5 anxiety disorders

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PREFACEWhy buy a book about psychopharmacology if you don’t prescribe medications?Ask yourself, how many of your clients tell you about the medications they aretaking or wonder if they should be taking, for whatever disorder they are receivingtreatment for from you. Or, do they tell you that they appreciate having more timewith you than they get with the person who prescribes their medications so they canask their questions in a less hurried environment? This is the feedback from manymental health professionals, psychologists, social workers, therapists, and nurses,that we have received.Our purpose with this book is to provide a background into the what, why, how,and when questions of psychotropic medications. Recognizing that this conversationcannot exist in a vacuum, we also review diagnostic issues, treatment goals, andways to integrate psychotherapy with pharmacotherapy and then intersperse thisinformation with clinical examples. It is this combination, the “bio” with the “psychosocial”that optimizes care for so many of the people we treat.We hope that you enjoy this book, but more importantly, we hope that should wemeet, you will tell us that this book improved the outcome and quality of life forthose that you work with in treatment.Jeffrey E. Kelsey, M.D., Ph.D.D. Jeffrey Newport, M.D., M.S., M.DivCharles B. Nemeroff, M.D., Ph.D.xv
FACULTY DISCLOSUREJeffrey E. Kelsey, M.D., Ph.D.Research SupportAbbott LaboratoriesBristol-Meyers SquibbCyberonicsEli LillyForest Pharmaceuticals, Inc.GlaxoSmithKlineMerckMitsubishiOrganonPfizerWyethSpeakers BureauBristol-Meyers SquibbEli LillyForest Pharmaceuticals, Inc.GlaxoSmithKlinePfizerShireWyethConsultantBristol-Meyers SquibbEli LillyWyethD. Jeffrey Newport, M.D., M.S., M.Div.Grants/ResearchEli LillyGlaxoSmithKlineJanssen PharmaceuticaNARSADNIMHWyethxvii
Page 2 and 3: PRINCIPLES OFPSYCHOPHARMACOLOGYFOR
Page 4 and 5: Copyright © 2006 by John Wiley & S
Page 6 and 7: CONTENTSPrefaceFaculty Disclosurexv
Page 8: CONTENTSix5 ANXIETY DISORDERS 1275.
Page 13: xivCONTENTS13.2 Norepinephrine-Rela
Page 17 and 18: FACULTY DISCLOSURExixBoard of Direc
Page 19 and 20: 2 INTRODUCTION AND OVERVIEWThe goal
Page 21 and 22: 4 INTRODUCTION AND OVERVIEWClinical
Page 23 and 24: 6 INTRODUCTION AND OVERVIEWClinical
Page 25 and 26: 2BASICS OFPSYCHOPHARMACOLOGY2.1 INT
Page 27 and 28: NORMAL HUMAN NERVOUS SYSTEM 11ture
Page 29 and 30: NORMAL HUMAN NERVOUS SYSTEM 13a kne
Page 31 and 32: NORMAL HUMAN NERVOUS SYSTEM 15This
Page 33 and 34: NORMAL HUMAN NERVOUS SYSTEM 17to du
Page 35 and 36: PATHOPHYSIOLOGY: STUDY OF WHAT GOES
Page 37 and 38: PATHOPHYSIOLOGY: STUDY OF WHAT GOES
Page 39 and 40: PHARMACOLOGY 23Only when we look at
Page 41 and 42: PHARMACOLOGY 25However, if an indiv
Page 43 and 44: PHARMACOLOGY 27soon see that for al
Page 45 and 46: PHARMACOLOGY 29mitter. When a molec
Page 47 and 48: PHARMACOLOGY 31the bacteria more ef
Page 49 and 50: PUTTING IT ALL TOGETHER 33Diagnose
Page 51 and 52: ADDITIONAL READING 35Owens MJ, Mulc
Page 53 and 54: 38 MOOD DISORDERSMajor Depression (
Page 55 and 56: 40 MOOD DISORDERSMajor depression v
Page 57 and 58: 42 MOOD DISORDERSthe initial episod
Page 59 and 60: 44 MOOD DISORDERSTABLE 3.4. Medical
Page 61 and 62: 46 MOOD DISORDERSthese characterist
Page 63 and 64: 48 MOOD DISORDERSTABLE 3.7. Functio
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50 MOOD DISORDERSlar, stimulants we
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52 MOOD DISORDERSTABLE 3.8. Tricycl
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54 MOOD DISORDERSIn the 1980s, deca
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56 MOOD DISORDERSSertraline (Zoloft
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58 MOOD DISORDERSand norepinephrine
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60 MOOD DISORDERSThe cytochrome P 4
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62 MOOD DISORDERSThere are several
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TABLE 3.11. Choosing an Antidepress
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66 MOOD DISORDERSContinuation Phase
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68 MOOD DISORDERSfor those with an
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70 MOOD DISORDERStermed “endogeno
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72 MOOD DISORDERSTABLE 3.13. Diagno
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74 MOOD DISORDERSWhereas patients w
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76 MOOD DISORDERSmania prior to the
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78 MOOD DISORDERSreason, brain imag
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80 MOOD DISORDERSLithium toxicity c
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82 MOOD DISORDERSantidepressants (T
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84 MOOD DISORDERSor the reticulocyt
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86 MOOD DISORDERScannot predict in
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88 MOOD DISORDERSand to provide pro
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90 MOOD DISORDERSagents. Carbamazep
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92 MOOD DISORDERSof other medicatio
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94 MOOD DISORDERSADDITIONAL READING
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4SCHIZOPHRENIA4.1 BRIEF DESCRIPTION
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BRIEF DESCRIPTION AND DIAGNOSTIC CR
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PRESENTATION AND CLINICAL COURSE 10
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INITIAL EVALUATION AND DIFFERENTIAL
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HISTORY OF TREATMENT 107fact that t
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HISTORY OF TREATMENT 109drugs. Even
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HISTORY OF TREATMENT 111As a group,
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HISTORY OF TREATMENT 113Chlorpromaz
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HISTORY OF TREATMENT 115physicians.
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HISTORY OF TREATMENT 117most effect
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HISTORY OF TREATMENT 119Olanzapine
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CURRENT APPROACH TO TREATMENT 121Th
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CURRENT APPROACH TO TREATMENT 123If
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ADDITIONAL READING 125tion combinat
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128 ANXIETY DISORDERSwith a single
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130 ANXIETY DISORDERSdisasters, or
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132 ANXIETY DISORDERSresult of thei
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134 ANXIETY DISORDERSTricyclic Anti
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136 ANXIETY DISORDERSdizziness, and
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138 ANXIETY DISORDERSintensely noxi
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140 ANXIETY DISORDERSIn particular,
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142 ANXIETY DISORDERSLike the MAOIs
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144 ANXIETY DISORDERSagoraphobic av
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146 ANXIETY DISORDERSrange from 4%
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148 ANXIETY DISORDERSAnxiety Disord
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150 ANXIETY DISORDERSA controlled t
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152 ANXIETY DISORDERSthree times ea
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154 ANXIETY DISORDERSunclear whethe
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156 ANXIETY DISORDERSTourette’s D
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158 ANXIETY DISORDERSStarted at 15-
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160 ANXIETY DISORDERSTABLE 5.9. Dia
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162 ANXIETY DISORDERSothers, as the
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164 ANXIETY DISORDERSlimitation is
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166 ANXIETY DISORDERSfor the effect
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168 ANXIETY DISORDERSTABLE 5.10. Di
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170 ANXIETY DISORDERSwarrants lifel
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172 ANXIETY DISORDERSTricyclic Anti
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174 ANXIETY DISORDERSof PTSD, it ca
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176 ANXIETY DISORDERSNemeroff CB. A
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178 SUBSTANCE USE DISORDERSregularl
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180 SUBSTANCE USE DISORDERSIn contr
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182 SUBSTANCE USE DISORDERSOne impo
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184 SUBSTANCE USE DISORDERSSocial f
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186 SUBSTANCE USE DISORDERSdevelop
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188 SUBSTANCE USE DISORDERScation i
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190 SUBSTANCE USE DISORDERSAversion
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192 SUBSTANCE USE DISORDERSStage Th
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194 SUBSTANCE USE DISORDERSexcessiv
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196 SUBSTANCE USE DISORDERSAcampros
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198 SUBSTANCE USE DISORDERSsame ben
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200 SUBSTANCE USE DISORDERS6.10 NIC
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202 SUBSTANCE USE DISORDERSTABLE 6.
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204 SUBSTANCE USE DISORDERSLAAM (Le
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206 SUBSTANCE USE DISORDERSADDITION
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208 EATING DISORDERSdisorder is war
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210 EATING DISORDERSTABLE 7.2. Diag
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212 EATING DISORDERSTABLE 7.3. Some
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214 EATING DISORDERSThe use of appe
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216 EATING DISORDERS7.2.6 Current A
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218 EATING DISORDERSpsychiatric nos
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220 EATING DISORDERSTABLE 7.7. Phys
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222 EATING DISORDERSFinally, althou
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224 EATING DISORDERSduring purging
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226 EATING DISORDERSsignificantly i
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228 EATING DISORDERSdoses. The typi
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230 EATING DISORDERSRoerig JL, Mitc
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232 ATTENTION DEFICIT-HYPERACTIVITY
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9SLEEP DISORDERS9.1 INTRODUCTIONPsy
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INTRODUCTION 259eye movement (REM)
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INSOMNIA 261falling asleep (initial
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INSOMNIA 263to professional attenti
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INSOMNIA 265worsen obstructive slee
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INSOMNIA 267TABLE 9.3. Medical Illn
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INSOMNIA 269(besides their many use
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INSOMNIA 271antipsychotics are safe
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INSOMNIA 273Magnesium. Recent resea
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NARCOLEPSY 275• Use the bed only
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NARCOLEPSY 277of complete remission
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NARCOLEPSY 279Pemoline (Cylert). Pe
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ADDITIONAL READING 281regimen. The
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10ALZHEIMER’S DISEASE ANDOTHER DE
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PREVALENCE AND RISK FACTORS 285•
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PREVALENCE AND RISK FACTORS 287solv
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Page 303 and 304:
Page 305 and 306:
HISTORY OF PHARMACOLOGICAL TREATMEN
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Page 313 and 314:
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CURRENT APPROACH TO TREATMENT 303st
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CURRENT APPROACH TO TREATMENT 305us
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CURRENT APPROACH TO TREATMENT 307TA
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CURRENT APPROACH TO TREATMENT 309ch
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ADDITIONAL READING 311Bullock R. Tr
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314 PERSONALITY DISORDERSHow then h
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316 PERSONALITY DISORDERSnostic cri
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318 PERSONALITY DISORDERSis a repea
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320 PERSONALITY DISORDERScollateral
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322 PERSONALITY DISORDERSThe limite
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324 PERSONALITY DISORDERSthat child
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326 PERSONALITY DISORDERS11.3.4 His
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328 PERSONALITY DISORDERSin BPD. Th
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330 PERSONALITY DISORDERSaddress ea
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332 PERSONALITY DISORDERSDPD patien
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334 PERSONALITY DISORDERSand dopami
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336 PERSONALITY DISORDERSTrestman R
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338 TRAUMATIC BRAIN INJURYlong-term
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340 TRAUMATIC BRAIN INJURY12.1.4 In
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342 TRAUMATIC BRAIN INJURYescitalop
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344 TRAUMATIC BRAIN INJURYConsequen
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346 TRAUMATIC BRAIN INJURYwho exper
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348 TRAUMATIC BRAIN INJURYgeneral,
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350 TRAUMATIC BRAIN INJURYin TBI pa
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352 TRAUMATIC BRAIN INJURYa control
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354 MANAGING SIDE EFFECTSmany of th
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356 MANAGING SIDE EFFECTSTABLE 13.1
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358 MANAGING SIDE EFFECTSalthough t
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360 MANAGING SIDE EFFECTSeffects of
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362 MANAGING SIDE EFFECTS13.2.2 Sid
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364 MANAGING SIDE EFFECTStreat Park
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366 MANAGING SIDE EFFECTSAntidepres
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368 MANAGING SIDE EFFECTSpatient a
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370 MANAGING SIDE EFFECTSdose. Once
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372 MANAGING SIDE EFFECTSPsychiatri
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374 MANAGING SIDE EFFECTSSexual Sid
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376 MANAGING SIDE EFFECTSdo produce
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378 MANAGING SIDE EFFECTSTABLE 13.7
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380 MANAGING SIDE EFFECTStricyclic
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INDEXAbecarnil, see β-carbolineAbi
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INDEX 385Disulfiram, 195, 198Donepe
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INDEX 387Obesity, 227Obsessive-comp
Page 399:
INDEX 389Valerian root, 272Valium,
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