Episode 14: Generalized Anxiety Disorder

Episode 14: Generalized Anxiety Disorder

Assessment, Diagnoses, Treatment
Today’s episode is all about the assessment, diagnosis and management of generalized anxiety disorder. We will first review the epidemiology of GAD, followed by discussion of the clinical presentation, diagnostic criteria, and evaluation of GAD. We will then move on to management, including options for psychotherapy and pharmacotherapy. References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2015. Print. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington: American Psychiatric, 2014. Print. Stein, Murray B MD PhD, Sareen J MD. “Generalized Anxiety Disorder.” The New England Journal of Medicine, 373 (2015): 2059-2068. Web. 29 March 2018. Baldwin, David MA. “Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and…
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Episode 13: Treatment of Tobacco Use Disorder

Episode 13: Treatment of Tobacco Use Disorder

Assessment, Diagnoses, Psychopharmacology
Today’s episode focuses on managing tobacco use in our patients. As most mental health professionals come to find, cigarette smoking is a common comorbid condition in our patient population. Sometimes our patients are noncompliant with follow-up with a primary care physician, and as their psychiatrist we may be presented with the only opportunity to counsel that patient on the importance of smoking cessation as well as to provide treatment. Online Resources for Smoking Cessation The Great American Smokeout National Cancer Institute SmokeFree.gov Stop Smoking Center References Sadock, Benjamin James. Sadock, Virginia Alcott. Ruiz, Pedro. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2015. Print. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington: American Psychiatric, 2014. Print. Rigotti, Nancy…
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Episode 12: A Review of Adult ADHD

Episode 12: A Review of Adult ADHD

Assessment, Diagnoses, Psychopharmacology
Today’s episode constitutes a review of adult ADHD, with focus on evaluation, diagnosis, management, prognosis, and other concerns regarding adult ADHD. Adult ADHD has long been a controversial topic. The reality is that 50-66% percent of children with ADHD will continue to suffer symptoms into adulthood, and it is no longer considered to be a condition which spontaneously remits with age. In addition, it has more recently been determined that a number of patients that can be diagnosed with adult-onset ADHD did not have symptoms in childhood. However, diagnosing and treating adult ADHD presents its own unique set of challenges, which we will discuss towards the end of today’s episode. UpToDate.com members can click here to view a comprehensive table regarding pharmacotherapy options for adult ADHD, including dosage and titration schedules. References…
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Episode 11: Alcohol Withdrawal

Episode 11: Alcohol Withdrawal

Assessment, Diagnoses, Psychopharmacology
Today’s topic is the management of acute alcohol withdrawal. On our last episode #10 from December 2017, we covered alcohol use disorder, including evaluation and management of this condition. Please review episode 10 for more information on alcohol use disorder. Today we will discuss epidemiology, DSM5 criteria, etiology, evaluation, clinical course and treatment of acute alcohol withdrawal. As previously discussed in episode 10, in the US the 12-month prevalence of AUD is estimated to be 4.6% in teenagers and 8.5% in adults. However, the prevalence of AUD in hospitalized patients is estimated to be as high as 40%, with about half of patients with AUD experiencing alcohol withdrawal with reduction or cessation of alcohol use. Most individuals do not experience significant withdrawal symptoms; however, withdrawal is common within the emergency…
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Episode 10: Alcohol Use Disorder

Episode 10: Alcohol Use Disorder

Assessment, Diagnoses
Today’s topic is the diagnosis and management of alcohol use disorder. Alcohol use disorder is a prevalent illness throughout the country, and it accounts for over 85,000 deaths per year in the United States, with an estimated yearly cost of alcohol use disorder estimated at over 250 billion dollars. In the US, the 12-month prevalence of AUD is estimated to be 4.6% in teenagers and 8.5% in adults, with the 18 to 29-year-old age group having the highest rate of 16.2%. There are a number of risk factors that can contribute to development of AUD, and these include male gender, Native American or Alaska Native races, co-occurring conduct disorder or antisocial behavior in adolescence, family history of AUD or other substance abuse, and comorbid schizophrenia or bipolar disorder. Alcohol is the…
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Episode 8: Dementia in DSM5 – Part 2

Episode 8: Dementia in DSM5 – Part 2

Diagnoses
On today’s episode, we will discuss the second part of our 2-part discussion on neurocognitive disorders according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. In our previous discussion on neurocognitive disorders, we reviewed the evaluation of a patient with suspected delirium or neurocognitive disorder, the diagnosis and management of delirium, as well as the clinical presentation, diagnostic criteria, evaluation and treatment of major and minor neurocognitive disorder. Today, our discussion will turn to the specific etiologies of neurocognitive disorder as described in the DSM5. If you have not yet listened to part 1 of this discussion, I urge you to return to episode 5 originally aired on August 5th, 2017 to review those topics. (Please note: podcast states originally aired on 08/28/2017, however, this…
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Episode 5: Dementia in DSM5 – Part 1

Episode 5: Dementia in DSM5 – Part 1

Assessment, Diagnoses
On today’s episode, we will discuss the first part of a 2-part discussion on neurocognitive disorders according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Neurocognitive disorders involve acquired disruptions in one or more of the domains of cognition, which include Memory Language, Orientation, Judgment, Conductance of interpersonal relationships, Performing of tasks, and Problem-solving. It is important to be able to identify, diagnose, treat, and manage neurocognitive disorders in our patients as they can commonly be the basis for psychiatric symptoms, especially in our more elderly population. However, this proves to a challenging field in that it is not always black and white: there are a lot of gray areas as dementia can often have a multifactorial etiology. Neurocognitive disorders are a broad field, and…
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Episode 2: Sleep-Wake Disorders

Episode 2: Sleep-Wake Disorders

Diagnoses
On today’s episode we will be discussing sleep-wake disorders. We will first discuss a quick overview of normal sleep architecture, as well as the tools available for evaluation of sleep. We will then delve into the specifics of the various sleep-wake disorders, as classified by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, including insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, and we will also touch briefly on non-REM sleep arousal disorders, nightmare disorder, REM sleep behavior disorder, restless legs syndrome, and substance/medication-induced sleep disorder. Please click here to view an EEG recording of the various sleep stages, as discussed in the episode. Please click here to view and print my sleep hygiene handout for patients. This handout can be used free-of-charge for printing…
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