Arab Board Psychiatry Clinical Exam cheat sheet

Mental status examination components: appearance, behaviour, speech, mood, affect, thought form and content, perception, cognition, insight, judgement.

Cognitive screen domains: orientation, attention/concentration, memory (immediate, recent, remote), language, visuospatial, executive function; MMSE threshold ≤23/30 suggests impairment, MoCA ≤25/30.

Delirium screen (CAM): acute onset/fluctuating course PLUS inattention PLUS either disorganised thinking or altered consciousness.

Screening cut-offs: PHQ-9 ≥10 moderate depression; GAD-7 ≥10 moderate anxiety; AUDIT ≥8 hazardous drinking; CAGE ≥2 clinically significant.

Suicide risk assessment structure: ideation, plan, intent, means, prior attempts, protective factors, and documented risk formulation.

Collateral history from family/carers is required when cognition, insight, or psychosis limits the patient's reliability.

Capacity (four abilities): understand, retain, weigh/use information, and communicate a choice; assessed per decision, not globally.

Substance history: quantity, frequency, duration, route, last use, withdrawal history, and treatment attempts.

Thought disorder signs: derailment, loosening of associations, neologisms, word salad, clang associations, thought blocking.

First-rank (Schneiderian) symptoms: auditory hallucinations discussing/commenting, thought insertion/withdrawal/broadcast, passivity phenomena, delusional perception.

Delusion vs overvalued idea: delusion is fixed and held with unshakeable conviction despite contrary evidence; overvalued idea is less rigid but dominant.

Formulation sections: predisposing, precipitating, perpetuating, protective factors, plus differential diagnosis and management plan.

Negative symptoms: affective flattening, alogia, avolition, anhedonia, asociality; distinguish from depression and medication effects.

Insight dimensions: awareness of illness, need for treatment, and attribution of symptoms; impaired insight predicts non-adherence.

Clinical staging: prodrome, acute episode, remission, relapse; document baseline functioning to interpret change.

Diagnostic criteria require duration, functional impact, and exclusion of substance/medical causes before primary psychiatric diagnosis.

Schizophrenia requires ≥2 core symptoms (delusions, hallucinations, disorganised speech, grossly disorganised/catatonic behaviour, negative symptoms) with ≥1 from first three, continuous signs ≥6 months, and functional decline.

Brief psychotic disorder: duration ≥1 day but <1 month with full return to baseline; schizophreniform: ≥1 month but <6 months.

Schizoaffective disorder: mood episode concurrent with psychotic symptoms for majority of illness, plus ≥2 weeks delusions/hallucinations without prominent mood symptoms.

Delusional disorder: delusions ≥1 month, functioning relatively preserved, behaviour not obviously odd apart from delusion.

Substance/medication-induced psychosis requires symptoms during or shortly after intoxication/withdrawal and resolution with abstinence.

Antipsychotic response typically takes 2–4 weeks; 20–30% show treatment resistance (≥2 adequate trials of different antipsychotics).

Clozapine is indicated in treatment-resistant schizophrenia; monitor FBC weekly for 18 weeks then fortnightly, and check for agranulocytosis and myocarditis.

Acute dystonia is treated with anticholinergics (e.g., procyclidine) or benzodiazepines; akathisia with dose reduction or beta-blocker.

Major depressive episode: ≥5 of 9 symptoms for ≥2 weeks, including depressed mood or anhedonia; SIGECAPS mnemonic lists the symptoms.

Manic episode: ≥1 week of elevated/irritable mood with ≥3 (or ≥4 if irritable) of: grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased activity, risky behaviour.

Hypomania: ≥4 days, observable change, no marked functional impairment, no psychosis; does not require hospitalisation.

Bipolar I requires ≥1 manic episode; bipolar II requires hypomania plus major depression, never full mania.

Rapid cycling: ≥4 mood episodes in 12 months; more common in women and predicts poorer lithium response.

Serotonin syndrome triad: altered mental status, autonomic instability, neuromuscular hyperactivity (clonus, hyperreflexia); stop serotonergic agents.

Lithium monitoring: target trough 0.6–0.8 mmol/L (0.4–0.6 in elderly); check renal and thyroid function regularly; toxicity risk with dehydration and NSAIDs.

ECT indications: severe depression with psychosis, catatonia, life-threatening refusal of food/fluid, and treatment resistance.

Panic attack: abrupt surge of intense fear peaking within minutes with ≥4 of 13 symptoms; panic disorder requires recurrent unexpected attacks plus ≥1 month of worry/behaviour change.

Agoraphobia: fear of ≥2 situations (public transport, open spaces, enclosed places, crowds, being outside alone) due to escape difficulty.

Social anxiety disorder: fear of negative evaluation in social situations, ≥6 months, causing avoidance or distress.

OCD: obsessions and/or compulsions that are time-consuming (>1 hour/day) or cause distress/impairment; insight specifier (good/fair, poor, absent/delusional).

First-line OCD treatment: SSRIs at higher doses (e.g., fluoxetine 40–60 mg) plus exposure and response prevention (ERP) CBT.

PTSD requires exposure to trauma plus ≥1 intrusion, ≥1 avoidance, ≥2 negative cognition/mood, ≥2 arousal/reactivity symptoms, >1 month, with functional impairment.

Acute stress disorder: 3 days to 1 month post-trauma; PTSD: >1 month.

First-line PTSD psychotherapy: trauma-focused CBT or EMDR; SSRIs (sertraline, paroxetine) are first-line pharmacotherapy.

DSM-5 SUD criteria cluster into impaired control, social impairment, risky use, and pharmacological criteria (tolerance, withdrawal); ≥2 criteria = disorder, severity 2–3 mild, 4–5 moderate, ≥6 severe.

Alcohol withdrawal timeline: tremor/anxiety 6–12 h, seizures 12–48 h, delirium tremens 48–96 h; treat with benzodiazepines (chlordiazepoxide or diazepam) using symptom-triggered CIWA-Ar.

Wernicke encephalopathy triad: confusion, ataxia, ophthalmoplegia; give IV thiamine before glucose to prevent Wernicke–Korsakoff.

Opioid use disorder: first-line maintenance with buprenorphine or methadone; naltrexone is an alternative after detoxification.

Nicotine dependence: varenicline and combination NRT are first-line; bupropion is an alternative; combine with behavioural support.

Benzodiazepine withdrawal can cause seizures and delirium; taper gradually, never stop abruptly after long-term use.

Cannabis hyperemesis syndrome: recurrent vomiting, abdominal pain, relief with hot showers; resolves with cessation.

Screening tools: AUDIT for alcohol, CAGE for brief screen, DAST for drugs; urine drug screen detects metabolites with variable windows.

Delirium is a medical emergency: identify and treat the underlying cause (infection, drugs, metabolic, hypoxia, pain, urinary retention, constipation); use antipsychotics cautiously for severe agitation.

Dementia vs delirium: dementia has insidious onset, preserved consciousness, and progressive decline; delirium has acute onset, fluctuating course, and impaired attention.

Alzheimer's disease: earliest deficit is episodic memory (hippocampal); treat with cholinesterase inhibitors (donepezil, rivastigmine, galantamine) in mild-moderate disease; memantine in moderate-severe.

Frontotemporal dementia: early personality/behaviour change or language impairment with relatively preserved memory; behavioural variant most common.

Lewy body dementia: fluctuating cognition, visual hallucinations, parkinsonism, REM sleep behaviour disorder; severe neuroleptic sensitivity.

Vascular dementia: stepwise decline, focal neurological signs, cerebrovascular risk factors; prevent with vascular risk management.

Serotonin syndrome vs NMS: NMS has rigidity, hyperthermia, autonomic instability, elevated CK, and is caused by dopamine antagonists; serotonin syndrome has clonus and hyperreflexia.

Consultation-liaison: screen for depression in chronic illness, assess capacity for treatment refusal, and manage delirium in medically ill inpatients.

ADHD: ≥6 inattentive or hyperactive/impulsive symptoms for ≥6 months, onset before age 12, present in ≥2 settings, causing impairment.

Autism spectrum disorder: persistent deficits in social communication/interaction plus restricted, repetitive behaviours/interests, present in early development.

First-line ADHD pharmacotherapy: stimulants (methylphenidate, amphetamines); monitor height, weight, blood pressure, and cardiac history.

Separation anxiety disorder: developmentally inappropriate fear of separation from attachment figures, ≥4 weeks in children, causing distress/impairment.

Conduct disorder vs oppositional defiant disorder: ODD is a pattern of angry/irritable mood and defiance without serious violation of others' rights; conduct disorder involves aggression, property destruction, deceit/theft.

Tourette syndrome: multiple motor plus ≥1 vocal tic for >1 year; treat with behavioural therapy (CBIT) or alpha-2 agonists; antipsychotics for severe cases.

Child safeguarding: any suspicion of abuse requires documentation and reporting to child protection authorities regardless of parental consent.

Adolescent depression: assess for self-harm and substance use; fluoxetine is the only SSRI licensed for adolescent depression in many jurisdictions.

SSRIs: first-line for depression, anxiety, OCD, PTSD; onset 2–4 weeks; common side effects include GI upset, sexual dysfunction, hyponatraemia in elderly.

Serotonin syndrome risk increases with combinations of SSRIs, MAOIs, tramadol, triptans, and linezolid; MAOIs require 14-day washout before/after SSRIs.

Antipsychotic metabolic monitoring: baseline and periodic weight, BMI, waist, blood pressure, fasting glucose/HbA1c, and lipids.

Clozapine: monitor FBC weekly for 18 weeks then fortnightly; contraindicated in previous agranulocytosis; check for myocarditis in first 2 months.

Lithium: narrow therapeutic index; target 0.6–0.8 mmol/L; monitor renal function, thyroid, calcium; toxicity presents with tremor, ataxia, confusion, vomiting.

Benzodiazepines: short-term use only (2–4 weeks) due to tolerance, dependence, and withdrawal; avoid in elderly (falls, confusion).

Antidepressant discontinuation syndrome: dizziness, nausea, flu-like symptoms, paraesthesia; taper gradually, especially paroxetine and venlafaxine.

ECT: indications include severe depression with psychosis, catatonia, and life-threatening food refusal; common side effects are transient memory impairment and headache.

CBT model: thoughts, feelings, and behaviours interact; treatment targets cognitive distortions (catastrophising, all-or-nothing thinking) and behavioural avoidance.

Exposure and response prevention (ERP) is the first-line psychotherapy for OCD; exposure without response prevention is less effective.

Behavioural activation is an evidence-based treatment for depression, focusing on increasing activity and reducing avoidance.

Psychodynamic therapy focuses on unconscious conflict, transference, and defence mechanisms; typically longer-term.

DBT components: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness; indicated for borderline personality disorder and repeated self-harm.

Motivational interviewing: collaborative, non-judgemental approach to resolve ambivalence; uses open questions, affirmation, reflection, summarising (OARS).

Family therapy and psychoeducation reduce relapse in schizophrenia; expressed emotion (criticism, hostility, over-involvement) predicts relapse.

Group therapy is effective for substance use, anxiety, and psychoeducation; screen for suitability and confidentiality limits.

Suicide risk factors: male sex, older age, prior attempt, family history, substance misuse, access to means, hopelessness, social isolation, recent loss, and physical illness.

Protective factors: social support, reasons for living, engagement with services, children at home, and religious/cultural beliefs.

High-risk features: specific plan, available means, intent, agitation, command hallucinations, and recent discharge from hospital.

Immediate management of acute risk: ensure safety, remove means, consider voluntary or involuntary admission, and document risk formulation and plan.

Capacity assessment: the four abilities (understand, retain, weigh, communicate) apply to the specific decision; if capacity is absent, act in best interests per local law.

Confidentiality limits: risk of serious harm to self or others, child protection, and court order; disclose only necessary information.

Emergency sedation: use the least restrictive option; monitor airway, breathing, circulation, and vital signs; follow local rapid tranquillisation protocol.

Professional boundaries: avoid dual relationships, declare conflicts of interest, maintain accurate records, and obtain informed consent for treatment and research.

First-episode psychosis: prompt referral to early intervention services improves outcomes; avoid high-dose antipsychotics in first episode.

Positive symptoms: hallucinations, delusions, disorganised thinking; negative symptoms: flat affect, alogia, avolition, anhedonia, asociality.

Antipsychotic choice: consider side-effect profile (metabolic, extrapyramidal, prolactin, QT) and patient preference; monitor adherence.

Treatment-resistant schizophrenia: failure of ≥2 adequate antipsychotic trials; clozapine is the evidence-based next step.

Relapse prevention: continue antipsychotics for at least 1–2 years after first episode and longer after multiple episodes; psychoeducation reduces relapse.

Catatonia: immobility, mutism, negativism, posturing, waxy flexibility; treat with benzodiazepines (lorazepam challenge) and/or ECT.

Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, elevated CK; stop antipsychotic, supportive care, dantrolene or bromocriptine.

Physical health monitoring in psychosis: cardiovascular risk, metabolic syndrome, smoking, and reduced life expectancy of 15–20 years.

Depression severity: mild (few symptoms, minimal impairment), moderate (between), severe (most symptoms, marked impairment, possible psychosis).

Antidepressant selection: consider prior response, side-effect profile, drug interactions, and comorbidities; SSRIs are usually first-line.

Treatment-resistant depression: inadequate response to ≥2 adequate antidepressant trials; consider augmentation (lithium, atypical antipsychotic), switching, or ECT.

Bipolar disorder: avoid antidepressant monotherapy due to switch/rapid cycling risk; use mood stabilisers (lithium, valproate, lamotrigine) and atypical antipsychotics.

Valproate: teratogenic (neural tube defects); avoid in women of childbearing potential unless pregnancy prevention programme in place.

Perinatal depression: assess risk, consider psychological therapy first in mild-moderate cases; SSRIs (sertraline) are commonly used in breastfeeding.

Depression in older adults: screen for cognitive impairment, medical causes (hypothyroidism, anaemia, medications), and suicide risk.

Seasonal affective disorder: light therapy (10,000 lux for 30 minutes daily) is first-line; SSRIs are an alternative.

Generalised anxiety disorder: excessive worry for ≥6 months, difficult to control, with ≥3 of 6 symptoms (restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance).

Panic disorder treatment: CBT with interoceptive exposure plus SSRIs; avoid benzodiazepines long-term.

OCD: obsessions are intrusive thoughts/images/urges; compulsions are repetitive behaviours/mental acts performed to reduce distress.

PTSD: trauma-focused CBT and EMDR are first-line; SSRIs are first-line medication; avoid benzodiazepines due to risk of dependence and interference with therapy.

Acute stress reaction: symptoms within hours to days of trauma, usually resolve within days; supportive care and watchful waiting.

Adjustment disorder: emotional/behavioural symptoms within 3 months of a stressor, resolving within 6 months of stressor removal.

Social anxiety disorder: CBT with exposure and cognitive restructuring; SSRIs (sertraline, escitalopram) are first-line medication.

Body dysmorphic disorder: preoccupation with perceived defect, repetitive behaviours, poor insight; treat with SSRIs and CBT.

Alcohol dependence: features include tolerance, withdrawal, craving, loss of control, and continued use despite harm.

Alcohol withdrawal: use CIWA-Ar to guide symptom-triggered benzodiazepine dosing; monitor for seizures and delirium tremens.

Opioid overdose: pinpoint pupils, respiratory depression, reduced consciousness; treat with naloxone and supportive care.

Opioid substitution therapy: methadone and buprenorphine reduce mortality and illicit use; buprenorphine has a ceiling effect and lower overdose risk.

Stimulant use disorder: no approved pharmacotherapy; CBT and contingency management are evidence-based.

Cannabis use disorder: CBT and motivational enhancement; withdrawal symptoms include irritability, insomnia, and decreased appetite.

Dual diagnosis: treat both mental illness and substance use concurrently; integrated treatment improves outcomes.

Harm reduction: needle exchange, supervised consumption, and naloxone distribution reduce morbidity and mortality.

Delirium: common in hospitalised elderly; causes include infection, medications, metabolic derangement, hypoxia, and withdrawal; use the CAM for detection.

Dementia assessment: history, cognitive testing (MMSE/MoCA), blood tests (B12, thyroid, folate), and neuroimaging to exclude reversible causes.

Reversible causes of cognitive impairment: depression (pseudodementia), hypothyroidism, B12 deficiency, normal pressure hydrocephalus, chronic subdural haematoma.

Alzheimer's disease: cholinesterase inhibitors for mild-moderate; memantine for moderate-severe; behavioural symptoms managed with non-pharmacological approaches first.

Parkinson's disease dementia: occurs >1 year after motor symptoms; dementia with Lewy bodies: cognitive decline before or within 1 year of parkinsonism.

Huntington's disease: autosomal dominant, chorea, cognitive decline, psychiatric symptoms; genetic counselling is essential.

Consultation-liaison: assess for delirium, depression, capacity, and medication interactions in medically ill patients.

Medically unexplained symptoms: assess for underlying psychiatric disorder, provide continuity of care, and avoid unnecessary investigations.

ADHD assessment: multiple informants (parent, teacher), rating scales (Conners, SNAP-IV), and rule out other causes (hearing, sleep, learning disorders).

Autism assessment: developmental history, ADOS-2, and multidisciplinary evaluation; early intervention improves outcomes.

Childhood depression: assess for irritability, somatic complaints, and school refusal; CBT and family therapy are first-line; fluoxetine is first-line medication.

Anxiety in children: separation anxiety, social anxiety, and generalised anxiety are common; CBT is first-line; SSRIs are second-line.

Eating disorders: anorexia nervosa has the highest mortality of psychiatric disorders; monitor weight, electrolytes, and cardiac status; family-based treatment for adolescents.

Self-harm in adolescents: assess risk, underlying mental illness, and family functioning; safety planning and follow-up are essential.

Child protection: mandatory reporting of suspected abuse or neglect; document findings objectively.

Tics: transient tic disorder <1 year; Tourette syndrome >1 year with motor and vocal tics; CBIT is first-line behavioural treatment.

Antidepressant classes: SSRIs, SNRIs, mirtazapine, bupropion, tricyclics, MAOIs; choose based on side effects and interactions.

Tricyclic antidepressants: anticholinergic side effects, cardiotoxicity in overdose; contraindicated in recent MI and arrhythmias.

MAOIs: dietary restriction of tyramine (cheese, cured meats, fermented foods) to prevent hypertensive crisis; avoid sympathomimetics.

Mood stabilisers: lithium (first-line for bipolar), valproate, lamotrigine (depression prophylaxis), carbamazepine; monitor levels and side effects.

Antipsychotics: typical (haloperidol, chlorpromazine) have higher EPS; atypical (risperidone, olanzapine, quetiapine, aripiprazole) have higher metabolic risk.

QTc prolongation: risk with haloperidol, pimozide, quetiapine, and citalopram; monitor ECG in at-risk patients.

Benzodiazepine withdrawal: taper slowly (e.g., 10–25% every 2 weeks); abrupt cessation risks seizures and delirium.

ECT: safe in pregnancy and elderly; consent and capacity considerations; monitor for cognitive side effects.

CBT: structured, time-limited, collaborative; effective for depression, anxiety, OCD, PTSD, and insomnia.

Psychodynamic psychotherapy: explores unconscious processes, transference, and early relationships; longer-term.

Interpersonal therapy (IPT): focuses on role transitions, grief, disputes, and interpersonal deficits; effective for depression.

DBT: four modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness); for borderline personality disorder.

Motivational interviewing: OARS (open questions, affirmations, reflections, summaries); roll with resistance; support self-efficacy.

Family intervention: psychoeducation, communication skills, and problem-solving; reduces relapse in schizophrenia.

Cognitive remediation: improves cognitive function in schizophrenia; combined with vocational rehabilitation.

Therapeutic alliance: strong alliance predicts better outcomes across therapies; monitor and repair ruptures.

Risk assessment: gather history, current presentation, and collateral; formulate risk (static and dynamic factors) and document management plan.

Suicide risk: ask directly about ideation, plan, intent, and means; assess hopelessness and access to lethal means.

Violence risk: assess history, substance use, psychosis, impulsivity, and access to weapons; use structured tools (HCR-20) where appropriate.

Acute agitation: verbal de-escalation first; if needed, rapid tranquillisation with benzodiazepine and/or antipsychotic; monitor vital signs.

Capacity: assess understanding, retention, weighing, and communication; if lacking, act in best interests under mental health or capacity legislation.

Confidentiality: disclose only with consent or where legally required (risk of serious harm, child protection, court order).

Informed consent: provide information on diagnosis, treatment options, risks, benefits, and alternatives; document discussion.

Professional boundaries: avoid dual relationships, maintain confidentiality, and seek supervision when conflicts arise.

Schizophrenia: positive, negative, and cognitive symptoms; cognitive deficits predict functional outcome.

Antipsychotic adherence: poor adherence is the strongest predictor of relapse; use long-acting injectable antipsychotics when adherence is problematic.

Metabolic syndrome: monitor weight, waist, blood pressure, glucose, and lipids at baseline and periodically; antipsychotics differ in risk.

Hyperprolactinaemia: risperidone and typical antipsychotics raise prolactin; symptoms include galactorrhoea, amenorrhoea, and sexual dysfunction.

Tardive dyskinesia: involuntary movements (oro-facial); monitor with AIMS; treat by reducing or switching antipsychotic; VMAT2 inhibitors (valbenazine) may help.

Post-psychotic depression: common after acute episode; assess and treat; distinguish from negative symptoms.

Stigma and recovery: psychosocial interventions, supported employment, and family involvement improve outcomes.

Physical health: people with schizophrenia have higher rates of smoking, diabetes, and cardiovascular disease; annual physical health check recommended.

Bipolar depression: treat with quetiapine, lurasidone, or lamotrigine; avoid antidepressant monotherapy.

Mixed features: concurrent manic and depressive symptoms; associated with higher suicide risk and poorer response to antidepressants.

Rapid cycling: optimise mood stabiliser, avoid antidepressants, and consider thyroid function.

Lithium: first-line for bipolar maintenance; reduces suicide risk; monitor levels, renal, and thyroid function.

Valproate: effective for mania; avoid in women of childbearing age unless pregnancy prevention; monitor liver function and platelets.

Lamotrigine: effective for bipolar depression prevention; titrate slowly to avoid Stevens-Johnson syndrome.

Perinatal bipolar disorder: high risk of postpartum psychosis; plan pre-conception and monitor closely postpartum.

Depression with psychotic features: antipsychotic plus antidepressant or ECT; ECT is highly effective.

Panic disorder: CBT with interoceptive exposure and cognitive restructuring; SSRIs/SNRIs first-line medication.

GAD: CBT and SSRIs/SNRIs; buspirone is an alternative; benzodiazepines only short-term.

OCD: ERP is first-line psychotherapy; SSRIs at higher doses; clomipramine is an alternative.

PTSD: trauma-focused CBT, EMDR, and SSRIs; avoid benzodiazepines.

Acute stress disorder: symptoms 3 days to 1 month; trauma-focused CBT may prevent PTSD.

Adjustment disorder: symptoms within 3 months of stressor; psychotherapy is first-line.

Social anxiety disorder: CBT with exposure; SSRIs/SNRIs; beta-blockers for performance anxiety.

Body dysmorphic disorder: SSRIs and CBT; often chronic and underdiagnosed.

Alcohol: AUDIT screening; brief intervention for hazardous use; detoxification with benzodiazepines; relapse prevention with acamprosate or naltrexone.

Opioids: methadone and buprenorphine are first-line for opioid use disorder; naltrexone is an alternative.

Nicotine: varenicline, NRT, and bupropion; combine with behavioural support.

Stimulants: CBT and contingency management; no approved pharmacotherapy.

Cannabis: CBT and motivational enhancement; withdrawal symptoms are usually mild.

Benzodiazepines: taper gradually; risk of seizures with abrupt withdrawal.

Dual diagnosis: integrated treatment for mental illness and substance use.

Harm reduction: naloxone distribution, needle exchange, and supervised consumption.

Delirium: acute onset, fluctuating course, inattention; identify and treat cause; avoid restraints; use antipsychotics cautiously.

Dementia: progressive cognitive decline; assess with MMSE/MoCA; exclude reversible causes.

Alzheimer's disease: cholinesterase inhibitors and memantine; behavioural symptoms managed non-pharmacologically first.

Vascular dementia: stepwise decline; manage vascular risk factors.

Lewy body dementia: fluctuating cognition, visual hallucinations, parkinsonism; avoid typical antipsychotics.

Frontotemporal dementia: personality and language changes; manage behaviour with SSRIs and non-pharmacological approaches.

Consultation-liaison: assess capacity, delirium, depression, and medication interactions.

Medically unexplained symptoms: assess for psychiatric disorder; provide continuity and avoid unnecessary tests.

ADHD: stimulants first-line; monitor growth and cardiovascular status; behavioural interventions.

Autism: early intervention, speech and language therapy, and behavioural support; treat comorbid conditions.

Depression: CBT and family therapy first-line; fluoxetine is first-line medication.

Anxiety: CBT first-line; SSRIs second-line.

Eating disorders: family-based treatment for adolescents with anorexia; monitor medical stability.

Self-harm: assess risk and underlying mental illness; safety planning.

Child protection: mandatory reporting; document objectively.

Tics: CBIT first-line; alpha-2 agonists or antipsychotics for severe cases.

SSRIs: first-line for depression and anxiety; onset 2–4 weeks; sexual dysfunction common.

SNRIs: venlafaxine and duloxetine; monitor blood pressure.

Mirtazapine: sedating, weight gain; useful in depression with insomnia.

Bupropion: activating; contraindicated in epilepsy and eating disorders.

Tricyclics: cardiotoxic in overdose; anticholinergic effects.

MAOIs: tyramine restriction; hypertensive crisis.

Lithium: narrow therapeutic index; monitor levels and renal/thyroid function.

Clozapine: treatment-resistant schizophrenia; monitor FBC weekly for 18 weeks.

CBT: effective for depression, anxiety, OCD, PTSD, and insomnia.

Psychodynamic therapy: explores unconscious conflict and transference.

IPT: focuses on role transitions, grief, disputes, and interpersonal deficits.

DBT: for borderline personality disorder and repeated self-harm.

Motivational interviewing: OARS; roll with resistance.

Family intervention: psychoeducation reduces relapse in schizophrenia.

Cognitive remediation: improves cognition in schizophrenia.

Therapeutic alliance: predicts outcome across therapies.

Suicide risk: ask directly; assess plan, intent, means, and protective factors.

Violence risk: history, substance use, psychosis, impulsivity, access to weapons.

Acute agitation: de-escalation first; rapid tranquillisation if needed; monitor vital signs.

Capacity: four abilities; act in best interests if lacking.

Confidentiality: disclose only with consent or legal requirement.

Informed consent: document discussion of risks, benefits, and alternatives.

Professional boundaries: avoid dual relationships; seek supervision.

Emergency detention: follow local mental health legislation; document rationale.

First-episode psychosis: early intervention improves outcomes; avoid high-dose antipsychotics.

Positive symptoms: hallucinations, delusions, disorganised thinking.

Negative symptoms: flat affect, alogia, avolition, anhedonia, asociality.

Treatment-resistant schizophrenia: clozapine after ≥2 failed antipsychotic trials.

Relapse prevention: continue antipsychotics for 1–2 years after first episode.

Catatonia: benzodiazepines and/or ECT.

NMS: rigidity, hyperthermia, autonomic instability, elevated CK; stop antipsychotic.

Physical health: monitor cardiovascular and metabolic risk.

Depression: ≥5 symptoms for ≥2 weeks; SIGECAPS.

Manic episode: ≥1 week; ≥3 symptoms (or ≥4 if irritable).

Hypomania: ≥4 days; no marked impairment.

Bipolar I: ≥1 manic episode; bipolar II: hypomania plus depression.

Rapid cycling: ≥4 episodes in 12 months.

Serotonin syndrome: altered mental status, autonomic instability, clonus.

Lithium: target 0.6–0.8 mmol/L; monitor renal and thyroid.

ECT: for severe depression with psychosis, catatonia, and food refusal.

Panic attack: abrupt surge peaking within minutes; ≥4 symptoms.

Agoraphobia: fear of ≥2 situations due to escape difficulty.

Social anxiety: fear of negative evaluation; ≥6 months.

OCD: obsessions and/or compulsions; >1 hour/day or impairment.

PTSD: trauma exposure plus intrusion, avoidance, negative mood, arousal; >1 month.

Acute stress disorder: 3 days to 1 month post-trauma.

First-line OCD: SSRIs at higher doses plus ERP.

First-line PTSD: trauma-focused CBT or EMDR; SSRIs.