PGIM MD Psychiatry flashcards

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

Delirium core features

Acute onset and fluctuating disturbance of attention and awareness, often with perceptual or sleep-wake changes, caused by an underlying medical or toxic condition.

Serotonin syndrome signs

Mental status change, autonomic instability, and neuromuscular hyperactivity with clonus and hyperreflexia, typically beginning within 24 hours of a serotonergic change.

NMS classic tetrad

Hyperthermia, lead-pipe rigidity, autonomic instability, and altered consciousness, with raised creatine kinase; onset is usually over one to three days.

Lithium therapeutic range

Maintenance serum levels are approximately 0.6 to 0.8 mmol/L; toxicity risk rises above 1.0 mmol/L and monitoring includes renal and thyroid function.

Clozapine agranulocytosis timing

Risk is highest in the first 18 weeks of treatment, which is why frequent full blood count monitoring is mandatory during initiation and according to the licensed schedule.

Schneider first-rank symptoms

Thought insertion, withdrawal, or broadcast; voices discussing or commenting; delusional perception; and made impulses, acts, or feelings, historically used in schizophrenia diagnosis.

Gillick competence

In England and Wales, a child under 16 may consent to treatment if they have sufficient understanding and intelligence to fully comprehend the proposed intervention.

Four capacity criteria

To have capacity a person must understand, retain, weigh, and communicate the relevant information for that specific decision at that time.

SPIKES framework

A six-step structure for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or Summary.

Section 12 approval

A status in England and Wales indicating a doctor is recognised as having special experience in the diagnosis or treatment of mental disorder for Mental Health Act purposes.

Advance decision refusal

A legally binding refusal of specified treatment made by a person with capacity, which must be respected if valid and applicable to the current circumstances.

CPA care coordinator

The named professional responsible for coordinating a patient's care plan, reviews, and communication between services under the Care Programme Approach.

Safeguarding adults referral

A referral to local authority safeguarding services when an adult with care and support needs is at risk of abuse or neglect, triggering a Section 42 enquiry.

Annual physical health check

Recommended yearly review for people with severe mental illness covering cardiovascular risk, metabolic parameters, and lifestyle, coordinated between primary and secondary care.

Need-to-know disclosure

Sharing confidential information only with those involved in the patient's care or where legally permitted, disclosing the minimum necessary for the purpose.

Metabolic monitoring schedule

Baseline and repeated measures of weight, waist, blood pressure, glucose, and lipids, typically at 12 weeks and then annually for patients on antipsychotics.

Smoking and clozapine

Tobacco smoke induces CYP1A2; stopping smoking can raise clozapine and olanzapine levels, so doses may need reduction and levels should be checked.

Life expectancy gap

People with severe mental illness die roughly 15 to 20 years earlier than the general population, mostly from preventable cardiovascular and metabolic disease.

Person-first language

Describing someone as a person with schizophrenia rather than a schizophrenic reduces stigma and is preferred in clinical documentation and correspondence.

Section 5(2) holding power

A doctor's or approved clinician's power to detain a voluntary inpatient in England and Wales for up to 72 hours for assessment, not treatment.

Section 136 place of safety

Police power to remove a person in a public place to a place of safety for assessment, normally for up to 24 hours, extendable to 36 in limited circumstances.

Clinical audit cycle

A quality improvement cycle: set standards, measure current practice, compare, implement change, and re-audit; it does not generate new generalisable knowledge.

High-dose antipsychotic rule

Prescribing above the licensed maximum requires documented rationale, a recorded risk-benefit discussion, and ECG monitoring for QT prolongation.

Sensitivity formula

Sensitivity equals true positives divided by true positives plus false negatives; it is the proportion of people with disease correctly identified.

Specificity formula

Specificity equals true negatives divided by true negatives plus false positives; it is the proportion of people without disease correctly identified.

Number needed to treat

NNT equals one divided by the absolute risk reduction; it is the number of patients who must be treated for one additional favourable outcome.

I-squared heterogeneity

A meta-analysis statistic giving the percentage of variability across studies due to heterogeneity rather than chance; above 50% suggests substantial heterogeneity.

Allocation concealment

Concealing the randomisation sequence from those recruiting participants, preventing selection bias in randomised controlled trials.

Duty of candour

When harm occurs, clinicians must promptly apologise, explain what happened, and document the discussion openly with the patient or their family.

Consent and refusal

An adult with capacity may refuse any treatment, even if refusal risks death; valid consent requires capacity, information, and voluntariness.

Professional boundaries

Clear limits on relationships with patients; sexual relationships with current patients are prohibited and conflicts of interest or gifts must be declared.

Gibbs reflective cycle

A structured reflection model with six stages: description, feelings, evaluation, analysis, conclusion, and action plan, used in appraisal and portfolios.