TEP Psiquiatria cheat sheet

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

Formal thought disorder descriptors: derailment (loosening of associations), flight of ideas, thought blocking, neologisms, clang associations, word salad.

Delusions are fixed false beliefs held despite contrary evidence; they are distinguished from overvalued ideas, which retain some doubt.

Capgras syndrome: delusion that a familiar person has been replaced by an identical impostor; reduplicative paramnesia is its spatial analogue.

Erotomania (de Clerambault): delusional belief that another person, usually of higher status, is in love with the patient.

Insight is rated dimensionally: awareness of illness, need for treatment, and attribution of symptoms; poor insight predicts non-adherence.

Diagnostic formulation structure: summary of presentation, differential diagnosis with supporting and refuting evidence, biopsychosocial factors, risk, plan.

Multiaxial DSM models are superseded; DSM-5-TR and ICD-11 use single-axis diagnosis plus specifiers and functional assessment.

Major depressive episode requires at least five of nine symptoms for two weeks, including depressed mood or anhedonia, with functional impairment.

Bipolar I requires at least one manic episode (elevated mood plus increased energy, at least one week or hospitalisation); depression is not required.

Bipolar II requires hypomania (at least four days) plus at least one major depressive episode, with no history of mania.

Mixed features specifier: at least three manic symptoms during depression or at least three depressive symptoms during mania/hypomania.

Rapid cycling: at least four mood episodes in twelve months; more common in women and associated with poorer treatment response.

First-line acute bipolar mania: antipsychotic (e.g., haloperidol, olanzapine, risperidone) with or without lithium or valproate; avoid antidepressant monotherapy.

Lithium monitoring: trough level, renal function, thyroid function, calcium; therapeutic range typically 0.6-0.8 mmol/L maintenance, 0.8-1.0 acute.

Depression with psychotic features requires antidepressant plus antipsychotic, or ECT; antidepressants alone are insufficient.

Panic attack is a discrete surge of fear peaking within minutes with at least four of thirteen symptoms; panic disorder requires recurrent attacks plus one month of worry or behaviour change.

Agoraphobia is fear of situations where escape is difficult; it is diagnosed independently of panic disorder in DSM-5.

Social anxiety disorder: persistent fear of negative evaluation in social situations, typically onset in adolescence, first-line SSRIs and CBT.

OCD requires obsessions and/or compulsions that are time-consuming (over one hour daily) or cause impairment; insight and tic specifiers apply.

First-line OCD treatment: SSRI at higher doses (e.g., fluoxetine, fluvoxamine, sertraline) and exposure and response prevention; clomipramine is second-line.

PTSD requires exposure to trauma plus symptoms in four clusters: intrusion, avoidance, negative cognitions/mood, hyperarousal, lasting over one month.

Acute stress disorder: same trauma exposure, symptoms lasting three days to one month; PTSD requires duration beyond one month.

Trauma-focused CBT and EMDR are first-line psychological treatments for PTSD; SSRIs are first-line pharmacotherapy.

Schizophrenia requires at least two core symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behaviour, negative symptoms) for six months, with one month active.

First-rank (Schneiderian) symptoms: audible thoughts, voices arguing or commenting, thought withdrawal/insertion/broadcast, made feelings, made impulses, made volition, delusional perception.

Brief psychotic disorder lasts at least one day but under one month; schizophreniform disorder lasts one to six months.

Delusional disorder: delusions for at least one month with functioning otherwise preserved and no prominent hallucinations.

Negative symptoms (blunted affect, alogia, avolition, anhedonia, asociality) predict poorer functional outcome more than positive symptoms.

Treatment-resistant schizophrenia: inadequate response to two adequate antipsychotic trials; clozapine is indicated and requires white cell monitoring.

Clozapine monitoring: full blood count weekly for eighteen weeks, then fortnightly to one year, then monthly; stop if neutrophils fall below defined thresholds.

Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, raised creatine kinase; stop antipsychotic and treat supportively with dantrolene or bromocriptine.

DSM-5 substance use disorder combines abuse and dependence into a single continuum with eleven criteria; two or more in twelve months indicate disorder.

Tolerance and withdrawal are physiological criteria; their presence does not by itself define severity, which counts total criteria (mild 2-3, moderate 4-5, severe 6 or more).

Alcohol withdrawal: tremor, sweating, anxiety within hours; seizures at 12-48 hours; delirium tremens at 48-96 hours with confusion and autonomic instability.

Wernicke encephalopathy triad: ophthalmoplegia, ataxia, confusion; treat immediately with parenteral thiamine before glucose to prevent Korsakoff syndrome.

Opioid substitution: methadone and buprenorphine reduce mortality; buprenorphine is a partial agonist with a ceiling effect on respiratory depression.

Alcohol pharmacotherapy: naltrexone reduces craving and relapse; acamprosate supports abstinence; disulfiram requires supervised adherence.

Benzodiazepine withdrawal can cause seizures and psychosis; taper gradually rather than stop abruptly.

Fetal alcohol spectrum disorder: prenatal alcohol exposure with characteristic facial features, growth deficiency and neurodevelopmental impairment.

Delirium: acute onset, fluctuating course, inattention plus disorganized thinking or altered consciousness; commonly hypoactive and missed in older adults.

Delirium causes: infection, medication, withdrawal, metabolic derangement, hypoxia, pain, retention of urine or stool; screen systematically.

Dementia requires progressive cognitive decline sufficient to impair independence, without delirium or another mental disorder explaining it.

Alzheimer disease: insidious episodic memory decline, medial temporal atrophy; acetylcholinesterase inhibitors for mild-moderate, memantine for moderate-severe.

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

Frontotemporal dementia: early personality change or language impairment with relatively preserved memory and visuospatial function.

Vascular dementia: stepwise decline, focal neurological signs, cerebrovascular disease on imaging; risk factor control is central.

Delerium tremens and hepatic encephalopathy are organic causes of psychosis and confusion; always exclude before attributing to primary psychiatric illness.

Typical antipsychotics act on D2 receptors; extrapyramidal side effects are dose-related, and tardive dyskinesia risk rises with duration of exposure.

Clozapine and olanzapine carry the highest metabolic risk (weight gain, diabetes, dyslipidaemia); baseline and periodic monitoring is required.

SSRIs: onset of effect two to four weeks; hyponatraemia, bleeding risk and serotonin syndrome are important adverse effects.

Serotonin syndrome triad: altered mental state, autonomic instability, neuromuscular hyperactivity (clonus, hyperreflexia); stop serotonergic drugs and give supportive care.

Lithium toxicity features: coarse tremor, ataxia, vomiting, confusion, seizures; risk increased by dehydration, NSAIDs, ACE inhibitors and thiazides.

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

ECT adverse effects: transient anterograde and retrograde amnesia; pre-treatment assessment includes anaesthetic risk and cognitive baseline.

Tardive dyskinesia management: consider switching to clozapine; VMAT2 inhibitors (valbenazine, deutetrabenazine) are evidence-based treatments.

CBT targets the link between thoughts, emotions and behaviour; effective for depression, anxiety disorders, OCD and insomnia.

Behavioural activation is a structured, evidence-based treatment for depression delivered by trained staff with comparable efficacy to CBT.

Psychodynamic psychotherapy focuses on unconscious conflict, transference and defence mechanisms; longer-term forms are used for personality difficulties.

DBT for borderline personality disorder combines individual therapy, skills group, phone coaching and therapist consultation team.

Motivational interviewing uses open questions, affirmation, reflection and summarization to build intrinsic motivation for change.

Family interventions reduce relapse in schizophrenia; psychoeducation plus communication skills training is recommended.

Mentalization-based treatment targets unstable sense of self and interpersonal difficulties in borderline personality disorder.

Therapeutic alliance is a consistent predictor of psychotherapy outcome across modalities.

ADHD requires symptoms before age twelve, in at least two settings, causing impairment; first-line treatment is stimulant medication plus behavioural interventions.

Autism spectrum disorder: persistent deficits in social communication plus restricted, repetitive behaviours, with onset in early development.

Separation anxiety disorder is the most common childhood anxiety disorder; school refusal is a frequent presentation.

Conduct disorder involves violation of rights of others or major norms; callous-unemotional traits predict more severe, persistent course.

Tourette syndrome: multiple motor tics plus at least one vocal tic for over one year; comorbid ADHD and OCD are common.

Anorexia nervosa has the highest mortality of psychiatric disorders; refeeding syndrome risk requires cautious reintroduction and electrolyte monitoring.

Adolescent depression: fluoxetine is the best-evidenced SSRI; combine with psychological therapy and monitor for suicidality.

Child protection: safeguarding concerns require reporting to statutory services; confidentiality is limited when a child is at risk.

Fitness to plead requires understanding the charge, the plea, the trial process and the ability to instruct counsel and challenge jurors.

McNaughton rules: not guilty by reason of insanity if a defect of reason from disease of mind prevented knowing the nature of the act or that it was wrong.

Duty to warn or protect identifiable third parties at risk from a patient may override confidentiality depending on jurisdiction.

Capacity assessment (four abilities): understand, retain, weigh and communicate information relevant to the decision.

Involuntary detention requires mental disorder plus risk to self or others or serious deterioration, with proportionate and least restrictive care.

Confidentiality may be breached with consent, in the public interest, by statute or court order; disclose the minimum necessary.

Assisted dying and euthanasia requests require assessment of decision-making capacity and treatable depression before any action.

Advance statements and directives should be considered in treatment planning, especially for patients with relapsing illness.

Deliberate self-harm assessment: establish intent, lethality, precipitants, psychiatric history, social support and future risk; treat physical needs first.

Suicide risk factors: male sex, older age, previous attempt, psychiatric illness, substance misuse, isolation, access to lethal means.

Acute agitation: verbal de-escalation first; if medication needed, use oral or intramuscular benzodiazepine or antipsychotic, monitoring for sedation and respiratory depression.

Excited delirium or severe agitation requires urgent medical assessment; restraints must be used with monitoring and clear documentation.

Medically unexplained symptoms: assess for depression, anxiety and somatization; avoid premature reassurance and unnecessary investigations.

Post-partum psychosis is a psychiatric emergency, typically within two weeks of delivery, with high risk of harm to infant and mother.

Serotonin syndrome and neuroleptic malignant syndrome are medical emergencies that may present to liaison services with agitation or confusion.

Capacity in the emergency department: a patient with delirium or intoxication may lack capacity; reassess when the acute state resolves.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence; a highly specific test is useful for ruling in, a highly sensitive test for ruling out.

Number needed to treat = 1 / absolute risk reduction; number needed to harm = 1 / absolute risk increase.

Randomised controlled trials reduce confounding by random allocation; intention-to-treat analysis preserves randomisation benefits.

Odds ratio approximates relative risk when the outcome is rare; cohort studies yield relative risk directly.

Publication bias and selective outcome reporting inflate apparent treatment effects; funnel plots and trial registration help detect them.

Confidence intervals convey precision; a result is statistically significant if the interval excludes the null value.

Systematic reviews with meta-analysis sit at the top of the evidence hierarchy for treatment questions.

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

Formal thought disorder descriptors: derailment, flight of ideas, thought blocking, neologisms, clang associations, word salad.

Delusions are fixed false beliefs held despite contrary evidence; overvalued ideas retain some doubt.

Capgras syndrome: delusion that a familiar person has been replaced by an identical impostor.

Erotomania (de Clerambault): delusional belief that another person, usually of higher status, is in love with the patient.

Insight is rated dimensionally: awareness of illness, need for treatment, attribution of symptoms; poor insight predicts non-adherence.

Formulation structure: summary, differential with supporting and refuting evidence, biopsychosocial factors, risk, plan.

DSM-5-TR and ICD-11 use single-axis diagnosis plus specifiers and functional assessment.

Major depressive episode: at least five of nine symptoms for two weeks, including depressed mood or anhedonia, with impairment.

Bipolar I requires at least one manic episode (elevated mood plus increased energy, at least one week or hospitalisation).

Bipolar II requires hypomania (at least four days) plus at least one major depressive episode, with no history of mania.

Mixed features specifier: at least three manic symptoms during depression or at least three depressive symptoms during mania/hypomania.

Rapid cycling: at least four mood episodes in twelve months; more common in women and associated with poorer treatment response.

Acute mania first-line: antipsychotic with or without lithium or valproate; avoid antidepressant monotherapy.

Lithium monitoring: trough level, renal and thyroid function, calcium; maintenance range typically 0.6-0.8 mmol/L.

Depression with psychotic features requires antidepressant plus antipsychotic, or ECT.

Panic attack is a discrete surge of fear peaking within minutes with at least four of thirteen symptoms; panic disorder adds one month of worry or behaviour change.

Agoraphobia is fear of situations where escape is difficult; in DSM-5 it is diagnosed independently of panic disorder.

Social anxiety disorder: persistent fear of negative evaluation, typically adolescent onset; first-line SSRIs and CBT.

OCD requires obsessions and/or compulsions that are time-consuming (over one hour daily) or cause impairment.

First-line OCD treatment: SSRI at higher doses plus exposure and response prevention; clomipramine is second-line.

PTSD requires trauma exposure plus intrusion, avoidance, negative cognitions/mood and hyperarousal lasting over one month.

Acute stress disorder: symptoms lasting three days to one month; PTSD requires duration beyond one month.

Trauma-focused CBT and EMDR are first-line psychological treatments for PTSD; SSRIs are first-line pharmacotherapy.

Schizophrenia requires at least two core symptoms for six months, with one month active, including delusions, hallucinations, disorganized speech or behaviour, or negative symptoms.

First-rank symptoms: audible thoughts, voices arguing or commenting, thought withdrawal/insertion/broadcast, made feelings, made impulses, made volition, delusional perception.

Brief psychotic disorder lasts at least one day but under one month; schizophreniform disorder lasts one to six months.

Delusional disorder: delusions for at least one month with functioning otherwise preserved and no prominent hallucinations.

Negative symptoms (blunted affect, alogia, avolition, anhedonia, asociality) predict poorer functional outcome than positive symptoms.

Treatment-resistant schizophrenia: inadequate response to two adequate antipsychotic trials; clozapine is indicated.

Clozapine monitoring: full blood count weekly for eighteen weeks, then fortnightly to one year, then monthly.

Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, raised creatine kinase; stop antipsychotic and treat supportively.

DSM-5 substance use disorder combines abuse and dependence into one continuum of eleven criteria; two or more in twelve months indicate disorder.

Severity counts total criteria: mild 2-3, moderate 4-5, severe 6 or more; tolerance and withdrawal are only two of the criteria.

Alcohol withdrawal: tremor and sweating within hours; seizures at 12-48 hours; delirium tremens at 48-96 hours with confusion and autonomic instability.

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

Opioid substitution: methadone and buprenorphine reduce mortality; buprenorphine is a partial agonist with a ceiling effect.

Alcohol pharmacotherapy: naltrexone reduces craving and relapse; acamprosate supports abstinence; disulfiram requires supervision.

Benzodiazepine withdrawal can cause seizures and psychosis; taper gradually rather than stop abruptly.

Fetal alcohol spectrum disorder: prenatal alcohol exposure with facial features, growth deficiency and neurodevelopmental impairment.

Delirium: acute onset, fluctuating course, inattention plus disorganized thinking or altered consciousness; hypoactive delirium is commonly missed.

Delirium causes: infection, medication, withdrawal, metabolic derangement, hypoxia, pain, urinary retention, constipation.

Dementia requires progressive cognitive decline sufficient to impair independence, not explained by delirium or another mental disorder.

Alzheimer disease: insidious episodic memory decline, medial temporal atrophy; cholinesterase inhibitors for mild-moderate, memantine for moderate-severe.

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

Frontotemporal dementia: early personality change or language impairment with relatively preserved memory and visuospatial function.

Vascular dementia: stepwise decline, focal neurological signs, cerebrovascular disease on imaging; risk factor control is central.

Always exclude organic causes such as hepatic encephalopathy before attributing confusion or psychosis to primary psychiatric illness.

Typical antipsychotics act on D2 receptors; extrapyramidal side effects are dose-related, and tardive dyskinesia risk rises with exposure duration.

Clozapine and olanzapine carry the highest metabolic risk; baseline and periodic weight, glucose and lipid monitoring is required.

SSRIs: onset of effect two to four weeks; hyponatraemia, bleeding risk and serotonin syndrome are important adverse effects.

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

Lithium toxicity features: coarse tremor, ataxia, vomiting, confusion, seizures; risk increased by dehydration, NSAIDs, ACE inhibitors, thiazides.

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

ECT adverse effects: transient anterograde and retrograde amnesia; pre-treatment assessment includes anaesthetic risk and cognitive baseline.

Tardive dyskinesia management: consider switching to clozapine; VMAT2 inhibitors (valbenazine, deutetrabenazine) are evidence-based.

CBT targets the link between thoughts, emotions and behaviour; effective for depression, anxiety disorders, OCD and insomnia.

Behavioural activation is a structured, evidence-based treatment for depression with efficacy comparable to CBT.

Psychodynamic psychotherapy focuses on unconscious conflict, transference and defence mechanisms; longer-term forms are used for personality difficulties.

DBT for borderline personality disorder combines individual therapy, skills group, phone coaching and therapist consultation team.

Motivational interviewing uses open questions, affirmation, reflection and summarization to build intrinsic motivation for change.

Family interventions reduce relapse in schizophrenia; psychoeducation plus communication skills training is recommended.

Mentalization-based treatment targets unstable sense of self and interpersonal difficulties in borderline personality disorder.

Therapeutic alliance is a consistent predictor of psychotherapy outcome across modalities.

ADHD requires symptoms before age twelve, in at least two settings, causing impairment; first-line treatment is stimulant medication plus behavioural intervention.

Autism spectrum disorder: persistent deficits in social communication plus restricted, repetitive behaviours, with onset in early development.

Separation anxiety disorder is the most common childhood anxiety disorder; school refusal is a frequent presentation.

Conduct disorder involves violation of rights of others or major norms; callous-unemotional traits predict a more severe, persistent course.

Tourette syndrome: multiple motor tics plus at least one vocal tic for over one year; comorbid ADHD and OCD are common.

Anorexia nervosa has the highest mortality of psychiatric disorders; refeeding syndrome risk requires cautious reintroduction and electrolyte monitoring.

Adolescent depression: fluoxetine is the best-evidenced SSRI; combine with psychological therapy and monitor for suicidality.

Safeguarding concerns require reporting to statutory services; confidentiality is limited when a child is at risk.

Fitness to plead requires understanding the charge, the plea, the trial process and the ability to instruct counsel and challenge jurors.

McNaughton rules: not guilty by reason of insanity if a defect of reason from disease of mind prevented knowing the nature of the act or that it was wrong.

Duty to warn or protect identifiable third parties at risk may override confidentiality depending on jurisdiction.

Capacity assessment (four abilities): understand, retain, weigh and communicate information relevant to the decision.

Involuntary detention requires mental disorder plus risk to self or others or serious deterioration, with proportionate and least restrictive care.

Confidentiality may be breached with consent, in the public interest, by statute or court order; disclose the minimum necessary.

Requests for assisted dying require assessment of decision-making capacity and treatable depression before any action.

Advance statements and directives should be considered in treatment planning, especially for patients with relapsing illness.

Deliberate self-harm assessment: establish intent, lethality, precipitants, psychiatric history, social support and future risk; treat physical needs first.

Suicide risk factors: male sex, older age, previous attempt, psychiatric illness, substance misuse, isolation, access to lethal means.

Acute agitation: verbal de-escalation first; if medication is needed, use oral or intramuscular benzodiazepine or antipsychotic with monitoring.

Severe agitation requires urgent medical assessment; restraints must be used with monitoring and clear documentation.

Medically unexplained symptoms: assess for depression, anxiety and somatization; avoid premature reassurance and unnecessary investigations.

Post-partum psychosis is a psychiatric emergency, typically within two weeks of delivery, with high risk of harm to infant and mother.

Serotonin syndrome and neuroleptic malignant syndrome are medical emergencies that may present with agitation or confusion.

Capacity in the emergency department: a patient with delirium or intoxication may lack capacity; reassess when the acute state resolves.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence; a highly specific test is useful for ruling in, a highly sensitive test for ruling out.

Number needed to treat = 1 / absolute risk reduction; number needed to harm = 1 / absolute risk increase.

Randomised controlled trials reduce confounding by random allocation; intention-to-treat analysis preserves randomisation benefits.

Odds ratio approximates relative risk when the outcome is rare; cohort studies yield relative risk directly.

Publication bias and selective outcome reporting inflate apparent treatment effects; funnel plots and trial registration help detect them.

Confidence intervals convey precision; a result is statistically significant if the interval excludes the null value.

Systematic reviews with meta-analysis sit at the top of the evidence hierarchy for treatment questions.