Psychosocial Disorders Answers 541organic etiologies are ruled out. Treatment involves identifying the stressor
and addressing the issue.
(a)Somatization disorder involves patients with many complaints with
no organic cause. (c)Hypochondriasis involves the preoccupation of serious
illness despite appropriate medical evaluation and reassurance. (d)Retinal
detachment can cause unilateral vision loss and generally presents with
progressively worsening vision loss with patients complaining of “floaters.”
(e)Anxiety disorders involve excessive fear and apprehension that dominates
the psychologic life of a person.
488.The answer is c.(Tintinalli, p 1810.)This patient presents with a
first manic episode. It is necessary to admit these patients in order to prevent
behavior that is impulsive and dangerous. A full manic syndrome is one of
the most striking and distinctive conditions in clinical practice. The main
disturbance in mood is one of elation or irritability.
(a)This man is not a threat to him or others and can be treated as an
outpatient.(b)This is a suicidal gesture and the patient should be evaluated
by a psychiatrist. She may be able to be managed as an outpatient if reliable
family and social support systems are in place and appropriate psychiatric
follow-up is arranged. (d)This patient can be safely discharged once her
visual hallucinations resolve. (e)This man is appropriately treated.
489.The answer is c.(Tintinalli, p 1041.)Tranylcypromineis a monoamine
oxidase inhibitor(MAOI) that is used in the treatment of depression. Patients
who take this medication should avoid eating or drinking foods that contain
tyramine(similar structure to amphetamine). Tyramine is found in many foods
such as aged cheese, wine, certain fish, meats, and sauerkraut. The combination
of a MAOI and tyramine can lead to a sympathomimetic reactioncalled a
tyramine reaction.It occurs within 15 to 90 minutes of ingestion of tyramine.
The hallmark symptoms include headache, hypertension, diaphoresis, mydri-
asis, neck stiffness, pallor, neuromuscular excitation, palpitations, and chest
pain. Most symptoms gradually resolve over 6 hours; however, deaths have
been reported secondary to intracranial hemorrhage and myocardial infarction.
Patients who take a MAOI should be instructed to avoid all tyramine-containing
foods.
All of the other answer choices do not cause a tyramine reaction—it is
limited only to MAOIs. (a and d)These are a serotonin reuptake inhibitors,
(b)is a benzodiazepine, (e)is a tricyclic antidepressant.