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Citalopram (Celexa): 20mg tab OD energy, lasting at least 4 consecutive days and present most of the
Escitalopram (Lexapro): 10mg tab OD day, nearly every day.
B. Same with Criteria B of Manic Episode
SECOND LINE: OTHER ANTI DEPRESSANTS C. The episode is associated with an unequivocal change in functioning
Tricyclic Antidepressants (TCA) that is uncharacteristic of the individual when not symptomatic.
Ex. Imipramine, Clomipramine, Trimipramine D. The disturbance in mood and the change in functioning are observable
Monoamine Oxidase Inhibitors (MAO-I) by others.
Ex. N/A in the Philippines E. The episode is not severe enough to cause marked impairment in
Selective Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) social or occupational functioning or to necessitate hospitalization. If
Ex. Duloxetine (Cymbalta), Venlafaxine (Effexor) there are psychotic features, the episode is, by definition, manic.
SIDE EFFECTS F. The episode is not attributable to the physiological effects of a
SSRI: sexual dysfunction substance (e.g., a drug of abuse, a medication, other treatment).
TCA: Anticholinergic effects, extreme sedation, convulsions, COMA Major Depressive Episode
MAO-I: reacts with tyramine-rich foods -> hypertensive crises *common but NOT required for diagnosis of Bipolar I Disorder
SNRI: headache, nausea, hypertension A. Five (or more) of the following symptoms have been present during
PSYCHOTHERAPEUTIC MANAGEMENT the same 2- week period and represent a change from previous
Cognitive-behavioral Therapy (CBT) functioning; at least 1 of the symptoms is either (1) depressed mood
Interpersonal Therapy or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, as
Behavior Therapy
indicated by either subjective report (e.g., feels sad, empty, or
Psychoanalytically Oriented Therapy
hopeless) or observation made by others (e.g., appears tearful).
Family Therapy
(Note: In children and adolescents, can be irritable mood.)
BIPOLAR DISORDER I: Manic+ Hypomanic/ MDD 2. Markedly diminished interest or pleasure in all, or almost all,
For a diagnosis of bipolar I disorder, it is necessary to meet the following activities most of the day, nearly every day (as indicated by
criteria for a manic episode. The manic episode may have been preceded by either subjective account or observation).
and may be followed by hypomanic or major depressive episodes. 3. Significant weight loss when not dieting or weight gain (e.g., a
change of more than 5% of body weight in a month), or
Manic Episode decrease or increase in appetite nearly every day. (Note: In
*at least 1 lifetime manic episode IS REQUIRED for diagnosis of Bipolar I children, consider failure to make expected weight gain.)
Disorder 4. Insomnia or hypersomnia nearly every day.
A. A distinct period of abnormally and persistently elevated, expansive, 5. Psychomotor agitation or retardation nearly every day
or irritable mood and abnormally and persistently increased goal- (observable by others; not merely subjective feelings of
directed activity or energy, lasting at least 1 week and present most restlessness or being slowed down).
of the day, nearly every day (or any duration if hospitalization is 6. Fatigue or loss of energy nearly every day.
necessary). 7. Feelings of worthlessness or excessive or inappropriate guilt
B. During the period of mood disturbance and increased energy or (which may be delusional) nearly every day (not merely self-
activity, 3 (or more) of the following symptoms (4 if the mood is only reproach or guilt about being sick).
irritable) are present to a significant degree and represent a 8. Diminished ability to think or concentrate, or indecisiveness,
noticeable change from usual behavior: nearly every day (either by subjective account or as observed
1. Inflated self-esteem or grandiosity. by others).
2. Decreased need for sleep (e.g., feels rested after only 3 hours 9. Recurrent thoughts of death (not just fear of dying), recurrent
of sleep). suicidal ideation without a specific plan, or a suicide attempt or
3. More talkative than usual or pressure to keep talking. a specific plan for committing suicide.
4. Flight of ideas or subjective experience that thoughts are B. The symptoms cause clinically significant distress or impairment in
racing. social, occupational, or other important areas of functioning.
5. Distractibility (i.e., attention too easily drawn to unimportant C. The episode is not attributable to the physiological effects of a
or irrelevant external stimuli), as reported or observed. substance or another medical condition.
6. Increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation (i.e., purposeless MANAGEMENT
non-goal-directed activity). FIRST LINE: VALPROATE
7. Excessive involvement in activities that have a high potential Valproate 750 - 2,500 mg per day, achieving blood levels bet. 50 and
for painful consequences (e.g., engaging in unrestrained buying 120 ug/Ml
sprees, sexual indiscretions, or foolish business investments). equal in safety and efficacy to Lithium
C. The mood disturbance is sufficiently severe to cause marked SE: gastrointestinal distress (e.g., anorexia, nausea, dyspepsia,
impairment in social or occupational functioning or to necessitate vomiting, diarrhea), benign hepatic transaminase elevations,
hospitalization to prevent harm to self or others, or there are osteoporosis, tremor, and sedation
psychotic features.
D. The episode is not attributable to the physiological effects of a SECOND LINE: LITHIUM CARBONATE
substance (e.g., a drug of abuse, a medication, other treatment) or to Lithium Carbonate 300 mg TID
another medical condition. for short term and prophylactic treatment of bipolar I disorder
controls acute mania (effect in 1-3 weeks) and MDD (with
Hypomanic Episode antidepressant effect)
*common but NOT required in diagnosis of Bipolar I Disorder therapeutic levels are between 0.6 and 1.2 mEq/L
A. A distinct period of abnormally and persistently elevated, expansive, or Use with supplemental thyroid hormone (e.g. 25 mg Iiothyronine)
irritable mood and abnormally and persistently increased activity or
PSYCHO WACKO | Page 3 of 10
Psychiatry OSCE Reviewer
SE: polyuria, polydipsia, weight gain, cognitive problems (e.g., dulling, 3. Disorganized speech (e.g., frequent derailment or
impaired memory, poor concentration, confusion, mental slowness), incoherence).
tremor, sedation or lethargy, impaired coordination, gastrointestinal 4. Grossly disorganized or catatonic behavior.
distress (e.g., nausea, vomiting, dyspepsia, diarrhea), hair loss, benign **Note: Do not include a symptom if it is a culturally sanctioned response.
leukocytosis, acne, and edema B. Duration of an episode of the disturbance is at least 1 day but less
than 1month, with eventual full return to premorbid level of
OTHERS functioning.
Carbamazepine and oxcarbazepine C. The disturbance is not better explained by major depressive or bipolar
SE: diplopia, blurred vision, fatigue, nausea, and ataxia disorder with psychotic features or another psychotic disorder such as
schizophrenia or catatonia, and is not attributable to the physiological
SIDE Effects: (in general)
effects of a substance (e.g., a drug of abuse, a medication) or another
Tremor (Beta blocker: Increased urination
medical condition.
Propanolol) Kidney function impairment
GI distress Acne MANAGEMENT
Weight gain Psoriasis FIRST LINE: ANTIPSYCHOTICS
Cognitive impairment Haloperidol Moderate disease: 0.5-2 mg q8-12hr initially; Severe
Hypothyroidism (supplement thyroid; T3, because of its short half-life, disease: 3-5 mg q8-12hr initially
25 -50 microgram perday for acute and T4 for long-term maintenance) Ziprasidone 80-160mg/day (40 mg starting dose)
PSYCHOTHERAPEUTIC MANAGEMENT SECOND LINE
Hospitalization for patients with risk of suicide Benzodiazepines: can be used in the short-term treatment of
Cognitive therapy psychosis
Anxiolytics are useful during the first 2 to 3 weeks after the resolution
BIPOLAR DISORDER II: Hypomanic + MDD/ NO MANIC
of the psychotic episode
For a diagnosis of bipolar II disorder, it is necessary to meet the following
criteria for a hypomanic episode and the following criteria for a current or SIDE EFFECTS
past major depressive episode: HALOPERIDOL (1st Gen Typical Antipsychotics): extrapyramidal
1. HYPOMANIC EPISODE – same as above symptoms (EPS), tachycardia, impotence and dizziness (non-selective
2. MAJOR DEPRESSIVE EPISODE – same as above interaction at the α adrenoceptor), sedation and weight gain (due to
histamine H1 receptor blockade)
MANAGEMENT
o EPS:
For acute bipolar depression:
Parkinsonism – tremors, rigidity, slowness of movement,
1ST LINE: fixed combination of olanzapine and fluoxetine for 8 weeks temporary paralysis, cogwheel rigidity, pill rolling, facial
2ND LINE: Lamotrigine or low dose ziprasidone 20 to 80 mg per day masking
3RD LINE: ECT - for those who do not respond to lithium or other Dystonia – involuntary muscle contractions
mood stabilizers and their adjuncts, particularly in those with suicidal Akathisia – inability to resist urge to move; restless
tendencies Tardive dyskinesia – involuntary movements of the mouth,
Maintenance lips, and tongue; some will have oculogyric crisis (the
Lithium, carbamazepine and valproate alone or in combination eyeballs become fixed in one position, typically upwardly
rotated, for minutes or hour)
Lamotrigine has prophylactic antidepressant and ,potentially, mood
ADMINISTER: serotonin-dopamine antagonist in patients
stabilizing properties. It appears to have superior acute and
who are at high risk for the development of
prophylactic antidepressant properties compared with antimanic
extrapyramidal adverse effects
properties
ZIPRASIDONE: (not available in the Philippines), significant QT
PSYCHOTHERAPEUTIC MANAGEMENT prolongation in susceptible patients, may cause hyperprolactinemia (<
Cognitive therapy risperidone), NOT associated with weight gain
Interpersonal Therapy BENZODIAZEPINES: Oversedation, Memory impairment, Depression,
Psychoanalytically oriented therapy emotional blunting, Floppy Infant Syndrome, paradoxical excitement
with increased anxiety, insomnia, nightmares, and hallucinations at the
PSYCHOTIC DISORDERS onset of sleep, irritability, hyperactive or aggressive behavior, and
SAMPLE CASE: C.M. is a 26 y/o male who appears disheveled. He proclaims that exacerbation of seizures in epileptics.
he is Zac Efron. He said that a voice keeps telling him to look for his missing
girlfriend who has amnesia. He suddenly approached a girl in a crowd and started PSYCHOTHERAPEUTIC MANAGEMENT
shouting that he had found ‘her’. Witnesses reported that C.M. was first seen Principles of Psychotherapy of Brief Psychotic Disorder
roaming the area around 3 weeks ago. Additionally, he was often caught staring o Exploration and development of coping strategies are the
blankly and talking to the air. major topics in psychotherapy.
Elicit perceptual disturbances (hallucination) and other psychotic o Associated issues include helping patients deal with the loss of
symptoms (delusions) self-esteem and to regain self-confidence.
What is your impression? What are your differential diagnoses?
o An individualized treatment strategy based on increasing
How do you manage this patient?
problem solving skills while strengthening the ego structure
appears to be the most efficacious.
BRIEF PSYCHOTIC DISORDER o Family involvement in the treatment process may be crucial to
A. Presence of one (or more) of the following symptoms. At least one of a successful outcome.
these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
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Psychiatry OSCE Reviewer
3. Persistent, distorted cognitions about the cause or alterations in cognitions and mood associated with the traumatic
consequences of the traumatic event(s) and lead the individual event(s), must be present, beginning after the event(s) or worsening after
to blame himself/herself or others the event(s):
4. Persistent negative emotional state (e/g fear, horror, anger, Persistent Avoidance of Stimuli
guilt or shame) 1. Avoidance of or efforts to avoid activities, places, or physical
5. Marked diminished interest or participation from others reminders that arouse recollections of the traumatic event(s).
6. Feelings of detachment or estranged from others 2. Avoidance of or efforts to avoid people, conversations, or
7. Persistent inability to experience positive emotions (e.g. interpersonal situations that arouse recollections of the
inability to experience happiness, satisfaction or loving feelings) traumatic event(s).
E. Marked alterations in arousal and reactivity associated with traumatic Negative Alterations in Cognitions
events(s), beginning or worsening after the traumatic event(s) 3. Substantially increased frequency of negative emotional states
occurred, as evidenced by two or more of the following: (e.g., fear, guilt, sadness, shame, confusion).
1. Irritable behavior and angry outburts ( with little or no 4. Markedly diminished interest or participation in significant
provocation) typically expressed as verbal or physical agression activities, including constriction of play.
toward people or objects 5. Socially withdrawn behavior.
2. Reckless or self-destructive behavior 6. Persistent reduction in expression of positive emotions.
3. Hypervigilance D. Alterations in arousal and reactivity associated with the traumatic
4. Exaggerated startle response event(s), beginning or worsening after the traumatic event(s) occurred,
5. Problems with concentration as evidenced by two (or more) of the following:
6. Sleep disturbance (e.g. difficulty or staying asleep or restless 1. Irritable behavior and angry outbursts (with little or no
sleep) provocation) typically expressed as verbal or physical
F. Duration of the disturbance (B,C,D,E) is MORE than 1 MONTH aggression toward people or objects (including extreme temper
G. The disturbance causes clinically significant distress or impairment in tantrums)
social, occupational or other important areas of functioning. 2. Hypervigilance
H. The disturbance is not attributable to the physiological effects of a 3. Exaggerated startle response
substance (e.g. medication, alcohol) or other medical condition. 4. Problems with concentration.
SPECIFY if with dissociative symptoms: 5. Sleep disturbance (e.g., difficulty falling or staying asleep or
1. Depersonalization restless sleep)
2. Derealization E. The duration of the disturbance is more than 1 month
F. The disturbance causes clinically significant distress or impairment in
Posttraumatic Stress Disorder for Children 6 Years and Younger relationships with parents, siblings, peers, or other caregivers or with
A. In children 6 years and younger, exposure to actual or threatened school behavior.
death, serious injury, or sexual violence in one (or more) of the
following ways: MANAGEMENT
1. Directly experiencing the traumatic event(s). FIRST LINE: SSRI
2. Witnessing*, in person, the event(s) as it occurred to others, NOTE: SSRI may also increase the risk of suicide among children and
especially primary caregivers adolescents. Thus, monitoring (suicide precaution risk) is needed.
3. Learning that the traumatic event(s) occurred to a parent or Fluoxetine (Prozac) – Black Box Warning: increased risk of suicidal
caregiving figure. thinking and behavior in children, adolescents anD young adults (<24)
*Witnessing does not include events that are witnessed only in electronic Citalopram (Celexa) – 20-40mg/ day; approved for children and
media, television, movies, or pictures. adolescents
Ecitalopram – this is the most available in the country.
B. Presence of one (or more) of the following intrusion symptoms
associated with the traumatic event(s), beginning after the traumatic SECOND LINE
event(s) occurred: BETABLOCKERS
1. Recurrent, involuntary, and intrusive distressing memories of o Propanolol – decreases the hyperarousal and agitation in
the traumatic event(s). children
**NOTE: Spontaneous and intrusive memories may not necessarily ALPHA AGONIST
appear distressing and may be expressed as play reenactment. o Clonidine – for nightmares
2. Recurrent distressing dreams in which the content and/or
affect of the dream are related to the traumatic event(s). SIDE EFFECTS
**NOTE: It may not be possible to ascertain that the frightening content FLUOXETINE: headache, nausea, insomnia, anorexia, anxiety,
is related to the traumatic event. asthenia, diarrhea, nervousness, somnolence.
3. Dissociative reactions (e.g., flashbacks) in which the child feels CITALOPRAM: 15% Insomnia, 20% nausea and dry mouth, In general:
or acts as if the traumatic event(s) were recurring. (Such tremor, anxiety, agitation, yawning, headaches, dizziness, restlessness
reactions may occur on a continuum, with the most extreme and sedation, drop in BP and inc. HR; sexual dysfunction (dec. sexual
expression being a complete loss of awareness of present and diff of ejaculation in men. Side effects usually diminish or
surroundings.) Such trauma-specific reenactment may occur in disappear after 4 weeks of use.
play.
4. Intense or prolonged psychological distress at exposure to PSYCHOTHERAPEUTIC MANAGEMENT
internal or external cues that symbolize or resemble an aspect Trauma-focused Cognitive- Behavior Therapy- The treatment is
of the traumatic event(s). generally administered over 10-16 treatment sessions.
5. Marked physiological reactions to reminders of the traumatic Steps:
event(s). 1. Psychoeducation 4. Cognitive Processing
C. One (or more) of the following symptoms, representing either persistent 2. Stress inoculation 5. Parental Treatment component
avoidance of stimuli associated with the traumatic event(s) or negative 3. Gradual
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Psychiatry OSCE Reviewer
Crisis intervention/ Psychological Debriefing F. The fear, anxiety, or avoidance is persistent, typically lasting for 6
Eye movement desensitization and reprocessing (EMDR months or more
G. The fear, anxiety, or avoidance causes clinically significant distress or
PANIC DISORDER impairment in social, occupational, or other important areas of
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge functioning.
of intense fear or intense discomfort that reaches a peak within H. If another medical condition (e.g., inflammatory bowel disease,
minutes, and during which time four (or more) of the following Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly
symptoms occur: excessive.
**NOTE: The abrupt surge can occur from a calm state or an anxious state. I. The fear, anxiety, or avoidance is not better explained by the
1. Palpitations, pounding heart, or accelerated heart rate symptoms of another mental disorder—for example, the symptoms
2. Sweating are not confined to specific phobia, situational type; do not involve
3. Trembling or shaking only social situations (as in social anxiety disorder); and are not related
4. Sensations of shortness of breath or smothering exclusively to obsessions (as in obsessive-compulsive disorder),
5. Feelings of choking perceived defects or flaws in physical appearance (as in body
6. Chest pain or discomfort dysmorphic disorder), reminders of traumatic events (as in
7. Nausea or abdominal distress posttraumatic stress disorder), or fear of separation (as in separation
8. Feeling dizzy, unsteady, light-headed, or faint anxiety disorder).
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations) **NOTE: Agoraphobia is diagnosed irrespective of the presence of panic
11. Derealization (feelings of unreality) or depersonalization (being disorder. If an individual’s presentation meets criteria for panic disorder and
detached from oneself). agoraphobia, both diagnoses should be assigned.
12. Fear of losing control or “going crazy.” MANAGEMENT (Panic Disorder & Agoraphobia)
13. Fear of dying. FIRST LINE: ALPRAZOLAM & PAROXETINE
**Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache,
ALPRAZOLAM
uncontrollable screaming or crying) may be seen. Such symptoms should not o 0.5mg tab every 8 hours
count as one ofthe four required symptoms.
PAROXETINE
B. At least one of the attacks has been followed by 1 month (or more) of
o 10mg tab once a day (20mg if social phobia)
one or both of the following:
o For rapid effect: ALPRAZOLAM + SSRI
1. Persistent concern or worry about additional panic attacks or
o For Panic Attack w/ depression: FLUOXETINE
their consequences (e.g., losing control, having a heart attack,
o For Anticipation Anxiety: Clonazepam
“going crazy”)
2. A significant maladaptive change in behavior related to the PSYCHOTHERAPEUTIC MANAGEMENT
attacks (e.g., behaviors designed to avoid having panic attacks, Family Therapy
such as avoidance of exercise or unfamiliar situations). Insight Oriented Psychotherapy
C. The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical OBSESSIVE-COMPULSIVE DISORDER
condition (e.g., hyperthyroidism, cardiopulmonary disorders). A. Presence of obsessions, compulsions, or both:
D. The disturbance is not better explained by another mental disorder Obsessions are defined by (1) and (2):
(e.g., the panic attacks do not occur only in response to feared social 1. Recurrent and persistent thoughts, urges, or images that are
situations, as in social anxiety disorder; in response to circumscribed experienced, at some time during the disturbance, as intrusive
phobic objects or situations, as in specific phobia; in response to and unwanted, and that in most individuals cause marked
obsessions, as in obsessive-compulsive disorder; in response to anxiety or distress.
reminders of traumatic events, as in posttraumatic stress disorder; or 2. The individual attempts to ignore or suppress such thoughts,
in response to separation from attachment figures, as in separation urges, or images, or to neutralize them with some other
anxiety disorder). thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
AGORAPHOBIA 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or
A. Marked fear or anxiety about two (or more) of the following five mental acts (e.g., praying, counting, repeating words silently)
situations: that the individual feels driven to perform in response to an
1. Using public transportation (e.g., automobiles, buses, trains, obsession or according to rules that must be applied rigidly.
ships, planes) 2. The behaviors or mental acts are aimed at preventing or
2. Being in open spaces (e.g., parking lots, marketplaces, bridges) reducing anxiety or distress, or preventing some dreaded event
3. Being in enclosed places (e.g., shops, theaters, cinemas) or situation; however, these behaviors or mental acts are not
4. Standing in line or being in a crowd. connected in a realistic way with what they are designed to
5. Being outside of the home alone. neutralize or prevent, or are clearly excessive.
B. The individual fears or avoids these situations because of thoughts that **NOTE: Young children may not be able to articulate the aims of these
escape might be difficult or help might not be available in the event behaviors or mental acts.
of developing panic-like symptoms or other incapacitating or B. The obsessions or compulsions are time-consuming (e.g., take more
embarrassing symptoms (e.g., fear of falling in the elderly; fear of than 1 hour per day) or cause clinically significant distress or
incontinence). impairment in social, occupational, or other important areas of
C. The agoraphobic situations almost always provoke fear or anxiety. functioning.
D. The agoraphobic situations are actively avoided, require the presence C. The obsessive-compulsive symptoms are not attributable to the
of a companion, or are endured with intense fear or anxiety. physiological effects of a substance (e.g., a drug of abuse, a
E. The fear or anxiety is out of proportion to the actual danger posed by medication) or another medical condition.
the agoraphobic situations and to the sociocultural context.
D. The disturbance is not better explained by the symptoms of another POSTTRAUMATIC STRESS DISORDER at least 1 month
mental disorder (e.g., excessive worries, as in generalized anxiety o ACUTE: <3 months
disorder; preoccupation with appearance, as in body dysmorphic o CHRONIC: >3 months
disorder; difficulty discarding or parting with possessions, as in a. Reexperiencing/ Intrusion (at least 1)
hoarding disorder; hair pulling, as in trichotillomania [hair-pulling Paulit-ulit mo bang naaalala ang mga nangyari?
disorder]; skin picking, as in excoriation [skin-picking] disorder; Napapanaginipan mo ba?
stereotypies, as in stereotypic movement disorder; ritualized eating Pakiramdam mo ba ay nangyayari ulit ang lahat?
behavior, as in eating disorders; preoccupation with substances or b. Avoidance (at least 3)
gambling, as in substance-related and addictive disorders; Gusto mo bang hindi na naiisip ang mga nangyari?
preoccupation with having an illness, as in illness anxiety disorder; Umiiwas ka ba sa mga gawain, lugar, o mga taong
sexual urges or fantasies, as in paraphilic disorders; impulses, as in nakakapagpaalala sa iyo nito?
disruptive, impulse-control, and conduct disorders; guilty ruminations, Di mo na ba maalala kahit katiting?
as in major depressive disorder; thought insertion or delusional Nawawalan ka ba ng gana sa buhay?
preoccupations, as in schizophrenia spectrum and other psychotic Pakiramdam mo ba ay gusto mong lumayo sa iba?
disorders; or repetitive patterns of behavior, as in autism spectrum Pakiramdam mo ba hindi ka na magkakatrabaho, makapag-
disorder). aasawa, o magkakapamilya?
Mayroon ka bang pagmamahal sa iba?
MANAGEMENT c. Arousal ( at least 2)
FIRST LINE: SSRI (FLUVOXAMINE) Nahihirapan/ Hindi ka ba makatulog?
FLUVOXAMINE May poot o galit ka ba sa puso?
o 50mg once a day during bed time Di ka ba makapag-isip ng maayos?
SECOND LINE Palagi ka bang nakabantay sa paligid mo?
Clomipramine, Valproate, Lithium, Carbamazepine, Clonazepam, Madali ka bang mabigla o magulat?
Risperizone PAROXETINE 20 mg tablet once a day for 1 month
PSYCHOTHERAPEUTIC MANAGEMENT PANIC DISORDER
Insight Oriented Psychotherapy Panic attack 1 month PANIC DISORDER
Family Therapy AGORAPHOBIA
ECT o Takot ka bang mapunta sa isang lugar na pakiramdam mo,
Psychosurgery kung may mangyayaring masama ay hindi ka makakaligtas?
o Umiiwas ka bas a lugay na kagaya ng tulay, bus, tren, o sa
SUMMARY labas ng bahay lalo na kapag mag-isa ka lang?
MOOD DISORDERS
MAJOR DEPRESSIVE DISORDER: 5/9 symptoms for 2 weeks ALPRAZOLAM 0.5mg tab every 8 hours
PAROXETINE 10mg tab once a day (20mg if social phobia)
FLUOXETINE 20mg tablet PO once daily for 1 month (continue for 6
months if responsive) OBSESSIVE- COMPULSIVE DISORDER
BIPOLAR I: Manic + Hypomanic or MDD May mga bagay ka bang paulit-ulit na iniisip na hindi lamang mga
BIPOLAR II: Hypomanic + MDD; NO MANIC EPISODE simpleng alaala, at gusto mo nang hindi isipin?
o Manic 1 week Bipolar I May mga bagay bang paulit-ulit mong ginagawa para mabawasan o
o Hypomanic 4 days Bipolar II maibsan ang hindi magandang pakiramdam o kaba?
*2 years FLUVOXAMINE 50mg once a day at bed time
o Dysthymic = Bipolar I; Cyclothymic = Bipolar II
VALPROIC ACID 250 mg capsule every 12hrs ( 1tab am/ 1 tab night)
CLONAZEPAM 0.5 mg tablet PO every 8 hrs
OLANZAPINE 5mg tab once a day ( 1tab at night)
PSYCHOTIC DISORDERS
NOTE: Elicit delusion, hallucination; Observe speech, behaviour, negative
symptoms
BRIEF PSYCHOTIC DISORDER: at least 1 day but less than 1 month
SCHIZOPHRENIFORM DISORDER: 1 month
SCHIZOPHRENIA: at least 2 symptoms for 1 month straight 6months
SUBSTANCE-INDUCED PSYCHOSIS:
OLANZAPINE 5mg tablet once a day for 1 month (if responsive, continue
for 6 months)
ALPRAZOLAM 0.5mg tablet PO every 8 hours for one day
Haloperidol 0.5 mg tablet every 8 hours for 1 month
EMERGENCY: HALOPERIDOL or ARIPIPRAZOLE (IM)
ANXIETY DISORDERS
GENERAL ANXIETY DISORDER: at least 6 months
FLUOXETINE 20mg tablet PO once daily