PsychConsultPt2

PSYCHIATRIC HISTORY:
Past psychiatric diagnoses: [checkbox value="Denies past psychiatric diagnoses|depression|MDD|situational depression|anxiety|GAD|panic attacks|mood disorder|bipolar disorder|somatic symptoms|somatic symptom disorder|ADHD|PTSD||OCD|psychosis|Borderline personality disorder|schizoaffective disorder, bipolar type|schizoaffective disorder|schizophrenia|psychosis|unknown mental health diagnosis|Anorexia|Bulimia|eating disorder"][textarea memo=" " rows="5"].
Past psychiatric hospitalizations: [select name="variable_1" value="Denies|1x-|2x-|3x-|4x-|multiple times, including "][checkbox name="variable_5" value="MTMHI| Vanderbilt|Skyline|Parthenon|Moccasin Bend|McFarland|St Thomas Stones River|Trust Point|Rolling Hills|Moccasin Bend|Western State|psychiatric hospital in "].  [textarea name="variable_6" default=""]
Past hx of outpatient psychiatric treatment: [select name="variable_7" value="Denies|Psychotherapy| Community Mental Health Center|Psychiatric medication management"][select name="variable_8" value=", psychotherapy|, Community Mental Health Center|, psychiatric medication management"][select name="variable_9" value=", psychotherapy|, Community Mental Health Center|, psychiatric medication management"].
Past psychiatric medication trials include: [checkbox value="Has taken antidepressant before, cannot recall name| Amitriptyline/Elavil|Citalopram/Celexa|Duloxetine/Cymbalta|Bupropion/Wellbutrin|Desipramine| Doxepin/Senequin |Escitalopram/Lexapro|Fluoxetine /Prozac|Fluvoxamine /Luvox| Imipramine|Isocarboxazid/Marplan|Mirtazapine/Remeron|Nortriptyline|Paroxetine /Paxil|Phenelzine/Nardil|Sertraline/Zoloft|Selegiline/Emsam|Tranylcypromine/Parnate|Trazodone/Desirelle |Venlafaxine/Effexor|Vilazodone /Viibryd|Vortioxetine/Trintellix

|Risperidone Risperdal|Olanzapine Zyprexa|Quetiapine Seroquel|Ziprasidone /Geodon|Aripiprazole/Abilify|Paliperidone/Invega|Lurasidone/Latuda|Clozapine|Asenapine/Saphris|Haloperidol/Haldol|Chlorpromazine Thorazine|Loxapine/Loxitane)|Fluphenazine/Prolixin|Perphenazine/Trilafon|Long acting injectable:
|Lithium|Lamotrigine Lamictal|Valproic Acid/Depakote|Carbamazepine /Tegretol| Oxcarbazepine/Trileptal
|Clonazepam/Klonopin|Diazepam /Valium|Lorazepam /Ativan)|Alprazolam /Xanax|Hydroxyzine /Vistaril|Diphenhydramine /Benadryl|Ambien|Lunesta|Rozerem|Sonata|Temazepam|Gabapentin for anxiety/mood stabilizer/Neurontin|Buspirone /Buspar
|Adderall /Dextroamphetamine Sulf-Saccharate|Focalin /Dexmethylphenidate|Vyvanse /Lisdexamfetamine|clonidine for ADHD|Kapvay for ADHD|Guanfacine for ADHD (Intuniv, Tenex)|Atomoxetine /Straterra|Adderall XR /Dextroamphetamine Sulf-Saccharate|Focalin XR /Dexmethylophenidate|MetadateCD/ER/Methylphenidate
| misc for psychiatric sx:|Folic Acid|Melatonin|Multivitamin|Prazosin|Propranolol
|Savella /milnacipran|Cogentin /Benztropine|Namenda /Memantine|Rivastigmine /Exelon|Donepezil /Aricept|Galantamine/Razadyne"]
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