WAPCP Part I key terms

Blocking the presynaptic transporter protein that normally clears a neurotransmitter such as serotonin or noradrenaline from the synaptic cleft, prolonging its action on postsynaptic receptors. This mechanism underlies SSRIs, SNRIs and many tricyclics.

A theory proposing that repeated mood episodes lower the threshold for future episodes, so illness becomes progressively more autonomous and easier to trigger. It supports early and sustained prophylaxis in bipolar disorder and recurrent depression.

The proportion of variance in a trait within a given population attributable to genetic differences. It is a population statistic, not a statement about any individual, and is estimated from twin and family studies.

The phenomenon where the effect of an environmental exposure on illness risk depends on genetic vulnerability, or vice versa. It explains why identical stressors produce different outcomes across individuals.

A framework holding that disorder emerges when a pre-existing vulnerability (biological, psychological or social) meets a sufficient stressor. Neither predisposition nor stress alone is considered sufficient.

Disruption of the roughly 24-hour internal timing system governing sleep, temperature, cortisol and mood. It is implicated in depression, bipolar disorder and shift-work-related illness, and is targeted by light therapy.

Observable disturbance in the flow, structure or coherence of speech and thinking, such as loosening of associations, derailment or word salad. It is assessed from speech behaviour rather than from the patient's reported content.

Rapid, pressured speech in which successive thoughts are linked by understandable associations, rhyme or wordplay, so the listener can still follow the drift. Classic in mania.

Deficits relative to normal function, including blunted affect, alogia, avolition, anhedonia and social withdrawal. In schizophrenia they predict functional outcome and respond poorly to dopamine-blocking drugs.

Excessive, purposeless motor activity accompanying heightened inner tension, such as pacing, hand-wringing or inability to sit still. Distinguish from akathisia, which is drug-induced and has a different history.

A patient's awareness that their experiences represent an illness, that treatment is needed and that symptoms are not externally caused. Poor insight predicts non-adherence and is common in psychosis and mania.

A structured, usually cross-sectional description of appearance, behaviour, speech, mood and affect, thought, perception, cognition and insight at interview. It complements rather than replaces the longitudinal psychiatric history.

Brief standardised testing such as the MMSE or MoCA used to detect and track impairment in attention, memory, language and executive function. It flags need for fuller neuropsychological assessment and helps exclude delirium or dementia.

An acute, fluctuating disturbance of attention and awareness, usually with altered sleep-wake cycle and perceptual changes, caused by an underlying medical or toxic condition. It is a medical emergency and often mistaken for psychosis.

Half-life is the time for plasma concentration to halve after dosing stops; steady state is reached after roughly four to five half-lives of regular dosing. These determine dosing intervals and washout periods.

Measurement of plasma drug concentration to guide dosing for agents with narrow therapeutic windows or unpredictable kinetics, such as lithium, clozapine and tricyclics. Interpretation requires knowing the sampling time relative to last dose.

Drug-induced movement disorders from dopamine blockade, including parkinsonism, acute dystonia, akathisia and tardive dyskinesia. Risk rises with higher potency first-generation antipsychotics and longer exposure.

Involuntary, often choreoathetoid movements of the mouth, tongue and face, sometimes trunk or limbs, emerging after prolonged dopamine-blocking treatment. It may persist after the drug is stopped and requires regular screening.

A rare, life-threatening reaction to dopamine antagonists marked by rigidity, hyperthermia, autonomic instability and altered consciousness with raised creatine kinase. Management is drug withdrawal, supportive care and sometimes dantrolene or bromocriptine.

A toxic state from serotonergic excess, with clonus, hyperreflexia, agitation, tremor, sweating and fever. It is distinguished from neuroleptic malignant syndrome by clonus and faster onset after serotonergic combinations.

Poisoning from lithium excess, presenting with coarse tremor, vomiting, diarrhoea, ataxia, confusion and seizures. Precipitated by dehydration, renal impairment or interacting drugs, and requires level measurement and often dialysis.

A drug that treats acute mania or depression and prevents recurrence of mood episodes, canonically lithium, with valproate and lamotrigine as alternatives. Choice depends on episode polarity and tolerability.

The cumulative effect of drugs blocking muscarinic receptors, causing dry mouth, constipation, urinary retention, blurred vision and confusion, especially in older adults. Reducing the total load improves cognition and falls risk.

Mandatory regular blood counts to detect neutropenia, plus checks of weight, glucose, lipids and myocarditis risk, required for patients on clozapine. It is reserved for treatment-resistant psychosis because of these risks.

Schizophrenia that has not responded adequately to two or more antipsychotics at appropriate dose and duration, with adherence confirmed. Clozapine is the evidence-based next step.

The extent to which a person takes medication or follows a care plan as agreed. It is improved by shared decision-making, simplified regimens, side-effect management and addressing practical and cultural barriers.

Structured, ongoing information and coping training given to service users and families about the illness, its treatment and early warning signs. It reduces relapse and carer burden when delivered as a planned intervention.

The level of criticism, hostility and emotional over-involvement shown by relatives toward a person with mental illness. High levels predict relapse in psychosis and are targeted by family interventions.

A collaborative approach helping people with serious mental illness build skills, supports and roles needed for valued community living, such as housing, work and social participation. It is strengths-based and recovery-oriented.

A philosophy that care should support personal meaning, hope, identity and community inclusion rather than only symptom reduction. It places the service user's own goals at the centre of planning.

A multidisciplinary team providing intensive, mobile, long-term outreach to people with severe mental illness and high service use. It delivers medication, practical help and crisis response in the person's own environment.

A structured, time-limited therapy examining links between thoughts, feelings and behaviour, then testing and modifying unhelpful patterns through behavioural experiments and homework. Strong evidence exists in depression and anxiety disorders.

A therapy that increases engagement in rewarding and meaningful activities to reverse the withdrawal and inactivity maintaining low mood. It is as effective as full CBT for depression and simpler to deliver.

The patient's displacement onto the therapist of feelings, expectations and relationship patterns originating with earlier significant figures. Recognising it in the here-and-now is central to psychodynamic work.

The clinician's emotional reactions to a patient, which may reflect the patient's relational patterns or the clinician's own unresolved issues. Used reflectively, it informs understanding; unexamined, it distorts care.

The collaborative bond and shared agreement on goals and tasks between clinician and patient. It is among the strongest predictors of psychotherapy outcome across modalities.

The functional ability to make a specific decision, judged by understanding, retaining, weighing and communicating relevant information. It is decision-specific and presumed present unless shown otherwise.

Voluntary agreement to treatment given after receiving adequate information about its nature, benefits, risks and alternatives, by someone with capacity. It must be documented and can be withdrawn at any time.

The professional duty not to disclose information learned in a clinical relationship without the patient's permission, subject to defined legal exceptions such as serious risk to others or statutory reporting.

Legal holding of a person in hospital without consent, permitted only where mental disorder, risk to self or others and necessity criteria set by statute are met, with independent review and appeal rights.

The principle that any restriction on a person's liberty or autonomy should be the minimum necessary to achieve the clinical or safety aim, with less intrusive alternatives considered and documented first.

A breach of the professional frame, such as sexual contact, exploitative financial dealings or inappropriate self-disclosure, that harms or risks harming the patient. It differs from a benign boundary crossing.

A recurrent pattern of depressive episodes tied to a particular season, usually winter, with remission at other times. Light therapy and standard antidepressant approaches are used.