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FOCUS, VOL. 3, No. 2

CLINICAL SYNTHESIS | April 01, 2005

Quick Reference for Psychosomatic Medicine

FOCUS 2005;3:203-207.

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Drug Interactions	Effect
Antipsychotics
Alcohol	Intensifies CNS depression
Amphetamines	Antagonizes efficacy
Antacids	Decreases neuroleptic absorption
Anticholinergics	Additive anticholinergic effects
Antihypertensives^a	Hypotension
Barbiturates	Decreases neuroleptic levels
Epinephrine^a	Hypotension
Levodopa	Antagonizes levodopa efficacy
Lithium	Increases neurotoxicity
MAOIs^a	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
Cimetidine^b	Increases BZ levels
Disulfiram^b	Increases BZ levels
SSRIs	Increases BZ levels
Isoniazid^b	Increases BZ levels
Oral contraceptives^b	Increases BZ levels
Rifampin^b	Decreases BZ levels
Tobacco/nicotine^b	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
BZs^b	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

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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

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Pain Assessment Instruments

Source: Leo RJ: Concise Guide to Pain Management for Psychiatrists, Washington, DC, American Psychiatric Publishing, 2003, p 52

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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

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Depression Screening Tool

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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

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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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Pain Assessment InstrumentsSource: Leo RJ: Concise Guide to Pain Management for Psychiatrists, Washington, DC, American Psychiatric Publishing, 2003, p 52

View Large
Download Slide(.ppt)

Add to My POL

Depression Screening Tool

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Download Slide(.ppt)

Add to My POL

View Large | Add to My POL

Drug Interactions	Effect
Antipsychotics
Alcohol	Intensifies CNS depression
Amphetamines	Antagonizes efficacy
Antacids	Decreases neuroleptic absorption
Anticholinergics	Additive anticholinergic effects
Antihypertensives^a	Hypotension
Barbiturates	Decreases neuroleptic levels
Epinephrine^a	Hypotension
Levodopa	Antagonizes levodopa efficacy
Lithium	Increases neurotoxicity
MAOIs^a	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
Cimetidine^b	Increases BZ levels
Disulfiram^b	Increases BZ levels
SSRIs	Increases BZ levels
Isoniazid^b	Increases BZ levels
Oral contraceptives^b	Increases BZ levels
Rifampin^b	Decreases BZ levels
Tobacco/nicotine^b	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
BZs^b	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

View Large | Add to My POL

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

View Large | Add to My POL

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

View Large | Add to My POL

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:

View Large | Add to My POL

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:

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Quick Reference for Psychosomatic Medicine. FOCUS: The Journal of Lifelong Learning in Psychiatry. 2005 Apr;3(2):203-207.

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