Adult ADHD

Articles

• Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults

• Medication Guide

Alcohol Abuse/Dependence

Articles 

Outpatient Management of Alcohol Withdrawal Syndrome

Referrals

If patient is a relative or friend of someone with an alcohol use disorder, they should be referred to Al-Anon or AlaTeen, 513-947-3700. http://www.cincinnatiafg.org/.  

The following can be copied/pasted into discharge instructions or a quick-text, in addition to the referral list:

Anxiety

For Patients:

Patient handout on GAD from familydoctor.org (includes a simple deep breathing exercise).

Patient handouts on Panic Disorder from familydoctor.org and NAMI.

Patient handouts on OCD from familydoctor.org and NAMI.

Patient handout on PTSD from familydoctor.org.

Patient handout on Social Phobia from familydoctor.org.

For Providers: 

GAD-7: helpful screening/scoring tool to diagnosis and then follow a person with GAD (General Anxiety Disorder)

PC-PTSD (Primary Care PTSD, 4-question screen) or the longer PSS (PTSD Symptom Scale) or PCL-C which has Spanish, Chinese, and Bosnian versions: both are screening tools for Post Traumatic Stress Disorder. Short article about childhood sexual trauma and its effects on Adults.

Florida Obsessive Compulsive Inventory: screening tool for OCD, and Yale-Brown-Inventory (YBOCS): more detailed but quite helpful.

AAFP article "Generalized Anxiety Disorder" from 2009: includes table with DSMIV-TR criteria for GAD.

AAFP Article "Panic Disorder" from 2005: includes table with DSMIV-TR criteria for a panic attack

AAFP Article "Herbal and Dietary Supplements for treatment of Anxiety Disorders" from 2007

NEJM OCD article 2014, and AAFP Article "OCD: Dx and Management" from 2009.

AAFP Article "PTSD Identifying and Managing" from 2013

Bipolar

For Patients: pending

Daily Mood Chart (or different format): good way to aid diagnosis and/or encourage patient self-management, for short-term or long-term.

For Providers:

MDQ (Mood Disorder Questionnaire): a screening tool for Bipolar Disorder and/or other mood disorders. Note that this is very sensitive but not specific, so just because a patient screens "positive" does not mean they have Bipolar Disorder. The Ddx is broad and includes PTSD, Borderline Personality Disorder, Anxiety/Panic Disorders, Hyperthyroid, medication/substance-induced-mania.

PSS (PTSD Symptom Scale): a screening tool for Post Traumatic Stress Disorder, as this is very comorbid with and/or often difficult to distinguish from Bipolar Affective Disorder. A shorter (4-question) version is the PC-PTSD Screen, designed for use in primary care and other medical settings and currently used to screen for PTSD in veterans at the VA. 

AAFP article on "Bipolar Disorders: A Review" from 2012.

Dementia/Cognitive Evaluations

 For Patients: pending

 For Providers:

 MOCA (Montreal Cognitive Assessment): has been translated into many other languages as well. Can usually be administered in 30-45 minutes; use these instructions for how to administer and score.

NEJM article about decision-making capacity (DMC). Although "capacity" and "competence" are often used interchangeable, "capacity" broadly refers to the ability to perform a specific task, whereas "competence" refers to the legally defined standard for performing a specific task. "Competence" is legally determined," whereas "capacity" may be determined  clinically. Every physician (not just psychiatrist) can determine capacity. That being said, capacity can only be determined moment by moment and is subject to change with the clinical picture. If someone is determined not to have DMC now it does not mean they may not have DMC later. In your notes you can say "At the time of evaluation, Mr J appears to lack decision making capacity on the basis that he is unable to [here you state which of the 4 essential questions he was unable to answer, see NEJM article Table 1). He should be reevaluated as the clinical picture is subject to change."

Depression

For Patients: The following can be copy/pasted and/or turned into a quicktext:

There are many different causes for depression and, therefore, many different ways to treat it. Often what works for one person may not work for another. In general, there are four main ways to treat depression, and most people do best when a combination of these are used.

1. Counseling and/or therapy.  

2. Self-management techniques  

3. Improve sleep

4. Medications

Great patient handout on "Major Depression" from familydoctor.org.

Variety of handouts (one, two, and three) on self-management.

Daily Mood Chart (or different format): good way to aid diagnosis and/or encourage patient self-management, for short-term or long-term.

Patient handout on Insomnia from familydoctor.org, has a great section on sleep hygiene, also another good patient handout on Sleep Hygiene Do's and Don't (1 page).

Several websites, such as MoodGYM, Blue Pages, and ODIN, have been shown in randomized trials to help improve depressive symptoms (SOR C).

For Providers:

PHQ-9 (English or Spanish): helpful scoring system for tracking "response" to depression treatments whether pharmacologic, therapeutic or (hopefully) both.

APA Depression treatment guidelines (2009) & AAFP article on Treatment Resistant Depression (2012).

AAFP article on Postpartum Depression, includes Edinburgh Postnatal Depression Scale (EPDS).

AAFP article on Treatment of Child & Adolescent Depression. CBT +/- SSRIs (fluoxetine, sertraline, citalopram, then venlafaxine or escitalipram).

AAFP article on Seasonal Affective Disorder. includes light therapy appropriate specs.

PMDD (Pre-Menstrual Dysphoric Disorder): AAFP article from 2011, Current Psychiatry article from 2012 (discusses herbal/OTC treatments as well), and an example of a PMDD daily mood chart handout (have the patient record daily mood for 2 months or more).

AAFP article on Grief vs Depression at End of Life

Illicit Drugs

For Patients & Providers: 

Screening tools to calculate a person's risk of having a substance-abuse problem in general include the DAST and CRAFFT tests.

Great up to date website ("Above The Influence") that provides information about street drugs including their various "street names" and effects. 

Helpful Urine Drug Screen reference: when (if ever) to suspect false positives, how long substances can be detected in the urine, etc.

Substance Abuse Referral list: used in PES (Psychiatric Emergency Services)

Primary Care Approach to Substance Abuse AAFP 2013 article, helpful phrases/approach

Insomnia

For Patients:

Patient handout on Insomnia from familydoctor.org, has a great section of sleep hygiene.

Patient handout on Sleep Hygiene Do's and Don't (1 page).

For Providers:

Epworth Sleepiness Scale

AAFP article on "Nonpharmacologic Management of Chronic Insomnia" from 2009. Includes great tables on ddx, secondary-causes, and sleep hygiene. Another AAFP article on "Treatment Options for Insomnia" from 2007 includes pharmacologic options as well. A mostly comprehensive Chart of pharmacotherapy options for primary insomnia (add to this Gabapentin and Chloral Hydrate); just because benzos are listed first doesn't mean they're at-all first line though!

Opioid Abuse/Dependence

 For Providers:  

ORT (Opioid Risk Tool): Score to be calculated prior to initiating opioids to determine a patient's potential risk for developing aberrant behaviors when prescribed opioids for chronic pain. Can be self-administered (patient version) or completed by the physician (physician version) as part of interview. If moderate risk, consider referring to pain management; if high-risk then strongly recommend referral. 

Great educational modules about Adolescent Substance Abuse Treatment (specifically for primary care setting!)

Pediatric ADHD

 For Patients: :

 Booklet handouts from the NIMH (National Institute for Mental Health) on ADHD: easy-to-read (6-pages) and more detailed (24-pages).

 Patient handout on ADHD from familydoctor.org.

 Packet on Behavioral interventions for school-age child with ADHD, includes suggested reading list last 2 pages (total 18 pages).

 For Providers:

 Vanderbilt Forms: parent (print 1) and teacher (print 2).

 AAFP Article on Tourette's as this is often comorbid with ADHD.

2014 AAFP ADHD Management article, and Short AAFP Article on Management of ADHD in Preschool-Aged Children

Psychosis   

DDX includes substance-induced vs delirium vs MDD w/ psychotic features vs Bipolar, mania w/ psychotic features vs Bipolar, Depressed w/ psychotic features, vs shizophrenia vs schizoaffective vs secondary to GMC (General Medical Condition)

Helpful article in Schizophrenia in Primary Care, table 4 lists the metabolic s/e risk profile (lowest for Aripiprazole and Ziprasidone).

Sexual Addictions

Brief AAFP article "Evaluating and Treating Sexual Addication" includes table of helpful resources to refer patients

Somatization Disorders

Psychogenic NonEpileptic Seizures (PNES): AAFP article from 2005