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Table ofContents
PSYCHIATRY
Mental Status Exam (MSE)
Ego Defense Mechanisms
Psychotic Disorders
Psychotic Disorders & Antipsychotics
Antipsychotics & Emergencies
Neurobiology
Mood Disorders
Antidepressants
Personality Disorders
Mood Disorders
Mood Stabilizers
Anxiety Disorders
Factitious & Somatic Disorders
Dissociative Disorders
Sleep Disorders
Eating Disorders
Child & Adolescent
Child & Adolescent Disorders
Stimulants & Hallucinogens
Depressants & Alcohol Use Disorder
Neurocognitive Disorders
Dementia vs Delirium
Types of Psychiatric Therapy
DSM-5Summary
Notes
About the Author
Disclaimners
5
6,7
8
10
11
12, 13
14
15
16
17
18, 19
20
21
22, 23
24
25
26,,27
28
29
30,
32
33
34, 35
36
37
38
LEGEND
!
RISK FACTORS
SUPPORTIVE
MANAGEMENT
PHARMACOLOGIC
MANAGEMENT MEMORY TRICKS HIGH-YIELD CONCEPTS
Mental Status Exam(MSE)
MSE
APPEARANCE
Grooming, stated age, clothing
BEHAVIOR
Mannerisms (gestures, expression, eye
contact) + attitude (cooperative, hostile,
focused, distracted)
SPEECH
Quantity, rate, volume, fluency/rhythm
MOOD
Patient's own description of mood
AFFECT
Observation of patient's mood
THOUGHT PROCESS
Logic, relevance, organization, flow
THOUGHT CONTENT
Thoughts, worries, beliefs, delusions
PERCEPTUAL DISTURBANCES
Hallucinations, illusions
COGNITION
Orientation, memory, reasoning.
consciousness
INSIGHT
Understanding of illness
JUDGMENT
Decisions regarding illness
MOTOR
Movements
GAIT
Observation of patient walking
EXAMPLE
Shuffling gait, well-groomed, appears stated age,
appropriately dressed.
Good/poor eye contact, restless, disinhibited.
Pressured speech, quiet, clear, perseverative
(repeating phrases).
"Good," "angry," "sad," "fine".
FLUCTUATION:labile (sudden shifts)
RANGE:full, flat, constricted
DESCRIPTION:sad, hostile, euphoric.
Linear, goal-directed, circumstantial,
tangential, flight of ideas.
DELUSIONALwith fixed, false beliefs.
HALLUCINATIONS:false perceptions without real
stimuli (can be auditory, visual, etc.)
LLUSIONS:false perceptions of real stimuli.
Oriented x3 (person, place, time), disoriented,
alert, fluctuating.
Poor, improving, good.
Poor, improving, good.
Normal, psychomotor agitation,
psychomotor retardation.
Normal, wide based, shuffling.
Ego Defense Mechanisnms
ID/EGO/SUPEREGO
CONSCIOUS MIND
Freudian psychoanalytic theory for structural
components of the brain that guide behavior
EGO -mediator/middle"
rational decision-maker between
demands of D andSUPEREGO
SUPEREG0- "superior
societal rules andmorals that
dfferentiate right fromwrong
ID= instincts"
unconscious, primitive demands
for immediate satisfaction
Mechanisms to reduce stress and facilitate coping
(mature = adaptive, immature = maladaptive/detrimental)
SUBLIMATION
→ALTRUISM
SUPPRESSION
HUMOR
Maturedefense
mechanisms can be
rememberedwith
the mnemonic:
SASH
REPRESSION
(imvoluntary)
Ws
UNCONSCIOUS MIND
EGO DEFENSE MECHANISMS
A student redirects anger to perform well in
athletics
A wealthy businessperson donates a portion of
their money to charity
A nurse voluntarily puts a bad outcome out of
mind to finish seeing patients
A surgeon cracks a joke after performing a
difficult procedure
A man with alcohol use disorder does not
believe he has a problem
A patient with troubled relationships does not
recall abuse from childhood
A man starts wetting the bed after
experiencing a traumatic event
A man who was abused in childhood continues
to wet the bed into adulthood
DENIAL
REPRESSION (invotuntary)
REGRESSION
go back stages
FIXATION
RETT SYNDROME
Ws Regression + hand
flapping + ataxiaMS
(MeCP2 mutation)
never get past the stage
Ego Defense Mechanisms Cont.
EGO DEFENSE MECHANISMS
A patient expresses their anger by throwing
their meal tray.
A father who never wanted children becomes
a "super dad."
A man becomes angry and yells at the family
dog (neutral 3rd party).
A person stealing money from their
workplace accuses a coworker of stealing.
An alcoholic justifies drinking by saying that
it helps him relax and sleep better.
An alcoholic justifies drinking by saying that
only 1/10 have severe liver disease.
A child explains abuse they endured without
expressing any emnotion.
A teenager who is bullied at school begins
bullying his younger siblings.
A medical student boasts about the resident
they are working with while ignoring any flaws.
A war veteran cannot recall events from a
family party that involved fireworks.
A patient "loves her doctor but refuses to
speak to them the following day.
EGO DEFENSE MECHANISMS
Projection
Rationalization
Dissociation
Splitting
Intellectualization
Isolation of Affect
ldentification
ldealization
Reaction Formation
Acting Out
Displacement
ACTING OUT
V/S
REACTION FORMATION
doing the exact opposite of thoughts
DISPLACEMENT
PROJECTION
"projecting" inner thoughts
RATIONALIZATION
justifying with reasonableexamples
INTELLECTUALIZATION
ISOLATION OF AFFECT
"isolating" emotion
IDENTIFICATION
IDEALIZATION
DISSOCIATION
SPLITTING
associated with:
BORDERLINE PERSONALITY DISORDER
ĐortTRY this at home!
Cover the right side with a piece of paper
and read the descriptions on the left,
trying to match them with the egodefense
mechanisms listed in the word bank.
Psychotic Disorders
Brief PsychoticDisorder
TYPICALLY STRESS-RELATED)
Symptoms of schizophrenia lasting
d month with 1+ positivesymptom.
NOT TO BE CONFUSED WITH
S SCHIZOAFFECTIVE
lDISORDER
 1 month.
Persistent delusion(s) without major
impairment in function.TREATMENT:
CBT, antipsychotics
ILLUSIONS
HALLUCINATION
PsychoticDisorders& Antipsychotics
Schizophrenia
2+ of the following symptoms lasting for 6+ months
> Must include at least 1 positive symptom
+Marked dysfunction in work, relationships, hygiene, etc.
POSITIVE SYMPTOMS
Positive = presence of additional behavior or experience.
Delusions
Hallucinations (auditory = most common)►
Disorganizedspeech
Disorganizedbehavior
M>E PEAKONSET:
Males (18-25), Females (25-35)
MRVCT FINDINGS:
> enlarged ventricles & decreased cortical volume
NEGATIVE SYMPTOMS:A'S
Negative = loss of prior function.
Arfect (flat)
Anhedonia
Alogia (poverty of speech)
Asociality
First line: atypical antipsychotic (fewer side effects)
Second line: typical antipsychotic (indefintely)
>6months
TYPICAL ANTIPSYCHOTICS
HIGH-POTENCY
HALOperidol
TriFLUoperazine
FLUphenazine
THINK!
# A'S
ctel Better prognosis: Acute onset,
older,predominantlypositive / mood
symptoms (acute, old, positive)
D2 receptor antagonists treat positive symptoms
LOW-POTENCY
Chlorpromazine
Thioridazine
SIDE EFFECTS
Corneal deposits,
purple-yelowdiscoloration
ReTinat deposits
HALOS FLYHIGH
Typical antipsychotics are more likely to cause:
EXTRAPYRAMIDAL SYMPTOMS
Neuroleptic Malignant Syndrome (NMS)
al-antagonism (orthostasis)
EXTRAPYRAMIDAL SYMPTOMS
Acute Dystonia
-4hours
(Hours to days)
Musclerigidity.
fever
Benztropine or
anticholinergic
(Diphenhydramine)
Akathisia
-4 days"
(Days to months)
0Restlessness
B-blocker
(Propranolo) or
benzodiazepines
RULEOF 4S
QTcprolongation
Antihistamine (drowsiness)
Anticholinergic(drymouth /constipation)
(Avoid inelderly,ifpossible)
REMEMBER!"ADAPT"
Parkinsonism
-4weeks"
(Weeks to months)
Akinesia/
bradykinesia
Amantadine
(benztropine)
OR anticholinergic
(Diphenhydramine)
Tardive Dyskinesia
-4 months
(Months to years)
Abnormal facial movement
G.e., lip smacking)
Switch from typical to atypical
to Clozapine
Add or treat with VMAT-
inhibitor (valbenazine)
TREATMENT
Antipsychotics &Emergencies
ATYPICAL ANTIPSYCHOTICS
FEWER SIDEEFFECTS = FIRST-LINE TX OF SCHIZOPHRENIA
D2 + 5-HT2A antagonists treat positive + negative symptoms
RISPERIDONE
THINKI"Ris-pair-adone" =
milk from a "pair" of breasts
QUETIAPINE
THINKI"Quiet"
ZIPRASIDONE/
LURASIDONE
OLANZAPINE
THINKI"Big "o" for Obesity
NEUROLEPTIC
MALIGNANT
SYNDROME
LEAD-PIPErigidity
Rhabdomyolysis(tCK)
Myoglobinuria
► Encephalopathy
Lan patientstakingantipsychotic
TYPICAL >ATYPICALD
TREATMENT:
Discontinue agent
Dantrolene
THINK!
D'S
Diazepam (benzodiazepine)
D2 agonist (bromocriptine)
SIDEEFFECTS
Hyperprolactinemia
ARIPIPRAZOLE
THINK!"A-Rush-priprazole"=
quick uptitration → restlessness
CLOZAPINE
THINK! Watch "Clozely"
for neutropenia
Sedation (dosed
at night)
Ziprasidone is
also known for
QTc prolongation
Metabolic effects
(obesity)
Used for refractory
schizophrenia (due toSEs)
SIDE EFFECTS
Agranulocytosis
Metaboliceffects
Lowers seizure Threshold
Myocarditis/Cardiomyopathy
Atypicalantipsychotics are more likely to cause: metabolic syndrome & prolonged QTc!
SEROTONIN SYNDROME
CLONUS (hyperreflexia)
Hyperactivity
► Diarrhea
Tremor
MAOIS
TCAS
Tramadol
SSRI +/- ►Ondansetron
Triptans
MDMA
Antitussive
a InpatientstakingSSRI+/-
(SSRIalone is an unlikely causeofSS)*
DIAGNOSIS: Urinary 5-HIAA
TREATMENT:
Assess for co-ingestion
Benzodiazepine
THINK!
ABCD'S
Cyproheptadine (5-HT2 receptor antagonist)
Discontinue agent
Fever
Tachycardia
Hypertension
Sweating
Neurobiology
Dopamine Pathways
PREFRONTALCOR
CORTEX
NUCDEUS
ACČyphsENs
HYPOTHALAMUS
ANTERIOR
vT PITUITARY
ŠUBŚTANTIA
NIGRA
STRIATUN
MESOLIMBIC
► Increased activity= positive symptoms of schizophrenia.
Antipsychotics (APs) block mesolimbic pathway, reducing
positive symptoms.
MESOCORTICAL
Antipsychotics decrease activity in schizophrenia
= negative symptoms.
THINK! Cortex is responsible for thoughts/feelings
NIGROSTRIATIAL
Antipsychotics block this pathway = extrapyramidal
symptoms (ADAPT).
THINK! Substantia nigra and striatum are responsible for motor control
TUBEROINFUNDIBULAR
Antipsychotics block this pathway = increase prolactin
lgalactorrhea.
THINKI "tube" = "boob" (lactation and gynecomastia)
Very broadly: GABA and serotonin are calming
norepinephrine and acetylcholine are activating
Dopamine Norepinephrine
Mood Disorders
GABA Serotonin Acetylcholine
ANXIETY
DEPRESSION
ALZHEIMER'S
DISEASE
Decreased Acetylcholine
with widespread cortical
atrophy.
"Sadness Decreases Neurotransmitters"
Neurocognitive Disorders
PARKINSON'S
DISEASE
Decreased dopamine
(substantia nigra) and
serotonin (raphe).
HUNTINGTON
DISEASE
GABA
Acetylcholine
Substance P
Hunter Gasping
"GASP"
Mood Disorders
MAJOR DEPRESSIVEDISORDER
Sleep changes
Interest decrease
Guilt/worthlessness
Energy loss/fatigue
Anhedonia (inability to feeljoy) ORdepressedmood
+4 SIGECAPS symptoms lasting »2 weeks
THINK! "Blues formorethan 2" (weeks)
Concentration issues
Appetite I weightchange
Psychomotor impairment/agitation
Suicidal ideation (Warrantshospitalization)
GWORKUP:Checkunderlyingconditions
(i.e. colon cancer, hypothyroidism)
(CheckTSH: +/- constipation, cold
intolerance, weight gain)
80| TREATMENT:CBT +SSRI,
ECT (treatment-resistant
depression)
Can also present as:
ATYPICALDEPRESSION Leaden paralysis, hyperphagia,
hypersomnelence
DEPRESSIONINCHILDRENMay present as irritability +/-
academic decline, social withdrawal
NOTTOBECONFUSEDWITH -
SEASONAL AFFECTIVE DISORDER
>2 MDDepisodes with seasonal
pattern (fall /winter) lasting > 2 years
9TREATMENT:Light therapy+-SSRIS
Also called: Persistentdepressive disorder
REMEMBER!
2/2/2
Psychosisoccursat peak
DYSTHYMIA
Depressed mood with 2+ depressive symptoms for 2+ years
with no lapses in symptoms longer than 2+ months.
TREATMENT:CBT +/- SSRI
MOOD DISORDER WITH PSYCHOSIS
Persistent mood disorder with psychosis occuring during
mood exacerbation (psychosis is never present in absence of
mood symptoms).
MDD +Psychosis
Depressedmood Depressedmood
Psychosis
Depressed mood
NOTE: often resistant to treatment!
Elevated mood
Psychosis occursat trough
12
Mood Disorders Cont.
Postpartum Onset
WEEKS:
PSYCHOSIS
Symptoms that emerge within 12 months of giving birth
1 2 3
0-4 weeks postpartum = Postpartum psychosis
Delusions / hallucinations / thoughts of harming self or baby
8TREATMENT: Hospitalization + CBT + antipsychotics
DEPRESSION: 60)
Depression
+
Access to
firearms is an
independent risk
factor for suicide:
completion.
2+ weeks = Postpartum depression
Depressed affect, anxiety. poor
concentration, functional impairment
cBT + SSRI
4
Acceptance Anger
REMEMBER!
SAD PERSONS
Priorattempt
Ethanol / drug use
Rational thinking
impaired
Sickness (medical
illness)
Organized plan
No social support
Stated future intent
Suicidal intent
requires
hospitalization
Depression
PATHOLOGIC
Functional impairment.Coping with no functional impairment.
Normal grieving period
Months
Bargaining
If longer, diagnose. PERSISTENT
COMPLEX
BEREAVEMENT
DISORDER
Hearing voices of living or
hearing voices saying to
hurt oneself is abnormal
Children
Hearing voices of
deceased can be normal
Patients CAN also meet criteria for MDD or brief
psychotic (+hallucinations)
Adults
Antidepressants
Antidepressants
-FIRST + SECOND-LINE
No response in 6-8 weeks? increase dose or prescribe a different SSRI/SNRI
SSRI TREATMENT:
Depression/dysthymia, anxietydisorders,
PTSD, fibromyalgia, OCD
SIDEEFFECTS:
Gl upset, headaches, stimulating effects,
sexualdysfunction / anorgasmia (treatment
for premature ejaculation)
SIDE EFFECTS:
Hypertension
-THIRD-LINE-
MAO Phenelzine
Tranylcypromine
Isocarboxazid
TCAS
DURATION OFTREATMENT:
First MDD episode:
Treat until remission, then
continue for 6months.
Recurrent MDD:
Treat until remission, then
continue for 2years.
SIDE EFFECTS:
Serotonin syndrome (irreversibly
inhibits the reuptake of serotonin,
norepinephrine, and dopamine)
Hypertensiveemergencywith
tyramine-containing foods (treat
with phentolamine)
TREATMENT:
Neuropathic pain (1st line),
migraine prophylaxis,
treatment-resistant depression
SIDE EFFECTS:
Anticholinergic: opposite
of DUMBBELLS
Fluoxetine
Sertraline
Citalopram
Paroxetine
Escitalopram
VenlafaxineSNRI Duloxetine
Antidepressant
-Discontinuation-
Syndrome
Remember FINISH
Ftu-like symptoms May last up to 2
weeks forSSRIS
with longhalf-Gfe
(Eg fluoxetine)
Insomnia
Nausea
Instability
Sensory disturbances
Hyperarousal
Amitriptyline
Nortriptyline
Clomipramine
Doxepin
3C's of TRlcyclic overdose!
Cardiotoxicity
Coma
TREATMENT:
Convulsions Antiadrenergic:orthostatic
hypotension
Antihistaminic: sedation,
weight gainSodium bicarbonate
BEFORE STARTING AN ANTIDEPRESSANT:
Screen for past manic episodes (differentiates between
MDD / Bipolar I / Bipolar I1)DIGFAST
Starting an antidepressant in a patient with
Bipolar I /Bipolar ll can precipitate acute mania!
AtypicalAntidepressants
PROS
No sexualsideeffects
Disincentivizes smoking----Few sexual side effects
Increases appetite/sleep
Improves sleep
(treats insomnia)
BUPROPION
MIRTAZAPINE
TRAZODONE
Used for treatment-resistant depression or to treat
comorbid conditions (insomnia, sexual dysfunction)
CONS
► Lowers seizure threshold (especially
in patients with eating disorders)
Sedation
Weight gain THINK! MEALtazapine!
--
Priapism Traza-bone!
► Orthostatic hypotension
THINK! TraZ2Zodone for sleep
PersonalityDisorders
Patterns of thought or behavior that are enduring, stable between different situations, and deviate from
expected mores for that particular culture/community.
May cause the person or others distress, functional impairment, etc. Are considered egosyntonic
→ patient does not recognize
behaviours as problematic!
SCHIZOTYPAL
"a"typal = Atypical
SCHIZOID
Purposely avOIDs others
PARANOID
Reality testing is
intact vs. Psychosis
ClusterA Wacky/ Weird"
Genetic association with Schizophrenia
Eccentric person with odd beliefs, magical thinking.
"Loner who has little interest in forming relationships.
Person with enduring distrust and suspicion of others.
Cluster B WilerGeneticassociationwithMoodDisorders / SubstanceAbuse
Person who needs to be the center of
attention," with sexual suggestibility.
Impulsive person with unstable
relationships, self-harm, emotionality.
Person who violates the rights of others
and breaks laws.
Self-entitled, grandiose person who
needs admiration and lacks empathy.
ClusterC "Woried
Genetic association with anxiety disorders
Person who desires relationships but has social
inhibition and extreme sensitivity to rejection.
"Type A person who is preoccupied with order,
perfection, and control.
"Clingy' person who has excessive need to be
taken care of, and cannot be left alone.
AVOIDANT
Stilt Desires
relationships
OBSESSIVE-
COMPULSIVE
Ego syntonic
DEPENDENT
HISTRIONIC
BORDERLINE
May exhibit splitting
-believing people are
all good or all bad.
ANTISOCIAL
NARCISSISTIC
TX: DIALECTICAL
BEHAVIOR THERAPY
NOT TO BE
CONFUSED WITH:
CONDUCTDISORDER
(same presentation
but 
Disorientation
Partialamnesia
Temporary headaches
Resolves within weeks
17
Anxiety Disorders
PTSD
Disturbance lasting
>1 month with:
Disinterest
Acute Stress
Disorder
Symptoms of PTSD lasting 3 days to
1 month without evidence of:
► Hallucinations
Delusions
Disorganization
9TREATMENT:
Psychotherapy(CBT)
More suspicious
of brief psychotic
disorder;seepage6
REMEMBER!
DISTURBING
DREAMS",
Re-experiencing event /Reckless behavior
Event preceding disturbance
Avoiding associated stimuli / Angry outbursts
Month+ ofsymptoms
Sympathetic arousal /I Sleep disturbance
9)TREATMENT:
CBT (trauma-focused) +/- SSRI/SNRI
Prazosin used for PTSD-related nightmares!
PTSD
MONTH
ASD 4
PD
Panic Disorder
One unexpected panic attack (without trigger) followed by
>1 month of preoccupations with having another attack (not
attributable to medications, substance use, social anxiety
disorder, or phobias).
PANIC
ATTACK
PRESENTATION
Paresthesias, Palpitations
Abdominal distress
Nausea
Intense fear of dying
Chest pain, Choking. Chills
Shortness of breath, Sweating. Shaking
Specific Phobia
Fear of specific situations (E.g. heights)
or things (E.g. spiders) leading to marked
distress / functional impairment.
ACUTE TREATMENT:
Short-acting benzodiazepines
(sedation is beneficia)
MAINTENANCE:
CBT, SSRIS
REMEMBER!
"PANICS"
eTREATMENT:
First line:CBT
Second line: SSRIS,
benzodiazepines
NOT TOBE CONFUSED WITH
MEDICALCAUSESOF ANXIETYVPANICATTACKS: Pheochromocytoma, hyperthyroidism,
neuroblastoma, Wilson's disease (hemochromatosis), etc.
18
Anxiety DisordersCont.
Generalized Anxiety Disorder
3/6 of the following lasting >6 months:
Wound up (irritability)
Worn out (fatigued)
Absentminded
Restlessness
Tension in muscles
Steep disturbances
REMEMBER!
"WORRY WARTS"
9TREATMENT:
CBT and/orSSRI/SNRI
(situation dependent)
► Buspirone (second-line)
Agoraphobia
Marked fear and anxiety lasting >6 months
regarding 2+ situations due to difficulty
escaping (Eg. crowded bus).
5
AD
TREATMENT:
REMEMBER!
1DONTWANTTOAGO
ANYWHEREr
CBT (biofeedback) +/- SSRI
6
GAD
Adjustment Disorder
Marked dysfunction occurring within 3 months of a stressor that causes significant functional
impairment for 18.5
BINGE EATING DISORDER
Frequently consuming a large amount of food over a short
period of time (binging) without compensatory behaviors
(purging) often accompanied by feelings of guilt/shame.
tpurging
BULIMIA NERVOSA
Frequently consuming a large amount of food over a short
period of time (binging) with compensatory behaviors
(purging) such as vomiting. excessive exercise, laxatives, etc.
Vomiting = hypochloremic, hypokalemic metabolic
alkalosis →ook fordentalenamelerosion,
enlarged parotid glands, scars on dorsal hand.
BODY DYSMORPHIC DISORDER
Intense preoccupation with minor or imagined
bodily defect that causes significant impairment.
NOTE No disordered eating behavior.
BMIMOTOR
Pull tostand
Cruises
Run
Walk up stairs
Kick aball
Ridetricycle
Walk up stairs (alternating feet)
Catch a large ball
Hop onone foot
LANGUAGE/SOCIAL
Say "mama"dada"
Understands "no
2-word phrases
50 wordsby2.5
3-word phrases
75%intelligible
4-wOrd sentences
Namecolors
Fullsentences
Count to 10
Child should be able to stack 3x as many blocks as their age in years (E.g. 2 years old = stack 6 blocks)
CHILD ABUSE
Suspect child abuse when:
Child's injuries do not match story
Spiral fracture (twisting)
Circular burns (cigarettes) or burns that spare flexor surfaces
Subdural hematoma (shaken baby syndrome)
► Childavoidseye contact duringphysicalexam -
NOT TO BE CONFUSED WITH SENSSORINEURAL HEARING LOSS
which may present with limited eye contact
5
Zebra" stripe "Doughnut hole
sparing
*Due to flexion while
being submersed in
scalding liquid
Associated with early child abuse, deprivation, neglect
(question stem may describe fostered or adopted child)
DISINHIBITED SOCIAL
ENGAGEMENT DISORDER
REACTIVE ATTACHMENT DISORDER
(Child does not REACT)
ATTACHMENT
DISORDERS
Child hugsstrangers /sits on their lap
Child has trouble forming a
relationship with caretaker
25
Child & Adolescent Disorders
ENCOPRESIS
The repeated involuntary
or intentional
elimination of feces in a
child 4+ years old.
TREATMENT:
CBT
BEHAVIORAL
DISORDERS
ENURESIS
Involuntary enuresis
2x per week for 3+
months in a child 5+
years old.
TREATMENT:
Enuresisalarm
Desmopressin
Parent training in behavior management (PTBM)
is a good intervention for all behavioral disorders.
Angry outbursts out of proportion to the situation with return to expected
mood between episodes and feelings of regret, embarrassment.
Angry outbursts out of proportion to the situation with persistent
irritability/anger between episodes episodes, occurring over> 1 year.
Hostile behavior towards authority figures and deliberately annoying and
blaming others without violating social norms for > 6 months.
Repetitive behaviors that violate social norms (harming people/animals,
stealing) in children 6 months.
Intrusive thoughts/urges +/- repetitive behaviors to relieve marked
distress lasting for longer than 1 hour/day (both criteria not necessary
for diagnosis).
KLEPTOMANIA
Strong urge to steal, typically in
females (Strong comorbidity with
bulimia nervosa)
S80
PYROMANIA
Strong urge to set fires,
typically inmales.
"Play with fire due to inner desire"
TREATMENT:
CBT
SSRI
Parent training in
behavior management
Child & Adolescent Disorders Cont.
TICDISORDERS
TICS = sudden, rapid, recurrent,
nonrhythmic movements or sounds.
Motor or vocal tics
for > 1 year
TREATMENT
Both MOTORAND VERBAL
Tics are present in Tourette's
THINK!
TWO'rette
TOURETTE
SYNDROME
(tics present > 1yr)
CHRONIC
TIC DISORDER
Initial Treatment: Behavior
Otherapy (habitreversaltherapy) combination therapy
INTERMITTENT EXPLOSIVE DISORDER
DISRUPTIVE MOOD DYSREGULATION
(must be diagnosed between ages 6 & 18)
OPPOSITIONAL DEFIANT DISORDER
CONDUCT DISORDER
> 18 years old = Antisocial PD)
ADHD
(symptoms present before age 12)
OBSESSIVE-COMPULSIVE DISORDER
Ifinitial therapy fails or
MOTOR TICS INCLUDE:
Blinking. shoulder
shrugging. facial grimacing.
VOCAL TICS INCLUDE:
Throat clearing. grunting.
shouting.
Sometimes inappropriate
words (coprolalia), though
this is rare.
Antidopaminergic agents (i.e.
antipsychotics, tetrabenazine)
A2 agonists(i.e.clonidine)
CBT
CBT
Assess for ADHD (High comorbidity)
CBT
FIRST LINE: Stimulants (i.e. methylphenidate.
dextroamphetamine) + behavior therapy
ALTERNATIVES (non stimulants): Atomoxetine
FIRST LINE: SSRIS (high dose)
ALTERNATIVES: Clomipramine (TCA)
CBT (exposure & desensitization)
- NOT TO BE CONFUSED WITH REPETITIVE BEHAVIORS SEEN IN:
AUTISM SPECTRUMDISORDER
Typically screened for at 18 and 24 months of age
Presents as:
Repetitivebehaviors (flapping, tapping)
Fixed interests (i.e. trains)
Social challenges
+/- intellectual disability
2
TREATMENT
CBT
TREATMENT: Behavioural therapy
& symptom-targeted medication
27)
Stimulants & Hallucinogens
STIMULANTS
AMPHETAMINES
THINK! AMPedup!
Intoxication
Autonomic stimulation (e.g.
HTN, mydriasis, tachycardia)
+ psychomotor agitation
lasting > 1 hour.
Autonomic stimulation (e.g.
HTN, mydriasis, tachycardia) +
psychomotor agitation lasting
1hour.
Withdrawal
Crash with anxiety
Lethargy
► Headache
► Gl symtoms
COCAINE
THINK! Fast Cars Crash!
Otherstimulantsinclude: Nicotine & Caffeine
TREATMENT for STIMULANT intoxicaton: benzodiazepines + supportive
HALLUCINOGENS
PHENCYCLIDINE (PCP)
THINK! Psychotic Crazy Pupils
MDMA
THINK! Mood elevation,
Dental grinding, Myriad senses,
Autonomic Stimulation
CANNABIS
THINK!Cravings&Conjunctiva!
LSD
THINK! Lights,Sounds,Dreams
BUTANE/GLUE/PAINT
THINK!
Sniff, Spin, Stumble!
Craving
K estlessness
nxiety
S omnolence
H ypersomnia
THINK!
.CRASH
Recurrence of
intoxication symptoms
Depression
Anxiety
Concentration problems
Autonomic stimulation (e.g.. HTN,
mydriasis, tachycardia) lasting
>1 hour + nystagmus + aggression.
► Autonomic stimulation
(i.e. HTN, mydriasis, tachycardia)
+ euphora
► Heightened senses
Bruxism (teeth grind)
Euphoria
► Increased appetite
Drymouth
Conjunctival injection
Visual hallucinations (Lights).
altered auditory perception
(Sound), flashbacks
& delusions (Dreams).
Sniff (inflamednostrils)
leading to:
. Spin: transientdizziness,
disorientation
. Stumble:syncope&
slurred speech
Irritability
Anxiety
Insomnia
NOTE: Most withdrawal
symptoms are the OPPOSITE
of the intoxication symptoms!
Stimulant intoxication
(high energy)> withdrawal =
lethargy
Hallucinogen intoxication
(high senses)> withdrawal =
anxiety/irritability
Depressants & Alcohol Use Disorder
DEPRESSANTS
OPIOIDS/HEROIN
THINK! Drop (CNSdepression)
Stop (resp. depression)
Miosis (pinpoint pupils)
BENZODIAZEPINES
THINK! BenzosCalm but
rebound HARD
BARBITUATES
THINK! The Bar is Low,
but the Risk is High!
Intoxication
► Euphoria, CNS depression.
Autonomic depression
(i.e. respiratory depression,
miosis) reversed with naloxone
→miosis & constipation persist
w/tolerance!
► Autonomic depression (i.e.
respiratory depression, miosis)
reversed with flumazenil
(GABA antagonist).
Contraindication: elderly, liver
dysfunction.
► Autonomic depression (i.e.
respiratory depression, miosis)
that is not reversible.
► Low safety margin! Rarely
prescribed anymore.
Disinhibition, slurred
speech, mood changes
& autonomic depression.
Withdrawal
► Yawning. nausea, muscle
aches, diarrhea, insomnia
Mydriasis, piloerecton
TXINTOX low dose
methadone, suboxone.
(buprenorphine/naloxone)
Rebound anxiety, seizures,
tremor, insomnia
TX: restart benzodiazepines &
taper.
Rebound anxiety.
seizures, ife threatening
cardiovascular collapse.
ALCOHOL
EARLY(6-24HRS)
4 Tremors, insomnia, Gl upset
Ộ SECOND(6-48HRS)
4 Seizures come Second (2nd)!
OỎ HOURS(12-48HRS)
4 Hallucinosis (tactile or visua)
DAYS (2-4 DAYS)
4Delirium tremens(autonomic
instability, seizures, tachycardia)
.THINK! NAD
is Deadly! AỘ
ALCOHOL USE DISORDER
Etiology
M>F, ages21-34
Look forsignsof endorgan
complications (i.e. palmar erythema)
Diagnosis
,THINK! TOASTto alcohol!
Labs: classic2:1 ratioofAST:ALT
Screening with CAGE questionnaire
Complications
► Gastritis, varices, Mallory-Weiss syndrome
► Pancreatitis, liver disease. peripheral neuropathy
TREATMENT
Naltrexone (while drinking, for abstinence)
Acamprosate (when sober, for aversion)
Disulfiram (second line, for aversion)
+ Alcoholics Anonymous for long term rehab!
Withdrawal
► Thiamine (administer before glucose),
benzodiaze pine tapermedium-length
+/- haloperidol for psychosis
29
Neurocognitive Disorders
MILD COGNITIVE
IMPAIRMENT
Typically Patient is aware of cognition
issues (comes in seeking help with memory).
MOCA:high 20s/30 Reassurance
ALZHEIMER'S
Presents as:
Gradual cognitive decline, with no motor or
sensory deficits.+/-behavioralchanges.
Caused by: B-amyloidplaquesandneurofibrillary
tangles(hyperphosphorylated Tau).
EGENETIC COMPONENT:
J Presenilin gene
Apo4
► Amyloid precursor protein (Chromosome 21)
Recall Early onset in DownSyndrome
TREATMENT:
Acetylcholinesterase inhibitors (donepezil,
galantamine, rivastigmine)
OR
NMDA glutamateantagonists(memantine)
CREUTZFELDT-JAKOB
DISEASE
Presents as: Rapid cognitive decline (within a year)
in patients of any age.
Prions can be contracted at any age
Caused by: Accumulation of mistoldedproteins.
,-- NOTTOBECONFUSEDWITH
PSEUDODEMENTIA
Cognitive decline due to apathy, low mood
E.g. MDD and will present with SIGECAPS
TRUE DEMENTIA
Typically Patient is unaware of cognition
issues (brought in by family member).
MMSE:low 20s/30 see below
FRONTOTEMPORALA
DEMENTIA ("Pick Disease")
Presents as: Early personalitychange,
apathy, disinhibition + cognitive decline,
typically in younger patients (60s).
Caused by: Accumulation of Pick bodies in
frontal and temporal lobe.
Recall! Frontal lobe = executive function
TREATMENT: Addressany comorbid
conditions (SSRI for depression, non-
benzodiazepine sedative hypnotics
for insomnia).
zzZs Zolpidem,Zaleplon, Zopiclone
VASCULAR DEMENTIA
Presents as: Stepwisecognitive decline,
with motor or sensory deficits due to transient
ischemic events or strokes.
Caused by: Multiplecerebralinfarcts.
Patient will likelyhavecomorbiditiessuch
as hypertension, hyperlipidemia, etc.
8TREATMENT:
CBT
SSRI
30
Neurocognitive Disorders Cont.
HUNTINGTON'S DISEASE
Presents as:
Autosomal dominant
Behavioral change
Chorea
May present with anticipation where
more severe symptoms begin at an
earlier age in subsequent generations.
Depression/dementia in age 40s- 50s
Caused by: autosomal dominant trinucleotide(CAG)
repeats in the HD gene
LEWY BODY DEMENTIA
Presents as:
Cognitivedecline
Visualhallucinations
► Parkinsonism (bradykinesia/akinesia, tremor, shuffling gait
cogwheelrigidityl
Causedby:
Accumulation of a-synuclein throughout the brain
PARKINSON'S DISEASE
Presents as: bradykinesia/akinesia,tremor, shuffling gait,
cogwheel rigidity
Caused by: accumulation of a-synuclein in the
substantia nigra pars compacta (dopamine center)
Excess dopamine can cause psychosis (hallucinations)
TREATMENT:
Carbidopa-levodopa,amantadine,D2agonists
(ropinirole, pramipexole, cabergoline)
Lower carbidopa-levodopa +/- addantipsychotic
Parkinsonism in a young person should be suspicious
for Wilson's or MPTP (synthetic heroin)
(May predispose to Parkinson's)
Dementia vs Delirium
Delirium waxingbwaninginnature*
Abrupt onset of memory impairment, altered
consciousness, hallucinations.
Most commonly seen in patients who are:
Elderly
Post-op
Intensive care unit
Assess for
underlying
cause:
TREATMENT:
Treat underlying medical
cause +/- haloperidol
in symptomatic
disturbances.
Medication side effect or withdrawal
Infection (UTI,pneumonia)
Dehydration
Alcohol intoxication or withdrawal
Delirium that occurs in
people with dementia
in the late evening
"SUN-DOWNING
Dementia
Progressive, chronic decline in cognitive
function affecting: memory, reasoning.
language, and daily functioning.
Gradual
Structural changes in brain
NORMAL
Dementia Due ToA Medical Condition
IRREVERSIBLE
HIV/AIDS
OR
WILSON'S DISEASE
Due to copper
accumulation in brain,
liver, eye
REVERSIBLE
TERTIARYSYPHILIS
HYPOTHYROIDISM
TREATMENT
Penicillin
Levothyroxine
Vit B12 injection +/-
thiamine (alcohol use)
Ventriculoperitoneal shunt
SEVERE
Check VDRL
CheckTSH/T4
VITAMIN DEFICIENCY (B12)
NORMALPRESSUREHYDROCEPHALUS
4 Presents as:
n
Presents with
Kayser-Fleischer rings
Prevention:
Chelation (Penicillamine)
PARKINSONISM
Wet
e 2024
Wacky Wobbly
Types of Psychiatric Therapy
THERAPY TYPE DESCRIPTION
Talk therapy that seeks to
correct false assumptions,
negative feelings, and
maladaptive behaviors.
COGNITION
BEHAVIOR
Similar to CBTwith a focus on
managing intense emotions.
Similar to CBT with a focus
on trauma and bringing
repressed memories/
emotions into awareness.
Complex, structured therapy
combining talk, emotion, and
eye movement.
Involves increasing exposure
to feared objects, situations,
or activities in a safe
environment.
Involves recognizing bodily
signals (HR, muscle tension)
to indicate and control
emotional distress.
Involves inducing a
controlled seizure while the
patient is sedated.
USED TO TREAT
COGNITIVE
BEHAVIORAL
(CBT)
THERAPY
DIALECTICAL
BEHAVIORAL
TRAUMA-FOCUSED
EMDR
Eye Movement
Desensitization &
Reprocessing
EXPOSURE
BIOFEEDBACK
Depression
Anxiety
Personalitydisorders
Eating disorders
Somaticsymptom
disorders
Behavioraldisorders
Adjustmentdisorder
Borderline personality
disorder
EMOTION
PTSD
Dissociativeidentity
disorder
PTSD
Specificphobia
Panicdisorder
PTSD
Stressdisorders
Refractory mood disorders
& acute suicidality
Catatonia
► Pregnant and elderly
patients.
SIDEEFFECTS: Temporaryheadaches Partial amnesia (resolves within months) Disorientation
ELECTROCONVULSIVE
DSM-5 Summary
Childhood Disorders
"onset
2weeks
ManicSxof BipolarDisorder>1week
•>5 "SIGECAPS
•>3DIGFAST
Narcolepsy>3months
3 months 6 months
Sleep Disorders !
1 week 2 week
Psychotic Disorders
1 month
Schizoaffective Disorder >2 weeks
DelusionalDisorder>1 month
BriefPsychoticDisorder1 month !
Post-Traumatic Stress Disorder (PTSD) >1 month
Adjustment Disorder 6 months
Oppositional Defiant
>6 months *onset 1year
"onset 1year
Sleepdistrubances, Interestdecreased,Guilt, Energydecreased, Concentration
problems, Apetite changes, Psychomotor agitation, Suicidal ideation
Distractibility, Irresponsibility, Grandiosity, Fight of ideas,
Activity increase, Sleep decrease, Talkativeness
"Antisocial > 18 y/o
Dysthymic Disorder> 2years
Eyclothymie Disorder > 2 year
1 year
>2 weeks of delusions or hallucinations without mood symptoms
2 years
Schizophrenia> 6months
GeneralizedAnxietyDisorder> 6months
>6 months
Illness Anxiety
Disorder >6 months
Somatic SymptomDisorder(months-years)
References: American Psychiatric Association (2013 Diagnostc and statistical manual
of mentaldisordersSth ed) http/ldol org/101126/appibocks9780890425596
Notes
About the Author
JACOBPORTNOFFis a passionate medical student (MS4) and social media
influencer, known as "MedSchoolBro who has established himself as a
growing presence in the medical community. Combining his knowledge
of medical topics and his ability to communicate complex medical
concepts, Jacob has developed a unique approach to medical education
that has garnered a large following.
As a student preparing for his USMLE licensing exams (Step16 Step 2CK)
and Shelf exams, Jacob recognized the need for a comprehensive guide
that encompasses all the essential aspects of Psychiatry. Inspired by his
own successful learning techniques and visual approach to learning, he
created this Psychiatry Review Guide, a 31-page resource that integrates
the various disciplines of medicine to enhance understanding and
retention.
Jacob's commitment to helping fellow medical students achieve their academic goals is reflected in the
meticulously crafted content of his guide. Drawing from his own experiences, he incorporates memory
tricks and creative elements to make studying the content not onlyeasier, but more enjoyable to study from!
Beyond this, he also made sure to incorporate the highly tested Step 2CK principles, including management
and key risk factors (look out for these icons!). Fueled by his passion for medical education and teaching,
Jacob hopes to continue to positively impact the medical education landscape!
ACKNOWLEDGEMENTS
Jacob would like to extend his gratitude to his medical student colleague Sydney Whalen for her workassisting with the content of this study guide. He also extends his appreciation to Dr. Jake Goodman for his
expertise and careful peer review of the guide Finally he extends his thanks to Maria Massad & Amir Ebadi
for the beautiful editorial design which helped bring this guide to life
SYDNEYWHALENis an MS4 at the University of linois College of Medicine.
She is passionate about medical education, mentorship, and helping
others Honor their Shelf exams! She plans to apply into OBGYN residency
in Fall 2025.
DR. JAKE GOODMAN MD, MBA is a final-year psychiatry resident and
educator who has built a social media platform with over 2 million
followers to raise mental health awareness. He is the author of
Psychiatry for Kids, aimed at educating children about mental health.