Psych #

Delerium #

• EtOH usually visusal, small “creepy crawlies” vs normal which is usually “larger” things

Dementia #

Alzheimer: short term memory loss, apraxia, no motor signs, late hallucinations/delusions Vascular dementia: “step wise” decline, h/o or risk factor for TIA/stroke Lewy body: psychosis early, Parkinson’s features, falls

Agitation and Behavioral Distrubances #

• Abilify (aripiprazole)
  • Start 5-10mg daily
  • Don’t use more than 15mg qday
• Risperdal (risperidone)
  • Start low (1-2mg)
  • Usual dose 4-6mg
• Depakote (valproic acid)
  • Can be added to either of the above
  • Start at 500mg XR
  • Check level and titrate up to about 50-110 after 4-5 days

Preference:

1. Abilify
2. Abilify + Depakote
3. Risperdal
4. Risperdal + Depakote

Treatment #

• Cholinesterase inhibitors
  • Donepezil, Rivastigmine, Galantamine
  • AEs: Bradycardia, weight loss, GI intolerance, increased secretion (avoid with GI issues, COPD/asthma)
• Memantine

PHQ-9 Screener #

SIG E CAPS >5 = positive
Sleep
Interest
Guilt/Worthlessness
Energy
Concentration
Appetite
Psychomotor (restless/lethargic)
Suicidality

Scoring #

0-4: None
5-9: Mild (positive)
10-14: Moderate
15-19: Moderate Severe
20+: Severe

GAD-7 Screener #

Scores 10 and above with roughly 75-85% sensitvity and specificity for one of GAD, panic disorder, or social anxiety disorder.

Scoring #

• &lte;4: Minimal
• 5-9: Mild
• 10-14: Moderate
• &gte;15: Severe

Bipolar Screen #

Ask “Ever felt so happy/energetic that friends said you were talking to fast or too hyper?”

If yes => DIG FAST
Distractibility
Indescretion (excessive involvement in pleasurable activities)
Grandiosity
Flight of ideas
Activity incrase
Sleep deficit
Talkativeness (pressured speech)

Borderline Screener (PD criteria) #

Identity problems
Disordered affect
Empty feeling
Suicidal behavior
Paranoia
Abandonment terror
Impulsivity
Rage
Relationship Instability

>2 → positive

MiniCog Exam #

76% sensitive, 89% specific

1. Remember 3 items
2. Draw clock at 10 past 11
3. Recall 3 items

If 0/3 on recall => Dementia
If 3/3 on recall => No dementia
Else if clock ok => No dementia

Anxiety Treatments #

• Atarax (Hydroxyzine): 50-100mg 4x daily (QiD)
• Gabapentin: 300mg TID prn
• Risperidone 1-2mg (start at 0.5mg) daily
  • Can cause gynecomastia, let patients know and if see any changes dc med (reverts)
• Seroquel
  • 1/2 tab (12.5mg) prn for anxiety
  • full tab (25mg) at bedtime

Alcohol Abuse Screener (CAGE) >2 = positive #

Cut down
Annoyed
Guilt
Eye-opener

SSRIs #

Start with (if starting from scratch in generic patient):

1. Sertaline (Zoloft)
   • Least side effects
2. Escalitopram (Lexapro)
3. Fluoxetine (Prozac)

SNRIs #

If eating too much as part of depression/anxiety, SNRIs are good choice. NE part “shuts down” GI system a bit (fight/flight).
Serotonin/NE ratio -> more NE, the more “uplifitng” the med—in theory…

[Paper with annotations](/literature/Serotonin Norepinephrine Reuptake Inhibitors- A Pharmacological Comparison.pdf) and link to original.

Worksheets and Tools #

TherapistAid Psychology Tools

Pearls #