Addiction Medicine
Astra Clinical Library
Psychiatry
Practical psychiatry guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
33 guides
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Pediatrics and Psychiatry
Suicide Risk in Children and Adolescents
Assess youth suicide risk through direct, developmentally appropriate inquiry, collateral information, and evaluation of prior self-harm plus current ideation, plan, intent, and preparations. Match immediate safety measures, disposition, lethal-means counseling, safety planning, and evidence-based follow-up to dynamic clinical risk rather than a score alone.Addiction Medicine
Opioid Use Disorder
Diagnose opioid use disorder clinically with DSM-5 criteria, address overdose or psychiatric emergencies first, and promptly offer evidence-based medication treatment. Buprenorphine, methadone, and extended-release naltrexone have distinct initiation requirements, settings, and monitoring needs; withdrawal management alone is not treatment.Psychiatry
Major Depressive Disorder
Major depressive disorder requires clinical confirmation after screening, assessment of suicide and bipolar risk, and individualized psychotherapy and medication selection. Use measurement-based follow-up to detect inadequate response, intolerance, or worsening risk early, and escalate care for severe, psychotic, suicidal, or treatment-resistant illness.Psychiatry
Suicide Risk Assessment
Suicide assessment is a repeated, collaborative clinical process that identifies current ideation, intent, planning, access to lethal means, prior behavior, drivers, and protective factors to determine immediate safety actions, treatment needs, and follow-up rather than to assign a static risk category.Psychiatry
Bipolar Disorder
Bipolar disorder requires longitudinal diagnostic assessment and phase-specific treatment. Prioritize recognition of past mania or hypomania in depressed patients, manage acute episodes with mood stabilizers or antipsychotics, and sustain relapse prevention through individualized maintenance medication, psychosocial care, and safety monitoring.Psychiatry
Schizophrenia
Manage schizophrenia with measurement-based antipsychotic treatment, early detection of nonresponse and nonadherence, adverse-effect-directed drug selection, and timely clozapine for treatment resistance, persistent suicidality, or aggression. Long-acting formulations can strengthen relapse prevention when oral adherence is unreliable.Addiction Medicine
Patient Communication in Substance Use Disorders
Use nonjudgmental, person-centered communication to identify treatment goals, address ambivalence, reduce stigma, and connect patients with substance use disorders to evidence-based medications, behavioral treatment, harm reduction, and longitudinal follow-up.Psychiatry and Primary Care
Generalized Anxiety Disorder
Diagnose generalized anxiety disorder clinically after defining severity, functional impairment, comorbidity, substance contributions, and acute safety risk; then match treatment intensity to patient preference, access, and prior response using cognitive behavioral therapy, an SSRI, or an SNRI.Psychiatry
Acute Stress Disorder
Diagnose acute stress disorder only after a qualifying trauma when clinically impairing symptoms persist 3 days to less than 1 month; exclude intoxication, medical causes, and competing psychiatric disorders, address safety, and reassess for PTSD after 1 month.Emergency Medicine and Psychiatry
Neuroleptic Malignant Syndrome
Treat suspected neuroleptic malignant syndrome as a medical emergency: stop dopamine-blocking drugs, stabilize hyperthermia and rhabdomyolysis, exclude mimics, and escalate to intensive care when autonomic, respiratory, renal, or consciousness abnormalities are present.Psychiatry
Antisocial Personality Disorder
Antisocial personality disorder requires longitudinal, behavior-based diagnostic assessment, separation from psychopathy and acute substance-related risk, and treatment directed at comorbid disorders, aggression, impulsivity, offending, and safety rather than an assumed medication-responsive core disorder.Developmental-Behavioral Pediatrics and Psychiatry
Attention-Deficit/Hyperactivity Disorder
Diagnose ADHD through DSM-5 criteria, cross-setting impairment, collateral history, and active exclusion of competing conditions. Match treatment intensity to age, impairment, comorbidity, cardiovascular risk, adverse effects, and patient preference; monitor functional response rather than symptom scores alone.Psychiatry
Avoidant Personality Disorder
Diagnose avoidant personality disorder through persistent, impairing interpersonal avoidance and negative self-appraisal, while separating it from social anxiety disorder, psychotic-spectrum illness, depression, and trauma-related avoidance. Use longitudinal history, collateral data, functional assessment, and targeted treatment of comorbidity.Psychiatry
Binge-Eating Disorder
Diagnose recurrent loss-of-control eating while actively excluding compensatory behaviors and competing eating disorders, then prioritize cognitive behavioral therapy and consider lisdexamfetamine for adults with moderate to severe disease when stimulant risks are acceptable.Psychiatry
Borderline Personality Disorder
Borderline personality disorder requires structured longitudinal diagnosis, active suicide-risk assessment, and referral to a coherent disorder-specific psychotherapy. Avoid reflexive crisis pharmacotherapy and unstructured prolonged hospitalization; target medications to independently diagnosed comorbid disorders and build a crisis plan around measurable risk and treatment continuity.Psychiatry
Brief Psychotic Disorder
Brief psychotic disorder is a time-limited diagnosis requiring abrupt psychosis, full remission within one month, and exclusion of mood, substance-related, and medical causes. Manage the presentation as first-episode psychosis while longitudinal course establishes the final diagnosis.Addiction Medicine
Cannabis Use Disorder
Diagnose cannabis use disorder with a DSM-5 criterion-based assessment rather than toxicology alone, identify psychiatric and safety complications, and match treatment intensity to impairment, comorbidity, readiness, and response to evidence-based psychosocial care.Child and Adolescent Psychiatry
Conduct Disorder
Conduct disorder requires behavior-specific assessment, careful differentiation from trauma, mood, neurodevelopmental, and substance-related conditions, and treatment that targets family, school, peer, and comorbid drivers rather than aggression alone.Psychiatry
Dependent Personality Disorder
Dependent personality disorder requires longitudinal assessment of pervasive dependency, separation fears, and impaired autonomous decision-making while distinguishing mood, anxiety, trauma-related, cognitive, and medical drivers. Management centers on structured psychotherapy, functional goals, comorbidity treatment, and active assessment of coercion, self-harm, and suicide risk.Psychiatry
Illness Anxiety Disorder
Identify illness anxiety disorder only after a proportionate medical assessment, then replace repeated reassurance and fragmented testing with one coordinating clinician, structured cognitive-behavioral therapy, and treatment of comorbid psychiatric illness.Psychiatry
Narcissistic Personality Disorder
Evaluate narcissistic personality disorder longitudinally, corroborate impairment with collateral history, assess co-occurring mood, substance, and safety syndromes, and use a structured psychotherapy-centered plan. Medication has no established role for core narcissistic pathology but may target a clearly diagnosed comorbidity.Psychiatry
Obsessive-Compulsive Disorder
Manage OCD by measuring impairment and symptom severity, delivering exposure and response prevention or an SSRI, and reserving augmentation for persistent symptoms after verified adequate first-line treatment.Child and Adolescent Psychiatry
Oppositional Defiant Disorder
Evaluate persistent defiance by confirming clinically significant impairment, separating oppositional behavior from conduct disorder and chronic irritability syndromes, identifying ADHD and other comorbidity, and initiating parent-focused behavioral treatment while treating coexisting disorders with diagnosis-specific care.Psychiatry
Panic Disorder
Evaluate acute cardiopulmonary, respiratory, toxicologic, and substance-related mimics before diagnosing panic disorder. Confirm recurrent unexpected attacks plus persistent concern or avoidance, then select disorder-focused CBT, an SSRI or SNRI, or both according to severity, preference, access, and comorbidity.Psychiatry
Persistent Depressive Disorder
Persistent depressive disorder requires confirmation of a chronic depressive course, assessment for superimposed major depression and suicide risk, and treatment planning that anticipates prolonged therapy, psychiatric comorbidity, functional impairment, and frequent incomplete response.Psychiatry
Schizoaffective Disorder
Schizoaffective disorder requires longitudinal confirmation of psychosis outside major mood episodes, exclusion of substance and medical causes, acute safety management, and a treatment plan that addresses persistent psychosis, the bipolar or depressive course, adherence, and suicide risk.Psychiatry
Social Anxiety Disorder
Diagnose social anxiety disorder by persistent fear of negative evaluation, avoidance, disproportionate anxiety, and functional impairment; screen with Mini-SPIN or quantify severity with SPIN or LSAS. Select disorder-specific CBT first when acceptable, and use an SSRI when pharmacotherapy is preferred or needed.Psychiatry, Family Medicine, Internal Medicine
Somatic Symptom Disorder
Diagnose somatic symptom disorder positively when distressing symptoms coexist with persistent, disproportionate symptom-related thoughts, anxiety, or behaviors; continue indicated medical evaluation while replacing fragmented testing with structured follow-up, functional goals, and integrated behavioral care.Psychiatry
Posttraumatic Stress Disorder
Diagnose PTSD with a trauma-informed clinical assessment rather than a self-report score alone, then prioritize manualized trauma-focused psychotherapy. Use symptom measures to track change, assess suicide risk directly, and avoid benzodiazepines because they do not treat core PTSD symptoms and may undermine recovery.Addiction Medicine
Alcohol Withdrawal Medication Selection
Select benzodiazepines for most alcohol withdrawal, reserve phenobarbital for protocolized severe or benzodiazepine-refractory presentations, and avoid substituting adjunctive agents for seizure- and delirium-preventive therapy.Psychiatry
Suicide Risk Assessment and Disposition
Use a structured assessment after a positive screen to establish acute intent, plan, access to lethal means, modifiable drivers, supports, and a disposition that matches immediate safety needs. Pair discharge decisions with collaborative safety planning, lethal-means counseling, and active follow-up.Psychiatry