Egyptian Board Psychiatry cheat sheet

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

Formal thought disorder descriptors: derailment (loosening of associations), flight of ideas, thought blocking, neologism, clang association, perseveration, circumstantiality vs tangentiality.

Kraepelinian dichotomy: dementia praecox (deteriorating course) vs manic-depressive illness (episodic, remitting); Schneiderian first-rank symptoms are not pathognomonic of schizophrenia.

Cognitive screening: MMSE maximum 30 (≤23 suggests impairment, education-adjusted); MoCA maximum 30 (≤25 abnormal) and is more sensitive to mild cognitive impairment and executive dysfunction.

Clock-drawing tests visuospatial and executive function; the Mini-Cog combines 3-word recall with clock drawing and is validated for dementia screening in low-literacy populations.

Delirium is diagnosed by acute onset, fluctuating course, inattention plus either disorganized thinking or altered level of consciousness; the 4AT and CAM are brief validated instruments.

Premorbid IQ estimation: National Adult Reading Test (NART) and its revisions (NART-R, AMNART) use irregular-word reading, relatively preserved in dementia.

Capacity (four abilities): understand relevant information, appreciate its significance, reason about options, and communicate a choice; capacity is decision-specific.

Clozapine: ~1% risk of agranulocytosis; mandatory FBC monitoring (weekly for 18 weeks, then fortnightly to 1 year, then monthly); also risk of myocarditis (first 2 months), seizures (dose-related, >600 mg/day), constipation/ileus, and hypersalivation.

Antipsychotic potency and adverse effects: high-potency (haloperidol, fluphenazine) → more extrapyramidal symptoms; low-potency (chlorpromazine, thioridazine) → more sedation, anticholinergic effect, orthostasis, QT prolongation.

Lithium: therapeutic range 0.6–0.8 mmol/L (maintenance), toxicity >1.5; monitor levels 5 days after initiation or dose change, plus renal function, thyroid, calcium; avoid NSAIDs, thiazides, ACE inhibitors.

SSRIs and hyponatraemia/SIADH, especially in older adults; serotonin syndrome (clonus, hyperreflexia, agitation, hyperthermia) from serotonergic combinations including MAOIs, tramadol, linezolid.

MAOIs: irreversible (phenelzine, tranylcypromine) require 2-week washout before starting and 2 weeks after stopping; avoid tyramine-rich foods (aged cheese, cured meats, tap beer, soy) to prevent hypertensive crisis.

Tricyclics: overdose causes sodium-channel blockade → QRS widening, arrhythmia, seizures; sodium bicarbonate is the antidote; contraindicated in recent MI and narrow-angle glaucoma.

Benzodiazepines: GABA-A positive allosteric modulators; flumazenil reverses but risks seizures in dependent patients; avoid long-term use in older adults (falls, confusion).

ECT: indications include severe/psychotic depression, catatonia, treatment-resistant mania, and life-threatening conditions in pregnancy; usual course 6–12 sessions, 2–3 per week; cognitive side effects transient (retrograde amnesia).

CBT model: thoughts, feelings, behaviours interact; treatment targets cognitive distortions (catastrophizing, mind-reading, overgeneralization) via behavioural experiments and cognitive restructuring.

Exposure and response prevention (ERP) is the first-line psychological treatment for OCD; exposure must be graded and prolonged, response prevention blocks ritualizing.

Behavioural activation for depression targets avoidance and increases engagement in reinforcing activities; comparable efficacy to CBT for mild-moderate depression.

Psychodynamic psychotherapy focuses on transference, countertransference, defence mechanisms, and repetition compulsion; interpretative work is central.

Motivational interviewing: four processes (engaging, focusing, evoking, planning); OARS skills (open questions, affirmations, reflections, summaries); avoids confrontation.

Family interventions in schizophrenia reduce relapse: psychoeducation, communication training, problem-solving, and crisis planning, typically ≥10 sessions over 6–9 months.

Dialectical behaviour therapy for borderline personality disorder: individual therapy plus skills group (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) and phone coaching.

Group therapy therapeutic factors (Yalom): universality, altruism, instillation of hope, corrective recapitulation, imitative behaviour, interpersonal learning, catharsis, cohesiveness.

Major depressive episode: ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia, plus sleep, appetite, energy, concentration, psychomotor, guilt/worthlessness, and suicidal ideation.

Manic episode: elevated/irritable mood with increased energy for ≥1 week (or any duration if hospitalized), plus ≥3 of grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, risky behaviour.

Hypomania: same symptom criteria but ≥4 days, no marked functional impairment, no psychosis, not requiring hospitalization.

Bipolar I requires at least one manic episode; bipolar II requires hypomania plus major depression and no mania; cyclothymia is ≥2 years of subthreshold hypomanic and depressive symptoms.

Mixed features specifier: ≥3 manic symptoms during depression (or vice versa) nearly every day; associated with higher suicide risk and poorer response to antidepressants.

Treatment: lithium or valproate for acute mania; lithium, lamotrigine, or atypical antipsychotics for maintenance; antidepressant monotherapy is avoided in bipolar disorder due to switch risk.

Peripartum depression: onset within 4 weeks postpartum per DSM-5-TR; Edinburgh Postnatal Depression Scale (EPDS) score ≥13 suggests probable depression; screen at antenatal and postnatal visits.

Seasonal pattern: depressive episodes in autumn/winter with remission in spring/summer; light therapy (10,000 lux, 30 minutes in the morning) is first-line.

Schizophrenia (DSM-5-TR): ≥2 of delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behaviour, negative symptoms; ≥1 must be from first three; continuous disturbance ≥6 months with ≥1 month active symptoms.

Duration thresholds: brief psychotic disorder 1 day–1 month; schizophreniform disorder 1–6 months; schizophrenia ≥6 months; schizoaffective disorder requires delusions/hallucinations for ≥2 weeks in the absence of mood symptoms.

Positive symptoms respond better to antipsychotics; negative symptoms (avolition, alogia, anhedonia, affective flattening) and cognitive impairment predict poorer functional outcome.

First-episode psychosis: start low-dose second-generation antipsychotic, monitor metabolic parameters (weight, BMI, waist, fasting glucose, lipids) at baseline and periodically.

Treatment-resistant schizophrenia: inadequate response to ≥2 antipsychotics at adequate dose and duration; clozapine is indicated and reduces suicide risk and hospitalization.

Suicide risk in schizophrenia: ~5–10% lifetime; highest in young males, early illness, comorbid depression, recent discharge; command hallucinations alone are not the strongest predictor.

Catatonia: ≥3 of stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, echopraxia; treat with benzodiazepines and/or ECT.

Late-onset schizophrenia (after 40) has more prominent hallucinations and fewer negative symptoms; very-late-onset (after 60) is associated with sensory impairment and higher female proportion.

Panic attack: abrupt surge peaking within minutes with ≥4 of palpitations, sweating, trembling, dyspnea, choking, chest pain, nausea, dizziness, derealization, fear of dying, paresthesias, chills/heat.

Panic disorder requires recurrent unexpected attacks plus ≥1 month of worry about further attacks or maladaptive behaviour change; agoraphobia is diagnosed separately.

Generalized anxiety disorder: excessive worry ≥6 months, ≥3 of restlessness, fatigability, concentration difficulty, irritability, muscle tension, sleep disturbance.

Social anxiety disorder: fear of negative evaluation in social situations, typically performance or interaction subtype; first-line is CBT with exposure plus SSRI.

OCD: obsessions and/or compulsions that are time-consuming (>1 hour/day) or cause distress; insight specifiers (good/fair, poor, absent/delusional) and tic-related specifier in DSM-5-TR.

Body dysmorphic disorder is in the OCD spectrum: preoccupation with perceived appearance defects plus repetitive behaviours, with poor or absent insight in a large proportion.

PTSD (DSM-5-TR): exposure to actual/threatened death, serious injury, or sexual violence plus ≥1 intrusion, ≥1 avoidance, ≥2 negative cognition/mood, ≥2 arousal/reactivity symptoms, lasting >1 month.

Acute stress disorder: 3 days to 1 month after trauma with ≥9 of 14 dissociative, intrusion, avoidance, and arousal symptoms; trauma-focused CBT is first-line; debriefing is not recommended.

DSM-5-TR substance use disorder: ≥2 of 11 criteria in 12 months (impaired control, social impairment, risky use, pharmacological criteria); severity 2–3 mild, 4–5 moderate, ≥6 severe.

Tolerance and withdrawal do not count toward sedative, hypnotic, or anxiolytic use disorder when taken as prescribed; they do count for other substances.

Alcohol withdrawal timeline: tremor/anxiety 6–24 h, seizures 12–48 h, delirium tremens 48–96 h; treat with benzodiazepines (chlordiazepoxide or diazepam) using symptom-triggered CIWA-Ar.

Wernicke encephalopathy: ophthalmoplegia, ataxia, confusion; give parenteral thiamine before glucose to prevent precipitation; untreated can progress to Korsakoff syndrome.

Opioid use disorder: buprenorphine (partial agonist, ceiling effect, precipitated withdrawal risk) and methadone (full agonist, requires licensed clinic) reduce mortality; naloxone reverses overdose.

Nicotine: varenicline and combination NRT are first-line; varenicline is more effective than single NRT; bupropion is an alternative.

Cannabis: highest prevalence of use disorder among illicit substances worldwide; heavy use in adolescence is associated with earlier-onset psychosis and cognitive impairment.

Screening tools: AUDIT (alcohol), CAGE (4 items), DAST, and ASSIST; brief intervention (5–15 minutes) is effective for hazardous drinking.

ADHD (DSM-5-TR): ≥6 symptoms of inattention and/or hyperactivity-impulsivity for ≥6 months, present before age 12, in ≥2 settings; ≥5 symptoms required for age ≥17.

Autism spectrum disorder: deficits in social communication/interaction plus restricted, repetitive behaviours; language delay is not required in DSM-5; screen with M-CHAT at 18 and 24 months.

Intellectual disability: deficits in intellectual and adaptive functioning with onset during the developmental period; severity defined by adaptive, not IQ, level.

Separation anxiety disorder is the most common anxiety disorder of childhood; school refusal, somatic complaints, and clinging are typical; CBT with parental involvement is first-line.

Conduct disorder: repetitive violation of rights of others or major norms; callous-unemotional specifier (lack of remorse, empathy) predicts worse prognosis.

Enuresis: primary if never achieved continence; alarm therapy and desmopressin are first-line; secondary enuresis warrants medical and psychosocial assessment.

Eating disorders: anorexia nervosa has the highest mortality of any psychiatric disorder; refeeding syndrome risk (hypophosphataemia) with rapid reintroduction of calories.

Child maltreatment indicators: unexplained injuries in non-mobile infants, inconsistent history, delay in seeking care, and behavioural changes; mandatory reporting duties apply.

Dementia prevalence roughly doubles every 5 years after age 65; Alzheimer disease accounts for 60–70% of cases, followed by vascular dementia and Lewy body dementia.

Alzheimer disease: insidious episodic memory loss progressing to language, visuospatial, and executive dysfunction; acetylcholinesterase inhibitors for mild-moderate, memantine for moderate-severe.

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

Frontotemporal dementia: early personality change, disinhibition, or language impairment with relative preservation of memory and visuospatial skills; onset often before age 65.

Delirium vs dementia: delirium has acute onset, fluctuating course, and impaired attention; dementia has insidious onset and preserved attention until late.

Pseudodementia: depression presenting with cognitive complaints; patients often highlight deficits and give 'don't know' answers, unlike dementia patients who confabulate.

Older adults: start psychotropics at half the adult dose; avoid benzodiazepines, anticholinergics, and long-acting sulfonylureas per Beers criteria.

Elder abuse: physical, psychological, financial, sexual, neglect; screen when there are unexplained injuries, malnutrition, or sudden financial changes; mandatory reporting applies.

Delirium workup: full blood count, electrolytes, glucose, renal and liver function, calcium, thyroid, urinalysis, ECG, chest X-ray, blood gas; treat the underlying cause.

Serotonin syndrome (Hunter criteria): clonus plus agitation or diaphoresis, or ocular clonus plus agitation, or tremor plus hyperreflexia; stop serotonergic agents, supportive care, cyproheptadine in severe cases.

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

Acute agitation: verbal de-escalation first; if needed, short-acting IM antipsychotic (haloperidol ± benzodiazepine) or oral olanzapine; monitor for QT and dystonia.

Suicide risk assessment: highest risk in older males, prior attempts, family history, access to lethal means, recent loss, and recent discharge from inpatient care.

Capacity assessment in the emergency setting: assess understanding, appreciation, reasoning, and expression of choice for the specific decision; delirium and intoxication impair capacity.

Medically unexplained symptoms and functional neurological disorder: diagnosis is positive (inconsistency, distractibility) not merely exclusionary; avoid unnecessary investigations.

Postpartum psychosis is a psychiatric emergency: onset typically within 2 weeks of delivery, risk of infanticide and suicide; requires inpatient care and antipsychotic treatment.

Four principles of biomedical ethics: autonomy, beneficence, non-maleficence, justice; confidentiality may be breached when there is serious risk to others (Tarasoff-type duty to protect).

Informed consent requires capacity, adequate information, and voluntariness; documentation must record the discussion, alternatives, and the patient's decision.

Fitness to stand trial: ability to understand the proceedings and assist counsel; insanity defence (M'Naghten) concerns whether the accused knew the nature/wrongfulness of the act.

Involuntary admission criteria typically include mental disorder, risk to self or others, and refusal or inability to consent; periodic review by an independent body is required.

Restraint and seclusion: use only as a last resort, for the shortest time, with monitoring of vital signs, hydration, and circulation; document indication and review.

Duty to warn/protect: when a patient makes a credible threat to an identifiable person, confidentiality may be breached to warn the victim and notify authorities.

Physician-assisted death and euthanasia: legal status varies by jurisdiction; assess capacity, voluntariness, and treatable depression before any decision.

Child and elder abuse reporting: mandatory in most jurisdictions; reporting duties may override confidentiality, and the duty is to report suspicion, not confirmed abuse.

Incidence = new cases per population at risk per time; prevalence = all existing cases at a point (point) or over a period; prevalence ≈ incidence × duration for stable disease.

Relative risk = risk in exposed / risk in unexposed; attributable risk = risk in exposed − risk in unexposed; odds ratio approximates RR when the outcome is rare.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); PPV depends on prevalence.

Screening tests require high sensitivity; confirmatory tests require high specificity; a test with 99% specificity still has low PPV when prevalence is low.

Randomized controlled trial is the design of choice for treatment efficacy; cohort studies estimate incidence and natural history; case-control studies are efficient for rare outcomes.

Community mental health: assertive community treatment (ACT) reduces hospitalization for people with severe mental illness; early intervention services for first-episode psychosis improve outcomes.

Mental Health Gap Action Programme (mhGAP) targets low- and middle-income countries with task-shifting to non-specialist health workers for depression, psychosis, epilepsy, and substance use.

Stigma reduction: contact-based interventions (direct interaction with people with lived experience) are more effective than education alone.

Incidence = new cases per population at risk per time; prevalence = all existing cases at a point (point) or over a period; prevalence ≈ incidence × duration for stable disease.

Relative risk = risk in exposed / risk in unexposed; attributable risk = risk in exposed − risk in unexposed; odds ratio approximates RR when the outcome is rare.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); PPV depends on prevalence.

Screening tests require high sensitivity; confirmatory tests require high specificity; a test with 99% specificity still has low PPV when prevalence is low.

Randomized controlled trial is the design of choice for treatment efficacy; cohort studies estimate incidence and natural history; case-control studies are efficient for rare outcomes.

Community mental health: assertive community treatment (ACT) reduces hospitalization for people with severe mental illness; early intervention services for first-episode psychosis improve outcomes.

Mental Health Gap Action Programme (mhGAP) targets low- and middle-income countries with task-shifting to non-specialist health workers for depression, psychosis, epilepsy, and substance use.

Stigma reduction: contact-based interventions (direct interaction with people with lived experience) are more effective than education alone.