Iraqi Board Psychiatry flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Mesolimbic pathway

Dopamine projection from the ventral tegmental area to the nucleus accumbens and limbic structures; overactivity is linked to positive psychotic symptoms and is the target of antipsychotic D2 blockade.

Tuberoinfundibular pathway

Dopamine neurons from the arcuate nucleus to the pituitary stalk; dopamine inhibits prolactin release, so D2 blockade by antipsychotics causes hyperprolactinaemia with galactorrhoea, amenorrhoea and sexual dysfunction.

CYP1A2 and smoking

Tobacco smoke induces CYP1A2, lowering plasma levels of clozapine and olanzapine; smoking cessation raises levels and can cause toxicity, so doses may need reduction and levels should be checked.

Thought broadcasting

A Schneiderian first-rank symptom in which the patient believes their thoughts are accessible to others, for example being transmitted by radio or read directly; it supports a diagnosis of schizophrenia.

Capgras syndrome

Delusion that a familiar person has been replaced by an identical imposter; associated with schizophrenia, Lewy body dementia and right hemisphere lesions, and distinct from Fregoli and Cotard syndromes.

Circumstantiality versus tangentiality

Circumstantiality is over-inclusive speech that eventually reaches the point; tangentiality drifts to unrelated topics and never answers the question. Both are disorders of thought form, not content.

Schizoaffective disorder criteria

A mood episode occurs concurrently with psychosis, plus at least two weeks of delusions or hallucinations without mood symptoms; mood episodes predominate over the lifetime course.

Schizophreniform disorder duration

The same symptom criteria as schizophrenia but lasting at least one month and less than six months, with full return to functioning; beyond six months the diagnosis becomes schizophrenia.

Delusional disorder

At least one month of non-bizarre delusions with functioning otherwise preserved and no prominent hallucinations; subtypes include erotomanic, grandiose, jealous, persecutory and somatic.

Treatment gap

The proportion of people with a mental disorder who receive no treatment; it exceeds 75% in many low- and middle-income countries and is worsened by stigma and workforce shortages.

Idioms of distress

Culturally shaped ways of expressing suffering, such as somatic complaints, jinn attribution or religious language; they should be understood within the person's culture rather than automatically labelled delusional.

Positive predictive value

The probability that a person with a positive screening test truly has the disorder; unlike sensitivity and specificity, it rises as prevalence rises, so screening in low-prevalence groups yields many false positives.

Serotonin syndrome

A toxidrome of altered mental state, autonomic instability and neuromuscular hyperactivity with clonus and hyperreflexia, caused by serotonergic excess; stop the offending drugs and give supportive care.

Lithium maintenance target

Serum trough concentration of 0.6-0.8 mmol/L for maintenance and 0.8-1.0 mmol/L for acute mania; levels are checked five days after dose changes and every 3-6 months thereafter.

Rapid cycling bipolar disorder

At least four mood episodes within twelve months; more common in women and hypothyroidism, and managed by optimising mood stabilisers, checking thyroid function and avoiding antidepressants.

Clozapine blood monitoring

Full blood count at baseline and weekly for 18 weeks, then fortnightly to one year, then monthly; clozapine is stopped if neutrophils fall below 1.0 x 10^9/L.

Neuroleptic malignant syndrome

A life-threatening reaction to dopamine antagonists with lead-pipe rigidity, hyperthermia, autonomic instability, altered consciousness and raised creatine kinase; stop the drug and give dantrolene or bromocriptine.

Catatonia

A psychomotor syndrome of stupor, mutism, negativism, posturing and waxy flexibility; a lorazepam challenge is diagnostic and therapeutic, and ECT is used if refractory.

Exposure and response prevention

The first-line psychological treatment for obsessive-compulsive disorder; the patient is exposed to obsessional triggers while refraining from compulsions, allowing anxiety to habituate.

Acute stress disorder

Trauma-related symptoms lasting from three days to one month after the event; if symptoms persist beyond one month, the diagnosis changes to post-traumatic stress disorder.

Dissociative fugue

Purposeful travel or bewildered wandering away from home with amnesia for identity or personal history, often following psychological trauma; recovery is usually spontaneous.

CIWA-Ar

The Clinical Institute Withdrawal Assessment for Alcohol, revised; a ten-item scale guiding symptom-triggered benzodiazepine dosing in alcohol withdrawal and monitoring for delirium tremens.

Wernicke encephalopathy

A thiamine deficiency syndrome of ophthalmoplegia, ataxia and confusion, common in alcohol use disorder; treat immediately with parenteral thiamine before glucose to prevent Korsakoff syndrome.

Buprenorphine

A partial mu-opioid agonist used for opioid maintenance therapy; its ceiling effect makes overdose respiratory depression less likely, and it can precipitate withdrawal if given too soon after a full agonist.

Autism spectrum disorder

Persistent deficits in social communication and interaction plus restricted, repetitive behaviours and interests, present early in development and causing impairment; severity is graded by support needs.

Intellectual disability severity

Graded as mild, moderate, severe or profound on the basis of adaptive functioning in conceptual, social and practical domains, not on the IQ score alone.

Dementia with Lewy bodies

A neurodegenerative dementia with fluctuating cognition, visual hallucinations, parkinsonism and REM sleep behaviour disorder; patients are highly sensitive to antipsychotics, so these are avoided.

Delirium

An acute, fluctuating disturbance of attention and awareness due to a medical cause; it is a medical emergency and must be excluded before diagnosing a primary psychiatric disorder.

Dialectical behaviour therapy

A treatment for borderline personality disorder combining individual therapy, skills training in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, phone coaching and a consultation team.

Motivational interviewing

A collaborative, person-centred counselling style that explores and resolves ambivalence about change using open questions, affirmations, reflections and summaries, while avoiding confrontation.

Neuroleptic malignant syndrome versus serotonin syndrome

NMS shows rigidity, bradyreflexia and raised creatine kinase after dopamine antagonists; serotonin syndrome shows clonus, hyperreflexia and agitation after serotonergic drugs.

Fitness to stand trial

The defendant's ability to understand the charges, instruct counsel, follow court proceedings and understand the consequences; it concerns current mental state, not guilt.