The Clinician’s Guide to Common Psychiatric Disorders: A Pocketbook for Diagnosis and Treatment

This book is an easy-to-read resource that covers the most common psychiatric illnesses and preferred pharmacological treatments for said illnesses. This guidebook will assist providers new to the field of psychiatry to better understand how to treat common psychiatric disorders. What follows is the accumulation of 30 years of experience paired with an eagerness to help those overwhelmed by the field of psychiatry, just as the authors once were. The book is broken down into chapters that each cover a different illness. Each chapter briefly describes the diagnostic criteria of the illness, usually using a mnemonic to help memorize the criteria, and includes other information that may prove useful to the novice clinician. Chapters cover risk factors for the illness and common screening scales used for each diagnosis. This leads into the first-line preferred treatment. Some chapters, such as Depression, will have an easy-to-follow algorithm that covers what to do if treatment fails. Second-line treatments and off-label usage are clearly outlined throughout the book. Each medication will have the recommended starting dose of the drug according to the package insert of the medication as well as common titration methods. Maximum recommended dosages are also outlined. Drug profiles will describe the most common side effects as well as FDA indications. Each category will continue with recommended monitoring for the drug and pearls from the authors. The Clinician's Guide to Common Psychiatric Disorders is a book intended for any provider that may prescribe psychiatric medications, whether it be a primary care physician, a physician’s assistant, or a nurse practitioner working in family medicine, or a resident just starting out in psychiatry. Preface Acknowledgments Contents 1: Depressive Disorders Major Depressive Disorder (MDD) Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Relationships Matter Treatment Recommendations for Major Depressive Disorder First-Line Medications: SSRIs Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) SSRI-Like Medications Vilazodone (Viibryd): SSRI Plus 5HT1A Partial Agonist Vortioxetine (Trintellix): SSRI Plus 5H1 Receptor Modulator SNRI Medications Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Venlafaxine XR (Effexor XR) Adjunct Medications Bupropion XL (Wellbutrin XL): Norepinephrine and Dopamine Reuptake Inhibitor (NDRI) Dextromethorphan/Bupropion (Auvelity): NDRI/NMDA Receptor Antagonist Mirtazapine (Remeron): Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) Trazodone (Desyrel): Serotonin 2 Antagonist/Reuptake Inhibitor (SARI) Atypical Antipsychotic Adjuncts Aripiprazole (Abilify) Brexpiprazole (Rexulti) Cariprazine (Vraylar) Olanzapine-Fluoxetine (Symbyax) Quetiapine XR (Seroquel XR) Choosing Antidepressant Based on Comorbidities Traditional Medication Alternatives Electroconvulsive Therapy (ECT) Esketamine (Spravato) Transcranial Magnetic Stimulation Vagus Nerve Stimulator Dysthymia Diagnosing and Monitoring DSM-5-TR Treatment Options Seasonal Affective Disorder (SAD) Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Pharmacologic Interventions Fluoxetine (Prozac) Sertraline (Zoloft) Bupropion XL (Wellbutrin XL): Norepinephrine and Dopamine Reuptake Inhibitor (NDRI) Postpartum Depression Diagnosing and Monitoring DSM-TR-5 Screening Scales Treatment Mild to Moderate PPD Non-pharmacologic Interventions Severe PPD Medications Paroxetine (Paxil) Sertraline (Zoloft) Premenstrual Dysphoric Disorder Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Medications References 2: Anxiety Disorders Generalized Anxiety Disorder Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Treatment Recommendations: General Anxiety Disorder First-Line Medications: Generalized Anxiety Disorder Duloxetine (Cymbalta) Escitalopram (Lexapro) Paroxetine (Paxil) Venlafaxine XR (Effexor XR) Second-Line Medications Buspirone (Buspar) Hydroxyzine (Vistaril) Benzodiazepines Alprazolam (Xanax) Panic Disorder Is It Panic or Anxiety? Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment First-Line Medications: Panic Disorder Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Venlafaxine XR (Effexor XR) A Note About Benzodiazepines Adjunctive Medications: Panic Disorder Alprazolam (Xanax) Clonazepam (Klonopin) Social Anxiety Disorder DSM-5-TR Screening Scales Treatment First-Line Medications: Social Anxiety Disorder Fluvoxamine CR (Luvox CR) Paroxetine (Paxil) Sertraline (Zoloft) Venlafaxine XR (Effexor XR) Treatment-Resistant Anxiety Off-Label Use for Treatment-Resistant Anxiety Gabapentin (Neurontin) Olanzapine (Zyprexa) Pregabalin (Lyrica) Quetiapine XR (Seroquel XR) A Note About Benzodiazepines Alprazolam (Xanax) Clonazepam (Klonopin) Clorazepate (Tranxene) Lorazepam (Ativan) Oxazepam (Serax) References 3: Attention Deficit Hyperactivity Disorder (ADHD) Adult Attention Deficit Hyperactivity Disorder Diagnosing and Monitoring Mnemonic Diagnosis Screening Scales Treatment Non-pharmacologic Interventions Pharmacologic Interventions Nonstimulant ADHD Medications Atomoxetine (Strattera) Clonidine (Kapvay): Ages 6–17 Guanfacine (Intuniv): Ages 6–17 Viloxazine (Qelbree) (12 years old +) Stimulant Medications Amphetamine, d, (Dexedrine) Amphetamine, d, l (Adderall, Adderall XR) Lisdexamfetamine (Vyvanse) Methylphenidate d (Focalin) Methylphenidate d Extended Release Capsules (Focalin XR) Methylphenidate d, l (Ritalin) Methylphenidate d, l (Concerta) Methylphenidate HCL (Jornay PM) Serdexmethylphenidate (Azstarys) References 4: Bipolar Disorder Bipolar Disorder Diagnosing and Monitoring DSM-5-TR Major Depressive Disorder Bipolar 1 Versus Bipolar 2 Hypomania Mania Screening Scales Screening Scales: Mania Treatment Non-pharmacologic Interventions Electroconvulsive Therapy (ECT) Pharmacologic Interventions Treatments Based on Mood State First-Line Medications Mood Stabilizers Carbamazepine (Equetro) Divalproex (Depakote ER) Lamotrigine (Lamictal) (Goal Is 150–250 mg) Lithium (It Is Best for Mania and Depression as well as Suicidality. It Helps Preserve Brain Size) Second-Generation Antipsychotics Aripiprazole (Abilify) Asenapine (Saphris) Cariprazine (Vraylar) Lumateperone (Caplyta) Lurasidone (Latuda) Olanzapine (Zyprexa) Olanzapine-Fluoxetine (Symbyax) Quetiapine (Seroquel) Quetiapine XR (Seroquel XR) Risperidone (Risperdal) Cyclothymic Disorder Diagnosing and Monitoring DSM-5-TR Screening Scales Screening Scales: Mania Treatment References 5: Obsessive Compulsive Disorder (OCD) Obsessive Compulsive Disorder Diagnosing and Monitoring Mnemonic DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Pharmacological Interventions Maximum Dosage of SSRIs for OCD Clomipramine (Anafranil) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) References 6: Insomnia Insomnia Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Sleep Hygiene Cognitive Behavioral Therapy Medications Based on Type of Insomnia Non-hypnotic Medications Doxepin (Silenor) Ramelteon (Rozerem): Melatonin 1 and 2 Receptor Agonist Non-benzodiazepine Hypnotics Daridorexant (QUVIVIQ): Dual Orexin Receptor Antagonist/Hypnotic Eszopiclone (Lunesta) Lemborexant (Dayvigo): Dual Orexin Receptor Antagonist/Hypnotic Suvorexant (Belsomra): Dual Orexin Receptor Antagonist/Hypnotic Zaleplon (Sonata) Zolpidem (Ambien) Zolpidem (Ambien CR) Zolpidem (Intermezzo) Benzodiazepine Hypnotics Temazepam (Restoril) Dual-Purpose Adjuncts Mirtazapine (Remeron) Trazodone (Desyrel) References 7: Posttraumatic Stress Disorder (PTSD) Posttraumatic Stress Disorder (PTSD) Diagnosing and Monitoring DSM-5-TR Posttraumatic Stress Disorder in Individuals Older Than 6 Years Screening Scales Treatment Non-pharmacologic Interventions Pharmacologic Interventions First-Line Medications Paroxetine (Paxil) Sertraline (Zoloft) Off-Label Treatment for Hyperarousal/Nightmares Clonidine (Catapres) Prazosin (Minipress) Irritability Off-Label Adjuncts Quetiapine (Seroquel) Risperidone (Risperdal) Insomnia Non-hypnotic Medications Doxepin (Silenor) Ramelteon (Rozerem): Melatonin 1 and 2 Receptor Agonist Non-benzodiazepine Hypnotics Daridorexant (QUVIVIQ): Dual Orexin Receptor Antagonist/Hypnotic Eszopiclone (Lunesta) Lemborexant (Dayvigo): Dual Orexin Receptor Antagonist/Hypnotic Suvorexant (Belsomra): Dual Orexin Receptor Antagonist/Hypnotic Zaleplon (Sonata) Zolpidem (Ambien) Zolpidem (Ambien CR) Zolpidem (Intermezzo) Benzodiazepine Hypnotics Temazepam (Restoril) Dual Purpose Adjuncts Mirtazapine (Remeron) Trazodone (Desyrel) References 8: Substance Use and Abuse Alcohol Use Disorder Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Pharmacologic Interventions Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Revia/Vivitrol) Off-Label Topiramate (Topamax) Tobacco Use Disorder Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Pharmacologic Interventions Bupropion SR (Wellbutrin SR) Nicotine Transmucosal (Nicorette Gum) Nicotine Transdermal (Nicoderm CQ) Varenicline (Chantix) References 9: Schizophrenia Schizophrenia Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Non-pharmacologic Interventions Hospitalization First-Line Medications Aripiprazole (Abilify) Asenapine (Saphris) Cariprazine (Vraylar) Lumateperone (Caplyta) Lurasidone (Latuda) Olanzapine (Zyprexa) Olanzapine-Fluoxetine (Symbyax) Quetiapine (Seroquel) Quetiapine XR (Seroquel XR) Risperidone (Risperdal) References 10: Eating Disorders Anorexia Nervosa Diagnosing and Monitoring DSM-5-TR Screening Scales Treatment Hospitalization Criteria Bulimia Nervosa DSM-5-TR Screening Scales Treatment First-Line Medication Fluoxetine (Prozac) Binge-Eating Disorder DSM-5-TR Screening Scales Treatment First-Line Medication Lisdexamfetamine (Vyvanse) References Appendix A Antidepressants/Anxiolytics Bupropion XL (Wellbutrin XL)—Norepinephrine and Dopamine Reuptake Inhibitor (NDRI) Buspirone (Buspar) Citalopram (Celexa) Clomipramine (Anafranil) Desvenlafaxine (Pristiq) Dextromethorphan/Bupropion (Auvelity)—NDRI/NMDA Receptor Antagonist Duloxetine (Cymbalta) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine CR (Luvox CR) Gabapentin (Neurontin) Hydroxyzine (Vistaril) Mirtazapine (Remeron)—Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) Paroxetine (Paxil) Pregabalin (Lyrica) Sertraline (Zoloft) Trazodone (Desyrel)—Serotonin 2 Antagonist/Reuptake Inhibitor (SARI) Venlafaxine XR (Effexor XR) Vilazodone (Viibryd)—SSRI Plus 5HT1A Partial Agonist Vortioxetine (Trintellix)—SSRI Plus 5H1 Receptor Modulator Benzodiazepines Alprazolam (Xanax) Clonazepam (Klonopin) Clorazepate (Tranxene) Lorazepam (Ativan) Oxazepam (Serax) Temazepam (Restoril) Insomnia Medications Daridorexant (QUVIVIQ)—Dual Orexin Receptor Antagonist/Hypnotic Doxepin (Silenor) Eszopiclone (Lunesta) Lemborexant (Dayvigo)—Dual Orexin Receptor Antagonist/Hypnotic Ramelteon (Rozerem)—Melatonin 1 and 2 Receptor Agonist Suvorexant (Belsomra)—Dual Orexin Receptor Antagonist/Hypnotic Temazepam (Restoril) Zaleplon (Sonata) Zolpidem (Ambien) Zolpidem (Ambien CR) Zolpidem (Intermezzo) Mood Stabilizers Carbamazepine (Equetro) Divalproex (Depakote ER) Lamotrigine (Lamictal) (Goal is 150–250 mg) Lithium (Best for Mania and Depression. As Well as Suicidality. Helps Preserve Brain Size) Non-stimulant ADHD Medications Atomoxetine (Strattera) Clonidine (Kapvay)—Ages 6–17 Guanfacine (Intuniv) Ages 6–17 Viloxazine (Qelbree) (12 Years Old +) PTSD Medications Clonidine (Catapres) Prazosin (Minipress) Second-Generation Antipsychotics Aripiprazole (Abilify) Asenapine (Saphris) Brexpiprazole (Rexulti) Cariprazine (Vraylar) Lumateperone (Caplyta) Lurasidone (Latuda) Olanzapine (Zyprexa) Olanzapine-Fluoxetine (Symbyax) Quetiapine (Seroquel) Quetiapine XR (Seroquel XR) Risperidone (Risperdal) Stimulants Amphetamine, d, (Dexedrine) Amphetamine, d, l (Adderall, Adderall XR) Lisdexamfetamine (Vyvanse) Methylphenidate d (Focalin) Methylphenidate d Extended Release Capsules (Focalin XR) Methylphenidate d, l (Ritalin) Methylphenidate d, l (Concerta) Methylphenidate HCL (Jornay PM) Serdexmethylphenidate (Azstarys) Substance Abuse Medications Acamprosate (Campral) Bupropion SR (Wellbutrin SR) Disulfiram (Antabuse) Naltrexone (Revia/Vivitrol) Nicotine Transmucosal (Nicorette Gum) Nicotine Transdermal (Nicoderm CQ) Topiramate (Topamax) Varenicline (Chantix) Index