Comorbidity with Axis I disorders US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Comorbidity with Axis I disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Comorbidity with Axis I disorders US Medical PG Question 1: A 29-year-old woman is brought to the physician by her father because of a change in her behavior over the past 8 months. The father says that his daughter has become increasingly withdrawn; she has not answered any phone calls or visited her family and friends. The patient says that she has to stay at home because a foreign intelligence service is monitoring her. She thinks that they are using a magnetic field to read her mind. Mental status exam shows disjointed and perseverative thinking. She is anxious and has a flat affect. Which of the following is the most likely diagnosis?
- A. Delusional disorder
- B. Schizophrenia (Correct Answer)
- C. Paranoid personality disorder
- D. Schizophreniform disorder
- E. Schizoid personality disorder
Comorbidity with Axis I disorders Explanation: ***Schizophrenia***
- The patient's presentation with **delusions of persecution and thought broadcasting**, accompanied by **disjointed, perseverative thinking**, and **flat affect** for 8 months, is highly indicative of schizophrenia.
- Schizophrenia is characterized by a combination of positive symptoms (delusions, hallucinations, disorganized speech), negative symptoms (flat affect, social withdrawal), and cognitive symptoms (disorganized thinking) lasting for at least 6 months.
*Delusional disorder*
- Delusional disorder is characterized by the presence of **non-bizarre delusions for at least 1 month** without other significant psychotic symptoms or marked impairment in functioning.
- The patient's symptoms include **disorganized thinking and flat affect**, which are not typical of delusional disorder and suggest a broader psychotic illness.
*Paranoid personality disorder*
- Characterized by a pervasive distrust and suspicion of others, where their motives are interpreted as malevolent, but **without the presence of frank delusions or other psychotic symptoms**.
- The patient is experiencing **fixed, false beliefs (delusions)** involving mind reading and foreign intelligence, which goes beyond the pervasive distrust seen in paranoid personality disorder.
*Schizophreniform disorder*
- Schizophreniform disorder presents with symptoms identical to schizophrenia, but the **duration is between 1 and 6 months**.
- Since the patient's symptoms have been present for **8 months**, it exceeds the diagnostic criteria for schizophreniform disorder, making schizophrenia a more likely diagnosis.
*Schizoid personality disorder*
- Characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of expression of emotions in interpersonal settings.
- While the patient exhibits social withdrawal, this condition does **not involve delusions, disorganized thinking, or other psychotic features**.
Comorbidity with Axis I disorders US Medical PG Question 2: A 21-year-old female was brought to the emergency room after losing large amounts of blood from slicing her wrists longitudinally. A few days later, she was interviewed by the psychiatrist and discussed with him why she had tried to kill herself. "My evil boyfriend of 2 months left me because I never let him leave my side for fear that he would cheat on me and leave me...now I feel so empty without him." Which of the following personality disorders does this female most likely have?
- A. Avoidant
- B. Dependent
- C. Borderline (Correct Answer)
- D. Paranoid
- E. Histrionic
Comorbidity with Axis I disorders Explanation: ***Borderline***
- The patient exhibits core features of **borderline personality disorder (BPD)**, including **impulsivity** (suicide attempt via wrist-slicing), **unstable relationships** marked by fear of abandonment, and intense feelings of **emptiness**.
- Her statement about her boyfriend refusing to let him leave her side reflects classic BPD traits of **frantic efforts to avoid abandonment** and a **pattern of intense and unstable interpersonal relationships**.
*Avoidant*
- Individuals with **avoidant personality disorder** are characterized by **social inhibition**, feelings of inadequacy, and hypersensitivity to negative evaluation, which are not the primary features presented in this scenario.
- They tend to *avoid* social interactions due to fear of criticism, rather than engaging in intense, unstable relationships and dramatic self-harm as described.
*Dependent*
- While a **dependent personality disorder** involves a pervasive and excessive need to be cared for, leading to submissive and clinging behavior, it typically doesn't manifest with the same level of **impulsivity**, **self-harm**, or extreme relationship instability seen here.
- The "fear that he would cheat on me and leave me" relates more to the **frantic efforts to avoid abandonment** characteristic of borderline personality, rather than general clinginess and submission.
*Paranoid*
- **Paranoid personality disorder** is characterized by pervasive distrust and suspiciousness of others, often interpreting their motives as malevolent.
- The patient's behaviors (suicide attempt, fear of abandonment in a short-term relationship, feeling empty) do not align with the prominent **distrust and suspiciousness** of paranoid personality.
*Histrionic*
- **Histrionic personality disorder** involves excessive emotionality and attention-seeking behavior. While the suicide attempt might be seen as attention-seeking, the underlying **fear of abandonment**, **feelings of emptiness**, and extremely rapid relationship deterioration are more indicative of borderline personality.
- Histrionic individuals tend to be dramatic and theatrical, using physical appearance to draw attention, which is not emphasized in this clinical picture.
Comorbidity with Axis I disorders US Medical PG Question 3: A 25-year-old woman is brought to the emergency department by her boyfriend after she cut her forearms with a knife. She has had multiple visits to the emergency department in the past few months for self-inflicted wounds. She claims that her boyfriend is the worst person in the world. She and her boyfriend have broken up 20 times in the past 6 months. She says she cut herself not because she wants to kill herself; she feels alone and empty and wants her boyfriend to take care of her. Her boyfriend claims that she is prone to outbursts of physical aggression as well as mood swings. He says that these mood swings last a few hours and vary from states of exuberance and self-confidence to states of self-doubt and melancholy. On examination, the patient appears well-dressed and calm. She has normal speech, thought processes, and thought content. Which of the following is the most likely diagnosis?
- A. Dependent personality disorder
- B. Borderline personality disorder (Correct Answer)
- C. Bipolar II disorder
- D. Cyclothymic disorder
- E. Histrionic personality disorder
Comorbidity with Axis I disorders Explanation: ***Borderline personality disorder***
- This patient exhibits characteristic features of **borderline personality disorder**, including **impulsivity** (self-harm), **unstable relationships** (frequent breakups, idealization/devaluation of boyfriend), **affective instability** (rapid mood swings lasting hours), and feelings of **emptiness** and **abandonment**.
- **Self-harm** in BPD is often a coping mechanism for intense emotional pain or a way to elicit care, rather than a genuine suicide attempt, as stated by the patient.
*Dependent personality disorder*
- Characterized by an **excessive need to be cared for**, leading to submissive and clinging behavior and fears of separation, which is not the primary presentation here.
- While there is a desire for care, the prominent features of **impulsivity**, **affective instability**, and **unstable relationships** are not typical of dependent personality disorder.
*Bipolar II disorder*
- Involves episodes of **hypomania** and **major depression**, with mood swings typically lasting for at least **four days** (hypomania) or **two weeks** (major depression), much longer than the hours described here.
- The patient's presentation emphasizes **interpersonal instability** and **self-harm** more than episodic mood disturbances.
*Cyclothymic disorder*
- Involves **numerous periods of hypomanic symptoms** and numerous periods of **depressive symptoms** for at least two years, but these symptoms are less severe than full-blown hypomanic or major depressive episodes.
- The rapid mood shifts within hours and the intensity of **interpersonal dysfunction** and **self-harm** are more indicative of borderline personality disorder.
*Histrionic personality disorder*
- Characterized by **excessive emotionality** and **attention-seeking behavior**, often sexually provocative, and using physical appearance to draw attention.
- While emotionality is present, the **self-harm**, **emptiness**, and **rapid mood shifts** are not core features of histrionic personality disorder.
Comorbidity with Axis I disorders US Medical PG Question 4: A 23-year-old woman is brought to the emergency department by her boyfriend 10 minutes after ingesting at least 15 acetaminophen tablets. She has been admitted to the hospital several times in the past few months after attempted self-harm. She claims that her boyfriend is “extremely selfish” and “does not care for her.” She says she feels lonely and wants her boyfriend to pay attention to her. Her boyfriend says that they have broken up 10 times in the past year because she is prone to outbursts of physical aggression as well as mood swings. He says that these mood swings last a few hours and can vary from states of “exuberance and affection” to states of “depression.” On examination, the patient appears well-dressed and calm. She has normal speech, thought processes, and thought content. Which of the following is the most likely diagnosis?
- A. Dependent personality disorder
- B. Borderline personality disorder (Correct Answer)
- C. Bipolar II disorder
- D. Cyclothymic disorder
- E. Narcissistic personality disorder
Comorbidity with Axis I disorders Explanation: ***Borderline personality disorder***
- Patients with **borderline personality disorder** often exhibit a pattern of **unstable relationships**, impulsive behaviors (like self-harm attempts), intense mood swings lasting hours, and efforts to avoid abandonment, consistent with this patient's presentation.
- The patient's description of her boyfriend, her history of self-harm attempts, and her rapid, fluctuating mood states ("exuberance and affection" to "depression") are characteristic features.
*Dependent personality disorder*
- This disorder is characterized by an excessive need to be cared for, leading to **submissive and clinging behavior**, and fears of separation. While she fears abandonment, the **mood swings** and **aggressiveness** point away from this diagnosis.
- Patients with dependent personality disorder rarely exhibit the **impulsive self-harm** and dramatic, aggressive outbursts described.
*Bipolar II disorder*
- Bipolar II disorder involves episodes of **hypomania** and **major depression**, with mood episodes typically lasting days to weeks, not just "a few hours" as described here.
- The prominent features of **unstable relationships**, impulsivity, and chronic feelings of emptiness are more characteristic of a personality disorder than bipolar II.
*Cyclothymic disorder*
- Cyclothymic disorder involves chronic, fluctuating moods with numerous periods of **hypomanic symptoms** and **depressive symptoms** over at least two years, but these symptoms are less severe and do not meet criteria for full hypomanic or major depressive episodes.
- While there are mood fluctuations, the **intensity**, **self-harm behavior**, and **interpersonal instability** observed are more typical of borderline personality disorder.
*Narcissistic personality disorder*
- Narcissistic personality disorder is characterized by a pervasive pattern of **grandiosity**, a need for admiration, and a lack of empathy.
- While the patient blames her boyfriend, her primary motivation appears to be a fear of abandonment and a desire for attention, rather than a sense of entitlement or inflated self-importance.
Comorbidity with Axis I disorders US Medical PG Question 5: A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?
- A. Dependent
- B. Schizotypal
- C. Histrionic
- D. Antisocial
- E. Paranoid
- F. Avoidant (Correct Answer)
Comorbidity with Axis I disorders Explanation: ***Avoidant***
- This patient exhibits symptoms consistent with **agoraphobia**, which is an **anxiety disorder** characterized by fear of situations where escape might be difficult or help unavailable, often leading to social isolation.
- **Avoidant Personality Disorder** has the strongest genetic association with anxiety disorders, particularly **social anxiety disorder and agoraphobia**, sharing common genetic vulnerability factors related to fear of negative evaluation and social avoidance.
- Studies demonstrate significant genetic overlap between avoidant personality disorder and anxiety spectrum disorders, making this the most likely genetically associated personality disorder.
*Schizotypal*
- **Schizotypal Personality Disorder** is genetically linked to the **schizophrenia spectrum** (not anxiety disorders), characterized by cognitive-perceptual distortions, eccentric behavior, and social deficits.
- While schizotypal patients may avoid social situations, this is due to odd thinking and discomfort with close relationships, not anxiety about specific situations like crowds or public transportation.
*Dependent*
- **Dependent Personality Disorder** is characterized by an excessive need to be taken care of, leading to **submissive and clinging behavior**, and fears of separation.
- This patient's withdrawal is due to fear of public places, not a reliance on others or fear of abandonment.
*Antisocial*
- **Antisocial Personality Disorder** involves a pervasive pattern of **disregard for and violation of the rights of others**, often presenting as deceitful and impulsive behavior.
- The patient's symptoms are rooted in anxiety and social avoidance rather than a lack of empathy or antisocial behavior.
*Paranoid*
- **Paranoid Personality Disorder** is characterized by a pervasive **distrust and suspiciousness of others**, interpreting their motives as malevolent.
- The patient's withdrawal stems from fear of specific situations (crowds, public transport) rather than paranoid ideation or general suspicion of people's intentions.
*Histrionic*
- **Histrionic Personality Disorder** is marked by **excessive emotionality and attention-seeking behavior**, often displaying dramatic and superficial interactions.
- The patient's isolation and fear of public spaces are directly opposite to the attention-seeking nature of histrionic traits.
Comorbidity with Axis I disorders US Medical PG Question 6: A 23-year-old female college senior comes to the physician with a 1-year history of recurrent palpitations accompanied by sweating, facial blushing, and sometimes nausea. The symptoms are worse during class when she is occasionally called out to speak, which causes her to feel embarrassed. She has been skipping class on discussion days because she is concerned that her classmates may notice her symptoms. The patient does not enjoy jogging in the park anymore and has gained 2 kg (4 lbs 7 oz) over the past 2 months. Her appetite is unchanged. She has no history of serious illness. She does not smoke or drink alcohol. She has experimented with marijuana but does not use it currently. She appears nervous and does not make eye contact with the physician. Her vitals show a pulse of 85/min, her blood pressure is 125/70 mmHg, and her temperature is 36.8°C. Mental status examination reveals full range of affect. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?
- A. Schizotypal personality disorder
- B. Social anxiety disorder (Correct Answer)
- C. Generalized anxiety disorder
- D. Normal shyness
- E. Avoidant personality disorder
Comorbidity with Axis I disorders Explanation: ***Social anxiety disorder***
- This patient exhibits characteristic symptoms of **social anxiety disorder**, including significant anxiety in social situations (e.g., public speaking in class), fear of being judged negatively, and resulting avoidance behaviors (skipping class).
- The physical symptoms (palpitations, sweating, blushing, nausea) are typical physiological responses to social performance anxiety, and the 1-year history indicates a chronic pattern.
*Schizotypal personality disorder*
- Characterized by pervasive patterns of social and interpersonal deficits marked by **acute discomfort with, and reduced capacity for, close relationships**, as well as cognitive or perceptual distortions and eccentric behavior.
- The patient's symptoms are primarily anxiety-driven in social contexts, not due to thought disorders, magical thinking, or eccentric behaviors common in schizotypal personality disorder.
*Generalized anxiety disorder*
- Involves **excessive, uncontrollable worry** about a variety of events or activities, often not specific to social situations.
- While the patient has anxiety, it is specifically triggered by social performance and evaluation, distinguishing it from the pervasive, non-specific worry of generalized anxiety disorder.
*Normal shyness*
- While the patient is shy, her symptoms are severe enough to cause **significant distress and functional impairment**, such as skipping classes and avoiding activities she once enjoyed (jogging).
- Normal shyness typically does not lead to this level of avoidance or functional compromise, nor does it typically present with such intense physiological symptoms.
*Avoidant personality disorder*
- While both social anxiety disorder and avoidant personality disorder involve social avoidance, the latter is a more pervasive pattern involving a **deep-seated sense of inadequacy, hypersensitivity to negative evaluation**, and a fear of intimacy across many social contexts.
- The symptoms described are more acutely tied to **performance and scrutiny** in social situations rather than a global pattern of avoidant behaviors stemming from a core sense of inadequacy.
Comorbidity with Axis I disorders US Medical PG Question 7: A 35-year-old woman presents to clinic in emotional distress. She states she has been unhappy for the past couple of months and is having problems with her sleep and appetite. Additionally, she reports significant anxiety regarding thoughts of dirtiness around the house. She states that she cleans all of the doorknobs 5-10 times per day and that, despite her actions, the stress related to cleaning is becoming worse. What is this patient's diagnosis?
- A. Panic Disorder (PD)
- B. Generalized anxiety disorder (GAD)
- C. Obsessive compulsive personality disorder (OCPD)
- D. Obsessive compulsive disorder (OCD) (Correct Answer)
- E. Tic disorder
Comorbidity with Axis I disorders Explanation: ***Obsessive compulsive disorder (OCD)***
- The patient's **recurrent distressing thoughts** about dirtiness (obsessions) and **repetitive cleaning behaviors** (compulsions) designed to reduce anxiety are hallmark symptoms of OCD.
- The significant **emotional distress**, impact on daily life, and worsening stress despite the compulsions further support this diagnosis.
*Panic Disorder (PD)*
- Characterized by **recurrent, unexpected panic attacks** and persistent worry about additional attacks or their consequences.
- While anxiety is present, the patient's primary distress is driven by specific obsessions and compulsions, not sudden episodes of intense fear.
*Generalized anxiety disorder (GAD)*
- Involves **excessive, uncontrollable worry** about a variety of events or activities for at least 6 months.
- The anxiety symptoms are general, not focused on specific obsessions leading to compulsive behaviors as seen in this case.
*Obsessive compulsive personality disorder (OCPD)*
- Marked by pervasive patterns of **perfectionism, orderliness, and control** at the expense of flexibility and efficiency.
- While there may be a preoccupation with rules, OCPD does not typically involve intrusive, ego-dystonic obsessions or ritualistic compulsions like repetitive cleaning to reduce anxiety.
*Tic disorder*
- Characterized by **sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations**.
- Tics are distinct from the complex, goal-directed, and anxiety-driven compulsive behaviors described by the patient.
Comorbidity with Axis I disorders US Medical PG Question 8: A 52-year-old man presents with a 1-month history of a depressed mood. He says that he has been “feeling low” on most days of the week. He also says he has been having difficulty sleeping, feelings of being worthless, difficulty performing at work, and decreased interest in reading books (his hobby). He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. A review of systems is significant for a 7% unintentional weight gain over the past month. The patient is afebrile and his vital signs are within normal limits. A physical examination is unremarkable. The patient is prescribed sertraline 50 mg daily. On follow-up 4 weeks later, the patient says he is slightly improved but is still not feeling 100%. Which of the following is the best next step in the management of this patient?
- A. Switch to a different SSRI
- B. Continue sertraline (Correct Answer)
- C. Add buspirone
- D. Switch to an MAOI
- E. Add aripiprazole
Comorbidity with Axis I disorders Explanation: ***Continue sertraline***
- Many antidepressants, including SSRIs like sertraline, require **4-6 weeks at a therapeutic dose** to achieve their full effect. Since the patient reports slight improvement after 4 weeks, continuing the current medication allows more time for optimal response.
- The goal is for the patient to feel "100%", which often takes longer than one month. **Gradual improvement** after initial therapy suggests the medication is working, but needs more time.
*Switch to a different SSRI*
- Switching to another SSRI is typically considered if there is **no improvement or significant intolerance** after an adequate trial (at least 4-6 weeks) at a therapeutic dose of the initial SSRI.
- This patient has shown *slight improvement*, indicating that sertraline may still be effective with more time.
*Add buspirone*
- Buspirone is an **anxiolytic medication** sometimes used as an augmentation strategy for depression, particularly if anxiety is a prominent symptom.
- However, it's generally added *after* an initial antidepressant has failed to achieve a full response, and typically *after* optimizing the dose and duration of the primary antidepressant.
*Switch to an MAOI*
- **Monoamine oxidase inhibitors (MAOIs)** are older antidepressants with a more challenging side effect profile and significant drug-drug and drug-food interactions.
- They are typically reserved for patients who have **failed multiple trials of other antidepressants** due to their safety concerns.
*Add aripiprazole*
- Aripiprazole, an **atypical antipsychotic**, is sometimes used as an augmentation strategy for **treatment-resistant depression**.
- This approach is usually considered when trials of several different antidepressant classes have failed or when the depression has not responded adequately to optimized antidepressant therapy.
Comorbidity with Axis I disorders US Medical PG Question 9: A 22-year-old man comes to the physician because of generalized fatigue for the past 3 months. During this time, his grades have declined in his college courses because he has had difficulty focusing on assignments and sometimes sleeps in class. He no longer plays the drums for his band and has stopped attending family events. His temperature is 37°C (98.6°F), pulse is 60/min, and blood pressure is 130/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he describes his mood as “ok.” He has a flat affect. There is no evidence of suicidal ideation. His speech is slow in rate and monotone in rhythm, and his thought process is organized. He has no delusions or hallucinations. Which of the following is the most appropriate next step in treatment?
- A. Diazepam therapy
- B. Escitalopram therapy (Correct Answer)
- C. Phenelzine therapy
- D. Reassurance
- E. Amitriptyline therapy
Comorbidity with Axis I disorders Explanation: ***Escitalopram therapy***
- The patient presents with symptoms consistent with **major depressive disorder**: generalized fatigue, anhedonia (stopped playing drums, attending family events), poor concentration, and hypersomnia (sleeping in class) for 3 months.
- An **SSRI like escitalopram** is a first-line pharmacotherapy for MDD, particularly given its good tolerability profile and effectiveness in addressing core depressive symptoms.
*Diazepam therapy*
- **Diazepam is a benzodiazepine**, primarily used for acute anxiety or insomnia, and can be habit-forming.
- It is not indicated as a first-line treatment for major depressive disorder due to its addictive potential and lack of efficacy for core depressive symptoms.
*Phenelzine therapy*
- **Phenelzine is a MAOI (monoamine oxidase inhibitor)**, which are older antidepressants typically reserved for atypical depression or treatment-resistant depression due to their significant side effects and dietary restrictions.
- It is not appropriate as a first-line agent, especially given safer and equally effective options like SSRIs.
*Reassurance*
- The patient's symptoms are significant, persistent for 3 months, and causing functional impairment (decline in grades, social withdrawal); therefore, **simple reassurance is insufficient** and would delay appropriate treatment.
- These symptoms warrant a more proactive and evidence-based therapeutic approach.
*Amitriptyline therapy*
- **Amitriptyline is a TCA (tricyclic antidepressant)**, which are generally associated with a higher incidence of side effects, such as anticholinergic effects, sedation, and cardiac conduction abnormalities, compared to SSRIs.
- While effective for depression, it is typically not a first-line treatment due to its less favorable side effect profile compared to SSRIs like escitalopram.
Comorbidity with Axis I disorders US Medical PG Question 10: A 32-year-old man comes to the physician because of a 2 month history of difficulty sleeping and worsening fatigue. During this time, he has also had difficulty concentrating and remembering tasks at work as well as diminished interest in his hobbies. He has no suicidal or homicidal ideation. He does not have auditory or visual hallucinations. Vital signs are normal. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and flat affect with slowed thinking and speech. The physician prescribes sertraline. Three weeks later, the patient comes to the physician again with only minor improvements in his symptoms. Which of the following is the most appropriate next step in management?
- A. Augment with aripiprazole and continue sertraline
- B. Provide electroconvulsive therapy
- C. Continue sertraline for 3 more weeks (Correct Answer)
- D. Change medication to duloxetine
- E. Augment with phenelzine and continue sertraline
Comorbidity with Axis I disorders Explanation: ***Continue sertraline for 3 more weeks***
- Antidepressants like **sertraline** typically require **4 to 6 weeks** to reach their full therapeutic effect.
- Since only three weeks have passed with minor improvements, the patient should continue the medication to allow time for the drug to work fully.
*Augment with aripiprazole and continue sertraline*
- **Augmentation** with an atypical antipsychotic like aripiprazole is considered if there is **no significant improvement after an adequate trial** (at least 6-8 weeks) of antidepressant monotherapy.
- It is too early to consider augmentation as the patient has not completed a sufficient trial of sertraline.
*Provide electroconvulsive therapy*
- **Electroconvulsive therapy (ECT)** is reserved for **severe, treatment-resistant depression**, depression with psychotic features, or when rapid response is required (e.g., severe suicidality).
- The patient's symptoms, while bothersome, do not meet criteria for severe, treatment-resistant depression or acute emergencies warranting ECT.
*Change medication to duloxetine*
- Changing antidepressants is usually considered if there is **minimal or no response** after an adequate trial of the initial medication.
- Switching medications before allowing sufficient time for the current treatment to work is premature and may delay effective treatment.
*Augment with phenelzine and continue sertraline*
- **Phenelzine** is a **monoamine oxidase inhibitor (MAOI)**, and using it in combination with an **SSRI like sertraline** is contraindicated due to the risk of **serotonin syndrome**.
- MAOIs are generally reserved for **refractory depression** due to their dietary restrictions and potential for severe drug interactions.
More Comorbidity with Axis I disorders US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
