Quick Reference for Psychosomatic Medicine
| Drug Interactions | Effect |
|---|---|
| Antipsychotics | |
| Alcohol | Intensifies CNS depression |
| Amphetamines | Antagonizes efficacy |
| Antacids | Decreases neuroleptic absorption |
| Anticholinergics | Additive anticholinergic effects |
| Antihypertensivesa | Hypotension |
| Barbiturates | Decreases neuroleptic levels |
| Epinephrinea | Hypotension |
| Levodopa | Antagonizes levodopa efficacy |
| Lithium | Increases neurotoxicity |
| MAOIsa | Hypotension |
| TCAs | Increases TCA plasma levels |
| BZs | |
| Alcohol (and other CNS depressants) | Intensifies CNS depression |
| Alcohol (acute) | Increases BZ levels |
| Alcohol (chronic) | Decreases BZ levels |
| Antacids | Decreases BZ levels |
| Cimetidineb | Increases BZ levels |
| Disulfiramb | Increases BZ levels |
| SSRIs | Increases BZ levels |
| Isoniazidb | Increases BZ levels |
| Oral contraceptivesb | Increases BZ levels |
| Rifampinb | Decreases BZ levels |
| Tobacco/nicotineb | Decreases BZ levels |
| Carbamazepine (induces CYP450 3A3/3A4) | |
| Alprazolam | Decreases alprazolam levels |
| Cimetidine | Increases carbamazepine levels |
| Clonazepam | Decreases clonazepam levels |
| Diltiazem, verapamil | Increases carbamazepine levels |
| Erythromycin | Increases carbamazepine levels |
| Isoniazid | Increases carbamazepine levels |
| Phenobarbital | Decreases carbamazepine levels |
| Phenytoin | Decreases carbamazepine levels |
| Primidone | Decreases carbamazepine levels |
| Propoxyphene | Increases carbamazepine levels |
| SSRIs | Increases carbamazepine levels |
| Valproate | Decreases valproate levels |
| Lithium | |
| Acetazolamide | Decreases lithium levels |
| Antipsychotics | Increases neurotoxicity |
| Beta-blockers | Decreases tremor |
| Carbamazepine | Increases lithium effects |
| Captopril, enalapril | Increases lithium levels |
| Cyclosporine | Markedly increases lithium levels |
| Diltiazem, verapamil | Increases lithium toxicity |
| Methyldopa | Increases lithium toxicity |
| Potassium iodide | Enhances hypothyroid effects |
| Tetracycline | Increases lithium levels |
| Thiazide diuretics | Increases lithium levels |
| SSRIs | |
| BZsb | Increases BZ levels |
| Carbamazepine | Increases carbamazepine levels |
| Antipsychotics | Increases neuroleptic levels |
| TCAs | Increases TCA levels |
| MAOIs | |
| Alcohol | Additive CNS depression |
| Clomipramine | Serotonin syndrome |
| SSRIs | Serotonin syndrome |
| Meperidine | Serotonin syndrome |
| Phenothiazine | Hypotension |
| Succinylcholine | Prolongs muscle relaxation |
| Tyramine | Potential hypertensive crisis |
| Sympathomimetic drugs (amphetamine, cocaine, dopamine, ephedrine, epinephrine, metaraminol, norepinephrine, phenylpropanolamine, phenylephrine) | Potential hypertensive crisis |
| TCAs | |
| Alcohol | Additive CNS depression |
| Anticholinergics | Additive anticholinergic effects |
| Antihypertensives (guanethidine, clonidine, debrisoquin) | Increases hypertension |
| Antipsychotics | Increases TCA plasma levels |
| BZs | Additive CNS depression |
| Class I antiarrhythmics (disopyramide, lidocaine, quinidine, procainamide) | Prolongs cardiac conduction |
| Liothyronine | Enhances antidepressant action |
CNS=central nervous system; MAOI=monoamine oxidase inhibitor; TCA=tricyclic antidepressant; BZ=benzodiazepine; SSRI=selective serotonin reuptake inhibitor; CYP450=cytochrome P450
a Phenothiazines (chlorpromazine, thioridazine, and mesoridazine)
b Except oxazepam, lorazepam, alprazolam, and temazepam
Source: Rundell JR, Wise MG: Concise Guide to Consultation Psychiatry, 3rd ed, Washington, DC, American Psychiatric Press, 2000, pp 176–178
| Acute Pain | Recurrent/Chronic Pain |
|---|---|
| Visual analog scale or numeric rating scale | Visual analog scale, McGill Pain Questionnaire |
| Medication use | Medication use |
| Observer rating | Observer rating |
| Pain diary | |
| West Haven–Yale Multidimensional Pain Inventory | |
| Psychological measures |
Source: Leo RJ: Concise Guide to Pain Management for Psychiatrists, Washington, DC, American Psychiatric Press, 2003, p 50
| Assess pain |
| Assess intervening variables that affect pain |
| Prognosticate (consider factors that might influence pain, treatment compliance, and effects of treatment) |
| Determine problem areas for the patient |
| Establish a treatment approach |
| Delineate goals of treatment |
| Reassess treatment efficacy |
| Make modifications in the treating plans as necessary |
Source:Leo RJ: Concise Guide to Pain Management for Psychiatrists, Washington, DC, American Psychiatric Press, 2003, p 8
| Proxy consent of next of kin |
| Adjudication of incompetence; appointment of a guardian |
| Institutional administrators or committees |
| Treatment review panels |
| Substituted consent of the court |
| Advance directives (living will, durable power of attorney, health care proxy) |
| Statutory surrogates (spouse or court-appointed guardian)a |
a Medical statutory surrogate laws (when treatment wishes of the patient are unstated)
Source: Simon RI, Schindler BA, Levenson JL: Legal issues, in The American Psychiatric Publishing Textbook of Psychosomatic Medicine. Edited by Levenson JL. Washington, DC, American Psychiatric Publishing, 2005, p 43
| 1. Do you and your partner argue a lot? Does it ever get physical? Has either one of you hit the other? Has either one of you injured the other? |
| 2. Do you ever feel unsafe at home? |
| 3. Has anyone hit you or tried to injure you in any way? |
| 4. Has anyone ever threatened you or tried to control you? |
| 5. Have you ever felt afraid of your partner? |
| 6. Is there anything particularly stressful going on now? How are things at home? |
| 7. I see patients in my practice who are being hurt or threatened by someone they love. Is this happening to you? Has this ever happened to you? |
Source:Onyike CU, Lyketsos CG: Aggression and violence, in The American Psychiatric Publishing Textbook of Psychosomatic Medicine. Edited by Levenson JL. Washington, DC, American Psychiatric Publishing, 2005, p 184
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