Psychiatry Boot Camp 2.2 Medical Mimmickers
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Nov 19, 2023 Dr. Kimberly Nordstrom, a psychiatrist, discusses the importance of considering medical factors in psychiatric illness. Topics include red flags for medical contributions to psychiatric illness, common medical-psychiatric conditions, recognizing and treating schizophrenia, directed testing and collaboration in psychiatry, advocating for patients with neurological symptoms, analyzing patient cases, the importance of vital signs, and the overlap between NMS and catatonia.
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Use Imaging Only When Directed
- Reserve neuroimaging for directed concerns: falls, focal deficits, new seizures, or first-episode psychosis workup.
- In ED settings, prefer CT for acute direction and involve neurology for non-urgent MRI planning.
ABCs First In Altered Mental Status
- For confusion/altered mental status, start with ABCs, vitals, collateral, and a focused neurologic exam before lab-directed workup.
- Recheck vitals after initial agitation calms and use physical exam findings (e.g., clonus, reflexes) to narrow differential.
Investigate Medical Contributors To Depression
- For depression, assess context, severity, suicidality, meds, and a full review of systems to catch medical contributors.
- If no PCP, obtain directed labs (CMP, CBC, TSH) and coordinate care with primary care when possible.