ABPN C-L Psychiatry flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Confusion Assessment Method (CAM)

Bedside delirium screen requiring acute onset or fluctuation plus inattention, and either disorganized thinking or altered consciousness; highly sensitive when used correctly.

Hypoactive delirium

Subtype marked by withdrawal, reduced motor activity, and sparse speech; frequently misdiagnosed as depression or fatigue and associated with worse outcomes than hyperactive delirium.

Serotonin syndrome features

Caused by serotonergic excess; presents with clonus, hyperreflexia, mydriasis, agitation, diaphoresis, and diarrhea, typically within 24 hours of a precipitating agent or dose increase.

Neuroleptic malignant syndrome

Dopamine antagonist exposure causes lead-pipe rigidity, hyperthermia, autonomic instability, bradyreflexia, elevated creatine kinase, and leukocytosis over days; treat by stopping the agent and supportive care.

MoCA versus MMSE

Montreal Cognitive Assessment is more sensitive than the Mini-Mental State Examination for mild cognitive impairment and executive dysfunction but is more affected by education and language.

CL consultation triage

Prioritize requests by immediate danger: agitation, suicide or violence risk, delirium with safety risk, capacity for urgent decisions, and active withdrawal; routine capacity and adjustment questions can wait.

Curbside consultation

Informal advice without full record review or examination; document the limits, avoid definitive recommendations, and convert to a formal consultation when risk or complexity is high.

Closed-loop communication

Referring team restates recommendations back to the consultant to confirm accuracy; reduces errors in high-risk transfers and medication changes in the medically ill.

Capacity versus competency

Capacity is a clinical, task-specific judgment made by any physician; competency is a legal status determined by a court, though the terms are often used loosely.

42 CFR Part 2

US federal rule protecting substance use disorder treatment records more strictly than HIPAA; requires specific written consent for most disclosures, including to other treating clinicians.

Lithium in renal failure

Lithium is renally cleared, so reduced glomerular filtration causes accumulation and toxicity; avoid or use low doses with frequent levels and avoid NSAIDs, ACE inhibitors, and thiazides.

Sertraline in liver disease

Preferred SSRI in hepatic impairment because of moderate protein binding and clearance; start at low dose; avoid fluoxetine due to its long half-life and active metabolite.

Bupropion lowers seizure threshold

Contraindicated in bulimia, anorexia nervosa, and seizure history; inhibits CYP2D6, raising risperidone, tricyclics, and tamoxifen metabolite levels; also causes insomnia and hypertension risk.

Codeine with CYP2D6 inhibitors

Fluoxetine, paroxetine, and bupropion block conversion of codeine to morphine and can abolish analgesia; ultrarapid metabolizers risk toxicity; avoid codeine in breastfeeding.

QT prolongation antipsychotics

Ziprasidone, haloperidol (especially intravenous), thioridazine, and citalopram above 40 mg daily prolong QT; obtain ECG and correct potassium and magnesium in cardiac patients.

Clozapine myocarditis

Rare but potentially fatal inflammatory cardiac reaction most common in the first two months; check troponin and CRP and stop clozapine if suspected; also causes agranulocytosis and ileus.

Catatonia lorazepam challenge

Give 1 to 2 mg lorazepam intravenously or intramuscularly and reassess in minutes; a marked reduction in rigidity or mutism supports catatonia and predicts response to benzodiazepine treatment.

Malignant catatonia treatment

Features fever, autonomic instability, and elevated creatine kinase; treat with high-dose benzodiazepines and, if refractory or life-threatening, electroconvulsive therapy without delay.

Four abilities of capacity

Understanding, appreciation, reasoning, and expressing a choice; a patient needs all four for the specific decision, and capacity varies by decision and over time.

ABCDEF ICU bundle

Assess and treat pain, both spontaneous awakening and breathing trials, choice of sedation, delirium monitoring, early mobility, and family engagement; reduces delirium and ICU length of stay.

Transplant psychosocial evaluation

Assesses adherence history, substance use, social support, psychiatric stability, and comprehension of the regimen; identifies modifiable risks and predicts post-transplant outcomes, not a single score.

Physical restraint monitoring

Requires a face-to-face evaluation by a physician or licensed independent practitioner within one hour, continuous monitoring of circulation, breathing, and mental status, and frequent reassessment.

Alcohol withdrawal treatment

Use symptom-triggered benzodiazepines guided by CIWA-Ar; give thiamine before glucose; lorazepam is preferred in liver disease; untreated delirium tremens has substantial mortality requiring ICU care.

Buprenorphine ceiling effect

Partial mu agonist with high affinity; increasing dose produces limited respiratory depression, reduces overdose risk, and precipitates withdrawal if given while full agonists are still present.

Naloxone dosing

Give 0.04 to 0.4 mg intravenously titrated to restore breathing, not full arousal; repeat every two to three minutes; duration is shorter than most opioids so monitor for renarcotization.

Opioid rotation

When switching opioids, calculate equianalgesic dose, reduce by 25 to 50 percent for incomplete cross-tolerance, then reassess frequently; methadone conversions are nonlinear and require expertise.

Terminal dyspnea treatment

Low-dose opioids reduce air hunger without hastening death when titrated to symptoms; oxygen helps only with hypoxemia; anxiolytics and fans of air address the affective component.

Valproate in pregnancy

Associated with neural tube defects and dose-dependent neurodevelopmental harm; avoid in pregnancy when possible, and use effective contraception and lowest effective dose with folate if unavoidable.

Postpartum psychosis

Psychiatric emergency with onset usually within two weeks of delivery; features mania, confusion, and hallucinations; treat with antipsychotics or lithium and hospitalize with infant safety planning.

Geriatric Beers criteria

Lists potentially inappropriate medications for older adults, including benzodiazepines, anticholinergics, and long-acting sulfonylureas; use to reduce falls, delirium, and adverse drug events.

EPDS screening

Edinburgh Postnatal Depression Scale is a 10-item self-report validated for perinatal depression; a score of 10 or more or any self-harm response warrants clinical assessment.

Adjustment disorder definition

Emotional or behavioral symptoms within three months of an identifiable stressor, causing impairment and not meeting another disorder; symptoms resolve within six months after the stressor ends.