Psychiatry

A

• Acute Agitation - Deescalation and Sedation

  Use verbal deescalation and environment control first; select pharmacologic agents based on etiology and comorbidity; use the least restrictive measures and monitor closely.
• Acute Agitation in the ED — De-escalation and Medications

  Prioritize safety and verbal de-escalation; treat underlying causes; use goal-directed pharmacology (benzodiazepines, antipsychotics, or combinations) with monitoring for respiratory depression and QT prolongation.
• Adult ADHD - Evaluation and Treatment

  Confirm childhood onset and functional impairment, screen for substance use and mood disorders, and treat with stimulants or non stimulants plus behavioral strategies.
• Alcohol Withdrawal - Severity Assessment and Benzodiazepine Protocol

  Assess severity, give symptom triggered or fixed dose benzodiazepines, and add adjuncts when indicated; admit severe cases and monitor for complications.
• Antidepressant Switching and Cross Taper Strategies

  Choose direct switch, cross taper, or washout based on pharmacology and risk; monitor for withdrawal and serotonin toxicity.
• Antipsychotic Induced Metabolic Syndrome - Management

  Baseline and periodic monitoring for weight, lipids, and glucose; lifestyle interventions, medication adjustments, and treatment of metabolic abnormalities.
• Autism in Adults — Diagnosis & Supports

  Adult autism assessment focuses on developmental history, current functioning, and differential diagnoses. Provide tailored supports for employment, education, and mental health; screen for co‑occurring conditions.

B

• Benzodiazepine Tapering — Outpatient Protocols

  Plan individualized, gradual tapers (5–10% dose reductions every 2–4 weeks), consider diazepam conversions, and address underlying anxiety/insomnia with CBT‑I/CBT; monitor for withdrawal and relapse.
• Benzodiazepine Withdrawal - Inpatient and Outpatient Management

  Recognize withdrawal risk, transition to long acting agent when appropriate, taper gradually, and monitor for seizures and autonomic instability.
• Bipolar Mania - Acute Management

  Assess safety and capacity, treat with mood stabilizer and antipsychotic, manage agitation, address sleep and substances, and plan close follow up or admission.
• Borderline Personality Disorder — Psychotherapy & Meds

  Psychotherapy is first‑line (DBT, MBT, TFP). Medications target symptoms; avoid polypharmacy and benzodiazepines. Crisis planning and safety are central.

C

• Catatonia - Recognition, Lorazepam, and ECT

  Identify motor and behavioral signs, perform lorazepam challenge, treat with benzodiazepines, and arrange ECT when refractory or malignant.
• Catatonia — Diagnosis & Management

  Catatonia presents with motor, behavioral, and speech abnormalities. Diagnose with Bush‑Francis scale and lorazepam challenge; treat with benzodiazepines and ECT; avoid antipsychotics until stabilized, especially if NMS suspected.
• Clozapine - Initiation, Monitoring, and Side Effects

  For treatment resistant schizophrenia; requires neutrophil monitoring, slow titration, seizure and myocarditis vigilance, and metabolic monitoring.

D

• Delirium in Hospital - Evaluation and Management

  Acute change in attention and cognition from medical causes; identify and treat precipitating factors, optimize environment, and use antipsychotics only when severe distress or danger.

E

• Eating Disorder - Refeeding Risk and Inpatient Management

  Identify medical instability, correct electrolytes, start cautious nutrition with monitoring for refeeding syndrome, and provide multidisciplinary care.

G

• Generalized Anxiety Disorder - First Line Treatment

  Offer cognitive behavioral therapy and an SSRI or SNRI as first line; use benzodiazepines sparingly short term and address sleep and stress management.

H

• Hoarding Disorder — Assessment & Treatment

  Characterized by persistent difficulty discarding possessions leading to clutter and impairment. Treat with specialized CBT‑HD and harm‑reduction strategies; involve family/public agencies when safety risks present.

I

• Insomnia Disorder - Nonpharmacologic and Pharmacologic Care

  Cognitive behavioral therapy for insomnia is first line; reserve hypnotics for short courses with careful selection and safety counseling.

L

• Lithium Toxicity - Acute Management

  Identify toxicity by symptoms and level, stop lithium, assess volume status and electrolytes, give fluids, and arrange hemodialysis for severe cases or renal failure.

M

• Major Depressive Disorder - Initial Pharmacotherapy

  Select an SSRI or SNRI based on comorbidities, prior response, and side effect profile; provide psychoeducation and arrange follow up for dose adjustment and adherence support.

N

• Neuroleptic Malignant Syndrome - Recognition and Management

  Hyperthermia, rigidity, altered mental status, and autonomic dysfunction after dopamine blockade; stop antipsychotic, give supportive care, and consider dantrolene or bromocriptine.
• Neuroleptic Malignant Syndrome — Recognition and Treatment

  Idiosyncratic reaction to dopamine antagonism with rigidity, hyperthermia, and autonomic instability; stop offending agent, provide ICU support, and consider dantrolene or bromocriptine.

O

• Obsessive Compulsive Disorder - Treatment Algorithm

  Use exposure and response prevention therapy as first line; high dose SSRI or clomipramine for moderate to severe cases; consider augmentation for partial response.
• Opioid Withdrawal - ED Buprenorphine Initiation

  Assess withdrawal severity, start buprenorphine when moderate withdrawal is present, link to ongoing care, and provide naloxone and harm reduction counseling.

P

• Panic Disorder - Acute and Long Term Care

  Treat acute attacks with reassurance and breathing techniques, avoid emergency dependence, and use CBT and SSRI or SNRI for long term control.
• Postpartum Psychosis - Emergency Management

  Rapid onset psychosis and mood symptoms after delivery with suicide or infanticide risk; ensure safety, admit urgently, give antipsychotics and mood stabilizers, and consider ECT.
• Posttraumatic Stress Disorder - Trauma Focused Therapy and Medication

  Offer trauma focused psychotherapies as first line; consider SSRIs or SNRIs when therapy is unavailable or as adjunct; avoid benzodiazepines.
• Premenstrual Dysphoric Disorder — Diagnosis & Treatment

  Diagnose prospectively with symptom diaries. First‑line SSRIs (continuous or luteal) and combined OCPs with drospirenone; lifestyle and CBT adjuncts; second‑line GnRH analogs with add‑back.
• Psychopharmacology in Pregnancy — Risk‑Benefit Counseling

  Balance maternal relapse risk against fetal/neonatal risks. SSRIs (sertraline) are first‑line for depression/anxiety; avoid valproate; use lithium with fetal echo and levels; lamotrigine relatively favorable; many SGAs acceptable with metabolic monitoring.

S

• Serotonin Syndrome - Recognition and Management

  Triad of mental status change, autonomic instability, and neuromuscular hyperactivity; stop serotonergic agents, give benzodiazepines, manage hyperthermia, and consider cyproheptadine.
• Somatic Symptom Disorder - Assessment and Communication

  Build a therapeutic alliance, validate distress, avoid unnecessary testing, schedule regular visits, and use cognitive behavioral strategies and functional goals.
• Somatic Symptom Disorder — Management Strategies

  Emphasize regular visits with one clinician, validate symptoms, and use CBT‑informed strategies; minimize unnecessary tests and avoid reinforcing disability.
• Stimulant Use Disorder - Contingency and Pharmacotherapy Options

  Use contingency management as core behavioral treatment, address comorbidities, consider off label pharmacotherapies where evidence exists, and provide harm reduction.
• Suicidal Ideation - ED Triage and Safety Planning

  Screen for risk, ensure safety, remove lethal means, involve supports, and create a safety plan with follow up; consult psychiatry for moderate to high risk.

T

• Tardive Dyskinesia - Recognition and Treatment

  Identify persistent involuntary movements after dopamine blockade; reduce antipsychotic dose when possible, switch to lower risk agent, and consider VMAT2 inhibitor therapy.
• Tourette Syndrome — CBIT & Pharmacologic Therapy

  CBIT is first‑line for bothersome tics; medications for impairment or when CBIT unavailable. Treat comorbid ADHD/OCD. Consider DBS for severe refractory cases.
• Treatment‑Resistant Depression — Augmentation Strategies

  For MDD not responding to ≥2 adequate trials, confirm diagnosis and adherence, address comorbidities, and use augmentation/switch strategies (atypical antipsychotics, lithium, T3, bupropion/mirtazapine) with psychotherapy; consider ECT/ketamine/esketamine when indicated.