What is the required washout period when switching between an SSRI (especially Fluoxetine) and an MAOI?

A minimum 2-week washout period is required for most SSRIs, and a 5-week washout period is mandatory for Fluoxetine (due to its long elimination half-life and active metabolite norfluoxetine) to prevent fatal Serotonin Syndrome.

What is the time frame distinction among Brief Psychotic Disorder, Schizophreniform Disorder, and Schizophrenia?

Brief Psychotic Disorder: >=1 day to =1 month to =6 months (including >=1 month of active phase symptoms).

What antidepressant is especially useful in elderly depressed patients with insomnia and severe anorexia/weight loss?

Mirtazapine (alpha-2 adrenergic antagonist and 5-HT2/3 antagonist). Its potent H1 antihistaminic properties promote sedation, stimulate appetite, and cause beneficial weight gain.

What is the difference in timeline between Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD)?

Acute Stress Disorder: Symptoms occur from 3 days up to 1 month following exposure to a traumatic event. Post-Traumatic Stress Disorder: Symptoms persist for >1 month (may have delayed expression).

What is the difference between Factitious Disorder and Malingering?

Factitious Disorder: Intentional falsification or induction of symptoms in order to assume the sick role ('primary/internal gain'), without external rewards. Malingering: Intentional falsification or exaggeration of symptoms for tangible external gain (money, disability, avoiding criminal prosecution, obtaining drugs; not a psychiatric diagnosis).

What duration and symptom count define a Manic Episode according to DSM-5-TR?

Distinct period of abnormally elevated, irritable, or expansive mood and increased energy lasting >=1 week (or any duration if hospitalized), with >=3 symptoms (>=4 if irritable): DIG FAST (Distractibility, Impulsivity/indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness/pressured speech).

What are the primary adverse effects and monitoring parameters for Lithium maintenance therapy in Bipolar Disorder?

Side effects: Nephrogenic diabetes insipidus, hypothyroidism, tremor, Ebstein's anomaly in utero, and chronic tubulointerstitial nephropathy. Routine monitoring: Serum lithium levels (narrow therapeutic index 0.6–1.2 mEq/L), BUN/creatinine, and TSH.

What are the DSM-5-TR diagnostic criteria for Schizoaffective Disorder?

Concurrent period of mood episode (major depression or mania) with active-phase symptoms of schizophrenia, PLUS delusions or hallucinations for >=2 weeks in the ABSENCE of prominent mood symptoms during the lifetime duration.

What does the SIGECAPS mnemonic stand for in Major Depressive Disorder?

S: Sleep changes (insomnia/hypersomnia); I: Interest decreased (anhedonia); G: Guilt/worthlessness; E: Energy loss (fatigue); C: Concentration impairment; A: Appetite/weight changes; P: Psychomotor agitation or retardation; S: Suicidal ideation.

What is the diagnostic hallmark of Somatic Symptom Disorder versus Illness Anxiety Disorder?

Somatic Symptom Disorder: Presence of one or more distressing physical symptoms that cause excessive, disproportionate thoughts, anxiety, and behaviors. Illness Anxiety Disorder: Preoccupation with having or acquiring a serious illness despite having NO or minimal somatic symptoms.

What is the mechanism of action of typical (first-generation) versus atypical (second-generation) antipsychotics?

First-generation (e.g., Haloperidol, Fluphenazine): High-potency D2 dopamine receptor antagonists. Second-generation (e.g., Risperidone, Olanzapine, Quetiapine): Combined 5-HT2A serotonin and D2 dopamine receptor antagonists, with lower EPS risk.

What is the clinical presentation and management of Neuroleptic Malignant Syndrome (NMS)?

Severe 'lead-pipe' muscle rigidity, hyperthermia, autonomic instability, altered mental status, and markedly elevated CK and leukocytosis. Discontinue causative antipsychotic, provide aggressive cooling/hydration, and administer Dantrolene or Bromocriptine.

Which personality disorders comprise Cluster A ('weird / eccentric')?

Paranoid (distrust and suspiciousness), Schizoid (voluntary social detachment, prefers solitary activities, restricted emotional range), and Schizotypal (magical thinking, odd beliefs, eccentric appearance, interpersonal deficits).

What hypertensive crisis can occur when taking Monoamine Oxidase Inhibitors (MAOIs) like Phenelzine or Tranylcypromine?

Tyramine hypertensive crisis: Ingestion of tyramine-rich foods (aged cheeses, cured meats, red wine) leads to displacement of stored catecholamines into the synapse because intestinal MAO-A is inhibited, causing severe malignant hypertension.

What is the difference between Persistent Depressive Disorder (Dysthymia) and Major Depressive Disorder in duration?

Persistent Depressive Disorder requires depressed mood on most days for >=2 years in adults (>=1 year in children/adolescents), without being symptom-free for >2 consecutive months.

What antidepressant is preferred for patients concerned about weight gain or sexual dysfunction, and what is its major contraindication?

Bupropion (norepinephrine-dopamine reuptake inhibitor). Contraindicated in patients with bulimia nervosa, anorexia nervosa, or seizure disorders because it lowers the seizure threshold.

Which personality disorders comprise Cluster B ('dramatic / emotional / erratic')?

Antisocial (disregard for and violation of rights of others, conduct disorder before age 15), Borderline (unstable relationships, splitting, self-harm, fear of abandonment), Histrionic (attention-seeking, seductive, dramatic), and Narcissistic (grandiosity, need for admiration, lack of empathy).

What is the first-line medication and psychotherapy for Obsessive-Compulsive Disorder (OCD)?

Medication: High-dose SSRIs (e.g., Fluoxetine, Sertraline) or Clomipramine (TCA). Psychotherapy: Exposure and Response Prevention (ERP), a specialized form of CBT.

What are the four classic Extrapyramidal Symptoms (EPS) associated with antipsychotics and their respective treatments?

1. Acute Dystonia (hours-days: oculogyric crisis, torticollis) -> Benztropine or Diphenhydramine; 2. Akathisia (days-weeks: motor restlessness) -> Beta-blocker (Propranolol) or Benzo; 3. Parkinsonism (weeks-months: cogwheel rigidity, bradykinesia) -> Benztropine or Amantadine; 4. Tardive Dyskinesia (months-years: choreoathetoid movements) -> Valbenazine or Deutetrabenazine.

What are the DSM-5-TR diagnostic criteria and minimum duration for a Major Depressive Episode?

At least 5 of 9 SIGECAPS symptoms present for >=2 consecutive weeks, representing a change from previous functioning, where at least one symptom must be Depressed mood or Anhedonia (loss of interest/pleasure).

What are the two boxed hematologic and cardiac toxicities of Clozapine requiring strict registry monitoring?

Agranulocytosis/neutropenia (requires mandatory absolute neutrophil count [ANC] monitoring before dispensing; stop if ANC <1000/mcL) and Myocarditis/cardiomyopathy.

Which personality disorders comprise Cluster C ('anxious / fearful')?

Avoidant (hypersensitivity to rejection/criticism, desires relationships but avoids due to fear of inadequacy), Dependent (excessive need to be taken care of, submissive, clingy), and Obsessive-Compulsive Personality Disorder (preoccupation with orderliness, perfectionism, control; ego-syntonic).

What is the first-line medication and behavioral treatment for Attention-Deficit/Hyperactivity Disorder (ADHD)?

First-line pharmacotherapy: Psychostimulants (Methylphenidate or Amphetamine salts). Behavioral therapy / parent training in behavior management is recommended, especially as first-line in children under 6.

What is Conversion Disorder (Functional Neurological Symptom Disorder)?

Development of one or more symptoms of altered voluntary motor or sensory function (e.g., non-epileptic seizures, blindness, paralysis) that are incompatible with recognized neurological or medical conditions (e.g., positive Hoover sign for functional weakness).

What criteria distinguish Delusional Disorder from Schizophrenia?

Presence of >=1 delusion for >=1 month without meeting Criterion A for schizophrenia; functioning is not markedly impaired and behavior is not obviously bizarre outside the impact of the delusion; hallucinations are absent or minor.

What is Refeeding Syndrome and what electrolyte abnormality is the primary driver of fatal complications?

Rapid reintroduction of carbohydrates in malnourished patients triggers insulin surge, driving phosphate, potassium, and magnesium into cells. Severe Hypophosphatemia leads to ATP depletion, cardiac arrhythmias, and respiratory arrest.

What duration of symptoms is required to diagnose Generalized Anxiety Disorder (GAD)?

Excessive anxiety and worry about a variety of topics, occurring more days than not for at least 6 months, difficult to control, and accompanied by >=3 somatic symptoms (restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance).

What are the first-line pharmacotherapies for Major Depressive Disorder, and how long should a trial last before assessing efficacy?

Selective Serotonin Reuptake Inhibitors (SSRIs: Escitalopram, Sertraline, Fluoxetine) or SNRIs (Duloxetine, Venlafaxine). An adequate trial requires 4 to 8 weeks at a therapeutic therapeutic dose.

What mood stabilizer carries a black-box warning for Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?

Lamotrigine (antiepileptic mood stabilizer). The risk is minimized by slow, gradual dose titration; risk is significantly increased if co-administered with Valproate (which inhibits lamotrigine glucuronidation).

What clinical features characterize Anorexia Nervosa versus Bulimia Nervosa?

Anorexia Nervosa requires significantly low body weight (BMI <18.5 kg/m2 in adults) and intense fear of weight gain. Bulimia Nervosa maintains normal or elevated BMI, characterized by binge eating followed by inappropriate compensatory purging behaviors.

What is the key diagnostic difference between Bipolar I Disorder and Bipolar II Disorder?

Bipolar I requires at least ONE lifetime Manic episode (>=7 days or requiring hospitalization; marked impairment; +/- psychosis). Bipolar II requires at least one Hypomanic episode (>=4 days, no marked impairment, no psychosis) AND at least one Major Depressive Episode.

What is the acute and maintenance first-line pharmacotherapy for Panic Disorder?

First-line maintenance: SSRIs (e.g., Sertraline, Escitalopram) or SNRIs combined with Cognitive Behavioral Therapy (CBT). Acute rapid relief during severe panic: Short-acting Benzodiazepines (e.g., Lorazepam, Alprazolam), used sparingly.

Psychiatry & DSM-5-TR — Mood, Psychotic, Anxiety, Personality Disorders & Psychopharmacology

Diagnostic criteria, time thresholds, mood/psychotic spectrums, personality clusters, and psychotropic pharmacology.

Level: basic
Languages: en → en
Cards: 32
Markdown: Psychiatry & DSM-5-TR — Mood, Psychotic, Anxiety, Personality Disorders & Psychopharmacology (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
1	What is the required washout period when switching between an SSRI (especially Fluoxetine) and an MAOI?	A minimum 2-week washout period is required for most SSRIs, and a 5-week washout period is mandatory for Fluoxetine (due to its long elimination half-life and active metabolite norfluoxetine) to prevent fatal Serotonin Syndrome.
2	What is the time frame distinction among Brief Psychotic Disorder, Schizophreniform Disorder, and Schizophrenia?	Brief Psychotic Disorder: >=1 day to <1 month (full return to premorbid functioning). Schizophreniform Disorder: >=1 month to <6 months. Schizophrenia: Continuous signs of disturbance for >=6 months (including >=1 month of active phase symptoms).
3	What antidepressant is especially useful in elderly depressed patients with insomnia and severe anorexia/weight loss?	Mirtazapine (alpha-2 adrenergic antagonist and 5-HT2/3 antagonist). Its potent H1 antihistaminic properties promote sedation, stimulate appetite, and cause beneficial weight gain.
4	What is the difference in timeline between Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD)?	Acute Stress Disorder: Symptoms occur from 3 days up to 1 month following exposure to a traumatic event. Post-Traumatic Stress Disorder: Symptoms persist for >1 month (may have delayed expression).
5	What is the difference between Factitious Disorder and Malingering?	Factitious Disorder: Intentional falsification or induction of symptoms in order to assume the sick role ('primary/internal gain'), without external rewards. Malingering: Intentional falsification or exaggeration of symptoms for tangible external gain (money, disability, avoiding criminal prosecution, obtaining drugs; not a psychiatric diagnosis).
6	What duration and symptom count define a Manic Episode according to DSM-5-TR?	Distinct period of abnormally elevated, irritable, or expansive mood and increased energy lasting >=1 week (or any duration if hospitalized), with >=3 symptoms (>=4 if irritable): DIG FAST (Distractibility, Impulsivity/indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness/pressured speech).
7	What are the primary adverse effects and monitoring parameters for Lithium maintenance therapy in Bipolar Disorder?	Side effects: Nephrogenic diabetes insipidus, hypothyroidism, tremor, Ebstein's anomaly in utero, and chronic tubulointerstitial nephropathy. Routine monitoring: Serum lithium levels (narrow therapeutic index 0.6–1.2 mEq/L), BUN/creatinine, and TSH.
8	What are the DSM-5-TR diagnostic criteria for Schizoaffective Disorder?	Concurrent period of mood episode (major depression or mania) with active-phase symptoms of schizophrenia, PLUS delusions or hallucinations for >=2 weeks in the ABSENCE of prominent mood symptoms during the lifetime duration.
9	What does the SIGECAPS mnemonic stand for in Major Depressive Disorder?	S: Sleep changes (insomnia/hypersomnia); I: Interest decreased (anhedonia); G: Guilt/worthlessness; E: Energy loss (fatigue); C: Concentration impairment; A: Appetite/weight changes; P: Psychomotor agitation or retardation; S: Suicidal ideation.
10	What is the diagnostic hallmark of Somatic Symptom Disorder versus Illness Anxiety Disorder?	Somatic Symptom Disorder: Presence of one or more distressing physical symptoms that cause excessive, disproportionate thoughts, anxiety, and behaviors. Illness Anxiety Disorder: Preoccupation with having or acquiring a serious illness despite having NO or minimal somatic symptoms.
11	What is the mechanism of action of typical (first-generation) versus atypical (second-generation) antipsychotics?	First-generation (e.g., Haloperidol, Fluphenazine): High-potency D2 dopamine receptor antagonists. Second-generation (e.g., Risperidone, Olanzapine, Quetiapine): Combined 5-HT2A serotonin and D2 dopamine receptor antagonists, with lower EPS risk.
12	What is the clinical presentation and management of Neuroleptic Malignant Syndrome (NMS)?	Severe 'lead-pipe' muscle rigidity, hyperthermia, autonomic instability, altered mental status, and markedly elevated CK and leukocytosis. Discontinue causative antipsychotic, provide aggressive cooling/hydration, and administer Dantrolene or Bromocriptine.
13	Which personality disorders comprise Cluster A ('weird / eccentric')?	Paranoid (distrust and suspiciousness), Schizoid (voluntary social detachment, prefers solitary activities, restricted emotional range), and Schizotypal (magical thinking, odd beliefs, eccentric appearance, interpersonal deficits).
14	What hypertensive crisis can occur when taking Monoamine Oxidase Inhibitors (MAOIs) like Phenelzine or Tranylcypromine?	Tyramine hypertensive crisis: Ingestion of tyramine-rich foods (aged cheeses, cured meats, red wine) leads to displacement of stored catecholamines into the synapse because intestinal MAO-A is inhibited, causing severe malignant hypertension.
15	What is the difference between Persistent Depressive Disorder (Dysthymia) and Major Depressive Disorder in duration?	Persistent Depressive Disorder requires depressed mood on most days for >=2 years in adults (>=1 year in children/adolescents), without being symptom-free for >2 consecutive months.
16	What antidepressant is preferred for patients concerned about weight gain or sexual dysfunction, and what is its major contraindication?	Bupropion (norepinephrine-dopamine reuptake inhibitor). Contraindicated in patients with bulimia nervosa, anorexia nervosa, or seizure disorders because it lowers the seizure threshold.
17	Which personality disorders comprise Cluster B ('dramatic / emotional / erratic')?	Antisocial (disregard for and violation of rights of others, conduct disorder before age 15), Borderline (unstable relationships, splitting, self-harm, fear of abandonment), Histrionic (attention-seeking, seductive, dramatic), and Narcissistic (grandiosity, need for admiration, lack of empathy).
18	What is the first-line medication and psychotherapy for Obsessive-Compulsive Disorder (OCD)?	Medication: High-dose SSRIs (e.g., Fluoxetine, Sertraline) or Clomipramine (TCA). Psychotherapy: Exposure and Response Prevention (ERP), a specialized form of CBT.
19	What are the four classic Extrapyramidal Symptoms (EPS) associated with antipsychotics and their respective treatments?	1. Acute Dystonia (hours-days: oculogyric crisis, torticollis) -> Benztropine or Diphenhydramine; 2. Akathisia (days-weeks: motor restlessness) -> Beta-blocker (Propranolol) or Benzo; 3. Parkinsonism (weeks-months: cogwheel rigidity, bradykinesia) -> Benztropine or Amantadine; 4. Tardive Dyskinesia (months-years: choreoathetoid movements) -> Valbenazine or Deutetrabenazine.
20	What are the DSM-5-TR diagnostic criteria and minimum duration for a Major Depressive Episode?	At least 5 of 9 SIGECAPS symptoms present for >=2 consecutive weeks, representing a change from previous functioning, where at least one symptom must be Depressed mood or Anhedonia (loss of interest/pleasure).
21	What are the two boxed hematologic and cardiac toxicities of Clozapine requiring strict registry monitoring?	Agranulocytosis/neutropenia (requires mandatory absolute neutrophil count [ANC] monitoring before dispensing; stop if ANC <1000/mcL) and Myocarditis/cardiomyopathy.
22	Which personality disorders comprise Cluster C ('anxious / fearful')?	Avoidant (hypersensitivity to rejection/criticism, desires relationships but avoids due to fear of inadequacy), Dependent (excessive need to be taken care of, submissive, clingy), and Obsessive-Compulsive Personality Disorder (preoccupation with orderliness, perfectionism, control; ego-syntonic).
23	What is the first-line medication and behavioral treatment for Attention-Deficit/Hyperactivity Disorder (ADHD)?	First-line pharmacotherapy: Psychostimulants (Methylphenidate or Amphetamine salts). Behavioral therapy / parent training in behavior management is recommended, especially as first-line in children under 6.
24	What is Conversion Disorder (Functional Neurological Symptom Disorder)?	Development of one or more symptoms of altered voluntary motor or sensory function (e.g., non-epileptic seizures, blindness, paralysis) that are incompatible with recognized neurological or medical conditions (e.g., positive Hoover sign for functional weakness).
25	What criteria distinguish Delusional Disorder from Schizophrenia?	Presence of >=1 delusion for >=1 month without meeting Criterion A for schizophrenia; functioning is not markedly impaired and behavior is not obviously bizarre outside the impact of the delusion; hallucinations are absent or minor.
26	What is Refeeding Syndrome and what electrolyte abnormality is the primary driver of fatal complications?	Rapid reintroduction of carbohydrates in malnourished patients triggers insulin surge, driving phosphate, potassium, and magnesium into cells. Severe Hypophosphatemia leads to ATP depletion, cardiac arrhythmias, and respiratory arrest.
27	What duration of symptoms is required to diagnose Generalized Anxiety Disorder (GAD)?	Excessive anxiety and worry about a variety of topics, occurring more days than not for at least 6 months, difficult to control, and accompanied by >=3 somatic symptoms (restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance).
28	What are the first-line pharmacotherapies for Major Depressive Disorder, and how long should a trial last before assessing efficacy?	Selective Serotonin Reuptake Inhibitors (SSRIs: Escitalopram, Sertraline, Fluoxetine) or SNRIs (Duloxetine, Venlafaxine). An adequate trial requires 4 to 8 weeks at a therapeutic therapeutic dose.
29	What mood stabilizer carries a black-box warning for Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?	Lamotrigine (antiepileptic mood stabilizer). The risk is minimized by slow, gradual dose titration; risk is significantly increased if co-administered with Valproate (which inhibits lamotrigine glucuronidation).
30	What clinical features characterize Anorexia Nervosa versus Bulimia Nervosa?	Anorexia Nervosa requires significantly low body weight (BMI <18.5 kg/m2 in adults) and intense fear of weight gain. Bulimia Nervosa maintains normal or elevated BMI, characterized by binge eating followed by inappropriate compensatory purging behaviors.
31	What is the key diagnostic difference between Bipolar I Disorder and Bipolar II Disorder?	Bipolar I requires at least ONE lifetime Manic episode (>=7 days or requiring hospitalization; marked impairment; +/- psychosis). Bipolar II requires at least one Hypomanic episode (>=4 days, no marked impairment, no psychosis) AND at least one Major Depressive Episode.
32	What is the acute and maintenance first-line pharmacotherapy for Panic Disorder?	First-line maintenance: SSRIs (e.g., Sertraline, Escitalopram) or SNRIs combined with Cognitive Behavioral Therapy (CBT). Acute rapid relief during severe panic: Short-acting Benzodiazepines (e.g., Lorazepam, Alprazolam), used sparingly.