ABPN Psychiatry flashcards

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

Mesolimbic dopamine pathway

Projects from the ventral tegmental area to the nucleus accumbens and is associated with reward processing; its hyperactivity is linked to positive psychotic symptoms.

Tuberoinfundibular dopamine pathway

Dopamine neurons from the arcuate nucleus inhibit prolactin release from the anterior pituitary; blockade by antipsychotics can cause hyperprolactinemia, galactorrhea, and amenorrhea.

HPA axis stress response

Hypothalamic CRH stimulates pituitary ACTH, which drives adrenal cortisol; cortisol feeds back negatively on the hypothalamus and hippocampus, and chronic activation is linked to depression.

Dexamethasone suppression test

A 1 mg overnight dexamethasone dose normally suppresses cortisol; nonsuppression occurs in about half of melancholic depression but is not diagnostically specific.

REM sleep in depression

Major depression is associated with shortened REM latency, increased REM density, and reduced slow-wave sleep; these findings reflect altered sleep architecture rather than a diagnostic test.

22q11 deletion syndrome

Also called velocardiofacial syndrome, it results from a microdeletion and carries roughly a 25% lifetime risk of schizophrenia, making it one of the strongest known genetic risk factors.

NMDA receptor hypofunction model

Glutamate NMDA receptor antagonists such as ketamine can produce positive, negative, and cognitive symptoms resembling schizophrenia, supporting glutamatergic dysfunction in the disorder.

Piaget developmental stages

Sensorimotor birth to 2 years, preoperational 2 to 7, concrete operational 7 to 11, and formal operational from 11 onward; each stage describes qualitatively different cognitive abilities.

Erikson psychosocial stages

Trust versus mistrust in infancy, autonomy versus shame, initiative versus guilt, industry versus inferiority, identity versus role confusion in adolescence, then intimacy, generativity, and integrity in adulthood.

Strange situation attachment types

Ainsworth's procedure classifies infant attachment as secure, insecure-avoidant, insecure-resistant, or disorganized; disorganized attachment is associated with frightened or frightening caregiving.

Mahler separation-individuation phases

Normal autistic and symbiotic phases precede differentiation, practicing, rapprochement, and object constancy; disruption during rapprochement is linked to borderline personality organization.

Mature defense mechanisms

Sublimation, humor, altruism, and suppression are adaptive defenses associated with better functioning; immature defenses include splitting, projective identification, and denial.

Theory of mind milestone

Most typically developing children pass false-belief tasks around 4 years of age; impairment is characteristic of autism spectrum disorder and contributes to social difficulties.

Major depressive episode criteria

At least five symptoms for two weeks, including depressed mood or anhedonia, plus sleep, appetite, energy, psychomotor, concentration, worthlessness, or suicidal symptoms causing impairment.

Manic episode criteria

Elevated or irritable mood with increased energy lasting at least one week or requiring hospitalization, plus three additional symptoms; four are needed if mood is only irritable.

Schizophrenia diagnostic threshold

Two or more core symptoms for a significant portion of one month, with continuous disturbance for six months and functional decline; at least one symptom must be delusions, hallucinations, or disorganized speech.

Panic attack symptom count

An abrupt surge peaking within minutes with at least four of thirteen symptoms, such as palpitations, sweating, trembling, dyspnea, choking, chest pain, nausea, dizziness, derealization, fear, paresthesias, chills, or heat.

PTSD symptom clusters

Trauma exposure followed by intrusion, avoidance, negative alterations in cognition and mood, and marked arousal or reactivity lasting more than one month and causing impairment.

Delirium versus dementia

Delirium has acute onset, fluctuating course, and impaired attention; dementia has insidious progressive cognitive decline with preserved attention until late stages.

NMS versus serotonin syndrome

Neuroleptic malignant syndrome features rigidity, hyperthermia, autonomic instability, and elevated creatine kinase after dopamine antagonists; serotonin syndrome features clonus, hyperreflexia, and agitation after serotonergic drugs.

Clozapine monitoring requirements

Absolute neutrophil count monitoring is weekly for six months, then every two weeks for six months, then monthly; clozapine also requires monitoring for myocarditis, seizures, and metabolic effects.

Lithium therapeutic range

Serum lithium is usually maintained at 0.6 to 1.2 mEq/L; toxicity risk rises above 1.5 mEq/L, and NSAIDs, thiazides, and ACE inhibitors increase levels.

Valproate teratogenicity

Valproate carries the highest teratogenic risk among common mood stabilizers, including neural tube defects and neurodevelopmental harm; it should be avoided in pregnancy when alternatives exist.

Lamotrigine titration rationale

Slow titration reduces the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis; risk increases with rapid titration, concurrent valproate, and prior rash.

Carbamazepine HLA-B*1502

The HLA-B*1502 allele, common in Han Chinese and some Southeast Asian populations, predicts Stevens-Johnson syndrome from carbamazepine; screening is recommended before treatment in high-risk groups.

ECT seizure adequacy

A generalized seizure of roughly 20 to 60 seconds is considered adequate; seizure threshold rises with age and with repeated treatments, so stimulus dose is adjusted accordingly.

CBT exposure principle

Exposure therapy uses repeated, prolonged contact with feared stimuli without avoidance or safety behaviors, allowing conditioned fear responses to extinguish through inhibitory learning.

Suicide risk strongest predictor

A prior suicide attempt is the strongest single predictor of completed suicide; access to lethal means, especially firearms, substantially increases risk.

Tarasoff duty

When a patient poses a serious threat to an identifiable third party, the clinician may have a duty to protect, which can include warning the victim, notifying police, or taking protective steps.

Informed consent capacity elements

Decision-making capacity requires the ability to communicate a choice, understand relevant information, appreciate the situation and consequences, and reason about alternatives.

Restraint and seclusion standard

Used only as a last resort for imminent danger, with physician order, close monitoring, face-to-face evaluation, and documentation; the least restrictive alternative must be attempted first.

Impaired physician reporting

Colleagues should report a physician whose impairment poses risk to patients to the state physician health program or licensing board, balancing confidentiality with patient safety.