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The adverse effects of depression on cardiovascular disease also may be mediated by platelet mechanisms. Markovitz and Matthews first proposed that enhanced platelet responses to psychologic stress may trigger adverse coronary…

Alterations in autonomic nervous system activity, as demonstrated by exaggerated responses in heart rate to orthostatic challenge or reduction in HRV, represent yet another mechanism that potentially contributes to the diminished survival of…

Usually underdiagnosed and undertreated, major depression and anxiety disorders are encountered commonly in patients with CAD and patients referred for evaluation of chest pain. However, a burgeoning…

As with other medical disorders, effective treatment of major psychiatric illnesses such as major depression and panic disorder, respectively, require patient access to informed health…

Pathophysiology
Hypothalamic-Pituitary-Adrenocortical and Sympathomedullary Hyperactivity

Advances in biological psychiatry have included the discovery of numerous neurochemical, neuroendocrine, and neuroanatomic alterations in unipolar depression. Often proposed as important adjuncts in the…

The neurocircuitry of anxiety has been postulated to arise from the amygdala, the brain area that registers the emotional significance of environmental stimuli and stores emotional memories. The efferent pathways from the central nucleus…

Relatively consistent point prevalence rates of depression have been documented in patients with CAD, ranging from 15 to 23 percent, despite the potential methodologic weaknesses of some of the studies (such…

This section describes a group of major adverse reactions associated with use of psychiatric medications. Minor adverse reactions and side effects are outlined on the pages of the respective medications. Although…

Legal issues affect all areas of medicine, including psychiatry. The laws that govern medical practice address physician duty, negligence, and malpractice as well as patient competence, consent, and right to refuse treatment. Previous…

Serotonin syndrome can occur when multiple medications that alter serotonin metabolism are used.

Classically, this syndrome is produced when other serotonin-altering medications are used with MAOls.

This syndrome, which can be life-threatening, consists…

There are a large number of competing theories influencing contemporary psychotherapeutic thinking. Psychotherapies derived from psychoanalytic, cognitive, and behavior theory are the most widely used. Cognitive and behavioral interventions have the strongest empirical…

TD is a movement disorder that develops with longterm neuroleptic use; rarely, especially in the elderly, onset may not be as delayed. TD consists of constant, involuntary, stereotyped choreoathetoid movements most frequently confined to…

NMS is an idiosyncratic and potentially life-threatening complication of antipsychotic drug use.

Symptoms of NMS may develop gradually over a period of hours to days and can often overlap with symptoms of…

EPS, also known as neuroleptic-induced parkinsonism, consist of the development of the classic symptoms of Parkinson’s disease but in response to neuroleptic use. The most common symptoms are rigidity and akinesia, which occur in…

The tragic shooting of Rigoberto Alpizar at the Miami International Airport by U.S. Marshals who thought he had a bomb offers an opportunity to discuss bipolar disorder and the need…

The FDA warned doctors today that preliminary results implicate the antidepressant Paxil (paroxetine) with an increased risk of birth defects.

The FDA informed doctors that results of new studies suggest that…

Benzodiazepines
Benzodiazepine dosing is generally titrated to maximize symptom relief while minimizing side effects and the potential for abuse. No routine monitoring is required; although serum drug levels can be obtained, they are…

Benzodiazepines

The selection of a benzodiazepine should be based on an understanding of potency, rate of onset, route of metabolism, effective half-life, and clinically proven effectiveness. Although all benzodiazepines appear to function by…

The medications discussed in this section have anxiolysis in common. Although benzodiazepines have a wide variety of clinical applications (e.g., as pre anesthetics, in the treatment of status epilepticus, as muscle relaxants, and…

This section includes medications that are commonly used in psychiatric practice but that do not fall into the conventional categories of psychotherapeutic drugs. Many medications used in general medical practice have side…

Antidepressants are used commonly in medical and psychiatric practice. As a class, antidepressants have in common their ability to treat major depressive illness. Most antidepressants are also effective in the treatment of panic…

Although Prozac has achieved phenomenal marketing success, it may not be as effective as certain other antidepressants, according to a recent systematic review.

Researchers led by Andrea Cipriani,…