CM1- Psychiatry Unit Fall 2022

Bipolar I can be mania + depression or just mania.

Bipolar II is major depression + hypomania.

Hi Quincy,

For medications that are used for withdrawal symptoms of substances (like methadone for OUD), are they given before the patient starts having withdrawal sx or while they're having it?

Like if I have a patient who wants to stop opioids but they are afraid of the withdrawal sx, can i give them the medication in anticipation of the withdrawal sx? or do i have to wait until they start experiencing withdrawal sx to prescribe it?

Hi Quincy,

if the sx for benzo and alcohol withdrawal are the same, how do we differentiate between them? (it is through hx?)

Is bipolar 1 mania and depression? Or just mania?

Is bipolar 2 hypomania and depression? Or can it just be hypomania?

I would recommend having a general sense of interpretation, but you do not need to memorize numbers. It's more important that you recognize signs/symptoms on the tools that correlate to diagnoses.

Hi Quincy,

Do you expect us to know how to interpret specific scores for the screening tests for mental illness (e.g. PHQ9, AUDIT, GAD-7)?

Your score will be the grade that is recorded.

Is the opioid module graded on completion or the number grade that is given?

Okay to say judgement is poor or fair, etc.

When writing up our mental status exam should we include reasoning for why we say certain things or is it okay just say "Judgement is impaired." for example

Thanks for asking! We hadn't opened it yet, but you should see it under assignments now.

Hello! Where can we upload the Mental Status assignment? Thank you.

Once you complete it, your score is recorded.

The current recommendation is to screen all adults for depression. Brand new USPSTF guidelines also recommend screening adolescents 12-18 for major depressive disorder. Basically, we're screening 12 and up at this point at least annually if not more frequently.

Yes! Great point-- to consider a broad differential that includes these diagnoses when considering depression. Thank you!

I am confused by the statement lecture on the USPSTF slide that when people come in for a physical we should screen for depression, but we should not screen the average person... so who should we be screening?

I think it might be important to include things like post-viral syndrome, post-covid syndrome, and ME/CFS in the differential diagnosis for depression. These patients tend to be written off or misdiagnosed with depression and not many providers are all that familiar with these conditions. Some even end up developing depression/anxiety due to the lack of help from the medical community.

How do we submit the opioid module?

I'm happy to be working with you all on the CM Psych Unit. I will check and respond to this board once daily during the course.

Good question! MDD with psychotic features is centered around depression and sometimes people will have delusions or hallucinations related to guilt or feelings of worthlessness. The person must meet the criteria for depression. With schizophreniform d/o or other psychotic disorders, the disorder is centered around the psychosis-- delusions, hallucinations, disorganization. There may be some mood changes, but the primary presentation is the psychosis. Sometimes we would have both of these diagnoses on our differential and it might take some time to determine which it is.

How do we distinguish between MDD with psychotic features and schizophreniform disorder?

Great question! For most of the medications, we wait until the person is in withdrawal as their symptoms guide dosing. There are also risks of some meds while still using (i.e. methadone and opioids).

Yes, history, physical exam, and diagnostic studies!

read over the slides, but no need to memorize.