DIP Episode 209 - Family Medicine Shelf Review Series 2

Source / episode info

• Episode: 209
• Title: Divine Intervention Episode 209 – Family Medicine Shelf Review Series 2.
• Published: 2020-02-10
• Source: Episode page

One-liner

This episode provides a comprehensive review of common psychiatric disorders tested on Family Medicine shelf exams, covering depression screening/treatment, bipolar spectrum disorders, anxiety (GAD, panic), somatic symptom differentials, eating disorders (AN, BN), PTSD, OCD, and ADHD management.

High-yield summary

• Depression Screening: Use the PHQ-2 or PHQ-9 questions ("over the past two weeks, have you felt down/depressed or hopeless?" / "little interest or pleasure in doing things?") to screen for Major Depressive Disorder (MDD).
• Bipolar Management: If a patient has MDD symptoms but a history of manic episodes, consider Bipolar Disorder. Treatment often involves Lithium; monitor for nephrogenic diabetes insipidus and hypothyroidism.
• Anorexia Nervosa Complications: Due to severe malnutrition and low estrogen, patients are at high risk for osteoporosis, hypophosphatemia (especially upon refeeding), metabolic alkalosis, and dangerous cardiac arrhythmias.
• PTSD Treatment: First-line treatment is SSR Is + CBT. For nightmares, Prazosin is the drug of choice; never use benzodiazepines.
• Somatic Symptom Differential: Differentiate between Somatic Symptom Disorder (real symptom causing distress), Illness Anxiety Disorder (excessive worry about health without symptoms), Malingering (secondary gain for external benefit), and Factitious Disorder (self-inflicted symptoms for internal gratification).
• Eating Disorder Management: For Bulimia Nervosa, treatment involves CBT + SSRI (Fluoxetine is often preferred); the key differentiator from Binge Eating Disorder is the presence of compensatory behaviors.

Learning objectives

• Master the screening tools and diagnostic criteria for major mood disorders, including MDD, Bipolar Disorder, and Seasonal Affective Disorder.
• Differentiate between various anxiety spectrum disorders (GAD, Panic Disorder, Social Anxiety) and their appropriate pharmacological/psychotherapeutic treatments.
• Recognize the key physiological complications of severe eating disorders (AN, BN), particularly electrolyte imbalances and cardiac risks.
• Apply knowledge of psychopharmacology to treat specific conditions like OCD, PTSD, and ADHD, including recognizing drug side effects and contraindications.
• Differentiate between various somatic symptom differentials (e.g., Malingering vs. Factitious Disorder vs. Conversion Disorder).

Board exam buzzwords

Rapid review table

Board-speak -> diagnosis

Differential diagnosis / distinguishing features

Anxiety Disorders (GAD vs Social Anxiety)

Somatic Symptom Disorders

Eating Disorders

Management pearls

• For any patient presenting with depressive symptoms, always screen for bipolar disorder history to avoid misdiagnosis (treating Bipolar Depression as MDD).
• When managing a patient with PTSD nightmares, Prazosin is the preferred agent due to its alpha-1 adrenergic blockade properties.
• In cases of severe malnutrition (AN), monitor for hypophosphatemia and administer IV phosphate supplementation upon refeeding initiation.
• For patients with suspected OCD, combine SSR Is (first line) with Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP).

Don't miss

Integration & clinical reasoning

• Psychiatry & Internal Medicine: Many psychiatric presentations (e.g., depression, anxiety) are exacerbated or mimicked by underlying medical conditions (hypothyroidism, Cushing syndrome, electrolyte imbalances). Always rule out organic causes first.
• Pharmacology & Metabolism: Understanding the mechanism of action for psychotropics is critical; e.g., SSR Is increase serotonin availability, while lithium affects renal tubular function.
• Psychiatry & Family Medicine: The family physician plays a essential role in initial screening (PHQ-2/9) and managing stable chronic conditions, knowing when to refer to specialized psychiatry care (e.g., acute mania, psychosis).

OMM / COMLEX integration

• Standard emergency management takes priority in acute psychiatric crises (e.g., suicidal ideation requires immediate hospitalization and consultation). OMT is adjunctive only after stabilization.
• When managing severe metabolic derangements (hypophosphatemia, hypokalemia), standard critical care protocols for electrolyte replacement take precedence over any manual or physical therapy interventions.

Concept connections / cross-references

• For detailed information on endocrine disorders that can mimic psychiatric symptoms (e.g., hypothyroidism), see [Episode 15].
• For general guidelines on metabolic derangements related to GI losses (e.g., hypokalemia/metabolic alkalosis), review [Episode 203].

High-yield association table

Key terms glossary

Study optimization

Question pattern recognition

• Pattern: Patient presents with persistent worry about multiple life domains and restlessness. -> Generalized Anxiety Disorder (GAD). Treatment: CBT + SSRI/SNRI or Buspirone.
• Pattern: Young patient presenting with motor deficits (e.g., weakness, paralysis) that cannot be explained by medical findings. -> Conversion Disorder. This is a functional neurological symptom disorder.
• Pattern: Patient has symptoms of depression but also reports periods of extreme energy, grandiosity, and decreased need for sleep. -> Bipolar Disorder. Always rule out mania/hypomania first.

Test yourself

Common mistakes to avoid

Common traps