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94 Cards in this Set
- Front
- Back
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3 highs of mood disorders
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high prevalence
high morbidity high mortality |
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3 moods in mood disorders
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depression
elation irritability |
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what percent of depressed patients are psychotic?
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1/5
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How long before most depressive episodes clear?
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6 months with most, spontaneous clearing.
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what % of depressed hospitalized patients commit suicide?
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10-15%
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what are the 3 moods of a manic episode?
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expansive, elevated or irritable mood
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how long does dysthymia need to present to make the dx?
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2 years
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what 2 specific characteristics must be present for melancholic depression?
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1. pervasive loss of interest or pleasure
2. inability to respond to pleasurable stimuli |
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what type of medication is helpful in atypical depression?
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MAOIs & SSRIs
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when does post-partum depression occur?
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within first 4 weeks post partum
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rapid cycling depression occurs how quickly?
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4 major depressive, manic, mixed or hypomanic episodes in past 2 months
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Lifetime prevalence for major depression?
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17%
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Lifetime prevalence for bipolar disorder I & II
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2%
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Lifetime prevalence for dysthymia
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3%
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Median age of onset for major depression
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32 y
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Median age of onset for bipolar disorder
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25 y
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Median age of onset for dysthymia
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31 y
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what is a powerful predictor of future episodes of depression?
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hx of 3 or more previous episodes of depression
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What is the effectiveness of antidepressants?
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65-70z5
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How long should an antidepressant be maintained in the first episode of depression?
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16-36 after pt considered well
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what do tricyclics block?
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norepi & serotonin and muscarinic, histamine and alpha-adrenergic receptors
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In whom is ECT indicated?
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very severe depression
high potential for suicide CVD pregnancy |
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what is the dose of lithium?
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600-1800 mg
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what is the dose of valproate?
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750 - 4200 mg
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what is the dose of carbamazepine?
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400 - 1600 mg
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what is the dose of gabapentin?
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900-3600 mg
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what is the dose of lamotrigine?
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100-400 mg
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what is the dose of oxycarbazepine?
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1200 -2400 mg
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What is the blood level needed when using lithium?
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0.6-1.2 mEq/L
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What is the blood level needed when using valproate?
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50-100 uq/mL
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What is the blood level needed when using carbamazepine?
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50-100 uq/mL
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What medications are commonly used in a manic episode?
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lithium
valproate carbamazepine SGA |
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what conditions fall under the criteria of anxiety disorder?
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panic w/ & w/o agoraphobia
Agoraphobia GAD social phobia specific phobia OCD PTSD Acute stress disorder |
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List 2 components of all anxiety disorders
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anxiety sxms & avoidance behaviors
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list 2 common comorbid psychiatric disorders with anxiety
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depression & substance abuse
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when do most people develop panic attacks?
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8 in 10 develop before age 30
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what are the medicines of choice in a panic attack?
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SSRIs are 70-80% effective in blocking attacks. SNRI venlafexine also effective
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how long does anxiety have to be present to dx GAD?
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more days than not for 6 months
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what therapy works well for social anxiety and phobia?
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behavior therapy works the best, SSRis also work
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what is the most common obsession?
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contamination
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what is the least common obsession?
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sexual impulses
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What is the most common compulsion
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checking
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What is the least common compulsion?
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hoarding
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what are the 3 major elements of PTSD
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1. reexperiencing the trauma through recurrent thoughts/dreams
2. emotional numbing 3. sxms of autonomic hyperarousal & exaggerated startle response |
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what are the txs of PTSD?
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paxil & zoloft approved for PTSD
but therapy is essential |
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what are the 3 dissociative sxms that preceed PTSD?
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emotional numbing
derealization amnesia |
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what disorders are comorbid with dissociative identity disorder?
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borderline personality in up to 70%
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what % of americans are heavy drinkers?
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12%
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what % of med-surg patients are alcohol dependent?
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25-50%
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what % of psychiatric pts have coexisting alcohol problems?
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50-60%
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how long before alcohol withdrawal begins?
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12-18 hours after cessation of drinking
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when does alcohol withdrawal peak?
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24-48 hours
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when do alcohol withdrawal seizures occur?
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7-38 hours after cessation, peaks in 24-48 hours
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what is the rate of depression and suicide in alcoholics
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60% depression, 2-3% suicide
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rate of drug abuse in US?
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3-8%
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In conversion disorder, what is frequently a comorbid condition?
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existing or preceding brain injury
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hypochondriasis has a duration of how long?
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6 m or more
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illness phobia, a type of hypochondriasis responds well to what tx?
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imipramine
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T/F Antidepressants are useful in treating somatoform do
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false - SSRIs are likely beneficial in hypochondriasis & BDD but meds don't have proven value in somatoform disorders
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how long do amnestic states associated with dissociative amnesia usually last?
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79% last less than a week
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what is standard tx of etoh withdrawal in outpatient setting?
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chlordiazepoxide (benzo)
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what withdrawal is more dangerous -sedative hypnotic or opiate?
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sedative hypnotic
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what disorders are included in the mood disorders?
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major depressive
Dysthymic disorder depressive disorder Bipolar disorder cyclothymia |
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what are the second most common symptoms in depression?
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anxiety
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Approximately what % of pts with depression also suffer from panic?
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30%
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lifetime rates of depression in men and women?
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men - 12-15%
women - 21-24% |
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what age group has highest rate of depression?
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25-44
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T/F there is an increased incidence of ADHD in children of adults with major depressive disorder.
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true
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in ___ months after dx of major depression, mortality rates are ___ times ___ than in age-matched subjects
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15 months, 4 times higher
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what is beck's triad of depression?
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negative view of self
negative interpretation of experiences negative expectation of future |
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T/F elderly pts typically present with classic depressive sxms
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F - somatic complaints, anxiety, irritability
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In melancholia, there is usually a history of endogenous or reactive depression?
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endogenous
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what % of patients recover in 1 year from depression?
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50%
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what % of patients are depressed one year later?
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20%
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what are the classic monamine neurotransmitters?
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norepi
dopamine serotonin |
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what are the catecholamine neurotransmitters?
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norepi & dopamine
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what is the most critical variable in determining the later vulnerability to psychiatric illness?
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quality of home life
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SSRIs cause what major side effect
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sexual dysfucntion
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what antidepressant is good for pts who sleep too much?
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fluoxetine
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What antidepressant works well in pts who need sedation or calming?
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paroxetine
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what is a good choice for a patient who has failed other antidepressant therapies?
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venlafaxine
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what is the probabilty of relapse in bipolar disorder at 1 and 5 years?
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1 year = 50%
5 years = 80-90% |
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T/F psychotic sxms are rare in manic patients
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False - 50% have
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first line tx for bipolar depressive sxms
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lithium or lamotrigine
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T/F over 3/4 of pts report that the initial panic attack is spontaneous but often follows within 6 months of a major stressor
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true
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what percent of patients with panic suffered from childhood separation anxiety disorder?
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20-50%
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what % of pts experiencing panic have also had a major depressive episode?
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66%
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Is buspirone effective for tx of panic?
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no more so than placebo
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the onset of social phobia is rare after age 25 - T/F
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True
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it is hardest to seperate social phobia from what other disorder?
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panic
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OCD shows increased blood flow in ______ while other anxiety states show it in _________.
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Orbito-frontal cortex bilaterally, right & anterior caudate nucleus while other anxiety is seen in limbic and/or paralimbic
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What drug is used for tx of OCD?
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clomipramine (no SSRIs while on this drug!)
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when can acute PTSD return to regular duty?
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24 - 72 h
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what drug is most effective in tx PTSD?
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Phenelzine but meds don't work well
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