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1.1 RC: Recall + Thea Gilks Review Decks > Gilks Deck 5: Grief + Psychotherapies + SUD buzz words + Forensics etc > Flashcards

Gilks Deck 5: Grief + Psychotherapies + SUD buzz words + Forensics etc Flashcards

1
Q

how is normal bereavement distinguished from MDD

A

predominant affect is feeling of EMPTINESS and LOSS, comes in WAVES associated w thoughts of the deceased

self esteem preserved

suicidal thoughts limited to “joining” the deceased

sx resolev in less than 12 mo

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2
Q

what are the TIPP skills for distress tolerance in DBT

A

Temperature (use cold water)

Intense exercise

Paced breathing

Paired muscle relaxation

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3
Q

what is the goal of DBT

A

to “build a live worth living”

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4
Q

what are the 5 components of DBT therapy

A
  1. skills group
  2. individual sessions, can feature chain analysis
  3. telephone coaching
  4. case management
  5. DBT consultation team to support staff
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5
Q

how long does DBT last

A

1 year

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6
Q

who developed IPT

A

Weissman and Klerman

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7
Q

list the CBT interventions

A
  1. identifying cognitive distortions
  2. automatic thought records
  3. problem solving
  4. cost benefit analysis (pros, cons)
  5. generating rational alternatives
  6. activity scheduling and graded tasks assignments
  7. behavioural experiments
  8. role play
  9. relapse prevention
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8
Q

what is gold standard treatment for insomnia disorder

A

CBT-insomnia

*more effective than medications

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9
Q

how long does CBT for insomnia run

A

weekly for 6-8 sessions

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10
Q

what are the 5 components of CBT-I (details are in the therapy section)

A

sleep hygiene

stimulus control

sleep restriction

relaxation training

cognitive therapy

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11
Q

what are the focuses of Maudsley family therapy

A

parents highly involved in re-feeding patient

externalize the eating disorder, blame is placed on the illness

once weight restored, focus on establishing healthy adolescent identity

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12
Q

which family therapy focuses on the most psychologically available person and combats enmeshment by shifting of the “hot triangle”

A

Bowen (family systems therapy)

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13
Q

which family therapy focuses on hierarchies, alliances, splits and subsystems

A

Minuchin (structural family therapy)

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14
Q

Which family therapy emphasizes individual maturation within the family and explores unconscious patterns in family relationships

A

psychodynamic experiential

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15
Q

list indications for expressive therapies

A
  1. strong MOTIVATION to UNDERSTAND
  2. significant SUFFERING
  3. ability to regress in the service of ego
  4. tolerance for FRUSTRATION
  5. capacity for INSIGHT
  6. INTACT REALITY TESTING
  7. meaningful RELATIONSHIPS
  8. good IMPULSE control
  9. ability to MAINTAIN A JOB
  10. capacity for analog and METAPHOR
  11. reflective responses to trial interpretations
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16
Q

indications for supportive therapies

A
  1. significant EGO DEFECTS of a CHRONIC NATURE
  2. severe LIFE CRISIS
  3. LOW anxiety tolerance
  4. POOR frustration tolerance
  5. LACK of psychological mindedness
  6. POOR REALITY TESTING
  7. severely IMPAIRED RELATIONSHIPS
  8. POOR IMPULSE control
  9. LOW intelligence
  10. little capacity for self observation
  11. tenuous ability to form a therapeutic alliance
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17
Q

what are some of the techniques used in Motivational Interviewing

A

express empathy through REFLECTIVE LISTENING

develop DISCREPANCY between clients goals or values and their current behaviour

AVOID ARGUMENT and direct confrontation

adjust to client resistance rather than opposing it directly

support SELF EFFICACY and OPTIMISM

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18
Q

what is a mnemonic to remember the spirit of Motivational Interviewing

A

Partnership

Acceptance

Compassion

Evocation

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19
Q

what is a mnemonic to remember the skills of motivational interviewing

A

OARS

Open ended questions

Affirmations

Reflections

Summaries

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20
Q

SUD buzz words

what treatment is preferable in a pregnant woman who is opioid dependent

A

methadone

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21
Q

SUD buzz words

what drug do you think is on board in a dancing girl with hyperthermia

A

MDMA

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22
Q

SUD buzz words

what medication might you offer to a patient with AUD who has a supportive wife/relative to aid them

A

disulfram

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23
Q

SUD buzz words

what medication might you avoid in a person who has BPD/is unstable and also has AUD

A

AVOID disulfram in unstable/BPD

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24
Q

SUD buzz words

what medication do you avoid in someone with kidney stones

A

AVOID topiramate in kidney stones

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25
Q

SUD buzz words

what medication do you avoid in a person who has both AUD and an opioid use disorder

A

avoid naltrexone

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26
Q

SUD buzz words

in an (intoxicated) patient presenting in ER with nystagmus and slurred speech, what drug do you think is on board

A

inhalants

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27
Q

SUD buzz words

in an (intoxicated) patient presenting with vertical nystagmus and is belligerent, what drug do you think is on board

A

PCP

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28
Q

SUD buzz words

in an intoxicated patient presenting with optical neuritis/blindness, what drug do you think is on board

A

methanol poisoning

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29
Q

what psychotherapy is recommended in the acute phase for panic + agoraphobia

A

combo of CBT + meds = more effective than either alone for acute period BUT CBT was same as combo in long term follow up so CBT favored over combo or meds alone

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30
Q

what is the most effective part of CBT for panic + agoraphobia

A

exposure (interoceptive, virtual reality)

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31
Q

what two types of therapy do NOT have evidence for panic + agoraphobia

A

EMDR, psychodynamic

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32
Q

what is the most common anxiety disorder in patients 65+

A

specific phobia

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33
Q

what therapy is favored for specific phobia

A

exposure based therapy–> especially with prolonged exposure, real exposure, exposure in different settings adn with therapist involvement

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34
Q

what type of therapy should you use for blood-injection-injury type phobia

A

applied muscle tension + exposure

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35
Q

what is the most effective therapy for social anxiety disorder

A

CBT = most effective

exposure therapy also effective

CBT + exposure = FIRST LINE

CBT lasts longer than pharmacotherapy

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36
Q

what component of CBT is most helpful in treating social anxiety disorder

A

challenging maladaptive thoughts

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37
Q

what therapies are favored for GAD

A

CBT is AS EFFECTIVE as meds–> no evidence for routine combo tx

some evidence for:
psychodynamic
ACT
meta-cognitive therapy
MBCT

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38
Q

what neurostimulation therapy is effective in GAD

A

rTMS is effective as monotherapy or as adjunct

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39
Q

what therapy is favored in OCD

A

CBT + ERP is equivalent to meds –> best if exposure is therapist guided

strong evidence for “danger ideation reduction therapy” (DIRT)

some evidence for:
ACT
various cognitive therapies
internet CBT

TARGET FAMILY ACCOMMODATION

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40
Q

how long have benefits of psychotherapy been shown to last in OCD

A

up to 5 tears

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41
Q

what therapies have been shown to be effective in PTSD

A

TF-CBT
EMDR
stress management
cognitive processing therapy (CPT)
prolonged exposure
virtual reality exposure
internet CBT

limited evidence for combo with meds

ottawa lecture said could consider IPT if patient not willing to undergo exposures etc

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42
Q

what treatment can reduce self harm in PTSD patients undergoing psychothearpy

A

DBT pretreatment can reduce self harm

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43
Q

name two forms of psychotherapy that are NOT effective in PTSD

A

psychodynamic
supportive

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44
Q

define “interoceptive exposure”

A

bring on physical lsymptoms of anxiety on purpose to allow for habituation

used for panic disorder and social anxiety disorder

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45
Q

define “flooding”

A

in vivo exposure to main fear, paired with RELAXATION techniques

does NOT use hierarchical exposure

fear is decreased through EXTINCTION

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46
Q

define “gradual exposure”

A

uses a HIERARCHY to do exposure but does NOT use relaxation techniques –> relies on HABITUATION to the anxiety response and not on relaxation

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47
Q

define “systematic desensitization”

A

HIERARCHICAL exposure to phobic object WHILE participating in some form of RELAXATION technique

uses RECIPROCAL INHIBITION

more OUTDATED technique replaced by flooding and gradual exposure

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48
Q

define “reciprocal inhibition”

A

a technique in behavioural therapy that aims to replace an undesired response i.e anxiety with a desired one by counterconditioning

relies on the gradual substitution of a response that is incompatible with the original one

used in systematic desensitizaation

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49
Q

name the 3 therapies that are FIRST line in ACUTE phase of MDD

A

CBT
IPT
behavioural activation

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50
Q

name the TWO therapies that are FIRST line for MAINTENANCE phase of MDD

A

CBT
MBCT

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51
Q

name 6 therapies considered second line for acute phase of MDD

A

MBCT
cognitive-behavioural analysis system of psychotherapy (CBASP)
problem solving therapy
short term psychodynamic therapy
telephone/internet CBT/IPT

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52
Q

name 3 therapies that are second line for the maintenance phase of MDD treatment

A

IPT
behavioural activation
CBASP

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53
Q

what two therapies are third line for MDD treatment

A

long term psychodynamic

motivational interviewing

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54
Q

what therapy is first line for maintenance phase of bipolar disorder

A

psychoeducation

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55
Q

what therapy is first line for bipolar depression

A

there are NO first line psychological treatments for bipolar depression

56
Q

what therapies are second line for bipolar maintenance

A

CBT
family focused therapy (FFT)

57
Q

what therapies are second line for bipolar depression

A

CBT
FFT

58
Q

which psychological interventions have level 1 evidence for borderline PD

A

DBT
psychodynamic therapy
schema focused therapy

59
Q

which psychological interventions have level 2 evidence for borderline PD

A

ACT

CBT

IPT

psychoeducation

60
Q

which psychological interventions have level 1 evidence for schiziphrenia

A

CBT

family intervention

psychoeducation

61
Q

which psychological interventions have level 2 evidence for shizophrenia

A

ACT

metacognitive therapy

62
Q

what non pharmacological intervention is first line for seasonal affective disorder

A

light therapy

10000 lux for 30 min every morning for 6 weeks

63
Q

what does it mean to be “unfit to stand trial”

A

this is defined by the Criminal Code

accused person is unable, because of a mental disorder, to defend against the charges they are facing or to tell their lawyer what they want to do with their case

requires at least 1/3 of:
1. accused is not able to understand that they are in a courtroom, who the people in the courtroom are (i.e judge, their lawyer) and why they are there
2. the accused is not able to understand what they are charged with, what kinds of pleas they can enter, what can happen to them if they plead guilty or what can happen if they dont tell the truth in court
3. the accused is not able to communicate with their lawyer and tell them, even in basic terms, what they want to do with their case

64
Q

what was “Taylors test” with regards to being fit or unfit to stand trial

A

based on the Taylor case

a fit person does NOT need to have “analytical capacity” to make choices in his or her own best interest–> they only need capacity to TELL LAWYER THEIR VERSION OF EVENTS and GIVE INSTRUCTIONS–> i.e “reasonably participate”

65
Q

what was the significance of the following trial with regard to forensic psychiatry:

Winko

A

canadian standard on duty to protect (pertains to review boards)

66
Q

what was the significance of the following trial with regard to forensic psychiatry:

Tarasoff

A

duty to warn and protect (US)

67
Q

what was the significance of the following trial with regard to forensic psychiatry:

Taylor

A

fitness to stand trial

68
Q

what was the significance of the following trial with regard to forensic psychiatry:

Smith v Jones

A

significant risk to public safety (duty to warn)

69
Q

what was the significance of the following trial with regard to forensic psychiatry:

Starson

A

treatment capacity (ontario)

70
Q

what was the significance of the following trial with regard to forensic psychiatry:

McNaughten

A

precursor to NCRMD

71
Q

list the exceptions to confidentiality

A
  1. FLYING hazard –> federal aeronautics act–> mandatory, notify transport canada
  2. RAILWAY hazard–> federal railway safety act–> mandatory
  3. MARITIME hazard–> federal canada shipping act–> mandatory
  4. CHILD ABUSE–> provincial legislation–> mandatory except Yukon
  5. depending on province, the following are either mandatory or discretionary:
    –driving hazards
    –elder abuse
    –professional sexual misconduct
    –births/stillbirths
    –communicable diseases
    –gunshot wounds
  6. civil litigation or court order
  7. duty to warn
  8. patient provides consent
72
Q

apparently there is a blood alcohol test question–> answer is SEARCH WARRANT not subpoena

A
73
Q

what 3 things does a person have to have/understand in order to have testamentary capacity to make a will

A
  1. Bounty–> knowledge of nature and extent of property
  2. BEQUEST–> knows that they are giving it away
  3. BENEFICIARIES–> knows the identities of their beneficiaries
74
Q

what type of study uses odds ratio

A

case control studies–> you are starting with the outcome and working backwards to look as exposures

75
Q

what type of study uses relative risk

A

cohort studies–> you are starting with an exposure and then working forward to the outcome

76
Q

what does it mean to have a low p value in stats

A

the lower the p value, the more “surprising” the evidence is and the more ridiculous the null hypothesis looks

77
Q

what is the use of correlation coefficients

A

used to measure how strong a relationship is between two variables

most popular is Pearsons, which has values between -1 and 1 (with a value of 0 meaning there is no relationship between the variables)

78
Q

what is the use of the t-test in stats

A

used to compared two continuous variables

79
Q

what is the use of the ANOVA test in stats

A

used to compare more than 2 continuous variables

80
Q

what is the use of the chi-squared test in stats

A

used to compare two or more categorical variables

81
Q

what tools can be used to assess fitness to stand trial

A

McGarry’s criteria

Fitness Interview Test-Revised (FIT-R)

the Nussbaum Fitness Questionnaire (NFQ)

Georgia Court Competency Screening test, Canadian Adaptation

82
Q

what is the GOLD STANDARD depression scale (per Gilks notes)

A

Montgomery-Asberg Depression Rating SCale (MADRS)

83
Q

what is the best test/scale for peripartum depression

A

Edinburgh Postnatal Depression Scale

–10 qs
–self reported

84
Q

do the PHQ-9 and C-SSRS have any utility in identifying risk for suicide and suidical behaviour in the near and long term?

A

yes, across diagnoses

have positive predictive value

85
Q

List some self reported scales for depression

A

PHQ-9

Beck depression inventory

(+Edinburgh for PPD)

86
Q

name two clinician rated scales for depression

A

MADRS

HAM-D

87
Q

what is a rating scale that can be used in social anxiety disorder

A

Leibowitz Social Anxiety Scale

88
Q

what is a scale that can be used to differentiate between social anxiety and panic disorder

A

Fear Questionnaire

89
Q

name a scale that can assess hypersomnolence

A

Epworth Sleepiness Scale

90
Q

name a scale that can be used to assess narcolepsy

A

Multiple Sleep Latency Test

91
Q

what is an exam for EPS

A

AIMS and ESRS

92
Q

name two rating scales that can be used to assess pediatric ADHD

A

SNAP-IV and Conner’s Symptom Rating Scale

93
Q

name a rating scales that can be used to assess adult ADHD

A

Adult ADHD Self Rating Scale

94
Q

name two scales that can be used in the assessment of IED, ODD and conduct disorder

A

Childrens Aggression Scale (parent/teacher)

Outburst Monitoring Scale

95
Q

name a rating scale for OCD

A

YBOCS

40 items, clinician rated

96
Q

which is more SENSITIVE for mild cognitive impairment, the MoCA or the MMSE

A

MoCa

97
Q

list 4 symptom rating scales that can be used in dementia

A

Dementia Observation Scale (DOS)

Behavioural Pathology in Alzheimer’s Disease (BEHAVE-AD)

Cohen Mansfield Agitation Inventory (CMAI)

Neuropsychiatric Inventory (NPI)

98
Q

what two components are in the Mini-Cog

A

3 word recall

clock drawing

99
Q

what is the most frequently used IQ test

A

Wechsler Adult Intelligence Scale (WAIS)

100
Q

what is the average score on the WAIS

A

100

2/3 people score between 85-115

101
Q

what four areas are tested on the WAIS

A

perceptual reasoning

processing speed

verbal comprehension

working memory

102
Q

what is an IQ test for children

A

Weschler Intelligence Scale for Children (WISC)

103
Q

what does the Weschler Individual Achievement Test (WIAT) assess

A

grade level/academic achievement

(vs the WISC which assesses IQ in kids)

104
Q

what is the Bender-Gestalt test

A

test of visuo-motor functioning in children ages 3+

105
Q

what is the best test for executive functioning

A

Wisconsin card sorting test

106
Q

other than the Wisconsin card sorting test, which is the best test for executive functioning, name 3 tests which assess frontal/executive functioning

A

Luria 3 step motor test

Trails B

clock drawing

107
Q

name a test for psychopathy

A

PCL-R

108
Q

name a scale/assessment tool for violence risk

A

HCR-20V3

20 item structured clinical guide for assessment of violence risk–> assesses risk to others, both current and future

can be used in clinical and forensic populations

109
Q

dont forget to review whats on the MMSE vs MoCA

A
110
Q

list 4 characteristics of late onset SCZ

A

more common in WOMEN

onset between ages 40-60

responds well to treatment

more POSITIVE symptoms

111
Q

rapid cycling bipolar is associated with what four factors

A

female sex

antidepressant use

hypothyroidism

substance use

112
Q

in the cell, what causes the rising action potential

A

influx of sodium

113
Q

what is the mechanism that causes the sialorrhea seen in clozapine

A

M4 agonism

114
Q

what bill deals with high risk offenders

A

bill C-55

115
Q

name a medication that causes/is highly associated with lithium toxicity

A

captopril (ACEi)

116
Q

name a heart medication that is OKAY to Rx with lithium

A

amlodipine (calcium channel blocker)

117
Q

what effect does the following have on lithium levels:

caffeine

A

decreases lithium levels

118
Q

what effect does the following have on lithium levels:

low sodium diet

A

increases lithium levels

119
Q

what effect does the following have on lithium levels:

ibuprofen

A

increases lithium levels

120
Q

what effect does the following have on lithium levels:

thiazide diuretics

A

increases lithium levels

121
Q

what should you do if someone trials a stimulant for ADHD with poor response?

A

trial the other class of stimulant first, before moving to a non stimulant

122
Q

what is the risk of developing SCZ if both parents haev SCZ

A

50%

123
Q

what is the risk of developing SCZ if your twin has SCZ

A

50%

124
Q

what is the risk of developing SCZ if non twin sibling has SCZ

A

10%

125
Q

list 3 risk factors for delusional disorder

A

social isolation

sensory impairment

old age

(MDD not a risk factor)

126
Q

does epival interact with the OCP

A

no

but carmabazepine does

127
Q

can you combine aripiprazole and venlafaxine

A

yes

128
Q

what would an EEG show prior to sleep attacks/nightmares

A

since they occur during N3, prior to attack the EEG would show slow waves

129
Q

what would you augment an SSRI with in the treatment of panic disorder

A

benzo (clonazepam)

130
Q

what meds are used to treat bipolar depression

A

QLLL

quetiapine

lithium

lamotragine

lurasidone

131
Q

list the anxiety disorders in order of age of onset, from youngest to oldest

A

separation anxiety
specific phobia
social anxiety (around age 12)
OCD (around age 20)
PTSD
GAD (around age 30)
panic disorder/agoraphobia (middle age)

132
Q

list first line meds for GAD

A

escitalopram
paroxetine
sertraline
venlafaxine
duloxetine
agomelatine
pregabalin

133
Q

D-cycloserine is broadly recommended in anxiety guidelines

A
134
Q

what two elements would suggests someone is experiencing a pseudoseizure and NOT an epileptic seizure

A

eyes closed

out of phase shaking movements

135
Q

list 5 medications recommended for BPSD

A

risperidone
abilify
olanzapine

not quetiapine

+SSRIs, trazodone

1.1 RC: Recall + Thea Gilks Review Decks (13 decks)

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