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 SSRIs + 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).