Arab Board Psychiatry Part 1 key terms

The theory that positive psychotic symptoms arise from excessive mesolimbic dopamine transmission, supported by antipsychotic potency correlating with D2 blockade and by dopamine-releasing drugs provoking psychosis. It explains positive symptoms better than negative or cognitive ones.

Dopaminergic projection from the ventral tegmental area to the nucleus accumbens and limbic structures, central to reward, motivation and salience attribution. Its overactivity is linked to delusions and hallucinations, and it is the main target of antipsychotic action.

The proportion of striatal dopamine D2 receptors bound by an antipsychotic drug. Roughly 65-80% occupancy is associated with antipsychotic effect, while above about 80% extrapyramidal side effects and hyperprolactinaemia become likely.

A potentially fatal toxic state from serotonergic excess, typically combining serotonergic drugs, marked by agitation, hyperthermia, clonus, hyperreflexia and autonomic instability. Clonus and hyperreflexia distinguish it from neuroleptic malignant syndrome.

A rare idiosyncratic reaction to dopamine-blocking drugs characterised by severe rigidity, hyperthermia, autonomic instability and raised creatine kinase. Lead-pipe rigidity and bradyreflexia distinguish it from serotonin syndrome; treatment includes stopping the drug and supportive care.

Involuntary choreoathetoid movements, especially of the tongue, lips and face, appearing after months or years of dopamine-blocking treatment. It may persist after drug withdrawal and is more common with older, higher-dose typical antipsychotics.

Drug-induced movement disorders from nigrostriatal dopamine blockade, comprising acute dystonia, parkinsonism, akathisia and tardive syndromes. They are dose-related, more frequent with typical antipsychotics, and treated by dose reduction or anticholinergics where appropriate.

A drug class blocking monoamine oxidase, raising brain and gut levels of noradrenaline, serotonin and dopamine. It is effective in atypical and treatment-resistant depression but carries hypertensive crisis risk with tyramine-rich food and serotonin toxicity with serotonergic drugs.

A hypertensive crisis caused by eating tyramine-rich foods while taking a monoamine oxidase inhibitor, because tyramine escapes gut breakdown and displaces noradrenaline. It presents with severe headache and raised blood pressure and requires emergency management.

A neurobiological theory that repeated subthreshold stressors or mood episodes progressively lower the threshold for further episodes, so illness becomes autonomous. It underpins the rationale for mood stabilisers and early prophylactic treatment in bipolar disorder.

The endocrine stress system in which hypothalamic CRH drives pituitary ACTH and adrenal cortisol release. Hyperactivity, with non-suppression on dexamethasone testing, is described in melancholic and psychotic depression and normalises with successful treatment.

A test of HPA-axis feedback in which a bedtime dose of dexamethasone normally suppresses next-day cortisol. Failure to suppress was once proposed as a depression marker but lacks diagnostic specificity, so it is not used clinically for that purpose.

A structured clinical description of a patient's current psychological functioning, covering appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, insight and risk. It complements history-taking and informs diagnosis and management.

A disturbance in the form or flow of thinking, evident in speech as derailment, loosening of associations, incoherence, neologisms or thought blocking. It is assessed in the mental state examination and is characteristic of schizophrenia.

A group of psychotic phenomena regarded as especially characteristic of schizophrenia, including audible thoughts, voices arguing or commenting, thought insertion, withdrawal and broadcasting, made feelings and actions, and delusional perception. Their presence supports but does not confirm the diagnosis.

Experiences in which a person feels that their thoughts, emotions, impulses or bodily actions are controlled or imposed by an external agency. They are a first-rank symptom of schizophrenia and reflect disturbed self-boundary.

A patient's awareness of having an illness, its nature and its need for treatment. Poor insight is common in psychosis, predicts non-adherence, and is assessed explicitly in the mental state examination and risk formulation.

An acute, fluctuating disturbance of attention and awareness due to an underlying medical or toxic cause, often with altered sleep-wake cycle and perceptual disturbance. It is a medical emergency and is managed by treating the cause plus environmental measures.

A brief structured tool for detecting delirium, requiring acute onset with fluctuation plus inattention, and either disorganised thinking or altered consciousness. It is widely used at the bedside and in consultation-liaison settings.

A chronic, progressive decline in multiple cognitive domains sufficient to impair daily function, in clear consciousness, usually due to neurodegenerative or vascular disease. Unlike delirium it is not acute or fluctuating, though the two often coexist.

A brief 30-point cognitive screening test covering orientation, registration, attention, recall, language and construction. It is quick and widely used but influenced by education and language, so scores must be interpreted in context.

A neurodegenerative syndrome affecting frontal and temporal lobes, presenting with early personality change, disinhibition or language impairment while memory is relatively spared. Onset is often before 65 and behavioural variant is commonest.

A persistent pattern of disregard for and violation of others' rights, with deceitfulness, impulsivity, irritability, recklessness and lack of remorse, beginning in childhood or adolescence. It overlaps with psychopathy but is not identical.

A personality construct marked by callous affect, grandiosity, manipulativeness, shallow emotion and remorseless exploitation, assessed with instruments such as the Hare Psychopathy Checklist. It is narrower than antisocial personality disorder and predicts violent recidivism.

The legal determination that a defendant can understand the charges and proceedings and assist in their own defence. If unfit, proceedings are usually stayed and treatment or diversion is arranged rather than a trial.

The classic legal test for insanity, asking whether at the time of the act the defendant was labouring under such a defect of reason from disease of mind as not to know the nature and quality of the act, or not to know it was wrong.

The ethical principle that competent people should make their own decisions about their care, including the right to refuse treatment. It can be overridden only in defined circumstances such as incapacity or serious risk to others.

A person's functional ability to make a specific decision, judged by whether they can understand, retain, weigh and communicate relevant information. Capacity is decision-specific and time-specific and is the key test before treatment without consent.

Detention and treatment of a person with mental disorder without consent, permitted by mental health law when there is mental disorder of a specified severity plus risk to self or others, with procedural safeguards. It is a serious restriction of liberty requiring regular review.

An experiment in which participants are randomly allocated to intervention or control, minimising selection bias and allowing causal inference. Randomisation, allocation concealment and blinding are key quality features, and results are summarised as relative and absolute effects.

The number of patients who must be treated for one additional patient to benefit, calculated as the reciprocal of the absolute risk reduction. It translates trial results into a clinically meaningful measure of effect.

Analysis of trial data by original randomised group regardless of adherence or crossover. It preserves randomisation and gives a pragmatic estimate of effectiveness, though it may dilute the effect of actually receiving treatment.

Sensitivity is the proportion of truly ill people correctly identified by a test; specificity is the proportion of truly well people correctly identified as negative. Both are properties of the test and do not depend on prevalence.

The probability that a person with a positive test result truly has the condition. Unlike sensitivity, it depends on prevalence, so it falls when a test is used in a population where the disorder is rare.

The ratio of the probability of a given test result in people with the disorder to that in people without it. It indicates how much a result shifts the pre-test probability of disease and is useful in clinical reasoning.

A structured, time-limited psychotherapy targeting unhelpful thoughts and behaviours through collaborative formulation, behavioural experiments and cognitive restructuring. It has strong evidence in depression, anxiety disorders and, with adaptation, psychosis.

The displacement onto the therapist of feelings, attitudes and conflicts originally attached to important early figures. Recognising and interpreting transference is central to psychodynamic therapy and can also complicate any clinical relationship.

The clinician's emotional reactions to a patient, shaped by the clinician's own past relationships and by the patient's behaviour. Used reflectively it informs formulation; unrecognised it can distort care and contribute to boundary violations.