Master the board step 3

Psychiatry
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Medical causes: Hyperthyroidism, pheochromocytoma, excess cortisol,
heart failure, arrhythmias, asthma, and COPD
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Drugs: Corticosteroids, cocaine, amphetamines, and caffeine, as well as
withdrawal from alcohol and sedatives
Adjustment Disorder
This is a normal psychological reaction (anxiety, depression, irritability) that
occurs soon after profound changes in a person’s life, such as divorce, migration,
or birth of a handicapped child. Symptoms are not severe enough to be classified
in another category. Adjustment disorder is not a true anxiety disorder.
Do not treat adjustment
disorder patients with
medications; instead
provide counseling to help
with the patient adjust to
the life stressor.
Panic Disorder
Panic disorder is the diagnosis when the case describes brief attacks of intense
anxiety with autonomic symptoms (e.g., tachycardia, hyperventilation, dizziness,
and sweating). Episodes occur regularly, with an obvious precipitant
and in the absence of other psychiatric illness.
Treatment
Treatment is cognitive-behavioral therapy and/or relaxation training and
desensitization. Relaxation and desensitization may be more useful when agoraphobic
symptoms are present. Medications include SSRIs (e.g., fluoxetine),
benzodiazepines (e.g., alprazolam, clonazepam), imipramine, and MAOIs (e.g.,
phenelzine).
Phobic Disorders
Phobic disorder is the diagnosis when the case describes a persistent, unreasonable,
intense fear of situations, circumstances, or objects. It is differentiated
from posttraumatic stress disorder (PTSD) and acute stress disorder
(ASD), which has a history of a traumatic event (threat to life or limb). There
are no known eliciting events in phobic disorders associated with the onset of
symptoms.
Agoraphobia
Fear or avoidance of places due to anxiety about not being able to escape (public
places, being outside alone, public transportation, or crowds). Agoraphobia
is more common in women.
Social Anxiety Disorder
Most common phobia: Fear or avoidance of objects or situations other than
those involved in agoraphobia. Commonly involves animals (e.g., carnivores,
spiders), natural environments (e.g., storms), injury (e.g., injections, blood),
and situations (e.g., heights, darkness).
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