Psych Notes

Major Depressive DO (Suicide)

-Depression Dx Sig. risk factor for suicide
-Largest risk factor male and female all ages: Hx of prior suicide
attempt
-90% of youth who commit suicide has comorbid psychiatric illness
-Cutting is NOT a risk factor for suicide
-Risk factors for completed suicide:
<>Male gender
<>Prior suicide attempt
<>Hx psychiatric illness
<>Fam HX
<>Substance abuse
-Pt 17yo F, hx of MDD, depressed mood, problems sleeping, appetite,
fatigue, problems concentrating. You are primary care doc.
-Next Step: Refer to psychiatrist to be seen in next few days
-Why not admit? No imminent risk of self harm or harm to others
-MDD First Line: SSRIs
-How do children present different than adults?
Adults: Depressed mood x 2 weeks or more
Children: Irritable mood may be substituted for depressed mood
--The required symptoms (sleep, appetite, anhedonia, concentration,
and psychomotor
functioning) are same for adults and adolescents in MDD
Sleep Terror DO
-Night terrors : Repeated episodes of sudden awakening from sleep +
panic sx that begin with a scream and association with unresponsiveness to
comfort or awaken them
-Stages 3-4 (Stage 3 DSM V)
Nightmare DO
-Latter third of night during REM sleep. When awakened person is easily
aroused and oriented
Intermittent Explosive DO
-Pt is awake; Outbursts of anger and sometimes violent behavior
Narcolepsy Triad
Sleep attacks
Cataplexy (sudden loss of muscle tone)
Hypnopompic/hypnagogic hallucinations or sleep paralysis