I'm rebuilding this site in a simpler format. Sorry that some of the pages are still unformatted.
Notes from The Curbsider's podcast, episode #35: Depression: MDD with DJ MMC
SSRI's should be first line for depression if no contraindications.
SNRI's instead if any neuropathic symptoms.
For mild-moderate depression, CBT is equal to medication.
In the Star-D study, Citalopram was the base SSRI.
Use the PHQ-9 to get a baseline score. Response to treatment is defined as a 50% drop in PHQ-9 score. Remission is defined as a score of 5 or less.
If, after treatment, the patient improves 50% (or less?) on the PHQ-9, add an adjunctive treatment. Possible augmentation meds include mirtazapine, bupropion, TCAs, aripiprazole, quetiapine.
Follow up in 2 weeks ideally. 4-6 is sometimes more realistic. Telephonic follow-ups have decent effectiveness.
What did they say about Abilify and Aripiprazole?
The key to the diagnosis of schizophrenia/psychosis is that there has been a marked decline in the level of functioning (i.e., the man is homeless and cannot care for himself). Although hallucinations or delusions are not mentioned in the case history, the presence of disorganized speech, grossly disorganized behavior, and the duration of symptoms (longer than 6 months) suggest a diagnosis of schizophrenia.
\r\nIn schizoaffective disorder, alterations in mood are present during a substantial portion of the illness.
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\r\nAlthough schizoid personality disorder produces detachment from social relationships and is characterized by restriction of emotional expression, it is not accompanied by a marked decline in occupational functioning.
\r\n
\r\nSchizophreniform disorder is characterized by schizophrenic-like symptoms, but the duration of symptoms is, by definition, less than 6 months.
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\r\nSchizotypal personality disorder is characterized by eccentricities of behavior, odd beliefs or magical thinking, and difficulties with social and interpersonal relationships. Unlike schizophrenia, schizotypal personality disorder is not characterized by a formal thought disorder.
Schizoid is, grossly simplified, adult-onset Autism
Schizoid personality disorder characteristics are a lack of desire for social relationships, a preference for solitary activities, little interest in most activities or intimacy, and a flattened affect. Schizoid personality disorder can be differentiated from autism spectrum disorder by the age of onset. SPD typically has an onset around the beginning of adulthood. Not experiencing any psychotic symptoms further lends support for this diagnosis.
The patient is experiencing auditory hallucinations and disorganized thinking, both of which are congruent; the symptoms have persisted for at least 1 month, but less than 6 months. These symptoms are consistent with a diagnosis of schizophreniform disorder.
Schizophrenia and schizoaffective disorder can be ruled out at the present time because the symptoms have not persisted for at least 6 months. The patient does not present with any symptoms of a mood disorder, which further supports ruling out schizoaffective disorder.
A brief psychotic disorder can be ruled out because the symptoms have persisted for at least 1 month.
Substance/medication-induced psychotic disorder can be ruled out due to the lack of any reported substance use.
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Find Jeff's Big M, little m thing and put it here.
'),Risperdal + Abilify are great for autism outbursts
Neuroleptic ~~ antipsychotic ~~anti-manic