- Insomnia in adults
Essential Evidence Topics, 2-Aug-2021
Overall Bottom Line: Cognitive behavioral therapy is the recommended initial treatment for patients with chronic insomnia. Sedative hypnotics (zolpidem, ramelteon, zaleplon, eszopiclone, lemborexant, and suvorexant) are moderately effective in the short - Intellectual disabilities (adult)
Essential Evidence Topics, 31-Dec-2021
Overall Bottom Line: In caring for adults with intellectual disability (ID), assess their capacity for decision making using a tool adapted to the patient, consider their need for accommodations and supports, and identify with them a support person who ca - Neuroleptic malignant syndrome
Essential Evidence Topics, 25-Sep-2021
Overall Bottom Line: Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal reaction to a neuroleptic or antipsychotic drug, or to the withdrawal of a patient from dopaminergic medication. Patients typically present with fever, altered men - Obsessive compulsive disorder
Essential Evidence Topics, 22-Nov-2021
Overall Bottom Line: Suspect obsessive-compulsive disorder (OCD) in patients with excessive anxiety, worry about their own thoughts, reassurance seeking, or repetitive behaviors, and use a validated assessment tool to confirm diagnosis. Effective treatm - Opioid overdose and intoxication
Essential Evidence Topics, 6-Sep-2021
Overall Bottom Line: Classic toxidrome of opiod overdose respiratory depression, stupor and miosis, but it is not always consistently present. Hypoventilation is invariably present in opioid overdose. Miosis is helpful in diagnosis, but may be absent be - Opioid use disorder
Essential Evidence Topics, 2-Nov-2021
Overall Bottom Line: Opioid use disorder (OUD) is a chronic, relapsing condition associated with increased morbidity and death; however, with appropriate treatment and monitoring, individuals can reach long-term remission. The United States Preventive Se - Panic disorder
Essential Evidence Topics, 4-Jan-2022
Overall Bottom Line: Complete a comprehensive history and focused physical examination; routine laboratory testing or imaging is not recommended unless suggested by history and physical. Use a validated screening instrument and confirm diagnosis using D - Persistent depressive disorder (formerly dysthymia)
Essential Evidence Topics, 17-Dec-2021
Overall Bottom Line: The most prominent characteristic is at least 2 years of persistently depressed mood (one year for children and adolescents). Chronic symptoms lead to significant distress or cumulative functional impairment. Only half of patients - Personality disorders
Essential Evidence Topics, 2-Aug-2021
Overall Bottom Line: Suspect personality disorder in difficult patients who have long-standing biopsychosocial issues. Conduct a comprehensive biopsychosocial interview and consider referring for psychological testing with the Minnesota Multiphasic Pers - Postpartum depression
Essential Evidence Topics, 26-Aug-2021
Overall Bottom Line: The United States Preventive Services Task Force (USPSTF) recommends screening for depression for pregnant and postpartum women; screening may occur at the postpartum visit or 2-month well child check . Diagnosis is greatly improved - Post-traumatic stress disorder (PTSD)
Essential Evidence Topics, 21-Jan-2022
Overall Bottom Line: Use 1 of several empirically validated brief posttraumatic stress disorder (PTSD) screening scales such as the PC-PTSD to assist with case identification (). Use a longer PTSD symptom measure and clinical interview to confirm screen - Premature ejaculation
Essential Evidence Topics, 30-Nov-2020
Overall Bottom Line: An intravaginal ejaculatory latency time (IELT) between 1 and 2 minutes or having 15 or fewer penile thrusts before ejaculation are diagnostic of premature ejaculation. Selective serotonin reuptake inhibitors (SSRIs) are effective a - Pruritus
Essential Evidence Topics, 21-Jul-2021
Overall Bottom Line: In patients with chronic pruritus (≥6 weeks), consider checking CBC, ferritin, ESR, CRP, glucose, serum creatinine, LFTs, TSH, LDH, and stool occult blood (for age ≥40). First-line treatment is with an H1-receptor blocker. Second- - Schizophrenia
Essential Evidence Topics, 29-Dec-2021
Overall Bottom Line: Patients with new onset psychosis should be assessed for a medical- or substance-related cause of their symptoms and for comorbid conditions. They should be assessed for suicidality and potential for violent behavior. Antipsychotic - Sexual dysfunction (female)
Essential Evidence Topics, 19-Nov-2021
Overall Bottom Line: Obtain a detailed patient history that elicits psychosocial information about individual functioning and interpersonal relationship functioning. Conduct a thorough gynecologic examination. Use patient education as first-line treat - Smoking cessation
Essential Evidence Topics, 23-Apr-2022
Overall Bottom Line: Screen all adults at every visit for smoking cessation ("smoking as a vital sign"). Assess readiness to quit using the 5 As: Ask, Advise, Assess, Assist, and Arrange. Individualized counseling, physician advice, tailored education - Social anxiety disorder
Essential Evidence Topics, 22-Sep-2021
Overall Bottom Line: True social anxiety disorder (SAD) is usually accompanied by significant avoidance, with adverse effects on relationships, academic, and occupational achievement, overall quality of life, and increased risk of suicide attempts. A br - Somatization
Essential Evidence Topics, 22-Nov-2021
Overall Bottom Line: Somatization typically presents as frequent visits for multiple vague symptoms. Consider use of a validated screening tool such as the PHQ-15. A strong therapeutic alliance, psychotherapy, and possibly antidepressants are the prim - Suicide risk assessment and management
Essential Evidence Topics, 30-Mar-2021
Overall Bottom Line: 50-65% of completed adult suicides visited a physician in the month prior to death and 10-40% in the week prior to the suicide, and 90% of those who die by suicide have a psychiatric illness at the time of death (can be diagnosed, und - Tardive dyskinesia
Essential Evidence Topics, 10-Jul-2021
Overall Bottom Line: Use neuroleptics only in patients who cannot use other medications and use doses as low as possible. There is some evidence that new antipsychotics may be less likely to cause tardive dyskinesia (TD). Screen patients taking neurol
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