ABPN Psychiatry key terms

A lasting increase in synaptic strength that follows rapid, repeated stimulation of a neuron, widely considered the cellular basis of learning and memory. It underlies extinction learning and the synaptic plasticity thought to mediate antidepressant and psychotherapeutic effects.

The progressive sensitization process in which repeated, initially subthreshold stressors or mood episodes trigger increasingly severe and spontaneous later episodes. It is used to explain episode acceleration in bipolar disorder and the rationale for early mood stabilization and prophylaxis.

The hypothalamic-pituitary-adrenal feedback system that releases cortisol in response to stress. Chronic activation, blunted diurnal rhythm, and impaired dexamethasone suppression are observed in major depression and posttraumatic stress disorder.

A dopamine circuit projecting from the ventral tegmental area to the nucleus accumbens and limbic structures. It mediates reward, salience, and motivation; its blockade is linked to antipsychotic efficacy and its stimulation to substance-induced psychosis.

A set of midline and lateral cortical regions, including the medial prefrontal cortex and posterior cingulate, that is active during rest and self-referential thought. Its abnormal connectivity is studied in depression, rumination, and schizophrenia.

The capacity to infer another person's beliefs, intentions, and emotions, and to recognize that those mental states can differ from one's own. Deficits are studied in autism spectrum disorder and in psychotic disorders with paranoid features.

Bowlby and Ainsworth's model holding that early caregiver responsiveness shapes internal working models of relationships. Secure, anxious-ambivalent, avoidant, and disorganized patterns, classified in the Strange Situation, predict later affect regulation and interpersonal functioning.

Mahler's developmental sequence, from roughly six to thirty-six months, in which a toddler moves from symbiosis through differentiation, practicing, rapprochement, and object constancy toward a stable separate sense of self.

A behavioral pattern in which repeated exposure to uncontrollable aversive events produces passivity and reduced coping even when escape later becomes possible. It is a foundational model for depression and for cognitive-behavioral accounts of hopelessness.

The cumulative physiological wear from chronic adaptation to stress, reflected in dysregulated cortisol, blood pressure, inflammatory markers, and metabolic measures. Higher load is linked to adverse childhood experiences and to elevated psychiatric and medical morbidity.

Largely unconscious mental operations that manage anxiety and internal conflict by distorting perception or impulse. They are ranked hierarchically from immature (splitting, projection, denial) to mature (humor, sublimation, suppression), with the level informing diagnosis and treatment planning.

Constitutionally based, early-appearing individual differences in reactivity and self-regulation, such as activity level, irritability, and sociability. Thomas and Chess described easy, difficult, and slow-to-warm-up profiles whose fit with the environment shapes later adjustment.

A structured bedside assessment of appearance, behavior, speech, mood, affect, thought process and content, perception, cognition, insight, and judgment. Serial examinations document change over time and distinguish psychiatric syndromes from delirium and other medical causes.

A brief validated instrument for detecting delirium using four features: acute onset with fluctuating course, inattention, disorganized thinking, and altered level of consciousness. Acute onset plus inattention plus either of the last two features establishes the diagnosis.

A syndrome of abnormal psychomotor activity that may include stupor, mutism, negativism, posturing, waxy flexibility, and agitation. It occurs across psychotic, mood, and medical conditions and responds to benzodiazepines or electroconvulsive therapy rather than antipsychotics alone.

A putatively prodromal phase marked by attenuated psychotic symptoms, brief self-limited psychotic episodes, or genetic risk with functional decline. Identification prompts close monitoring and psychosocial treatment, though antipsychotic prophylaxis remains controversial.

A DSM-5 structured interview of sixteen questions exploring a patient's cultural identity, explanatory models, stressors, and help-seeking preferences. It clarifies how culture shapes symptom presentation and improves engagement and diagnostic accuracy.

A nine-item self-report measure scoring each DSM depressive criterion from zero to three over the prior two weeks. Scores of five, ten, fifteen, and twenty suggest mild, moderate, moderately severe, and severe depression; the ninth item screens for suicidality.

A structured interview that grades suicidal ideation from a wish to die through active intent with a plan, and separately records preparatory acts and attempts. It is used to stratify risk and to track change in crisis and research settings.

The co-occurrence of a substance use disorder with another psychiatric disorder in the same person. Integrated treatment addressing both conditions simultaneously outperforms sequential or parallel care and reduces relapse and hospitalization.

Measurement of serum lithium, typically twelve hours after the last dose, with usual maintenance targets of 0.6 to 1.0 mEq/L. Monitoring also includes renal function, thyroid studies, calcium, and levels after dehydration, drug interactions, or toxicity symptoms.

Required hematologic surveillance for clozapine because it can cause severe neutropenia. Patients need weekly absolute neutrophil counts for six months, then biweekly for six months, then monthly indefinitely, with specific hold and discontinuation thresholds.

A rare idiosyncratic reaction to dopamine antagonists marked by rigidity, hyperthermia, autonomic instability, and altered consciousness, with elevated creatine kinase. Treatment is drug discontinuation, supportive care, and agents such as dantrolene or bromocriptine.

A toxic syndrome from serotonergic excess, presenting with clonus, hyperreflexia, agitation, hyperthermia, and autonomic instability. Onset is usually rapid, distinguishing it from neuroleptic malignant syndrome, and treatment is withdrawal of the offending agents plus supportive care.

Involuntary, often choreoathetotic movements of the face, tongue, trunk, or limbs appearing after prolonged dopamine antagonist exposure. VMAT2 inhibitors such as valbenazine and deutetrabenazine are approved treatments; prevention relies on minimal effective antipsychotic dosing.

A neuromodulation treatment delivering a generalized seizure under anesthesia with neuromuscular blockade. It is highly effective for severe or psychotic depression, catatonia, and acute mania, with transient anterograde and sometimes persistent retrograde memory impairment.

A cognitive-behavioral treatment for obsessive-compulsive disorder in which patients deliberately confront feared triggers while refraining from rituals. Repeated exposure produces habituation and new learning that obsessional threat estimates are inaccurate.

A manualized treatment combining individual therapy, skills group, telephone coaching, and therapist consultation. It targets emotion dysregulation and self-harm through mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation skills, with strong evidence in borderline personality disorder.

A collaborative, person-centered counseling style that elicits and strengthens a patient's own arguments for change. It uses open questions, reflective listening, and affirmation while avoiding confrontation, and is effective for substance use and treatment adherence.

A hepatic cytochrome enzyme that metabolizes many antidepressants, antipsychotics, and opioids, including conversion of codeine to morphine. Genetic poor metabolizers risk toxicity and ultrarapid metabolizers risk nonresponse; strong inhibitors such as fluoxetine and bupropion raise levels of substrates.

Lengthening of the heart rate-corrected QT interval on electrocardiogram, which raises torsades de pointes risk. Many antipsychotics, tricyclics, and methadone contribute; risk increases with female sex, hypokalemia, bradycardia, and multiple QT-prolonging drugs.

A hypertensive crisis caused by eating tyramine-rich foods or using sympathomimetic drugs while taking a monoamine oxidase inhibitor. Tyramine escapes gut and hepatic breakdown, triggering norepinephrine release; strict dietary restriction and washout periods are required.

A clinical judgment about a specific decision, assessed through four abilities: communicating a choice, understanding relevant information, appreciating the consequences, and reasoning about options. Capacity is task-specific, whereas competence is a legal status determined by courts.

A legal obligation, arising from Tarasoff v. Regents of the University of California, to take reasonable steps to protect an identifiable third party from a patient's serious threat of violence. Steps may include warning, notification, or hospitalization.

Legal detention for psychiatric evaluation or treatment without consent, justified by grave disability, danger to self, or danger to others as defined by state statute. It requires due process, periodic review, and the least restrictive appropriate setting.

A brief, collaboratively written, prioritized list of personal warning signs, coping strategies, distracting social contacts, people to call for help, professional resources, and steps to make the environment safer. It is completed with the patient during a suicidal crisis.

A structured, systems-focused review after a serious adverse event that asks why defenses failed rather than who erred. It produces corrective actions targeting policy, communication, staffing, and technology, and complements disclosure to patients and families.

An organizational framework that distinguishes human error, at-risk behavior, and reckless conduct so that reporting is encouraged while accountability is maintained. It supports learning from near misses and is central to patient safety improvement.

Emergency containment measures used only when less restrictive interventions fail and there is imminent danger. They require a physician order, time-limited intervals, face-to-face evaluation, continuous monitoring, and documentation, with rules varying by setting and accreditor.