CAM: Substances & Interactions
A patient on sertraline develops tremor, diaphoresis, and hyperreflexia after starting an OTC sleep aid. What supplement did they take
5-HTP or L-trytophan
This term describes combining conventional treatment with CAM in a coordinated, evidence informed manner
This parasomnia occurs during REM Sleep and strongly predicts future neurodegenerative disease
What is REM sleep behavior disorder
This DSM-5 Criterion separates a paraphilia from a paraphilic disorder
A patient with fatigue has normal hemoglobin but low ferritin and reports heavy menstrual bleeding.
What is-- iron deficiency without anemia
This herbal supplement induces CYP3A4 and CYP2C19, reducing oral contraceptive antiretroviral effectiveness
St Johns Wort
This physiologic measure of autonomic regulation is used in emotional dysregulation and stress research?
What is heart rate variability (HRV)?
This monoamine neurotransmitter is nearly silent during REM sleep
What is norepinephrine (also serotonin)
This medication class is used in severe paraphilic disorders to reduce libido via testosterone suppression. give a med class by saying the mechanism
What are GnRH analogs or antiandrogrens
A patient with depression and fatigue has macrocytosis, elevated homocysteine, and normal methylmalonic acid.
What is folate deficiency
This supplement has the strongest evidence as an adjunct for MDD and works through anti-inflammatory and membrane stabilizing mechanisms
What are omega 3 fatty acids (EPA-predominant)
This neurophysiologic marker - when decreased in the prefrontal cortex after SSRI initiation - predicts antidepressant response
What is decreased prefrontal cordance?
This sleep disorder requires PSG confirmation and is associated with treatment resistant depression
What is obstructive sleep apnea
This sexual dysfunction diagnosis is excluded if symptoms are better explained by severe relationship distress
What is female sexual interest/arousal disorder
A patient with chronic kidney disease presents with fatigue and normocytic anemia with low reticulocyte count. whats the cause of fatigue
erythropoietin deficiency
This CAM agent used for anxiety carries a boxed warning in some countries due to hepatotoxicity
What is Kava?
Recommending CAM therapies outside one's training primarily increases risk for this professional consequence
What is malpractice liability due to scope-of-practice violations?
This physiologic finding distinguishes REM sleep from wakefulness despite similar EEG patterns.
This diagnosis is often incorrectly grouped with sexual dysfunctions or paraphilias but is categorized separately in DSM-5-TR.
gender dysphoria
This condition can paradoxically present with fatigue, weakness, and malaise due to hypercalcemia from excessive supplementation. hint think back to Dr. Diertl's lecture...
Vitamin D toxicity
This CAM product may precipitate mania and should be avoided in bipolar spectrum disorders
What is rhodiola (St Johns wort)
!!*DAILY DOUBLE*!! A clinician recommends an unproven CAM therapy without documenting rationale or verifying practitioner credentials. The greatest ethical and legal risk us failure of THIS core professional duty
What is informed consent (and standard of care adherence)
Benzodiazepines increase which sleep stage and reduce which sleep stage
increasing stage 2 (light) and reducing restorative deep sleep (stage 3/4 slow wave sleep)
it decreases REM sleep
decreases sleep latency
cause rebound insomnia
This FDA approved medication for HSDD in premenopausal women acts as a serotonin antagonist and dopamine agonist
What is flibanserin
Two patients have microcytic anemia. One has elevated RDW and low ferritin; the other has normal RDW, normal ferritin, and a high RBC count.
thalassemia trait
Requires recognizing RBC count + RDW, not just MCV.