the psychiatry clerkship. This section remains a work in progress and under construction! Interviewing See main article: The Psychiatric Interview During your rotation, learning to develop interview skills is key. Depending on the population you are working with, you may need to do a more specialized | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatry Clinical Practice Guidelines (CPGs) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatry Clinical Practice Guidelines (CPGs) Primer Clinical Practice Guidelines (CPGs) (“Evidence-based guidelines”) are systematically developed statements to assist clinicians and patient in making decisions about appropriate health care for specific clinical circumstances. Often times, CPGs have an algorithmic or flow chart approach to help clinicians make decisions. Many different CPGs exists in different jurisdictions and countries. Here is a brief overview of the most common guideline… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cognitive Biases, Misdiagnosis, Iatrogenesis, and Overdiagnosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cognitive Biases, Misdiagnosis, Iatrogenesis, and Overdiagnosis Primer Cognitive Bias, Misdiagnosis, Diagnostic Overshadowing, Iatrogenic Diagnosis, and Overdiagnosis are important clinical issues to be aware about in medicine. This is especially important in psychiatry, since there are few objective clinical tests for most disorders, and relies on the subjectivity of both patient report and interpretation of these symptoms by clinicians. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Death and Dying | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Death and Dying Primer * New York Times: At His Own Wake, Celebrating Life and the Gift of Death * Driving Miss Norma: One Family's Journey Saying "Yes" to Living * New York Times: The End Series * New York Times: The Best Possible Day * 102 y/o Dancer Sees Herself on Film for the First Time * Randy Pausch: Last Lecture * NYT: The Deadly Choices at Memorial * The New Yorker: What Does It Mean to Die? Resources * YouTube: Sadie doesn't want her brother to grow up sh-suicide… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delusions and Hallucinations | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Delusions and Hallucinations Primer Psychotic symptoms (hallucinations and delusions) can occur in both clinical and normal, “non-clinical” populations.Verdoux, H., & van Os, J. (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia research, 54(1), 59-65. Thus, having a deep understanding of the phenomenology and possible diagnoses behind various subtypes of delusions and hallucinations is an important part of the diagnostic toolkit. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| V Codes (DSM-5) & Z Codes (ICD-10) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| V Codes (DSM-5) & Z Codes (ICD-10) Primer V Codes (used in the DSM-5 and ICD-9) and Z Codes (used in the ICD-10), also known as Other Conditions That May Be a Focus of Clinical Attention, are codes used to identify issues that are a focus of clinical attention or affect the diagnosis, course, prognosis, or treatment of a patient's mental disorder. However, these codes are | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Effect of Technology on Mental Health | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Effect of Technology on Mental Health Primer The Effect of Technology on Mental Health has become an increasing concern for clinicians. News Articles * The Walrus: Digital Distraction Is Bad for Creativity * Is social media out of control? * How to Beat F.O.B.O. (The Fear of Better Options), From the Expert Who Coined It * PsychologyToday - Gray Matters: Too Much Screen Time Damages the Brain * Manoush Zomorodi says it’s time to get bored * The Guardian: Facebook reveals news fe… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Exercise Prescription | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Exercise Prescription Primer Exercise is structured physical activity with the goal of maintaining or improving physical fitness or health. Exercise is a highly effective, but often under-utilized treatment in the management of psychiatric disorders. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatric Genetics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatric Genetics Primer Psychiatric Genetics is the study of the role of genetics in the development of mental disorders. Although many mental disorders are highly heritable, gene and environmental interactions play an important role.Musci, R. J., Augustinavicius, J. L., & Volk, H. (2019). Gene-environment interactions in psychiatry: recent evidence and clinical implications. Current psychiatry reports, 21, 1-10. Mitochondrial Diseases | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Psychiatry Interview | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Geriatric Psychiatry Interview Primer The Geriatric Psychiatry Interview is a specialized psychiatric interview tailored to older adults. It requires a particular focus on cognitive testing, neurological examination, and physical exam. An examination of psychosocial factors is important, in particular with functional status (ADLs and IADLs), family supports, and social isolation. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History of Psychiatry | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History of Psychiatry Primer The History of Psychiatry is important for all physicians to understand. Progress in mental health care has not always been in a straight line, and patients have also suffered because of this (e.g. - lobotomy and indiscriminate use of ECT). Understanding historical treatments and views of mental illness informs the care we provide today, and is important for all physicians. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Investigational Treatments | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Investigational Treatments Primer Many investigational and unconventional treatments have been tried in psychiatry. Some have been promising in small clinical trials, but have not panned out in larger studies. Open Dialogue * The Independent: Open Dialogue: The radical new treatment having life-changing effects on people's mental health * Freeman, A. M., Tribe, R. H., Stott, J. C., & Pilling, S. (2019). Open dialogue: a review of the evidence. Psychiatric Services, 70(1), 46-59. Pyrothe… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Landmark Psychiatric Research Studies and Papers | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Landmark Psychiatric Research Studies and Papers Primer There are many landmark psychiatric studies in psychiatry that clinicians should be aware of. Key studies are listed below (work in progress). STAR*D Level 1 STAR*D (Sequenced Treatment Alternatives to Relieve Depression) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Malingering | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Malingering Primer Malingering is the intentional production false or grossly exaggerated physical or psychological complaints with the goal of receiving a reward. Malingering is not a mental disorder or diagnosis. Incidence See also: Mittenberg, W. et al. (2002). Base rates of malingering and symptom exeggeration. Journal of clinical and experimental neuropsychology, 24(8), 1094-1102. * The true rates of malingering is difficult to determine, as the nature of malingering involves deceptio… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mass Psychogenic Illness (MPI) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mass Psychogenic Illness (MPI) Primer Mass Psychogenic Illness (MPI) (also known as called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria, or mass hysteria) is the spread of illness symptoms through a population where no infectious agent is identified for the contagion. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical Reversal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical Reversal Primer Medical reversal refers to when newer and more methodologically sound clinical trials produces findings that contradicts existing clinical practice (from which older trials were based on). The term was coined in 2011 by Vinay Prasad, Victor Gall, and Adam Cifu. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mental Status Exam (MSE) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mental Status Exam (MSE) Primer The Mental Status Exam (MSE) is a systematic way of describing a patient's mental state at the time you were doing a psychiatric assessment. An observant clinician can do a comprehensive mental status exam that helps guide them towards a diagnosis. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perspectives Approach to Psychiatry | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perspectives Approach to Psychiatry Primer The Perspectives Approach to Psychiatry is increasingly used as an alternative approach for the diagnosis and treatment of patients with psychiatric disorders, and is a valuable educational tool for teaching psychiatry to learners. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pharmaceutical Industry Influence | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pharmaceutical Industry Influence Primer Pharmaceutical Industry Influence is an important issue that all healthcare providers must be aware of. Unforunately, there is often little education on this during formal training. In psychiatry, the pharmaceutical industry and psychiatry have been inextricably tied together since the beginning of the psychopharmacology revolution in the 1950s. It should be noted that pharmaceutical industry influence is pervasive and not limited to psychiatry. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phototherapy (Light Therapy) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phototherapy (Light Therapy) Primer Phototherapy (Light Therapy) is exposure to daylight or to specific wavelengths of light as a treatment for psychiatric disorders. The light is typically administered at home with a fluorescent light box for a prescribed amount of time and, in some cases, at a specific time of day. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pseudobulbar Affect (PBA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pseudobulbar Affect (PBA) Primer Pseudobulbar affect (PBA) (also referred to as emotional lability, reflex crying or laughing, emotional incontinence, or involuntary emotional expression disorder) is a neuropsychiatric syndrome common in neurological disorders including | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychobiotics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychobiotics Primer Psychobiotics is a relatively new and emerging field of psychiatry. The body's microbiome plays important roles in inflammatory response and neurologic function. Mania * Certain individuals with acute mania have been found to have elevated levels of inflammation, suggesting a possible role for probiotic use. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rare and Unusual Neuropsychiatric and Psychiatric Syndromes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rare and Unusual Neuropsychiatric and Psychiatric Syndromes Primer Rare and Unusual Neuropsychiatric and Psychiatric Syndromes exist in the medical literature. Here are some of the more common ones to be aware of, especially during a medical and psychiatric assessment. Some external videos are also included on this page to help you better understand them (both humorous and educational ones). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Self-Harm (Nonsuicidal Self-Injury) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Self-Harm (Nonsuicidal Self-Injury) Primer Nonsuicidal Self-Injury (NSSI), commonly referred to as self-harm, is the intentional destruction of one’s own body tissue without suicidal intent and for purposes that are not socially sanctioned. Resources | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Social Determinants of Health | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Social Determinants of Health Primer Social Determinants of Health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatry STACER Preparation Guide | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychiatry STACER Preparation Guide Primer The Standardized Assessment of a Clinical Encounter Report (STACER) is a semi-structured examination of Canadian psychiatry resident’s interviewing and consultancy skills. An STACER examination is usually a 50 minute diagnostic interview of a volunteer patient that both the resident and examiners do not know. The purpose of the STACER is to demonstrate your | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical Assistance in Dying (MAiD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical Assistance in Dying (MAiD) Primer Medical Assistance in Dying (MAiD) was approved in Canada in June 2016, allowing for a legal pathway for Canadians to pursue and receive physician-assisted suicide. Suicide in Canada * Suicide was part of the Canadian Criminal Code starting in 1892, meaning anyone found guilty of committing suicide or aiding in suicide could be incarcerated | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suicide Risk Assessment (SRA) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suicide Risk Assessment (SRA) Primer The Suicide Risk Assessment is an important part of the psychiatric interview. A suicide risk assessment is a comprehensive assessment that determines what an individual's risk is for suicide at a given point in time | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suicide | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suicide Primer Suicide is the act of ending one's own life. From a historical perspective, for thousands of years, the concept of suicide has been debated philosophically and from religious viewpoints. Today, suicide is seen from a combination of medical, social, legal, and political lenses. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Violence and Mental Illness | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Violence and Mental Illness Primer The relationship between violence and mental illness is a challenging issue that clinicians face. The association between the two is commonly linked together in popular media and society, resulting in an exaggerated and misunderstood perception of mental illness. Clinicians are often placed in a difficult position of being asked to assess the risk that a patient could pose to the public, while also being asked by society/law to keep an individual's personal l… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical-Legal Liability | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Medical-Legal Liability Primer Medical-Legal Issues and Liability are important areas that a physician will either encounter themselves or know of a colleague who encounters it. Medical-legal issues against physicians span the spectrum, including complaints to a regulatory authority (college) or hospital, patient privacy issues, disciplinary proceedings, practice audits, malpractice or negligence, or in rare cases, criminal proceedings. The scope of this article is to discuss common medical-le… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Physician Wellness | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Physician Wellness Primer Physician wellness is often unaddressed in day-to-day practice. As medicine grows more complex, new stresses and demands are placed on healthcare providers. Only recently has the literature begun to investigate the role of burn out, compassion fatigue, and moral distress on healthcare providers. These phenomena do not just affect physicians, but also nurses, social workers, and other providers. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trauma and Stressor Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trauma and Stressor Disorders Primer Trauma is any event where an individual: (1) directly experiences, witnesses (in person), (2) learns about a trauma that occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental), or (3) experiences, first-hand, repeated, or extreme exposure to aversive (unpleasant) details of the traumatic event (and does not learn about it through media, pictures, television, or movies, except for work-relat… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute Stress Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute Stress Disorder Primer Acute Stress Disorder (acute stress reaction, psychological shock) is a mental disorder that arises in response to experiencing or witnessing a traumatic event that induces a strong emotional response within the individual. Common traumas include combat/war in males, assault/rape in females, torture, natural disasters, and serious accidents. Acute stress disorder is a | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjustment Disorder | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjustment Disorder Primer Adjustment Disorder (sometimes called situational depression) is an excessive and abnormal reaction to a life stressor.Casey, P., & Bailey, S. (2011). Adjustment disorders: the state of the art. World Psychiatry, 10(1), 11. The reaction is more severe than normally expected and results in significant social, occupational, or academic impairment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Posttraumatic Stress Disorder (PTSD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Posttraumatic Stress Disorder (PTSD) Primer Posttraumatic Stress Disorder (PTSD) is a mental disorder diagnosed after an exposure to trauma, including actual or threatened death, serious injury, or sexual violation. It is characterized by intrusive and distressing memories or dreams, dissociative reactions, and substantial psychological or physiological distress related to the event. A diagnosis of PTSD requires evidence of exposure to trauma, and is characterized by intrusive and dissociativ… | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| PsychDB Manual of Style (MoS) and Syntax | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PsychDB Manual of Style (MoS) and Syntax Primer The PsychDB Manual of Style (MoS) is the style manual for all PsychDB articles. This MoS details PsychDB's house style, to help editors write articles with consistent and precise language, layout, and formatting, making PsychDB easier and more intuitive for users. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cognitive Testing | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Psychopharmacology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| External Tools Psychopharmacopeia Medication Picker Drug Costs Medication Switcher Medication Stopper Psych. Meds. 3rd Ed. Medication List Welcome to the Medication section. Below is a non-comprehensive list of commonly used psychiatric/neurologic medications. Click on a drug below for more information. This section is still under construction. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| On-Call Resources | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| On-Call Resources On-Call Patient Care Suicide Risk Assessment (SRA) ---------- Always document “CAIPS” * Chronic Factors * Acute Factors * Imminent Warning Signs * Protective Factors * Summary Statement Safety Planning * [Coping with Suicidal Thoughts] * [Safety and Comfort Plan] * [Coping Card] * [Safety Planning Template (CAMH)] * [Using DBT Skills in the ER] ---------- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Personality Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Teaching Files | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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