PERSONALITY DISORDERS

Personality Disorder
“ A personality disorder is an
enduring pattern of inner
experience and behavior
that deviates markedly from
the expectations of the
individual’s culture, is
pervasive, and inflexible,
has an onset in adolescence
or early adulthood, is stable
over time and leads to
distress or impairment.”

- DSM IV -
Why people develop Personality Disorder?
10 Specific Personality Disorders
1. Paranoid Personality Disorder
2. Schizoid Personality Disorder
3. Schizotypal Personality Disorder
4. Antisocial Personality Disorder
5. Borderline Personality Disorder
6. Histrionic Personality Disorder
7. Narcissistic Personality Disorder
8. Avoidant Personality Disorder
9. Dependent Personality Disorder
10. Obsessive Compulsive Personality Disorder
CLUSTER A CLUSTER B
Paranoid Antisocial
Schizoid Borderline
Schizotypal Histrionic
Narcissist

CLUSTER C
Avoidant
Dependent
Obsessive Compulsive
Cluster A
Cluster A
1. Cluster A includes Paranoid, Schizoid and
Schizotypal Personality Disorders.
2. They have common characteristic of social
withdrawal and awkwardness.
3. They are influenced by distorted thinking and
eccentric behavior.
4. They start at early age with familial association
of psychotic disorders.
 Paranoid Personality Disorder
 Difficulty to trust others,
pervasive suspiciousness that
others will hurt them
 Hard to confide to others
 Always looking for signs of
betrayal or hostility
 Suspecting their partner is being
unfaithful, with no evidence
 Read threats and danger – which
others don’t see – into everyday
situations
DSM-IV-TR DIAGNOSTIC CRITERIA
A. A pervasive distrust and suspiciousness of others such that
their motives are interpreted as malevolent, beginning by
early adulthood and present in a variety of contexts, as
indicated by four (or more) of the following:

1. suspects, without sufficient basis, that others are

exploiting, harming, or deceiving him or her.
2. is preoccupied with unjustified doubts about the loyalty or
trustworthiness of friends or associates.
3. is reluctant to confide in others because of unwarranted
fear that the information will be used maliciously against
him or her.
4. reads hidden demeaning or threatening meanings into
benign remarks or events.
5. persistently bears grudges (i.e., is unforgiving of insults,
injuries, or slights).
6. perceives attacks on his or her character or reputation that
are not apparent to others and is quick to react angrily or to
counter-attack.
7. has recurrent suspicions, without justification, regarding
fidelity of spouse or sexual partner.

B. Does not occur exclusively during the course of

schizophrenia, a mood disorder with psychotic features,
or another psychotic disorder and is not due to the direct
physiological effects of a general medical condition.

Note: If criteria are met prior to onset of Schizophrenia, add “Premorbid.” e.g.,
“Paranoid Personality Disorder (Premorbid).”
 Schizoid Personality Disorder
 uninterested in forming close
relationships with other people
including your family
 feel that relationships interfere
with your freedom and tend to
cause problems
 prefer to be alone with your own
thoughts
 choose to live your life without
interference from others
 get little pleasure from life
 have little interest in sex or
intimacy
 be emotionally cold towards
others.
DSM-IV-TR DIAGNOSTIC CRITERIA

A. Pervasive pattern of detachment from social

relationships and a restricted range of expression of
emotions in interpersonal settings,beginning by early
adulthood and present in a variety of contexts, as
indicated by four (or more) of the following:

1. neither desires nor enjoys close relationships, including

being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having sexual experiences with
another person
4. takes pleasure in few, if any, activities
5. lacks close friends or confidants other than first-degree
relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affect

B. Does not occur exclusively during the course of

schizophrenia, a mood disorder with psychotic
features, another psychotic disorder, or a pervasive
developmental disorder and is not due to the direct
physiological effects of a general medical condition.

Note: If criteria are met prior to onset of Schizophrenia, add “Premorbid.”

e.g., “Schizoid Personality Disorder (Premorbid).”
Schizotypal Personality Disorder
• find making close relationships extremely difficult
• think and express in ways that others find ‘odd’, using
unusual words or phrases
• behave in ways that others find eccentric
• believe that they can read minds or that you have
special powers such as a ‘sixth sense’
• feel anxious and tense with others who do not share
these beliefs
 DSM-IV-TR DIAGNOSTIC CRITERIA
A. A pervasive pattern of social and interpersonal deficits
marked by acute discomfort with, and reduced capacity
for, close relationships as well as by cognitive or perceptual
distortions and eccentricities of behavior, beginning by
early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:

1. Ideas of reference (excluding delusions of reference)

2. Odd beliefs or magical thinking that influences behavior
and is inconsistent with subcultural norms (e.g.,
superstitiousness, belief in clairvoyance, telepathy, or
“sixth sense”; in children and adolescents, bizarre
fantasies or preoccupations)
3. Unusual perceptual experiences, including bodily illusions
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical,
overelaborate, or stereotyped)
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behavior or appearance that is odd, eccentric, or peculiar
8. Lack of close friends or confidants other than first-degree
relatives
9. Excessive social anxiety that does not diminish with familiarity and
tends to be associated with paranoid fears rather than negative
judgments about self.

B. Does not occur exclusively during the course of schizophrenia,

a mood disorder with psychotic features, another psychotic
disorder or a pervasive developmental disorder.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g.,
"Schizotypal Personality Disorder (Premorbid)."
CLUSTER B
 CLUSTER B

Antisoci Borderli
al ne
personal personal
ity ity
disorder disorder
Histrioni Narcissi
c stic
personal Personal
ity ity
disorder Disorder
ANTISOCIAL PERSONALITY
DISORDER
 DEFINITION

Characterized by their inability to conform to the social

norms that govern individual behavior.
Such persons are impulsive, egocentric. Irresponsible
amd cannot tolerate frustration.
Reject discipline and authority and have underdeveloped
conscience.
Associated with criminality, not actually synonyms with
it.
 EPIDEMIOLOGY

Prevalence is 3% in men and 1% in women in general

population. In prisons populations, it may be as high as
75%.
Five times more common among first degree relatives of
men than among control.
More common in lower socioeconomic groups.
Predisposing conditions include ADHD and conduct
disorders.
 ETIOLOGY

Genetic factors.
Brain damage or dysfunction.
Histories of parental abandonment or abuse are very
common. Repeated, arbitrary or harsh punishment by
parents is thought to be a factor.
 PSYCHODYNAMICS

Patient swith this disorders are impulse ridden, with

associated ego deficits in planning and judgment.
Superego deficits deficits or lacunae are present ;
conscience is primitive or poorly developed.
Object relational difficulties are significant, with a failure
in empathy, love and basic trust.
Aggressive features are prominent.
Associated features are sadomasochism, narcissism,
depression.
DIAGNOSIS AND DSM-IV CRITERIA

A. There is a pervasive pattern of disregard for and violation of the

rights of others occurring since age 15 years as indicated by
three (or more) of the following:
1) Failure to conform to social norms with respect to lawful behaviors as indicated
by repeatedly performing acts that are grounds for arrest
2) Deceitfulness, as indicated by repeated lying, use of all cases, or conning
others for personal profit or pleasure
3) Impulsivity or failure to plan ahead
4) Irritability and aggressiveness, as indicated by repeated physical fights or
assaults
5) Recklessness disregard for safety of self or others
6) Consistent irresponsibility as indicated by repeated failure to sustain consistent
work behavior or honor financial obligations
7) Lack of remorse, as indicated by being indifferent to or rationalizing having
hurt, mistreated, or stolen from another
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusive during the course
of schizophrenia or a manic episode.
 DIFFERENTIAL DIAGNOSIS

A) Adult antisocial behavior

B) Substance use disorder
C) Mental retardation
D) Psychoses
E) Borderline personality disorder
F) Narcissistics personality disorder
G) Personality change secondary to a general medical
condition
 DIFFERENTIAL DIAGNOSIS

A) Adult antisocial behavior

-does not meet all the criteria
B) Substance use disorders
-may exhibit antisocial behaviour as a consequence of
subtance abuse and dependence
C) Mental retardation
-may demonstrate antisocial behavior as consequence
of impaired intellect and judgment
D) Psychoses
-may engage in antisocial behavior as a consequence
of psychotic delusions
E) Borderline personality disorder
-often attempts suicide and exhibit self-loathing and
intense, ambivalent attachments
F) Narcissistic personality disorder
-law-abiding
G) Personality change secondary to a general medical
condition
-has had a different pre-morbid personality or shows
features of an organic disorder
H) ADHD
-cognitive difficulties and impulse dyscontrol are
present
 COURSE

 Chronic course
 Some improvements of symptoms may occur as the
patients ages
 Multiple somatic complaints and coexistence of
substance abuse and/or major depression is common
 Increase morbidity: substance abuse, trauma,
suicide/homicide
 PROGNOSIS

Often significantly improves after early or

middle adulthood

Complications
• Death by violence
• Substance abuse
• Suicide
• Physical injury
• Legal and financial difficulties
• Depressive disorders
 TREATMENT

Psychotherapy
Group therapy
Cognitive-behavioral therapy – self-destructive behavior, fear of
intimacy

Pharmacotherapy
B-adrenergics - Agression
Psychostimulants (Ritalin) – ADHD
Antiepileptic : carbamazepin (Tegretol) and valproate (Deoakote) -
impulsive behavior
BORDERLINE PERSONALITY
DISORDER
 BORDERLINE PERSONALITY
DISORDER

Definition:
Literally on the border of neurosis and psychosis.
Chracterized by: extraordinarily unstable mood, affect, behavior,
object relations and self-image.
Suicide attempts and acts of self-mutilation are common.
This individuals are very impulsive, and suffer from identity
problems as well as feelings of emptiness and boredom.
Also known as ambulatory schizophrenia, as-if personality,
pseudoneurotic schizophrenia and psychotic character disorder.
 EPIDEMIOLOGY

Prevalence is about 2% of general population, 10% of

outpatients, 20% of inpatients, and 30% to 60% of
patients with personality disorder.
More common in women than in men.
90% have one other psychiatric diagnosis, and 40% have
two.
The prevalence of mood and substance-related disorders
and antisocial personality disorder in families is
increased.
Five times more common among relatives of probands
with the disorder. The prevalence of borderline
personality disorder is increased in the mothers of
borderline patients.
 PSYCHODYNAMICS

Splitting
Projective identification
Patients have both intense aggressive needs ad intense
object hunger, often alternating.
The patient has marked fear of abandonment.
Turning against self : self-hate, self loathing – Is
prominent.
Generalized ego dysfunction results in identity
disturbance.
 ETIOLOGY

Brain damage may be present and represent perinatal brain

injury, encephalitis, head injury, and other brain disorders.
Histories of physical or sexual abuse, or abandonment.
 CLINICAL FEATURES

Splitting
Mood swings
Micropsychotic episodes (short-lived psychosis)
Self-destructive
Dependent
Express enormous anger
Chronic feeling of emptiness and boredom
 DIAGNOSIS AND DSM-IV
CRITERIA

 A pervasive pattern of impulsivity and unstable relationships, self image,

affects, and behaviours ,present by early adulthood and in a variety of
contexts.
 Atleast 5 of the following must be present:

1. Desperate efforts to avoid real/imagined abandonment

2. Unstable, intense interpersonal relationships
3. Unstable self image
4. Impulsivity in at least 2 potentially harmful ways (spending, sexual
activity, substance abuse, binge eating, etc)
5. Recurrent suicidal threats/attempts/self-mutilation
6. Unstable mood/affect
7. General feeling of emptiness
8. Difficulty controlling anger
9. Transient, stress-related paranoid ideation/dissociative symptoms
Antisocial • The defects in conscience and
personality attachment ability are more severe
disorder

Histrionic • Suicide and self-mutilation are less

personality common.
disorder • The patient tends to have more stable
interpersonal relationships
Narcissistic • Identity formation is more stable
personality
disorder

Dependent • Attachments are stable

personality
disorder

Paranoid • Suspiciousness is more extreme

personality and consistent
disorder
PROGNOSIS

Variable
Some improvement may occur in later years

Complications
• Self -injury
• Somatoform disorders
• Suicide
• Psychoses
• Substance abuse
• Sexual disorders
 TREATMENT

A) Psychotherapy
 Cognitive-behavioral therapy – control impulses and angry outbursts, reduce
sensitivity towards criticism and rejection
 Dialectical behavior therapy – parasuicidal behavior

B) Pharmacotherapy
 Antipsychotics – anger, hostility, and brief psychotic episodes
 Antidepressant – depressed mood
 Monoamine oxidase inhibitors (MAOIs) –impulsive behavior
 Benzodiazepines (alprazolam or Xanax) – anxiety and depression
 Anticonvulsant (carbamazepin or Tegretol) – improve global functioning
 Serotonergic agent (fluoxetine or Prozac)
HISTRIONIC PERSONALITY
DISORDER
 HISTRIONIC PERSONALITY
DISORDER

Characterized by flamboyant, dramatic, excitable, and over-

reactive behavior
Intent on gaining attention
Immature, dependant, and often seductive
Difficulty maintaining long-lasting relationship
 EPIDEMIOLOGY

Prevalence is 2% to 3%.

Prevalence is greater in women than men.

May be associated with somatization disorder, mood disorders

and alcohol use.
 ETIOLOGY

Early interpersonal difficulties may have been resolved by

dramatic behavior.
Distant/stern father with a seductive mother may be a
pattern.
 CLINICAL FEATURES

 Cooperative, eager to be helped

 Gestures and dramatic punctuation in conversation
 Colorful language
 High degree of attention –seeking behavior
 Exaggeration
 Display temper tantrums, tears, and accusations when not
the centre of attention
 Seductive behavior - coy or flirtatious
 Relationships tend to be superficial
 Repression and dissociation – unaware of their true feelings
 DSM-IV-TR DIAGNOSTIC
CRITERIA

A pervasive pattern of excessive emotionality and attention seeking,

beginning by early adulthood and present in a variety of contexts,
At least five of the following must be present: 
1) Uncomfortable when not the centre of attention 
2) Inappropriately sexually seductive or provocative behaviour 
3) Displays rapidly shifting and shallow expression of emotions 
4) Uses physical appearance to draw attention to self 
5) Has speech that is excessively impressionistic and lacking in
detail 
6) Shows self-dramatization, theatricality, and exaggerated
expression of emotion 
7) Easily influenced by others or situation 
8) Perceives relationships as more intimate than they actually are
 DIFFERENTIAL DIAGNOSIS
Borderline • More overt despair and suicidal
personality and self-mutilating features; the
disorder disorders can coexist

Somatization • Physical complaints predominate

disorder

Conversion • Physical symptoms are prominent

disorder

Dependant • The emotional flamboyance is

personality lacking
disorder
 COURSE AND PROGNOSIS
I
Improvement of symptoms with age.

Complications
Somatization disorder
Conversion disorder
Dissociative disorders
Sexual disorders
Mood disorders
Substance abuse
 TREATMENT

Psychotherapy
Psychoanalytically oriented psychotherapy (individual/group) –
clarification of inner feelings

Pharmacotherapy
Antidepressant – depression and somatic complaints
Antianxiety agents - anxiety
Antipsychotics – derealization and illusions
CLUSTER B

NARCISSISTIC
PERSONALITY DISORDER
NARCISSISTIC PERSONALITY
DISORDER

A heightened sense of self-

importance & persistent
grandiose feelings of uniqueness

Omnipotence
Grandiosity
Beauty
Talent
 EPIDEMIOLOGY
• Prevalence of the disorder is <1% of
the general population
• Strong family history
• Number of cases increasing steadily
 CLINICAL FEATURES
Grandiose sense of self-importance (special and
expect special treatment)
Striking sense of entitlement
Frequently ambitious to achieve fame and fortune
Want their own way
Refusal to obey conventional rules (norm) or behavior
Fragile relationships
Cannot show empathy
Handle criticism poorly (enraged or completely
indifferent)
Fragile self-esteem  depression
 DSM IV TR

A pervasive pattern of grandiosity (in fantasy or behaviour), need for

admiration, and lack of empathy, beginning by early adulthood and
present in a variety of contexts, as indicated by five (or more) of the
following: 
1) has a grandiose sense of self-importance (e.g., exaggerates
achievements and talents, expects to be recognized as superior
without commensurate achievements) 
2) is preoccupied with fantasies of unlimited success, power,
brilliance, beauty, or ideal love 
3) believes that he or she is "special" and unique and can only be
understood by, or should associate with, other special or high-
status people (or institutions) 
4) requires excessive admiration 
5) has a sense of entitlement, i.e., unreasonable expectations of
especially favourable treatment or automatic compliance with
his or her expectations 
6) is interpersonally exploitative, i.e., takes advantage of others to
achieve his or her own ends 
7) lacks empathy: is unwilling to recognize or identify with the
feelings and needs of others 
 COURSE & PROGNOSIS
Can be chronic and difficult to treat
(need to renounce narcissism)
Aging is handled poorly, more
vulnerable to midlife crises
 TREATMENT
1. Psychotherapy
1. Group therapy
• learn how to share with others
• develop empathy

2. Pharmacotherapy
1. Lithium (Eskalith) – mood swings
2. Antidepressant (esp SSRI) – depression
and somatic complaints
 CLUSTER C
AVOIDANT PERSONALITY DISORDER
DEPENDENT PERSONALITY DISORDER
OBSESSIVE-COMPULSIVE PERSONALITY
DISORDER
CLUSTER C

AVOIDANT PERSONALITY
DISORDER
 AVOIDANT PERSONALITY
DISORDER

Hypersensitivity to negative
evaluation
(extreme sensitivity to rejection)

Shy (Timid)

“Inferiority complex”
 EPIDEMIOLOGY
• Common
• Prevalence of the disorder is 0.05%
to 1% of the general population
• No information on sex ratio or
familial pattern
 CLINICAL FEATURES
• Main personality trait is timidity not asocial
• Show great desire for companionship but
need unusually strong guarantees of
uncritical acceptance
• Talking: Express uncertainty, lack of self
confidence, self effacing manner
• Afraid to speak up, afraid to make request
• Misinterpret comments as belittling &
ridiculing
• Often no close friends or confidants
 DSM IV TR

A pervasive pattern of social inhibition, feelings of

inadequacy, and hypersensitivity to negative evaluation,
beginning by early adulthood and present in a variety of
contexts, as indicated by four (or more) of the following:
(1) avoids occupational activities that involve
significant interpersonal contact, because of fears of
criticism, disapproval, or rejection
(2) is unwilling to get involved with people unless certain
of being liked
(3) shows restraint within intimate relationships
because of the fear of being shamed or ridiculed
(4) is preoccupied with being criticized or rejected in
social situations
(5) is inhibited in new interpersonal situations
because of feelings of inadequacy
(6) views self as socially inept, personally unappealing, or
inferior to others
 COURSE & PROGNOSIS
• Able to function in a protected
environment or support system
– If fail  depression, anxiety, and anger
• Phobic avoidance is common, may
have history of social phobia
 TREATMENT
1. Psychotherapy
1. Group therapy
• to understand how sensitivity of rejection affects them
and others
2. Assertiveness training (behavior therapy)
• Teach how to express their needs openly and enlarge their
self esteem

2. Pharmacotherapy
•. to manage anxiety and depression
•. Beta-adrenergic antagonists (Atenolol) to manage ANS
hyperactivity
•. Serotonergic agents may help rejection sensitivity
CLUSTER C

DEPENDENT PERSONALITY
DISORDER
DEPENDENT PERSONALITY
DISORDER

Pervasive pattern of
dependent
and submissive behavior

Pessimism, self doubt, passivity, fear

expressing feelings

“passive dependent personality”

 EPIDEMIOLOGY
• 2.5 percent of all personality
disorders
• women > men
• More common in young children
than in older ones
 DSM IV TR – Dependent Personality
Disorder
A pervasive and excessive need to be taken care of that leads to
submissive and clinging behaviour and fears of separation, beginning
by early adulthood and present in a variety of contexts, as indicated
by five (or more) of the following:
(1) has difficulty making everyday decisions without an excessive
amount of advice and reassurance from others
(2) needs others to assume responsibility for most major areas
of his or her life
(3) has difficulty expressing disagreement with others because
of fear of loss of support or approval (Note: do not include
realistic fears of retribution)
(4) has difficulty initiating projects or doing things on his or
her own (lack self-confidence in judgment or abilities)
(5) goes to excessive lengths to obtain nurturance and support
from others, to the point of volunteering to do things that are
unpleasant
(6) Feels uncomfortable or helpless when alone because of
exaggerated fears of being unable to care for himself or herself
(7) Urgently seeks another relationship as a source of care and
support when a close relationship ends
 COURSE & PROGNOSIS
• Impaired occupational functioning
– cannot act independently and without
close supervision
• Limited social relationships
– to those whom they can depend on
• May suffer physical or mental abuse
because they cannot assert themselves
• Risk MDD if lose the person they
depend on
 TREATMENT
1. Psychotherapy
1. Insight-oriented therapies
• To understand the antecedents of behavior
• To became more independent, assertive and self-reliant
2. Behavioral therapy (assertiveness training)
3. Family therapy
4. Group therapy

2. Pharmacotherapy
•. Deal with anxiety and depression
•. Imipramine (Tofranil): panic attacks or have high levels of
separation anxiety
•. Benzodiazepines and serotonergic agents
 CLUSTER C PERSONALITY
DISORDERS

AVOIDANT DEPENDE
NT
“Hypersensitivity to “Pervasive pattern of
negative evaluation dependent & submissive
(extreme sensitivity to behavior”
rejection)”

OBSESSIVE-
COMPULSIV
E
“Preoccupied with rules,
regulations, orderliness,
neatness, details &
perfectionism”
Obsessive-Compulsive
Personality Disorder
(OCPD)
Cluster C
 OBSESSIVE-COMPLUSIVE
PERSONALITY DISORDER
• Pervasive pattern of perfectionism,
inflexibility, and orderliness.
• Very preoccupied with unimportant details,
unable to to complete simple tasks in time.
• Appear stiff, serious, and formal with
constricted affect.
• Often successful professionally but have poor
interpersonal skills.
 Epidemiology

• Prevalence is 1% in general population.

• men > women .
• Occurs most often in oldest children.
• High incidence in first degree relatives.
 What Causes OCPD?

• There is no single, specific “cause” identified

• Several theories suggest that people with OCPD may have
been raised by parents who were unavailable and either
overly controlling or overly protective. Also, as children
they may have been harshly punished. The OCPD traits may
have developed as a sort of coping mechanism to avoid
punishment, in an effort to be “perfect” and obedient.
• Genetics may play a role, but this has not been well-
studied.
• Cultural factors may play a role. Societies or religions that
are very authoritarian and bound by strict rules may impact
early childhood development that affects personality
expression.
 DSM-IV Diagnostic Criteria
• Pattern of preoccupation with orderliness,
control, and perfectionism at the expense of
efficiency, present by early adulthood and in
variety of contexts.
• At least four of the following must be present:
1. Preoccupation with details, rules, lists, order,
organization, or schedules such that the
major point of the activity is lost.
2. Shows perfectionism that interferes with task
completion.
3. Excessive devotion to work
4. Excessive conscientiousness and
scrupulousness about morals and ethics
5. Will not delegate tasks with others
6. Unable to discard worthless objects
7. Miserly spending style
8. Rigid and stubborn
 Prognosis

• Course of OCPD is variable and unpredictable

• Some patient later develop obsessions or
compulsions (OCD), some develop
schizophrenia or major depressive disorder,
and others may improve or remain stable.
 Differential Diagnosis
1)obsessive compulsive disorder (OCD)
•) Patient with OCPD do not have recurrent
obsessions or compulsions that are present in
OCD
•) Symptoms of OCPD are ego-syntonic rather
than ego-dystonic as in OCD.
•) OCD patients are aware that they have
problem and wish that their thoughts and
behavior would go away.
 Differential Diagnosis

2) Narcissistic personality disorder (NPD)

• Both personalities involve assertiveness and
achievement, but NPD patients are motivated
by status, whereas OCD patients are
motivated by the work itself.
 Treatment
• Psychotherapy is the treatment of choice.
-Group therapy and cognitive-behaviorial therapy
may be useful.
• Pharmacotherapy
- clonazepam (Klonopin)
- benzodiazepine with anticonvulsant use
- clomipramine (Anafranil)
- Serotonergic agents (fluoxetine)
- nefazodone (serzone)