Kuwait Board Psychiatry flashcards

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

Mesolimbic dopamine pathway

Projects from the ventral tegmental area to the nucleus accumbens and amygdala; its hyperactivity is linked to positive psychotic symptoms and it is the main target of antipsychotic D2 blockade.

REM sleep features

Low-voltage mixed-frequency EEG resembling wakefulness, rapid eye movements, brainstem-mediated muscle atonia and vivid dreaming; REM latency is shortened in depression and REM behaviour disorder predicts synucleinopathies.

D2 occupancy therapeutic window

Antipsychotic efficacy usually appears at about 65-78% striatal D2 receptor occupancy; above roughly 78% extrapyramidal symptoms rise sharply, and tuberoinfundibular blockade above that range raises prolactin.

Delusion

A fixed false belief held with strong conviction, not shared by the person's culture and resistant to contrary evidence; it is a disorder of thought content, distinct from a hallucination, which is a perception without a stimulus.

Capgras syndrome

A delusional misidentification in which the patient believes a familiar person has been replaced by an identical impostor; classically associated with schizophrenia, dementia and right hemisphere or bifrontal lesions.

MMSE versus MoCA

MMSE scores below 24/30 suggest cognitive impairment; MoCA uses 26/30 and is more sensitive to mild cognitive impairment and executive dysfunction, while the MMSE is better established for staging moderate to severe dementia.

Cohen's kappa interpretation

A chance-corrected measure of inter-rater agreement: above 0.80 is excellent, 0.61-0.80 good, 0.41-0.60 moderate and below 0.40 poor; it is used to judge the reliability of psychiatric diagnoses in research.

Clozapine initiation criteria

Indicated in schizophrenia after failure of at least two antipsychotics, one a second-generation agent, given at adequate dose for six weeks; it requires baseline and weekly full blood counts for 18 weeks.

Neuroleptic malignant syndrome

A rare idiosyncratic reaction to dopamine antagonists with lead-pipe rigidity, hyperthermia, autonomic instability, altered consciousness and raised creatine kinase; treatment is drug withdrawal, supportive care, dantrolene or bromocriptine, and sometimes ECT.

Catatonia treatment

A benzodiazepine challenge, usually lorazepam 1-2 mg, can produce prompt relief and supports the diagnosis; electroconvulsive therapy is indicated for malignant catatonia or cases refractory to benzodiazepines.

Rapid cycling bipolar disorder

Defined as at least four mood episodes within 12 months; more common in women, associated with antidepressant use, thyroid disease and poorer response, and managed by simplifying the regimen and optimising mood stabilisers such as lithium.

Duration criteria for mania

Mania requires elevated, expansive or irritable mood with increased energy lasting at least one week, or any duration if hospitalisation is needed; hypomania requires at least four consecutive days of similar change.

Lithium therapeutic range

Serum lithium 0.6-1.0 mmol/L for acute and maintenance treatment, with 0.4-0.8 mmol/L often used in older adults; levels are drawn 12 hours after the last dose, with renal and thyroid checks every six months.

Panic attack duration

An abrupt surge of intense fear that reaches a peak within minutes and includes at least four of thirteen symptoms such as palpitations, sweating, trembling, breathlessness, chest pain, derealisation and fear of dying.

OCD first-line treatment

A serotonin reuptake inhibitor at a higher dose than used in depression, taken for 8-12 weeks before judging response, combined with exposure and response prevention, which is the psychological treatment of choice.

PTSD symptom clusters

DSM-5 requires exposure to trauma plus at least one intrusion symptom, one avoidance, two negative alterations in cognition or mood and two arousal or reactivity changes, lasting more than one month.

Delirium tremens timing

Alcohol withdrawal seizures occur 12-48 hours after the last drink, while delirium tremens typically begins 48-96 hours after and carries untreated mortality of up to 5-15%, requiring benzodiazepines and parenteral thiamine.

DSM-5 substance use severity

Eleven criteria over twelve months define substance use disorder: two to three criteria indicate mild, four to five moderate and six or more severe; tolerance and withdrawal each count as one criterion.

DBT four modules

Linehan's dialectical behaviour therapy teaches mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, targeting parasuicidal behaviour, therapy-interfering behaviour, quality of life and post-traumatic stress in that order.

Antisocial personality disorder criteria

A pervasive pattern of disregard for others' rights since age 15, shown by unlawful behaviour, deceitfulness, impulsivity, irritability, recklessness and lack of remorse; the person must be at least 18 with childhood conduct disorder.

ADHD diagnostic threshold

Requires at least six inattentive or hyperactive-impulsive symptoms, or five for people aged 17 and over, present before age 12, for six months, in two or more settings with clear impairment.

Disruptive mood dysregulation disorder

Diagnosed between ages 6 and 18 for severe persistent irritability with temper outbursts at least three times weekly for a year and onset before age 10; it excludes mania and reduces overdiagnosis of paediatric bipolar disorder.

Autism spectrum disorder domains

DSM-5 requires persistent deficits in social communication and interaction plus restricted, repetitive behaviours, interests or activities, present in early development and causing impairment; severity is graded by the level of support needed.

Lewy body dementia features

Fluctuating cognition, recurrent formed visual hallucinations, spontaneous parkinsonism and REM sleep behaviour disorder; patients show severe neuroleptic sensitivity, so antipsychotics are avoided and cholinesterase inhibitors are preferred.

Cholinesterase inhibitors in dementia

Donepezil, rivastigmine and galantamine are used for mild to moderate Alzheimer disease with modest symptomatic benefit; memantine, an NMDA antagonist, is used in moderate to severe disease, often added to a cholinesterase inhibitor.

Four abilities for decision capacity

Capacity requires the ability to understand relevant information, appreciate its personal significance, reason with it to compare options, and communicate a consistent choice; all four must be present for that specific decision.

Conversion disorder essentials

DSM-5 functional neurological symptom disorder: altered voluntary motor or sensory function incompatible with recognised disease, with clinical findings of internal inconsistency, not intentionally produced; the diagnosis is made positively, not by exclusion alone.

Serotonin syndrome

Caused by serotonergic excess, with clonus, hyperreflexia, agitation, tremor and hyperthermia, usually developing within hours of the trigger; management is stopping the agent, supportive care and, in severe cases, cyproheptadine.

Valproate teratogenicity

Prenatal exposure carries roughly a 10% risk of major congenital malformation, including neural tube defects, and a 30-40% risk of neurodevelopmental disorder; it should be avoided in women of childbearing potential.

Tricyclic overdose management

Tricyclics cause anticholinergic toxicity, coma, seizures and cardiotoxicity with QRS widening; treatment is airway support, activated charcoal if early, and intravenous sodium bicarbonate for arrhythmia or QRS above 100 ms.

Expressed emotion and relapse

High expressed emotion in relatives, meaning criticism, hostility and emotional overinvolvement, predicts relapse in schizophrenia; family interventions that lower it reduce relapse rates and are recommended alongside antipsychotic medication.

Stages of change model

Prochaska and DiClemente describe precontemplation, contemplation, preparation, action, maintenance and relapse; interventions should match the stage, with motivational interviewing used mainly before the action stage is reached.