Dr. Levinson says he divides psychiatric conditions into two broad groups. Acute and chronic. Acute within the last three months and chronic are longer than that.
Acute |
Chronic |
| Delirium – Two types – Hyperactive and hypoactive delirium Brief psychotic d/o Schizophreniform = schizophrenia Sx occurring for < 6 mo Anxiety d/o -Panic d/o -PTSD -Acute Stress d/o -Adjustment d/o –Depressed mood –Mixed anxiety and depression –Disturbance of conduct Dissociative d/o / Depersonalization Substance Abuse -Withdrawal -Intoxication -Psychosis -Mood d/o |
Neurodegenerative d/o [Dementias] -A.D / MCI/ Vascular dementia -Frontotemporal / Huntington’s disease -Parkinson’s disease / Lewy Body -Alcohol /Substance-induced / HIV ADD / Autism spectrum / Intellectual disorders (MR) Tic d/o, Tourette’s, Enuresis and Encopresis Thinking d/o – Schizo Mood d/o, Bipolar, MDD, PMD Anxiety d/o – Phobias, Social anxiety -Panic d/o, GAD, OCD, PTSD Somatic symptom d/o, conversion d/o Eating d/o / Impulse control d/o Substance-related / Addiction d/o Personality d/o |
| MCI = Mild Cognitive Impairment; A. D = Alzheimer’s disease; |
Schizophreniform = resembling schizophrenia. To diagnose schizophrenia, the symptoms have to be ongoing for at least 6 months.
Schizoaffective d/o is a type of schizophrenia that is a combination of schizophrenia sxs + affective/mood d/o like depression or mania.
Panic d/o happens more in people with certain physiologies – People who are more sensitive to PCO2 changes.
SSRI’s are first line choice of treatment for anxiety d/o, phobias, social anxiety, panic d/o, GAD, OCD, PTSD
Panic attack treatment per Dr. Levinson
SSRI (long term) + Benzo (short-term)
Dr. Levenson often uses short acting benzos in the short-term (Ativan 0.5-1.0mg) for people with anxiety and panic attack if he doesn’t deem this patient at risk for addiction.
He will start them the same day on Ativan short-term with a SSRI for long-term treatment. If the patient is having multiple attacks per day or having to use Ativan more than once per day or using Ativan multiple times per week, he will consider using Klonopin (Clonazepam), a longer acting benzo.
** Don’t give a SSRI to a patient with Bipolar! It can trigger a manic episode!
Substance abuse: There are two types of substances that are abused.
1) Ones that cause sedation or confusion e.g. alcohol. You treat withdrawals from these with benzos.
2) Stimulants e.g. cocaine, amphetamines.
Opioid withdrawal – People don’t die. They are really sick and think they will die. But it doesn’t kill them. You can do symptomatic treatment.
Alcohol withdrawal – This can kill people! About 10% of people die. You need to treat this!
Blood Alcohol Level
At 0.08% blood alcohol concentration and higher, it is illegal to drive whether you consider yourself drunk or not. Below 0.08%, you can drive. At 0.08% and up, driving is illegal.
You can measure blood alcohol concentration through a breathalyzer, blood test, or urine.
**At any one time that you enter a hospital in the U.S, about 30-35% of hospital admissions will be related to alcohol and drugs.