CAQ-Psychiatry cheat sheet

Delirium hallmark: acute onset, fluctuating attention/awareness, and a medical cause; antipsychotics treat agitation but do not treat the underlying etiology.

Major depressive disorder requires ≥5 of 9 symptoms for ≥2 weeks, including depressed mood or anhedonia; psychosis, mania, or substance/medical causation excludes it.

Bipolar I requires ≥1 manic episode (≥1 week or hospitalization); bipolar II requires hypomania (≥4 days) plus major depression and no mania.

First-line unipolar depression: SSRI, SNRI, mirtazapine, or bupropion; combine psychotherapy for moderate-severe illness; check response at 4-6 weeks before switching.

Serotonin syndrome triad: mental status change, autonomic hyperactivity, neuromuscular excitation (clonus, hyperreflexia); stop serotonergic agents and give cyproheptadine if severe.

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

Panic attack is abrupt, peaks within minutes, with ≥4 of 13 symptoms; panic disorder adds ≥1 month of worry or maladaptive behavior.

OCD is defined by obsessions and/or compulsions that are time-consuming (>1 hour/day) or cause distress/impairment; first-line is SSRI plus ERP.

PTSD requires exposure to trauma plus intrusion, avoidance, negative cognitions/mood, and hyperarousal lasting >1 month; first-line psychotherapy is trauma-focused CBT/EMDR.

Schizophrenia requires ≥2 of delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms, with ≥1 from the first three, for ≥6 months.

Substance intoxication/withdrawal: alcohol withdrawal tremor/hallucinosis begins 6-48 hours; delirium tremens at 48-96 hours; benzodiazepines are first-line.

Opioid use disorder: buprenorphine or methadone maintenance reduces mortality; naloxone reverses acute overdose but does not treat dependence.

Capacity requires understanding, appreciation, reasoning, and expressing a choice; a patient with capacity may refuse treatment even if the decision seems unwise.

Suicide risk: prior attempt is the strongest single predictor; asking about suicidal ideation does not increase risk.

Lithium monitoring: check levels 5 days after initiation or dose change, 12 hours post-dose; toxicity presents with tremor, ataxia, vomiting, confusion.

Antipsychotic metabolic monitoring: weight/BMI, waist, BP, fasting glucose or HbA1c, and lipids at baseline, 12 weeks, then annually or per risk.

Autism spectrum disorder: deficits in social communication plus restricted/repetitive behaviors, present in early development and causing impairment.

Mental status exam domains: appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, judgment.

Cognitive screening: MoCA is more sensitive than MMSE for mild cognitive impairment; both are influenced by education and language.

Somatic symptom disorder: distressing symptoms plus excessive thoughts, feelings, or behaviors about them, regardless of whether a medical cause exists.

Illness anxiety disorder: preoccupation with having or acquiring illness without prominent somatic symptoms; health anxiety persists despite reassurance.

ADHD diagnosis requires symptoms before age 12, in ≥2 settings, causing impairment; stimulants are first-line, with monitoring of growth, BP, and sleep.

Anorexia nervosa: significantly low weight, intense fear of weight gain, and body image disturbance; medical stabilization and refeeding risk (hypophosphatemia) come first.

Alcohol use disorder pharmacotherapy: naltrexone reduces heavy drinking; acamprosate supports abstinence; disulfiram requires motivated, supervised patients.

Electroconvulsive therapy is indicated for severe or psychotic depression, catatonia, and treatment-resistant illness; cognitive effects are usually transient.