EM Boards Survival Guide: Psychiatry 1

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)

emDocs will be providing you with regular tips and must-know items for EM boards and inservice. Each post will feature several key takeaways on a specific organ system.


Boards Must-Knows:

1) Look for red flags pointing towards organic etiologies: older age with new psych presentation; deranged vital signs; abnormal neuro exam; new medications; visual hallucinations; complications of substance abuse; etc.

EM@3AM

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WikEM

 

2) Delirium: differentiate from dementia. Look for trigger. Review med list, talk to family/caretaker, etc.

EM@3AM

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WikEM

 

3) Anxiety: while quite common, avoid anchoring and look for anxiety mimics with thorough history/physical. Screen for SI, HI, intimate partner violence, and trafficking.

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emDocs

 

4) Bipolar disorder: mania/hypomania <=> depression. High-risk behaviors including increased risk of suicide compared to general population. Review med list. Don’t forget about toxicities of lithium, valproic acid, etc.

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5) Depression: consider with SIGECAPS. Look for it in postpartum patients. Elderly present with dementia-like picture. Probe for high-risk SI features.

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6) Schizophrenia: combo of positive and negative symptoms. Screen for SI/HI. Know side effects of meds (dystonic reaction, akathisia, tardive dyskinesia, NMS, etc.)

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7) PTSD: initial significant psychosocial stressor => impairs life and pt experiences hypervigilant state + avoidance of similar situation. Screen for SI/HI. Rx: Psych f/u.

WikEM – Second Victom

 

8) Hypochondriasis: now known as illness anxiety disorder; diagnosis of exclusion; work up especially if 1st presentation. Pt is convinced that they are sick despite mounting evidence pointing in other direction. Rx: acknowledge signs/sxs; PCP/Psych f/u.

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9) Personality disorders: 3 clusters – A (odd); B (dramatic); C (worried). Rx: Psych f/u.

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10) Suicide risk: know high-risk presentation features and patient populations at risk.

WikEM Psych Evaluation

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