1. Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.
COMMON PSYCHIATRY COMPLAINTS CHEAT SHEET
DEPRESSION (MAJOR DEPRESSIVE DISORDER)
If you suspect any form of depression always ask about:
- Suicidal Ideation (Plan? Intent?)
- Homicidal Ideation
- Auditory or Visual Hallucinations
- Illicit & Prescription Drug or EtOH Use
- History of a hypomanic/manic
episode (bipolar)
- Past mental health hospitalizations
- Past suicide attempts
*Counsel the patient and tell them if they ever have thoughts of suicide to call 911 or go to the ER immediately.
Two-week continuous history of DEPRESSED MOOD and/or ANHEDONIA plus 4 additional positive
complaints of “SIG E CAPS”:
- Sleep problems (insomnia or sleeping all day)
- Interest/pleasure decreased from activities once enjoyed (“anhedonia”)
- Guilt/feelings of worthlessness which is excessive
- Energy loss; fatigue
- Concentration difficulty or more indecisiveness
- Appetite or weight changes (decreased or increased)
- Psychomotor retardation (as observed by physician)
- Suicidal thoughts, recurrent thoughts about death/dying
Classified as single or recurrent episodes. Classified as mild, moderate, and severe based on clinical subjectivity.
If they have psychotic symptoms, it is always severe.
Treatment
1st line: Selective Serotonin Inhibitors (SSRIs) + counseling. SSRIs are very safe & effective.
TTUHSC Free Clinic offers 3 SSRIs:
Fluoxetine (Prozac) – Interacts with other medications via cyp450, which can be problematic. Weight neutral!
Citalopram (Celexa) – Best option if patient is on multiple other medications because it has the fewest cyp450 interactions.
Weight neutral!
Paroxetine (Paxil) – Causes weight gain.
General SSRI Side effects: GI upset, sleep changes, headache and decreased libido, and other symptoms. GI upset and headache
usually resolve in 1-2 weeks after starting medication.
Counseling referrals: Covenant Counseling (sliding-scale payments based on income)
GENERALIZED ANXIETY DISORDER (GAD)
6 months of excessive worrying, often irrational, difficult to control, interferes with daily living. (Not due
to a substance or general medical condition.)
Need 3 or more criteria present most days for the past 6 months:
 Restlessness or feeling keyed up/on
edge
 Easily fatigued
 Difficulty concentrating
 Irritability
 Muscle tension
 Sleep disturbance
1st line: SSRIs.

2. Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.
BI-POLAR DISORDER
Dx: irritable mood + 4 DIGFAST criteria OR elevated mood + 3 DIGFAST criteria.
Ask about “DIG FAST” symptoms:
- Distractibility
- Irresponsible/risky behavior (e.g.
excessive spending, promiscuity)
- Grandiosity (special abilities,
purpose, role)
- Flight of ideas (rapid shifting of ideas
in speech)/racing thoughts
- Activity increased
- Sleep decreased
- Talkativeness
Hypomania: Symptoms last 4 or more days; change in function
Mania: Symptoms last 7 or more days with impaired function or psychosis or severe enough to
need hospitalization
Other Psych medications available at the free clinic:
Amitriptyline – Tricyclic Antidepressant – used for neuropathy and can be used for depression (if failed SSRIs).
Very dangerous / lethal in overdose. – used at low doses for insomnia and neuropathy
Trazodone – weak antidepressant – used at low doses for insomnia. Risk of priapism & orthostatic hypotension.
Buspirone – weak anxiolytic – can be used to treat GAD.
A complete Mental Status Exam (MSE) should be in Progress Note and include:
- Orientation to person, place and time (“A&Ox3”)
- Attitude: (Un)cooperative, Guarded, Hostile, Suspicious
- Psychomotor activity: Tremor? Slowed? Agitated? WNL?
- Eye contact: good/fair/poor
- Speech: rate, rhythm, volume
- Thought process: Logical & goal-directed? Tangential? Circumstantial? Thought
blocking? Flight of ideas? Slowed?
- Thought content: Delusions? Obsessions?
- Intelligence: above/average/below
- Memory: intact?
- Mood: how patient reports s/he feels
- Affect: emotion displayed by patient (Full/euthymic? Constricted? Labile? Blunted? Flat?
Dysphoric?)
- Insight (understands illness)
- Judgment (capacity to make good decisions)
- Suicidal/ homicidal ideation?
- Auditory or visual hallucinations?