Best first-line antidepressants for most patients: Sertraline (best combination of efficacy and tolerability); Escitalopram (similar in tolerability to sertraline; citalopram can also be used); Bupropion (best side effect profile, but less helpful for anxiety)

Therapeutic drug monitoring means measuring blood levels of medications to guide dosing and detect toxicity or nonadherence. Its usefulness is the subject of continuing debate. The only medications for which drug levels can actually help you fine tune dosing are lithium, valproic acid, carbamazepine, clozapine, and nortriptyline. For other drugs in psychiatry, blood levels are useful only to see if the patient is adherent or if they have a genetic variation affecting there ability to metabolize the drug normally.

In this fact sheet, we review the basic DSM-5 criteria for diagnosing major neurocognitive disorder (MND), and review the characteristics of the various subtypes of dementia. For our clinical approach to rapidly assessing for dementia, see the How to Diagnose MND.

The Token Economy (TE) is a method that promotes positive behaviors in patients, such as taking medications, going to groups, or maintaining hygiene. They earn tokens for their desirable actions on the unit, which can later be exchanged for rewards or privileges.Token economies are sometimes used in inpatient psychiatric units, as well as in residential treatment programs.

Although DSM-5 lists a variety of cognitive functions that can be impaired in dementia (see fact sheet on differential diagnosis in dementia), by far the most important aspect of the assessment is forgetfulness—specifically, rapid forgetting. While in forgetfulness of normal aging, we become slower at retrieving past information, in dementia, the hippocampus is so damaged that memories can no longer be stored, and this is the main target of your evaluation.

Serotonin syndrome is a rare but potentially life-threatening medical emergency that occurs in patients on medications that affect serotonin levels. Be particularly vigilant when patients are on high doses or multiple serotonergic agents.

To diagnose the presence of a major depressive episode, you have to establish that your patient has had a depressive mood state in addition to 5 out of 8 SIGECAPS for at least 2 weeks.

There's no "cure" for MND, but several medications help mitigate the progression of cognitive and functional decline. Most medications are FDA approved for Alzheimer’s dementia but are often used off-label for other memory disorders. Educate patients and caregivers about the importance of medication adherence: missing doses, even briefly, can cause significant memory deterioration, which may not be reversible even after resuming the medication.

Sexual attraction – and even sexual activity – sometimes occurs among individuals staying together in a psychiatric inpatient unit. Nevertheless, many psychiatric hospitals lack policies on patient-to-patient physical contact. This sheet describes the steps to take when sexual contact occurs on the inpatient unit, whether consensual or non-consensual.

Nausea or sensation of upset stomach beginning soon after first dose of a new medication.