Case files psychiatry 5th edition pdf free download

Case files psychiatry 5th edition pdf free download

[PDF] DOWNLOAD READ Case Files Psychiatry Fifth Edition (LANGE Case Files) Read Online,Case Files Psychiatry 5th Edition Pdf

WebSep 8,  · Case Files Psychiatry 5th Edition Pdf. Sixty high-yield psychiatry cases helps students sharpen their diagnostic and problem-solving skills. The Case Files WebDOWNLOAD MEDICAL BOOKS Case Files Psychiatry, Fifth Edition Psychiatry Oct Sixty high-yield psychiatry cases helps students sharpen their diagnostic and WebCase Files Psychiatry Fifth Edition DOWNLOAD READ ONLINE Author: Eugene C. Toy language: en Publisher: McGraw Hill Professional Release Date: Case WebCase Files: Psychiatry NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy WebJul 20,  · Download Case Files Psychiatry, Fifth Edition (LANGE Case Files) read ebook Online PDF EPUB KINDLE. Case Files Psychiatry, Fifth Edition (LANGE Case ... read more

Case Files Neurology 3rd Edition PDF Free Download. Case Files Internal Medicine 6th Edition PDF Free Download. Case Files Family Medicine 5th Edition PDF Free Download. Download Link. Disclaimer: This site complies with DMCA Digital Copyright Laws. Moreover Medicalstudyzone. com server does not store any type of book,guide, software, or images. Check out our DMCA Policy. If you feel that we have violated your copyrights, then please contact us immediately. This site comply with DMCA digital copyright. We do not store files not owned by us, or without the permission of the owner. We also do not have links that lead to sites DMCA copyright infringement. If You feel that this book is belong to you and you want to unpublish it, Please Contact us. Case Files Psychiatry 5th Edition.

Tags Psychiatry. Carbamazepine: A pretreatment CBC including a platelet count should be obtained to assess for agranulocytosis. Reticulocyte and serum iron levels should also be determined and all these tests performed monthly thereafter. Liver function tests should be performed every 3 to 6 months, and carbamazepine levels should be monitored this often as well. Valproate: Valproate levels should be monitored every 6 to12 months, along with liver function tests. Psychometric testing A. Structured clinical diagnostic assessments 1. Tests based on structured or semistructured interviews designed to produce numerical scores. Examples: Beck Rating Scale for Depression, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, and Structured Clinical Interview for DSM-IV Dissociative Disorders SCID-IV.

Psychological testing of intelligence and personality 1. Tests generally administered by psychologists trained to administer and interpret them. Such tests play a relatively small role in the diagnosis of psychiatric illness: The psychiatric interview and other observable signs and symptoms play a much larger role. These tests are therefore reserved for special situations. Objective tests generally consisting of pencil-and-paper examinations based on specific questions. They yield numerical scores and are statistically analyzed. Minnesota Multiphasic Personality Inventory: This self-report inventory is widely used and has been thoroughly researched.

It assesses personality using an objective approach. Projective Tests: These tests present stimuli that are not immediately obvious. The ambiguity of the situation forces patients to project their own needs into the test situation. Therefore, there are no right or wrong answers. Rorschach test: This projective test is used to assess personality. In skilled hands, it is helpful in bringing out defense mechanisms, subtle thought disorders, and pertinent patient psychodynamics. Thematic Apperception Test TAT. This test also assesses personality but does so by presenting patients with selections from 30 pictures and 1 blank card. The patient is required to create a story about each picture presented. Generally, the TAT is most useful for investigating personal motivation eg, why a patient does what he or she does than it is in making a diagnosis. Sentence completion test: A projective test in which the patient is given part of a sentence and asked to complete it.

Intelligence tests: These tests are used to establish the degree of mental retardation in situations where this is the question. The Wechsler Adult Intelligence Scale is the test most widely used in clinical practice today. Neuropsychologic tests: The aim of these tests is to compare the patient being tested with normal people of HOW TO APPROACH CLINICAL PROBLEMS 13 similar background and age. They are used to identify cognitive deficits, assess the toxic effects of substances, evaluate the effects of treatment, and identify learning disorders. Wisconsin Card Sorting Test: This test assesses abstract reasoning and flexibility in problem solving by asking the patient to sort a variety of cards according to principles established by the rater but not known to the sorter.

Abnormal responses are seen in patients with damaged frontal lobes and in some patients with schizophrenia. Wechsler Memory Scale: This is the most widely used battery of tests for adults. It tests rote memory, visual memory, orientation, and counting backward, among other dimensions. It is sensitive to amnestic conditions such as Korsakoff syndrome. Bender Visual Motor Gestalt Test: A test of visuomotor coordination. Patients are asked to copy nine separate designs onto unlined paper. They are then asked to reproduce the designs from memory. This test is used as a screening device for signs of organic dysfunction. Further diagnostic tests A. Additional psychiatric diagnostic interviews eg, the Diagnostic Interview Schedule for Children or the Beck Depression Scale B.

Interviews conducted by a social worker with family members, friends, or neighbors C. Psychological testing, including projective testing to help with the assessment of personality structure, psychosis, or depression D. Electroencephalogram to rule in or rule out a seizure disorder E. Computed tomography scan to assess intracranial masses F. Magnetic resonance imaging to assess intracranial masses or any other neurologic abnormality G. Tests to confirm other medical conditions. PART 2: APPROACH TO CLINICAL PROBLEM SOLVING A clinician typically undertakes four distinct steps to solve most clinical problems systematically: 1.

Making a diagnosis 2. Rendering treatment based on the disease 4. Making a Diagnosis A diagnosis is made by careful evaluation of the database, analysis of the information, assessment of the risk factors, and development of a list of possibilities the differential diagnosis. The process involves knowing which pieces of information are meaningful and which can be discarded. A good clinician also knows how to ask the same question in several different ways and to use different terminology. For example, patients at times may deny having been treated for bipolar disorder but answer affirmatively when asked if they have been hospitalized for mania. A diagnosis can be reached by systematically reading about each possible disease.

Usually, a long list of possible diagnoses can be pared down to the two or three most likely ones based on a careful delineation of the signs and symptoms displayed by the patient, as well as on the time course of the illness. For example, a patient with a history of depressive symptoms, including problems with concentration, sleep, and appetite and symptoms of psychosis that started after the mood disturbances may have major depression with psychotic features, whereas a patient with a psychosis that started before the mood symptoms may have schizoaffective disorder.

With a malignancy, this is done formally by staging the cancer. Some major mental illnesses, such as schizophrenia, can be characterized as acute, chronic, or residual, whereas the same clinical picture, occurring with less than a 6-month duration, is termed schizophreniform disorder. This categorization usually has prognostic or treatment significance. Treating Based on Stage Many illnesses are stratified according to severity because prognosis and treatment often vary based on these factors. If neither the prognosis nor the treatment is influenced by the stage of the disease process, there is no reason to subcategorize a disease as mild or severe. For example, some patients with suicidal ideation but no intent or plan can be treated as outpatients, but other patients who report intent and a specific plan, must be immediately hospitalized and even committed if necessary.

The measure of response should be recorded and monitored. Some responses are clinical, such as improvement or lack of improvement in the level of depression, anxiety, or paranoia. Obviously, the student must work on becoming skilled in eliciting the relevant data in an unbiased, standardized manner. Other responses can be followed by laboratory tests, such as a urine toxicology screening for a cocaine abuser or a determination of lithium level for a bipolar patient. The student must be prepared to know what to do if the measured marker does not respond according to what is expected. Is the next step to reconsider the diagnosis, to repeat the test, or to confront the patient about the findings? It can be based on symptoms the patient feels better or on a laboratory or some other test a urine toxicology screening.

It is the official psychiatric coding system used in the United States. The DSM-IV describes mental disorders and only rarely attempts to account for how these disturbances come about. Specified diagnostic criteria are presented for each disorder and include a list of features that must be present for the diagnosis to be made. The DSM-IV also systematically describes each disorder in terms of its associated descriptors such as age, gender, prevalence, incidence, and risk; course; complications; predisposing factors; familial pattern; and differential diagnosis. The DSM-IV uses a five-axis system that evaluates patients along several dimensions. Axes I and II make up the entire classification of mental disorders. Each patient should receive a five-axis diagnosis, which usually appears at the end of a write-up in the assessment section.

Axis I: Clinical disorders and other disorders that may be the focus of clinical attention Axis II: Personality disorders and mental retardation only Axis III: Physical disorders and other general medical conditions. The physical condition may be causing the psychiatric one eg, delirium, coded on axis I, caused by renal failure, coded on axis III , be the result of a mental disorder eg, alcoholic cirrhosis, coded on axis III, secondary to alcohol dependence, coded on axis I , or be unrelated to the mental disorder eg, chronic diabetes mellitus. Information about these stressors may be helpful when it comes time to develop treatment plans for the patient. Axis V: This axis is used to provide a global assessment of functioning GAF. The scale is based on a continuum of health and illness, using a point scale on which is the highest level of functioning in each area. People who had high GAF values before an episode of illness often have a better prognosis than those whose functioning was at a lower level.

Patients rarely present with symptoms that permit a clear diagnosis; hence, the student must become skilled in HOW TO APPROACH CLINICAL PROBLEMS 17 applying textbook information in the clinical setting. Furthermore, a reader retains more information when reading with a purpose. In other words, the student should read with the goal of answering specific questions. There are several fundamental questions that facilitate clinical thinking: 1. What is the most likely diagnosis? What should the next step be? What is the most likely mechanism for this process?

What are the risk factors for this condition? What complications are associated with this disease process? What is the best therapy? How can you confirm the diagnosis? Note that questions 3 through 5 are probably used less in the field of psychiatry than in other specialties, such as medicine, where the pathophysiology and risk factors of a particular disease process are known. Likewise, confirmation of a diagnosis question 7 is less often made by further laboratory tests or other diagnostic studies but can be achieved by carefully obtaining additional history obtained from family, colleagues, and so on.

The above questions should, however, be kept in mind for all patients. What Is the Most Likely Diagnosis? The method of establishing a diagnosis was covered in the previous section. It is helpful to understand the most common presentation of a variety of illnesses, for example, a common presentation of major depression. Clinical pearls appear at the end of each case. The clinical scenario might be the following: A year-old woman presents to her physician with a chief complaint of a depressed mood and difficulty sleeping. With no other information to go on, the student notes the depressed mood and the vegetative symptom of insomnia. However, what if the scenario also includes the following? Then the student would use the clinical pearl: A diagnosis of acute stress disorder should be considered in a patient with a depressed mood, insomnia, and a history of trauma.

These symptoms, however, are common in instances of trauma and bereavement as well, and so these details must be investigated in reference to the patient. What Should the Next Step Be? This question is difficult because the next step has many possibilities; the answer may be to obtain more diagnostic information, rate the severity of the illness, or introduce therapy. It is often a more challenging question than what is the most likely diagnosis because there may be insufficient information to make a diagnosis and the next step may be to pursue more diagnostic information. Another possibility is that there is enough information for a probable diagnosis and that the next step is to assess the severity of the disease. Finally, the most appropriate answer may be to start treatment. This ability is learned optimally at the bedside, in a supportive environment, with freedom to make educated guesses and with constructive feedback.

Smith has major depression because she has a depressed mood, problems with concentration, anhedonia, insomnia, loss of appetite, anergia, and a weight loss of 10 lb in 3 weeks. is the most difficult question because the answer may be diagnostic, may involve staging, or may be therapeutic. What Is the Likely Mechanism for This Process? This question goes further than making the diagnosis and also requires the student to understand the underlying mechanism of the process. The student must first diagnose a conversion disorder, which can occur after an emotionally traumatic event, once physical explanations for blindness have been ruled out. Then the student must understand that there is a psychodynamic explanation for the particular nature of the symptoms as they have arisen. While many mechanisms of disease are not well understood in psychiatry at the present time, it is anticipated that they will be further elucidated as the fields of neuropsychiatry and neuroimaging continue to grow.

What Are the Risk Factors for This Process? Understanding the risk factors helps a practitioner to establish a diagnosis and to determine how to interpret tests. For example, understanding the risk factor analysis may help in treating a year-old man who presents to a physician with a chief complaint of loss of memory. Thus, the presence of risk factors helps to categorize the likelihood of a disease process. What Are the Complications of This Process? Clinicians must be cognizant of the complications of a disease so that they understand how to follow and monitor the patient.

Sometimes the student has to make a diagnosis from clinical clues and then apply their knowledge of the consequences of the pathologic process. For example, a woman who presents with a depressed mood, anhedonia, anergia, loss of concentration, insomnia, and weight loss is first diagnosed as having major depression. A complication of this process includes psychosis or suicidal ideation. Therefore, understanding the types of consequences helps the clinician to become aware of the dangers to the patient. Not recognizing these possibilities might lead the clinician to miss asking about psychotic symptoms and treating them or to overlook a potentially fatal suicidal ideation. What Is the Best Therapy? To answer this question, the clinician needs to make the correct diagnosis, assess the severity of the condition, and weigh the situation to determine the appropriate intervention.

For the student, knowing exact doses is not as important as understanding the best medication, route of delivery, mechanism of action, and possible complications. It is important for the student to be able to verbalize the diagnosis and the rationale for the therapy. A common error is for a student to jump to a treatment by making a random guess; as a result he or she receives correct or incorrect feedback. There was no mention of a general medical condition like hyperthyroidism or a substance abuse problem like cocaine use that would account for these symptoms. Therefore, the best treatment for this patient with probable bipolar disorder would be lithium or valproic acid after the final diagnosis is made. There is no need to hospitalize all patients with major depression, but it may be lifesaving to do so if suicidal ideation with intent and plan are present.

How Can You Confirm the Diagnosis? In the previous scenario, the year-old woman is likely to have bipolar disorder— manic phase. Further information about the presence of other symptoms common in mania can also be helpful, as is ruling out any general medical conditions or substance abuse problems. The student should strive to know the limitations of various diagnostic tests and the manifestations of disease. SUMMARY 1. There is no replacement for a meticulously constructed history and a physical examination. There are four steps in the clinical approach to a patient: making a diagnosis, assessing the severity of the disease, treating based on the severity of the disease, and following the response to treatment.

There are seven questions that help to bridge the gap between the textbook and the clinical arena. The DSM-IV describes five axes: Axis I: Clinical disorders other than those listed in Axis II Axis II: Personality disorders, mental retardation Axis III: Physical disorders Axis IV: Psychosocial problems Axis V: Global assessment of functioning. Current diagnosis and treatment in psychiatry. New York, NY: McGraw-Hill. Goldman HH, ed. Review of general psychiatry, 5th ed. New York, NY: McGrawHill. Kaplan H, Sadock B. Synopsis of psychiatry, 8th ed. S E C T I O N I I Psychiatric Therapeutics PART 1. Psychotherapy PART 2. Psychopharmacotherapy Copyright © by The McGraw-Hill Companies, Inc.

Individual psychotherapy: Varies according to the time frame used psychotherapy can be either brief or protracted. It can be supportive, directive, and reality-oriented versus expressive, exploratory, and oriented toward a discussion of unconscious material. Supportive psychotherapy 1. Insight-oriented psychotherapy 1. Indicated in the treatment of anxiety, somatoform and dissociative disorders, personality disorders, neuroses, and trauma. It should be noted that although psychotherapy may be indicated for all these disorders, the degree of patient insight and motivation for undergoing treatment are critical to its success. Behavior modification: Includes a group of loosely related therapies that work according to the principles of learning. A short list of examples of these therapies follows.

Systematic desensitization: Exposing the patient to increasingly anxiety-provoking stimuli and at the same time teaching him or her to relax. This therapy is used in the treatment of phobias and in preventing compulsions. Substitution: Replacing an undesirable behavior smoking with a desirable one chewing gum. Hypnosis works in selected patients in the management of pain, the resolution of conversion disorders, and relaxation training. Cognitive-behavioral therapy A. Focuses on the cognitive responses that are the primary targets for intervention. Used in changing maladaptive behavior occurring as a result of cognitive responses. The most common use for this form of therapy is in the treatment of major depression, where the self-defeating attitudes that are so common are identified, challenged, and replaced with more realistic thoughts.

Social therapies: These therapies use the principles of supportive and individual or marital therapy, but occur in groups of similar patients, a family, or a couple. PART 2. Tables through summarize the characteristics of these agents. Many of these medications affect neurotransmitters Figure The main neurotransmitters are monoamines norepinephrine, dopamine, serotonin, acetylcholine, histamine , amino acids gamma-aminobutyric acid , and glutamic acid. Antidepressants: Antidepressants can be placed in three main categories. Tricyclics and heterocyclics, which once represented the first line of treatment. These drugs work by increasing the level of monoamines in the synapse by reducing the reuptake of norepinephrine and serotonin. Although they are quite effective, they are dangerous in overdose, causing fatal cardiac arrhythmias Table Selective serotonin reuptake inhibitors SSRIs are the most commonly used antidepressants today.

Major side effects include gastrointestinal and sexual dysfunction Table Monoamine oxidase inhibitors MAOIs are not commonly used because a tyramine-free diet no wine or cheese must be followed or a hypertensive crisis may result. These agents may be more helpful in depression with atypical features overeating, oversleeping, irritability Table Miscellaneous medications Table Mood stabilizers: These medications are used to treat mania and include agents such as lithium, valproic acid, and carbamazepine. Neurotransmitters in the neuronal synapse. Selective serotonin reuptake inhibitors block the reuptake of serotonin by the presynaptic neuron top , allowing more serotonin to be available at the postsynaptic receptor. Monoamine oxidase inhibitors block the ability of this enzyme to inactivate monoamines such as norepinephrine in the synaptic cleft bottom , allowing more neurotransmitter to bind to the postsynaptic receptor. It is characterized by confusion, muscle rigidity, high temperature, muscle twitching, shivering, and loss of consciousness, and it may be fatal.

older patients and in those with renal insufficiency. Lithium and valproic acid are both teratogenic and must be used with caution in women of childbearing age Table Antipsychotic agents A. First-generation antipsychotics typical antipsychotics 1. These medications work by blocking central dopamine receptors. They are most effective in reducing the positive symptoms of schizophrenia, including hallucinations and delusions. Side effects Table include the following. Central nervous system effects: i. Extrapyramidal symptoms EPS : Parkinsonian syndrome, acute dystonias, akathisia ii. Tardive dyskinesias: Late onset of choreiform and athetoid movements of the trunk, extremities, or mouth iii.

Sedation iv. Neuroleptic malignant syndrome NMS : Can occur at any time with an antipsychotic agent; typically movement disorder muscle rigidity, dystonia, agitation and autonomic symptoms high fever, sweating, tachycardia, hypertension. Treatment includes medication with dantrolene and bromocriptine. Anticholinergic effects c. Cardiovascular effects i. Alpha-adrenergic blockade, which causes orthostatic hypotension ii. Cardiac rhythm disturbances, especially prolongation of the QT interval. Endocrine effects: Decreasing the amount of dopamine in the pituitary gland leads to increased prolactin levels, which may cause gynecomastia and galactorrhea as well as sexual dysfunction. Weight gain. Second-generation antipsychotics atypical antipsychotics : These medications are more commonly used than first-generation antipsychotics because they are less likely to produce EPS, tardive dyskinesia, and NMS.

However, many have significant side effects Table of their own that limit their use eg, clozapine can cause fatal agranulocytosis. Benzodiazepines: These drugs work by binding to sites on GABA receptors. They are effective in anxiety and sleep disorders and in anxiety and agitation in other disorders such as acute psychosis. They are generally safe in overdose if used alone. They are metabolized mainly in the liver. Their side effects include sedation, behavioral disinhibition especially in the young or the elderly , psychomotor impairment, cognitive impairment, confusion, and ataxia. They are addictive, and after prolonged use, withdrawal may cause seizures and death. Table lists commonly used benzodiazepines.

Drugs used to treat the side effects of other psychotropic medications 1. Anticholinergic agents used to treat dystonias caused by the use of antipsychotic medication include benztropine, biperiden, diphenhydramine, and trihexyphenidyl. Medications used to treat akathisias restlessness caused by the use of antipsychotic medication include propranolol and benzodiazepines. Medications used to treat parkinsonian side effects caused by the use of antipsychotic medication include amantadine and levodopa. Which of the following medications is most likely responsible? What is the next step? He has no medical problems, states that he feels fine, and says that last night he even had a nice meal with wine. Which of the following medications is he most likely taking? She takes imipramine each evening for depression. Which of the following is the most likely cause of her symptoms?

He enjoys drinking beer on the weekends. Which of the following side effects is most likely to occur? Alcohol potentiation Alcohol withdrawal Sexual dysfunction Diabetes insipidus 40 [2. He comes to the emergency department several days later with muscle spasms, confusion, fever, tachycardia, and hypertension. Which of the following is the most likely cause? Which of the following medications should be avoided? Bipolar disorder B. Major depression C. Panic disorder D. Schizophrenia E. Social phobia [2. His temperature is ºF with no findings of infection. Haloperidol Risperidone Clozapine Thioridazine Fluphenazine [2. On hospital day 2, she experiences auditory and visual hallucinations, has tremors, and is agitated. Which of the following would be the best therapy?

Which of the following is the most likely etiology? Advanced maternal age Mood-stabilizing medication Folate excess Ethnicity [2. He is rushed to the emergency room where resuscitation is attempted but fails. Which of the following is most likely to be noted during the attempted resuscitation or the autopsy? Massive coronary artery occlusion Aortic valve stenosis Electrocardiographic conduction abnormalities Cardiac tamponade Massive pulmonary embolism Match the following therapies A through F to the clinical scenarios listed questions [2. Benztropine Propranolol Amantadine Dantrolene Dialysis Flumazenil [2.

Answers [2. High doses of thioridazine are associated with irreversible pigmentation of the retina, leading initially to symptoms of night vision difficulty and ultimately to blindness. This priapism is most likely caused by trazodone. One treatment is epinephrine injected into the corpus of the penis. This patient probably experienced a hypertensive crisis induced by an interaction between the wine and phenelzine, a MAOI. Sexual dysfunction is a very common side effect of SSRI medications. This patient was likely switched from a SSRI, sertraline, to a MAOI, such as phenelzine. Because both agents increase serotonin levels, 5 weeks should elapse between discontinuation of one medication and initiation of the other. The danger is very serious serotonin syndrome, which has features similar to those of NMS. Seizure disorders and eating disorders are contraindications for bupropion because of its possible lowering of the seizure threshold and its anorectic effects.

This patient has symptoms of diabetes insipidus, a side effect of lithium used in the treatment of bipolar disease. This individual has neutropenic fever as a result of agranulocytosis, a side effect of the atypical antipsychotic agent clozapine. This woman is probably experiencing either alcohol or benzodiazepine withdrawal; in either case, benzodiazepines would be the treatment. This woman was likely taking valproic acid, a mood stabilizer used in treating bipolar disorder, which increases the risk for teratogenicity eg, a neural tube defect. A tricyclic antidepressant overdose may lead to increased QT intervals and ultimately to cardiac dysrhythmias. Dialysis is used to treat lithium toxicity when it is severe and lifethreatening, such as causing seizures or coma. Akithisia restlessness can be treated with propranolol.

A benzodiazepam overdose can be treated with flumazenil, which is a benzodiazepam antagonist. The parkinsonian-like symptoms of neuroleptic agents are treated with amantadine or levodopa. An exception to this rule is amoxapine. Selective serotonin reuptake inhibitors are the most commonly used medications for depression but should not be used in conjunction with MAOIs. One medication should be discontinued for at least 5 weeks before the other is initiated to avoid serotonin syndrome. Serotonin syndrome is similar to NMS and is characterized by confusion, muscle rigidity, high temperature, muscle twitching, shivering, and loss of consciousness. It may be fatal. The most common side effects of SSRIs are gastrointestinal and sexual dysfunction. Individuals taking MAOIs should avoid cheese, wine, liver, and aged foods tyramine or an acute hypertensive crisis may ensue.

Trazodone can lead to priapism; thus, a prolonged painful erection that is trazodone-induced is considered an emergency and is treated with an intracorporeal injection of epinephrine or drainage of blood from the penis. Bupropion is used for smoking cessation but must be avoided in patients with eating disorders or seizures. Lithium is cleared through the kidneys and must be used with caution in older patients and in those with renal insufficiency. Lithium and valproic acid are both teratogenic and must be used with caution in women of childbearing age. Antipsychotic agents produce many adverse effects, including EPS, sedation, and orthostatic hypotension.

Neuroleptic malignant syndrome can be caused at any time by an antipsychotic agent. It typically includes movement disorder muscle rigidity, dystonia, agitation and autonomic symptoms high fever, sweating, tachycardia, hypertension. Clozapine can cause fatal agranulocytosis, and thus leukocyte count monitoring is mandatory. Benzodiazepine withdrawal resembles alcohol withdrawal and can be fatal. S E C T I O N I I I Clinical Cases Copyright © by The McGraw-Hill Companies, Inc. He was diagnosed with major depression for the first time 20 years ago. During a second episode, which occurred 15 years ago, he was treated with imipramine, and once again his symptoms remitted after 4 to 6 weeks. He denies illicit drug use or any recent traumatic events. The man states that although he is sure he is experiencing another major depression, he would like to avoid imipramine this time because although it worked in the past, it produced unacceptable side effects such as dry mouth, dry eyes, and constipation.

Previously he was successfully treated with a tricyclic antidepressant TCA , although this class of medication often produces anticholinergic side effects such as dry mouth, dry eyes, and constipation, which this patient complains about. The question becomes what medication should be used to treat recurrent major depression when tricyclics are not an option. Common side effects: Gastrointestinal symptoms—stomach pain, nausea, and diarrhea—occur in early stages of the treatment. Minor sleep disturbances—either sedation or insomnia—can occur. Other common side effects include tremor, dizziness, increased perspiration, and male and female sexual dysfunction most commonly delayed ejaculation in men and decreased libido in women. Analysis Objectives 1. Understand the treatment of uncomplicated major depression without psychotic features. Be able to counsel a patient in regard to the common side effects of SSRIs.

Considerations Although the patient has been successfully treated with a TCA imipramine two times in the past, these medications are no longer considered first-line treatments because of their common side effects and their potential lethality. If taken all at once, a weekly dosage of one these medications can produce lethal cardiac arrhythmias. For a patient such as this one, who has a successful history of being treated with imipramine on two prior occasions, one might consider using this medication again. However, the patient specifically requests another type of medication because of his previous discomfort with the side effects.

SSRIs, the current first-line treatment approach for patients with major depression, are thus the logical choice; they have fewer side effects and are safer.

In this blog post, we are going to share a free PDF download of Case Files Psychiatry 5th Edition PDF using direct links. In order to ensure that user-safety is not compromised and you enjoy faster downloads, we have used trusted 3rd-party repository links that are not hosted on our website. At Medicalstudyzone. com , we take user experience very seriously and thus always strive to improve. We hope that you people find our blog beneficial! Now before that we move on to sharing the free PDF download of Case Files Psychiatry 5th Edition PDF with you, here are a few important details regarding this book which you might be interested.

Sixty high-yield psychiatry cases helps students sharpen their diagnostic and problem-solving skills. The Case Files series is an award-winning learning system proven to improve shelf-exam scores and clerkship performance. Unlike other books on the market, this series helps students learn in the context of real patients instead of simply memorizing. Case Files Psychiatry teaches students how to improve their diagnostic and problem-solving skills as they work through sixty high-yield clinical cases. Each case includes a complete discussion, clinical pearls, references, and USMLE-style review questions with answers. The fifth edition has been updated to include a new Case Correlations feature which highlights differential diagnosis and related cases in the book, andNEW CASES highlighting DSM-V diagnostic entities. Case Files Pediatrics 5th Edition PDF Free Download.

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Case Files: Psychiatry,Case Files Psychiatry 5th Edition PDF Free Download

WebNov 23,  · Case Files Psychiatry 5th Edition Free PDF. Author: Eugene C. Toy Pages: Publisher: McGraw-Hill Education / Medical; 5 edition (August 26, ) WebJul 20,  · Download Case Files Psychiatry, Fifth Edition (LANGE Case Files) read ebook Online PDF EPUB KINDLE. Case Files Psychiatry, Fifth Edition (LANGE Case WebSep 8,  · Case Files Psychiatry 5th Edition Pdf. Sixty high-yield psychiatry cases helps students sharpen their diagnostic and problem-solving skills. The Case Files WebCase Files Psychiatry Fifth Edition DOWNLOAD READ ONLINE Author: Eugene C. Toy language: en Publisher: McGraw Hill Professional Release Date: Case WebCase Files: Psychiatry NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy WebDOWNLOAD MEDICAL BOOKS Case Files Psychiatry, Fifth Edition Psychiatry Oct Sixty high-yield psychiatry cases helps students sharpen their diagnostic and ... read more

Severely affected individuals do not even leave their own homes. In the United States, about one in seven individuals will suffer from this disorder at some time in their life. Selective serotonin reuptake inhibitors SSRIs are the most commonly used antidepressants today. It is the official psychiatric coding system used in the United States. With the patient supine, the breasts should then be palpated systematically to assess for masses. Nausea 8.

These symptoms, however, are common in instances of trauma and bereavement as well, and so these details must be investigated case files psychiatry 5th edition pdf free download reference to the patient. Schizophrenia E. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Table lists many of them. It is important for the student to be able to verbalize the diagnosis and the rationale for the therapy. Individuals taking MAOIs should avoid cheese, wine, liver, and aged foods tyramine or an acute hypertensive crisis may ensue. DOWNLOAD PDF.