Module 16: Psychiatric Disorders

Module Authors

David Sellen, MSHPE, Ph.D.
Adjunct Professor, Master of Science Health Professions Education
Western University of Health Sciences, Pomona, CA

Diana Lithgow, RN, MSN, FNP-C
Assistant Professor, Master of Science in Nursing/Family Nurse Practitioner Program
Western University of Health Sciences, Pomona, CA

Tina M. Meyer, PA-C
Clinical Consultant and Adjunct Professor
Western University of Health Sciences, Pomona, CA

Review Concepts

By the end of this Review Concept you should be able to:

• List the psychiatric conditions treated in the primary care setting
• State the percentage of patients treated for somatization versus hypochondriasis
• Define terms commonly used to describe psychiatric signs and symptoms
• State the definition and purpose of a psychiatric history
• List the items to assess in a mental status exam
• Identify questions the mental status exam should answer about the patient
• Identify cognitive functions assessed on the Mini-Mental State Examination (MMSE)
• Define the five axes described in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV)
• List the different approaches to psychotherapy and when to use each approach
• Identify the factors to consider when selecting, initiating, and determining the dosage of a psychotherapeutic drug
• Describe the conditions under which a psychiatric patient should be referred to a psychiatrist

By the end of this Review Concept you should be able to:

• Describe the epidemiology of depression
• List the common etiologies of depression and agents that can cause drug-induced depression.
• List the signs and symptoms of depression
• Differentiate the clinical presentation of dementia with that of depression
• Describe procedures and criteria for diagnosing depression
• Describe pharmacological and nonpharmacological options for the treatment of depression
• Summarize guidelines for the selection, implementation, and discontinuation of antidepressant therapy

By the end of this Review Concept you should be able to:

• Describe the clinical characteristics and epidemiology of bipolar disorder
• List the signs and symptoms of bipolar disorder, including both manic and depressive phases
• Describe pharmacotherapeutic agents and approaches commonly used in the acute and prophylactic treatment of bipolar disorde
• Compare and contrast dosing, adverse reactions, drug-drug interactions, and monitoring guidelines for agents commonly used to treat bipolar disorders

By the end of this Review Concept you should be able to:

• Describe the prevalence and morbidity/mortality associated with alcohol abuse.
• Compare the etiology of early-onset and late-onset alcohol abuse.
• Describe behavior patterns associated with alcohol abuse.
• Describe the physiological changes that occur as a result of alcohol abuse, and the resulting clinical signs and symptoms, and sequelae.
• Explain the difficulties in diagnosing alcohol abuse, and describe tests and metabolic markers that may be useful in confirming diagnosis.
• Define the four withdrawal states that can occur during detoxification.
• List conditions that can affect the treatment of alcohol abuse.
• Describe the process and some of the therapeutic options available for treating alcohol abuse.
• Describe drugs commonly used in the pharmacotherapy of alcohol abuse, including their effects, dosing, adverse reactions, monitoring protocols, and drug-drug interactions.
• Explain the risks associated with combining alcohol with prescription medications.
• Differentiate between experimental drug use and compulsive drug use.
• Identify cognitive functions assessed on the Mini-Mental State Examination (MMSE)
• Define the five axes described in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV)
• List the different approaches to psychotherapy and when to use each approach
• Identify the factors to consider when selecting, initiating, and determining the dosage of a psychotherapeutic drug
• Describe the conditions under which a psychiatric patient should be referred to a psychiatrist

By the end of this Review Concept you should be able to:

• Differentiate the types of drug abuse in terms of characteristic patterns of behavior
• Describe distinguishing characteristics of addictive behavior
• List drugs that are commonly abused in American society
• Describe the pharmacology, clinical presentation, and consequences of overdose and withdrawal for the following drugs.
  • Caffeine
  • Nicotine
  • Amphetamines and analogs
  • Cocaine
  • Marijuana
  • Phencyclidine (PCP)
  • Opioids
  • Barbiturates
  • Benzodiazepine

By the end of this Review Concept you should be able to:

• Differentiate different types of anxiety disorders
• Describe the epidemiology and etiology of generalized anxiety disorder
• List drugs that can cause anxiety
• Describe signs and symptoms of generalized anxiety disorder
• Describe diagnostic and treatment protocols for patients with anxiety disorders
• Identify pharmacological treatment options for patients with anxiety disorders
• Describe indications, contraindications, dosing, adverse effects, and drug-drug interactions for agents commonly used to treat anxiety disorders

By the end of this Review Concept you should be able to:

• Describe the epidemiology, etiology, and signs and symptoms of panic attacks.
• Describe the treatment protocols for patients with panic attacks.
• Identify nonpharmacological and pharmacological treatment options for patients with panic attacks.
• Identify common phobias.
• Describe the etiology and signs and symptoms of phobias.
• Describe diagnostic protocols for patients with phobias.
• Identify nonpharmacological and pharmacological treatment options for patients with phobias.
• Describe the etiology and signs and symptoms of Post-Traumatic Stress Disorder (PTSD).
• Describe the diagnostic and treatment protocols for patients with PTSD.
• Describe the signs and symptoms of depersonalization.
• Describe diagnostic and treatment protocols for depersonalization.

By the end of this Review Concept you should be able to:

• Define anorgasmia.
• Describe the etiology of anorgasmia.
• List the signs and symptoms of anorgasmia.
• Describe the diagnosis and treatment protocols for anorgasmia.
• State the definition of impotence.
• Define impotence.
• Describe the epidemiology of impotence.
• Describe the diagnosis and treatment protocols for impotence.
• Identify and define terms describing sexual diagnoses.

By the end of this Review Concept you should be able to:

• Describe the epidemiology of sleep disorders.
• Differentiate transient and chronic sleep disorders.
• Differentiate primary and secondary sleep disorders.
• List common primary sleep disorders.
• List psychiatric, medical, and pharmacological causes of secondary sleep disorders.
• Describe procedures for assessing and diagnosing sleep disorders.
• Describe nonpharmacological therapies for the treatment of insomnia.
• Describe pharmacological options for the treatment of insomnia.
• Describe effects, dosing, side effects, and contraindications for common agents used in the treatment of insomnia.
• Describe pharmacological and nonpharmacological options for the treatment of apnea and other sleep disorders.

By the end of this Review Concept you should be able to:

• Define borderline personality disorder.
• Describe the signs and symptoms of borderline personality disorder.
• Describe diagnostic and treatment protocols for borderline personality disorder.

By the end of this Review Concept you should be able to:

• Define the term psychosis.
• List the major types of psychotic disorders.
• Differentiate early-onset and late-onset schizophrenia.
• List the signs and symptoms of schizophrenia and other psychotic disorders.
• Summarize guidelines for diagnosing psychotic disorders.
• Describe pharmacotherapeutic agents for treating psychotic disorders and drawbacks to using such agents.

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