ABPS Psychiatry cheat sheet

Schizophrenia diagnosis requires ≥2 core symptoms (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms) with ≥1 from the first three, plus ≥6 months of disturbance including ≥1 month active symptoms.

Major depressive episode: ≥5 of 9 symptoms for ≥2 weeks, including depressed mood or anhedonia; exclude mania/hypomania, substance, and medical causes.

Manic episode: elevated/irritable mood with increased energy for ≥1 week (or hospitalization), plus ≥3 of 7 symptoms (4 if irritable); psychosis or severe impairment marks mania over hypomania.

Panic attack is a symptom specifier, not a standalone DSM-5 diagnosis; panic disorder requires recurrent unexpected attacks plus ≥1 month of worry or maladaptive behavior change.

OCD is diagnosed when obsessions and/or compulsions are time-consuming (>1 hour/day) or cause distress/impairment; insight and tic-related specifiers apply.

PTSD requires a Criterion A trauma plus symptoms across four clusters (intrusion, avoidance, negative cognition/mood, arousal/reactivity) lasting >1 month.

Delirium is an acute fluctuating disturbance of attention and awareness; it is a medical emergency and is distinguished from dementia by fluctuating course and impaired attention.

Neuroleptic malignant syndrome: hyperthermia, rigidity, autonomic instability, altered mental status, elevated CK, after dopamine antagonists; stop the agent and treat supportively with dantrolene or bromocriptine.

Mental status examination domains: appearance, behavior, speech, mood/affect, thought process and content, perception, cognition, insight, and judgment.

Thought process describes form (flight of ideas, loosening of associations, circumstantiality, tangentiality); thought content describes delusions and preoccupations.

Mini-Mental State Examination (MMSE) max score 30; ≤23 generally suggests cognitive impairment, but education and language confound results.

Montreal Cognitive Assessment (MoCA) max score 30; <26 suggests impairment; it is more sensitive to mild cognitive impairment and executive dysfunction than the MMSE.

Clock drawing and verbal fluency are brief executive/screening tests; abnormal results require formal neuropsychological testing for diagnosis.

Delusions are fixed false beliefs not explained by culture; hallucinations are sensory perceptions without external stimuli; illusions are misperceptions of real stimuli.

Capacity (clinical, decision-specific) is assessed by understanding, appreciation, reasoning, and expressing a choice; it differs from legal competence, decided by courts.

Screening instruments: PHQ-9 for depression severity, GAD-7 for anxiety, AUDIT-C for alcohol, C-SSRS for suicide risk stratification.

Clozapine requires regular absolute neutrophil count monitoring (weekly for 6 months, then every 2 weeks, then monthly) because of agranulocytosis risk; it is indicated in treatment-resistant schizophrenia.

SSRIs carry a black-box warning for increased suicidality in patients aged ≤24 at treatment initiation; serotonin syndrome presents with clonus, hyperreflexia, agitation, and hyperthermia.

Lithium has a narrow therapeutic index (roughly 0.6–1.2 mEq/L); toxicity causes tremor, ataxia, confusion, vomiting, and renal effects; monitor levels, renal and thyroid function.

Valproate is teratogenic (neural tube defects, neurodevelopmental harm); avoid in women of childbearing potential unless a pregnancy-prevention program is in place.

Antipsychotics differ in receptor profile: high-potency agents (haloperidol, fluphenazine) cause more extrapyramidal symptoms; low-potency agents (chlorpromazine, thioridazine) cause more sedation, orthostasis, and anticholinergic effects.

Tardive dyskinesia risk rises with duration of dopamine antagonist exposure; VMAT2 inhibitors (valbenazine, deutetrabenazine) are first-line treatments.

Benzodiazepines act at GABA-A receptors; abrupt withdrawal can cause seizures and delirium, so taper gradually.

ECT is effective for severe or psychotic depression, catatonia, and treatment-refractory mania; cognitive effects are typically transient and mitigated by unilateral electrode placement.

CBT targets cognitive distortions (catastrophizing, all-or-nothing thinking) and behavioral avoidance; it is first-line for panic disorder, OCD, and depression.

Exposure and response prevention is the psychotherapy of choice for OCD; exposure hierarchy plus blocking of compulsions drives habituation.

Dialectical behavior therapy (DBT) combines individual therapy, skills group, phone coaching, and consultation team; it reduces self-harm in borderline personality disorder.

Psychodynamic therapy focuses on transference, defense mechanisms, and repetition compulsion; supportive therapy emphasizes alliance and coping rather than interpretation.

Motivational interviewing uses open questions, affirmation, reflection, and summarization (OARS) to resolve ambivalence; it is effective for substance use.

Behavioral activation treats depression by scheduling rewarding activities and reducing avoidance; it is as effective as full CBT in many trials.

Psychotherapy combined with medication is superior to either alone for moderate-to-severe depression and for many anxiety disorders.

Common factors influencing outcome include therapeutic alliance, therapist empathy, and patient expectations, independent of specific technique.

Dopamine pathways: mesolimbic (reward/psychosis), mesocortical (cognition/negative symptoms), nigrostriatal (movement; EPS), and tuberoinfundibular (prolactin inhibition).

Serotonin (5-HT) has 14+ receptor subtypes; 5-HT2A antagonism contributes to atypical antipsychotic efficacy and reduced EPS.

The HPA axis regulates stress response: CRH from hypothalamus → ACTH from pituitary → cortisol from adrenal cortex; chronic stress causes feedback dysregulation.

Glutamate is the main excitatory neurotransmitter via NMDA/AMPA receptors; ketamine and esketamine act as NMDA antagonists with rapid antidepressant effects.

GABA is the principal inhibitory neurotransmitter; benzodiazepines and barbiturates potentiate GABA-A chloride currents.

Limbic system structures (amygdala, hippocampus, cingulate) mediate emotion, memory, and fear conditioning; hippocampal volume reduction is reported in recurrent depression and PTSD.

Neuroplasticity and long-term potentiation underlie learning and memory; BDNF signaling supports synaptic plasticity and is implicated in antidepressant response.

Neuroimaging: structural MRI shows atrophy/lesions; functional MRI and PET assess metabolism and perfusion; SPECT is used for perfusion and some dementia workups.

Delirium is the most common psychiatric consultation in hospitalized patients; identify and treat the underlying medical cause, and use antipsychotics cautiously for agitation.

Serotonin syndrome (clonus, hyperreflexia, hyperthermia) and neuroleptic malignant syndrome (rigidity, bradyreflexia, elevated CK) differ in onset and neuromuscular findings.

Suicide risk assessment includes ideation, intent, plan, access to means, prior attempts, and protective factors; document the formulation and safety plan.

Medical mimics of psychosis include thyrotoxicosis, porphyria, delirium, temporal lobe seizures, and substance intoxication/withdrawal.

Capacity assessment for treatment refusal is decision-specific; if capacity is absent, follow jurisdiction-specific emergency and surrogate consent rules.

Agitation management: verbal de-escalation first; if needed, use a combination such as haloperidol plus lorazepam, with monitoring for QT prolongation and respiratory depression.

Postpartum psychosis is a psychiatric emergency with high suicide and infanticide risk; it requires urgent inpatient care and antipsychotic or ECT treatment.

Alcohol withdrawal: use CIWA-Ar-guided benzodiazepines, thiamine before glucose, and monitor for seizures and delirium tremens (which carries significant mortality).

ADHD requires symptoms before age 12, in ≥2 settings, causing impairment; stimulants are first-line, with behavioral parent training especially for younger children.

Autism spectrum disorder is defined by persistent deficits in social communication plus restricted/repetitive behaviors; early intensive behavioral intervention improves outcomes.

Oppositional defiant disorder involves a persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting ≥6 months.

Conduct disorder involves violation of rights of others or major rules (aggression, property destruction, deceit/theft, serious rule violations).

Separation anxiety disorder: developmentally inappropriate excessive anxiety about separation from attachment figures, lasting ≥4 weeks in children.

Tourette disorder requires multiple motor and ≥1 vocal tics for >1 year; comorbid ADHD and OCD are common; behavioral therapy (CBIT) is first-line.

Eating disorders in adolescents: anorexia nervosa has low BMI with restriction and fear of weight gain; family-based treatment (Maudsley) is first-line for adolescents.

Child maltreatment reporting is mandated in most jurisdictions; clinicians report reasonable suspicion, not proof, to protective services.

Dementia prevalence rises steeply with age; Alzheimer disease is the most common cause, followed by vascular dementia and Lewy body disease.

Delirium superimposed on dementia is common and underrecognized; screen with the Confusion Assessment Method (CAM).

Anticholinergic burden worsens cognition and increases delirium risk; review medications (e.g., diphenhydramine, oxybutynin) in older adults.

Beers criteria identify potentially inappropriate medications in older adults, including benzodiazepines, anticholinergics, and long-acting sulfonylureas.

Start psychotropics at low doses and titrate slowly in older adults because of altered pharmacokinetics and pharmacodynamics.

Depression in older adults often presents with somatic complaints and cognitive slowing (pseudodementia); screen with the Geriatric Depression Scale.

Lewy body dementia features fluctuating cognition, visual hallucinations, parkinsonism, and severe neuroleptic sensitivity; avoid typical antipsychotics.

Elder abuse and neglect require screening and mandatory reporting when suspected; assess for financial exploitation and caregiver strain.

Informed consent requires capacity, disclosure of information, voluntariness, and the patient's decision; document the discussion.

Confidentiality has legal exceptions: imminent danger to self or others (duty to protect/warn), child or elder abuse, and court orders.

Competence to stand trial assesses whether the defendant can understand proceedings and assist counsel; it is distinct from criminal responsibility (insanity).

Involuntary commitment criteria generally require mental illness plus danger to self/others or grave disability; standards vary by jurisdiction.

Dual agency conflicts arise when a clinician serves both treatment and forensic/evaluative roles; forensic evaluators should avoid treating the evaluee.

Boundary violations (sexual contact with patients) are prohibited and reportable; boundary crossings may be clinically appropriate but require documentation.

Psychiatric advance directives and health care proxies support autonomy when decision-making capacity is lost.

Systems of care: stepped care and collaborative care models improve access and outcomes for common mental disorders by integrating behavioral health into primary care.

Alcohol withdrawal can be managed with symptom-triggered benzodiazepines using CIWA-Ar; give thiamine before or with glucose to prevent Wernicke encephalopathy.

Opioid use disorder: buprenorphine (partial agonist) and methadone (full agonist) reduce mortality; naltrexone is an alternative after detoxification.

Naloxone reverses opioid overdose; educate patients and families on take-home naloxone.

Alcohol use disorder medications include naltrexone, acamprosate, and disulfiram; naltrexone reduces craving and heavy drinking.

Tobacco cessation: varenicline, bupropion, and nicotine replacement are first-line; combine pharmacotherapy with counseling.

Benzodiazepine withdrawal can be life-threatening (seizures, delirium); use a gradual taper and consider substituting a long-acting agent.

Screening: AUDIT-C for alcohol, DAST for drugs, and CRAFFT for adolescents; brief intervention follows the 5 A's (ask, advise, assess, assist, arrange).

Stimulant use disorder has no approved pharmacotherapy; contingency management is the most effective behavioral treatment.