7113 Exam Cards

Major Depressive Disorder (MDD): What are the core symptom requirements, the 9 specific clinical symptoms, the necessary timeline, the key clinical specifiers, and the diagnostic exclusions?

Core Requirement: >5 symptoms present during the same 2-week period (must represent a change from previous functioning); at least 1 symptom must be (1) Depressed mood or (2) Anhedonia (markedly diminished interest or pleasure).

• Symptom Criteria (Acronym: SIG E CAPS):

  • Sleep: Insomnia or hypersomnia nearly every day.

  • Interest: Anhedonia.

  • Guilt: Feelings of worthlessness or excessive/inappropriate guilt.

  • Energy: Fatigue or loss of energy nearly every day.

  • Concentration: Diminished ability to think, concentrate, or indecisiveness.

  • Appetite: Significant weight loss/gain (> 5 change in a month) or decrease/increase in appetite.

  • Psychomotor: Agitation or retardation nearly every day (observed by others).

  • Suicide: Recurrent thoughts of death, suicidal ideation, or a suicide attempt.

• Exclusions: Never a history of a manic or hypomanic episode.

• Key Specifiers: Melancholic features (profound anhedonia, worse in morning, early morning awakening, psychomotor changes, severe anorexia/weight loss, excessive guilt), Anxious distress, Mixed features, Rapid cycling, Peripartum onset, Seasonal pattern.

Persistent Depressive Disorder (PDD): What is the core timeline rule, the 6 possible secondary symptoms, the maximum symptom-free duration permitted, and the continuous major depressive exclusion rule?

• Core Timeline: Depressed mood for most of the day, for more days than not, for at least 2 years (observed or subjective).

• Symptom Criteria: Presence of >2 of the following while depressed:

  • Poor appetite or overeating.

  • Insomnia or hypersomnia.

  • Low energy or fatigue.

  • Low self-esteem.

  • Poor concentration or difficulty making decisions.

  • Feelings of hopelessness.

• Duration Rule: During the 2-year period, the individual has never been without symptoms for more than 2 months at a time.

• Exclusion: Criteria for a chronic major depressive episode may be continuously present during this time.

Specific Phobia: What are the core clinical criteria (A–F), the minimum diagnostic duration rule, and the 5 primary clinical subtypes?

• A. Marked fear or anxiety about a specific object or situation.

• B. The phobic object/situation almost invariably provokes immediate fear/anxiety.

• C. The phobic object/situation is actively avoided or endured with intense fear/anxiety.

• D. The fear/anxiety is out of proportion to the actual danger posed.

• E. The fear, anxiety, or avoidance is persistent, typically lasting for >6 months.

• F. Causes clinically significant distress or impairment.

  • Main Subtypes: Animal, Natural environment (storms, heights), Situational (flying, tunnels), Blood-injection-injury (high fainting/syncope prevalence due to vasovagal response), Other (vomiting, choking).

Panic Disorder: What defines a panic attack (peak timeline and somatic/cognitive features) and what are the two core diagnostic criteria, including the required post-attack timeline?

• Panic Attack Definition: An abrupt surge of intense fear/discomfort peaking within 10–15 minutes, features > 4 physical/cognitive symptoms (palpitations, sweating, trembling, SOB, chest pain, dizziness, chills/heat, derealisation/depersonalisation, fear of losing control/dying).

• Panic Disorder Criteria:

  • A. Recurrent unexpected panic attacks.

  • B. At least one attack followed by > 1 month of one or both:

    • 1.Persistent concern/worry about additional panic attacks or their consequences (e.g., losing control, heart attack, "going crazy").

    • 2.A significant maladaptive change in behavior related to the attacks (e.g., avoidance of exercise or unfamiliar situations).

Agoraphobia: What are the 5 target situations (how many are required?), what is the core cognitive fear/avoidance rationale, and what is the minimum duration requirement?

A. Marked fear or anxiety about > 2 of the following 5 situations:

1. Using public transportation.

2. Being in open spaces (e.g., parking lots, bridges).

3. Being in enclosed places (e.g., shops, theaters, lifts).

4. Standing in line or being in a crowd.

5. Being outside of the home alone.

B. Avoids/fears these situations because of thoughts that escape might be difficult or help might not be available in the event of panic-like, incapacitating, or embarrassing symptoms.

C. Situations actively avoided, require a companion, or endured with intense distress.

D. Fear/avoidance is out of proportion to actual threat and lasts > 6 months.

Social Anxiety Disorder (SAD): What is the core situational trigger, the primary cognitive fear, the minimum duration rule, and the main clinical specifier?

A. Marked fear or anxiety about >1 social situations where the individual is exposed to possible scrutiny by others (e.g., social interactions, being observed eating/drinking, performing).

B. Fears acting in a way or showing anxiety symptoms that will be negatively evaluated (humiliated, embarrassed, rejected, or offend others).

C. Social situations almost always provoke fear/anxiety, and are actively avoided or endured with intense distress.

D. Fear/anxiety is out of proportion to actual threat and lasts > 6 months.

• Specifier: Performance only (if fear is restricted to speaking or performing in public).

Generalized Anxiety Disorder (GAD): What is the required timeline, the core behavioral impairment, and the 6 associated somatic/cognitive symptoms (how many are required)?

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (work, school performance).

B. The individual finds it difficult to control the worry.

C. Anxiety/worry are associated with > 3 of the following 6 symptoms (with at least some symptoms present more days than not for 6 months):

1. Restlessness or feeling keyed up/on edge.

2. Easily fatigued.

3. Difficulty concentrating or mind going blank.

4. Irritability.

5. Muscle tension.

6. Sleep disturbance (difficulty falling/staying asleep, restless sleep).

Obsessive-Compulsive Disorder (OCD): How are obsessions and compulsions clinically defined, and what is the exact daily time/severity threshold required for diagnosis?

A. Presence of Obsessions, Compulsions, or both:

• Obsessions defined by: (1) Recurrent, persistent thoughts, urges, or images experienced as intrusive/unwanted and cause marked anxiety/distress; (2) Individual attempts to ignore/suppress or neutralize them with some other thought or action.

• Compulsions defined by: (1) Repetitive behaviors (handwashing, checking, ordering) or mental acts (praying, counting, repeating words) the individual feels driven to perform in response to an obsession or according to rigid rules; (2) Behaviors are aimed at preventing/reducing anxiety or a dreaded event, but are not realistically connected or are clearly excessive.

B. Time/Severity Criterion: Obsessions/compulsions are time-consuming (take >1 hour per day) or cause clinically significant distress/impairment.

Post-Traumatic Stress Disorder (PTSD): What are the criteria for trauma exposure (Criterion A), the four symptom clusters (B–E) including their numerical requirements, the minimum timeline rule, and the primary dissociative specifiers?

• Criterion A (Trauma Exposure): Exposure to actual/threatened death, serious injury, or sexual violence via: direct experience, witnessing in person, learning it happened to a close family member/friend (must be violent/accidental), or repeated/extreme exposure to aversive details (e.g., first responders). (No media unless work-related).

• Criterion B (Intrusion - >1 required): Intrusive memories, distressing dreams, dissociative reactions (flashbacks), or marked psychological/physiological distress at reminders.

• Criterion C (Avoidance - > 1 required): Avoidance of internal reminders (thoughts, feelings) or external reminders (people, places, conversations).

• Criterion D (Negative Alterations in Cognition/Mood - > 2 required): Dissociative amnesia of trauma, exaggerated negative beliefs ("I am bad", "No one can be trusted"), distorted blame of self/others, persistent negative emotional state, anhedonia, detachment, or inability to feel positive emotions.

• Criterion E (Arousal/Reactivity - > 2 required): Irritable/aggressive behavior, reckless/self-destructive behavior, hypervigilance, exaggerated startle response, concentration problems, or sleep disturbance.

  • Timeline Rule: Symptoms must last > 1 month.

  • Specifiers: Dissociative specification (Depersonalization or Derealization).

Acute Stress Disorder (ASD): What are the trauma exposure rules, total symptom count requirements across the 5 categories, the diagnostic timeline window, and its clinical progression rule?

Criterion A (Trauma Exposure): Direct exposure, witnessing, or learning of actual/threatened death, serious injury, or sexual violence (matches PTSD Criterion A).

• Symptom Presentation: Presence of > 9 symptoms from any of the following 5 categories:

  • Intrusion (Distressing memories, dreams, flashbacks, or reactions to reminders)

  • Negative Mood (Inability to experience positive emotions)

  • Dissociation (Altered sense of reality or inability to remember details (amnesia))

  • Avoidance (Actively avoiding thoughts, feelings, or external reminders of the event)

  • Arousal (Sleep disturbance, irritability, hypervigilance, concentration issues, or exaggerated startle response).

• Timeline Rule: Symptoms develop and persist for 3 days to 1 month following trauma exposure.

• Clinical Progression: If symptoms appear before 3 days, it represents an acute reaction. If clinical symptoms last beyond 1 month, the diagnosis must be upgraded to PTSD.

Prolonged Grief Disorder (PGD): What is the core phenomenological feature, the mandatory post-death timeline rule for adults, the secondary symptom requirements, and the cultural caveat?

• Core Feature: Intense yearning or longing for the deceased person and/or preoccupation with thoughts or memories of the deceased person, present to a clinically significant degree.

• Timeline Rule: The death of a person close to the bereaved occurred at least 12 months ago (for adults).

• Symptom Criteria: Since the death, > 3 symptoms have been present most days to a clinically significant degree for at least the last month (e.g., identity disruption, intense emotional pain, emotional numbness, feeling that life is meaningless, avoidance of grief reminders).

• Cultural Context: The grief response is clearly uncharacteristic of cultural, religious, or age-appropriate norms.

Adjustment Disorder: What is the defining trigger, the required onset timeline window, the specific severity expression rules, and the post-termination resolution threshold?

• Core Feature: Development of emotional or behavioral symptoms in response to an identifiable stressor (e.g., divorce, job transition, illness).

• Timeline Rule: Symptoms develop within 3 months of the onset of the stressor.

• Symptom Expression: Manifested by marked distress out of proportion to the severity/intensity of the stressor, and/or significant impairment in social or occupational functioning.

• Termination Rule: Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

• Exclusion: Does not meet criteria for another mental disorder and is not merely normal bereavement.

Other Specified (OSTRD) vs. Unspecified (UTSRD) Trauma Disorders: What are the core definitions of each, and what is the critical reporting requirement that differentiates them?

• Other Specified (OSTRD): Symptoms characteristic of a trauma- and stressor-related disorder cause significant clinical distress or impairment but do not meet the full criteria for any specific condition. The clinician must record the specific reason why criteria are not met (e.g., "Adjustment-like disorder with delayed onset of symptoms lasting more than 6 months without prolonged duration of stressor").

• Unspecified (UTSRD): Symptoms cause significant distress or impairment but do not meet full criteria, AND the clinician chooses not to specify the reason (e.g., in an emergency setting with insufficient information to make a more specific diagnosis).

Differentiating a Manic Episode from a Hypomanic Episode: What is the symptom acronym (DIG FAST), and what are the exact differences in duration, social/occupational severity, hospitalisation rules, and psychotic features?

Acronym for Symptoms (Both): DIG FAST (Distractibility, Impulsivity, Grandiosity, Flight of ideas/Racing thoughts, Activity increase, Sleep deficit/decreased need, Talkativeness/Pressure of speech).

• Manic Episode:

  • Duration: At least 1 week, most of the day, nearly every day (or any duration if hospitalisation is required).

  • Severity: Sufficiently severe to cause marked impairment in social/occupational functioning, OR requires hospitalisation, OR features psychotic symptoms.

• Hypomanic Episode:

  • Duration: At least 4 consecutive days, most of the day, nearly every day.

  • Severity: Unequivocal change in functioning observable by others, but not severe enough to cause marked impairment, never requires hospitalisation, and contains NO psychotic features.

Bipolar I Disorder vs. Bipolar II Disorder: What are the exact structural combinations of manic, hypomanic, and major depressive episodes (MDE) required or permitted for each?

Bipolar I Disorder:

• Core Requirement: Criteria met for at least one full Manic Episode.

• Note: Major Depressive Episodes (MDE) and Hypomanic episodes are highly common but not required for diagnosis. 90% of individuals who have a manic episode will have recurrent episodes.

Bipolar II Disorder:

• Core Requirement: Criteria met for at least one Hypomanic Episode AND at least one Major Depressive Episode.

• Exclusion: There has never been a Manic Episode. If a manic episode occurs, the diagnosis permanently changes to Bipolar I.

Schizophrenia: What is Criterion A (the 5 primary symptoms, including the top 3 mandatory ones), the minimum duration rule for active-phase vs. global disturbance, and differential exclusions?

A. Symptom Criterion: > 2 of the following, each present for a significant portion of time during a 1-month period. At least one must be (1), (2), or (3):

1. Delusions (Persecutory, Grandiose, Nihilistic, Erotomanic, Control/Passivity).

2. Hallucinations (Auditory running commentaries are most common).

3. Disorganized speech (e.g., loosening of associations, frequent derailment, tangentiality).

4. Grossly disorganized or catatonic behavior.

5. Negative symptoms (Avolition, Alogia, Anhedonia, Affective flattening, Asociality).

B. Functioning: Significant decline in major areas of function (work, relationships, self-care).

C. Duration: Continuous signs of disturbance persist for at least 6 months, including at least 1 month of active-phase symptoms.

D. Differential: Exclude Schizoaffective Disorder or Depressive/Bipolar disorder with psychotic features.

Schizoaffective Disorder: What are the three core diagnostic criteria (A–C), the critical 2-week temporal rule, and the two major clinical subtypes?

Criterion A (Core Synergy): An uninterrupted period of illness during which there is a Major Mood Episode (either Major Depressive or Manic) concurrent with Criterion A of Schizophrenia (delusions, hallucinations, disorganized speech, disorganized behavior, or negative symptoms). Note: The MDE must include depressed mood.

Criterion B (The Critical Temporal Rule): Delusions or hallucinations must be present for > 2 weeks in the absence of a major mood episode at some point during the entire duration of the illness. (Crucial for differentiating from mood disorders with psychotic features).

Criterion C: Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.

• Subtypes: Bipolar Type (if mania occurs); Depressive Type (if only major depressive episodes occur).

Borderline Personality Disorder (BPD): What is the core defining clinical pattern, the 9 distinct symptom criteria (how many are required?), and the typical developmental onset?

Core Feature: A pervasive pattern of instability in interpersonal relationships, self-image, and affects, along with marked impulsivity, beginning by early adulthood and present across contexts.

Symptom Criteria (> 5 required):

1. Frantic efforts to avoid real or imagined abandonment.

2. A pattern of unstable, intense interpersonal relationships (alternating between idealization and devaluation).

3. Identity disturbance: markedly/persistently unstable self-image or sense of self.

4. Impulsivity in > 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating).

5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior.

6. Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety lasting hours to days).

7. Chronic feelings of emptiness.

8. Inappropriate, intense anger or difficulty controlling anger.

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Anorexia Nervosa (AN): What are the three core diagnostic criteria (A–C) and the clinical definitions/timelines for the two major behavioral subtypes?

Criterion A: Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

Criterion B: Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

Criterion C: Disturbance in the way one's body weight or shape is experienced, undue influence of weight/shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Subtypes:

• Restricting Type: Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise over the last 3 months (no regular bingeing/purging).

• Binge-Eating/Purging Type: The individual has regularly engaged in episodes of binge eating or purging (e.g., self-induced vomiting, misuse of laxatives/diuretics) over the last 3 months.

Bulimia Nervosa (BN): Diagnostic Criteria, What defines a binge episode (the two components), what constitutes inappropriate compensatory behavior, the mandatory frequency/duration rule, and the diagnostic exclusion?

Criterion A: Recurrent episodes of binge eating, characterized by both:

1. Eating an amount of food definitely larger than what most people would eat in a discrete period (e.g., a 2-hour period) under similar circumstances.

2. A sense of lack of control over eating during the episode.

Criterion B: Recurrent inappropriate compensatory behaviors to prevent weight gain (self-induced vomiting, misuse of laxatives/diuretics, fasting, or excessive exercise).

Criterion C (Frequency): The binge eating and compensatory behaviors both occur, on average, at least once a week for 3 months.

Criterion D: Self-evaluation is unduly influenced by body shape and weight.

Criterion E: The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Binge Eating Disorder (BED): What are the core episode criteria, the 5 associated behavioral features (how many are required?), the frequency/duration rule, and the critical distinction from Bulimia Nervosa?

Criterion A: Recurrent episodes of binge eating (same definitions of large volume and lack of control as BN).

Criterion B: Binge-eating episodes are associated with > 3 of the following:

• Eating much more rapidly than normal.

• Eating until feeling uncomfortably full.

• Eating large amounts of food when not feeling physically hungry.

• Eating alone because of feeling embarrassed by how much one is eating.

• Feeling disgusted with oneself, depressed, or very guilty afterward.

Criterion C: Marked distress regarding binge eating is present.

Criterion D (Frequency): Occurs, on average, at least once a week for 3 months.

• Distinction: Unlike Bulimia Nervosa, BED is not associated with the recurrent use of inappropriate compensatory behaviors.

Avoidant/Restrictive Food Intake Disorder (ARFID): What is the core behavioral/feeding presentation, the 4 associated clinical consequences (how many are required?), and the primary clinical exclusion that separates it from AN/BN?

• Core Feature: An eating or feeding disturbance (e.g., apparent lack of interest in eating; avoidance based on the sensory characteristics of food; concerns about aversive consequences of eating) manifested by a persistent failure to meet appropriate nutritional and/or energy needs.

• Associated Features (> 1 required): Significant weight loss (or failure to achieve expected growth); significant nutritional deficiency; dependence on enteral feeding or oral supplements; marked interference with psychosocial functioning.

• Critical Clinical Exclusion: There is no evidence of a disturbance in the way in which one's body weight or shape is experienced (distinguishing it completely from AN and BN).

Substance Use Disorders (SUD): What is the core defining framework, the 4 main clinical diagnostic domains containing the 11 target criteria, and the severity classification scale?

Core Framework: A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.

Symptom Groupings (11 Criteria total across 4 domains):

1. Impaired Control: Using larger amounts/longer than intended; persistent desire/failed attempts to cut down; excess time spent obtaining/using/recovering; craving.

2. Social Impairment: Failure to fulfill major role obligations; continued use despite social/interpersonal problems; important activities given up.

3. Risky Use: Use in physically hazardous situations; continued use despite knowledge of having a persistent physical/psychological problem caused/exacerbated by use.

4. Pharmacological Criteria: Tolerance (need for markedly increased dose or diminished effect); Withdrawal (characteristic withdrawal syndrome or taking substance to relieve withdrawal).

• Severity Scale: Mild (2–3 symptoms); Moderate (4–5 symptoms); Severe (> 6 symptoms).

SSRIs: What is the primary synaptic mechanism of action, the main clinical indications, common drug examples, and the critical manic switch/withdrawal warnings?

• Mechanism of Action: Blocks the recycling (reuptake) of Serotonin in the brain's synapses, leaving more available to boost mood signaling pathways.

• Primary Clinical Indications: MDD, GAD, Panic Disorder, SAD, OCD.

• Common Examples: Fluoxetine, Sertraline, Citalopram, Escitalopram.

• Key Side Effects & Warnings: Manic Switch Warning: Can precipitate an acute manic episode if given to an unmanaged Bipolar patient. Withdrawal syndrome upon sudden cessation (muscle aches, GI distress, anxiety).

Benzodiazepines: What is the neurobiological mechanism of action, the primary clinical indications, common drug examples, and the safety/dependency/therapy warnings?

• Mechanism of Action: Enhances the activity of GABA (the brain's primary inhibitory neurotransmitter), rapidly slowing down the central nervous system to reduce acute physiological panic/anxiety.

• Primary Clinical Indications: Short-term management of acute panic or severe anxiety flares.

• Common Examples: Diazepam, Alprazolam (Xanax), Clonazepam, Lorazepam.

• Key Side Effects & Warnings: High risk of dependency/addiction, sedation, tolerance, and accidental overdose. Can function as a cognitive safety behavior in panic exposure therapy if used maladaptively.

Typical Antipsychotics (First Generation): What is the primary receptor mechanism of action, the main clinical indications, common examples, and the critical neurological side effect warnings?

• Mechanism of Action: Strong, non-selective blockers of Dopamine D2 receptors in the brain pathways to lower dopamine overactivity.

• Primary Clinical Indications: Acute positive psychotic symptoms (schizophrenia, acute mania).

• Common Examples: Haloperidol, Chlorpromazine.

• Key Side Effects & Warnings: High risk of Extrapyramidal Side Effects (EPS): Muscle stiffness, tremors, acute dystonia, tardive dyskinesia.

Atypical Antipsychotics (Second Generation): What is the dual-receptor mechanism of action, the primary clinical indications, common drug examples, and the metabolic/blood safety warnings?

• Mechanism of Action: Blocks Dopamine D2 receptors more selectively and also acts on Serotonin receptors; balances dopamine signaling with rapid dissociation.

• Primary Clinical Indications: Positive and negative symptoms of Schizophrenia, Acute Mania, Bipolar Depression (specifically Lurasidone).

• Common Examples: Quetiapine, Lurasidone, Olanzapine, Risperidone, Paliperidone, Clozapine.

• Key Side Effects & Warnings: Metabolic Syndrome: Weight gain, lipid changes, sedation, sexual dysfunction. Clozapine requires intensive blood monitoring due to risk of agranulocytosis but is highly effective for treatment-resistance.

Mood Stabiliser - Lithium: What is the general mechanism of action, the gold-standard clinical indications, common examples, the diagnostic safety index warning, and its specific survival benefit?

• Mechanism of Action: Alters sodium transport across nerve cells and stabilizes neurotransmitter networks; exhibits neuroprotective qualities and targets prefrontal-limbic instability.

• Primary Clinical Indications: Gold standard for long-term Bipolar I maintenance, classic mania, and highly effective at reducing suicide rates (by 60%).

• Common Examples: Lithium Carbonate.

• Key Side Effects & Warnings: Narrow Therapeutic Index: Requires regular blood tests to avoid toxicity. Adverse effects include renal impairment, thyroid dysfunction, and worsening of psoriasis.

Mood Stabiliser (Anticonvulsants) - Anticonvulsant Mood Stabilizers: What is the underlying mechanism of action, the main clinical indications, common drug examples, and the specific life-threatening rash / pregnancy warnings?

• Mechanism of Action: Stabilizes hyper-excitable neuronal membranes and dampens excessive electrical firing via ion channels or GABA modulation.

• Primary Clinical Indications: Bipolar maintenance, rapid cycling, and mixed affective states.

• Common Examples: Sodium Valproate, Lamotrigine.

• Key Side Effects & Warnings: Sodium Valproate: Weight gain, hirsutism, severe teratogenicity (birth defects). Lamotrigine: Requires highly cautious, slow titration due to risk of life-threatening Stevens-Johnson Syndrome (severe rash).

Beck’s Cognitive Model vs. Lewinsohn’s Reinforcement Model of Depression: What are the core structural features, schemas, and maintenance cycles that define each model's view of depressive aetiology?

• Beck’s Cognitive Model: Early life adverse experiences lead to the formation of negative latent schemas. Critical incidents activate these schemas, generating a Cognitive Triad of automatic negative thoughts about the Self, World, and Future. Maintained by errors in logic (e.g., emotional reasoning, black-and-white thinking).

• Lewinsohn’s Behavioral Model: Depression develops and is maintained due to a sharp reduction in response-contingent positive reinforcement. This occurs via:

1. A loss of environmental reinforcement (e.g., relationship loss).

2. Deficits in social/coping skills to extract reinforcement.

3. An inability to enjoy reinforcement due to cognitive distortion.

• This drives a Vicious Cycle: Inactivity -> Less Enjoyment -> Decreased Mood -> Deeper Withdrawal.

Clark’s (1986) Cognitive Model of Panic: What are the sequential steps of the panic loop, and what are the primary conditioning and behavioral maintenance mechanisms?

• The Panic Loop: Internal or external trigger -> Perceived Threat -> Apprehension -> Body Sensations (e.g., dizziness, heart racing) -> Catastrophic Misinterpretation of sensations ("I'm having a heart attack", "I'm going crazy") -> Amplified Apprehension/Panic.

• Maintenance Mechanisms:

  • Interoceptive Conditioning: Mild physical sensations become conditioned stimuli (CS) that trigger a conditioned fear response (CR).

  • Safety Behaviors: Carrying medication, sitting near exits, body scanning. These prevent disconfirmation of the catastrophic beliefs.

Clark & Wells (1995) Cognitive Model of SAD: What is the core vulnerability, the 4 internal steps of the situational maintenance cycle, and the role of attention?

Core Vulnerability: Pervasive Fear of Negative Evaluation (FNE).

The Maintenance Cycle: When entering a social situation:

1. Activation of dysfunctional social assumptions -> Perceived social danger.

2. Shift to Self-Focused Attention: Attention turns sharply inward. They monitor their internal feelings (e.g., shaking, sweating) and use this misleading internal feedback to construct a distorted "observer-perspective" mental image of themselves (assuming others see them exactly this way).

3. Safety Behaviors: Avoiding eye contact, over-rehearsing lines. This makes them appear distant, eliciting negative external reactions that reinforce the original belief.

4. Pre- and Post-Event Processing: Post-mortem catastrophizing and filtering out positive data.

Borkovec's Avoidance Model vs. Wells' Meta-Cognitive Model of GAD: What are the main linguistic, cognitive, and meta-belief structures that maintain chronic worry in each framework?

• Behavioral Avoidance Model (Borkovec): Worry functions as a linguistic, abstract cognitive process that is less emotionally intense than vivid mental imagery. By worrying verbally about minor or everyday issues, the individual escapes/avoids the somatic activation of core, highly distressing underlying fears/images, resulting in negative reinforcement.

• Cognitive Model / Meta-Cognitive Perspective (Wells & Dugas):

  • Intolerance of Uncertainty (IU): A profound cognitive allergy to unexpected outcomes ("I must be 100% certain").

  • Positive Beliefs About Worry (Type 1): "Worrying keeps me safe," "It shows I care".

  • Negative Beliefs About Worry (Type 2 / Meta-Worry): "My worry is uncontrollable," "Worrying will make me physically sick/crazy". Type 2 worry drives clinical GAD distress.

Ehlers & Clark’s Cognitive Model vs. Brewin’s Dual Representation Theory (DRT) of PTSD: What are the exact memory structures, appraisals, and cognitive processing deficits responsible for trauma re-experiencing?

Ehlers & Clark (2000) Cognitive Model: Persistent PTSD occurs when individuals process a trauma in a way that generates a sense of serious current threat. Driven by:

1. Negative Appraisals/Meanings: Overgeneralizing the threat ("The world is completely dangerous", "My nervous system is permanently ruined").

2. Disorganized Trauma Memory: The trauma is poorly elaborated and inadequately integrated into its wider autobiographical context. Because it lacks a time/space anchor, sensory triggers cause the memory to be re-experienced as happening in the present.

Brewin’s Dual Representation Theory (DRT): Proposes two parallel memory systems process trauma parallelly:

• Verbally Accessible Memory (VAM): Conscious, narrative memory that can be voluntarily recalled and edited.

• Situationally Accessible Memory (SAM): Non-conscious, vivid sensory information (smell, sight, sound) captured under extreme fear. SAMs are automatically triggered by sensory cues, driving flashbacks and nightmares. Recovery requires transferring SAM data into the VAM network.

Schizophrenia (Dopamine Hypothesis): What are the specific neurochemical tracts, structural vulnerabilities, genetic heritability rules, and environmental triggers?

Schizophrenia (The Dopamine Hypothesis): Psychotic positive symptoms are driven by an excess of presynaptic dopaminergic activity within the striatum. Structural changes include subtle loss of global brain volume over time. Multiple early vulnerability factors intersect: advanced paternal age, maternal Vitamin D deficiency, birth complications, urban/low SES stress, and adolescent cannabis use.

Bipolar Disorder (Circadian/Social Rhythm Theory): What are the specific neurochemical tracts, structural vulnerabilities, genetic heritability rules, and environmental triggers?

Bipolar Disorder (Circadian & Social Rhythm Theory): Extremely high genetic heritability (~70–80%). The primary neurobiological pathway is a functional instability within the prefrontal cortex-limbic circuit (especially amygdala interconnectivity). Mood episodes are strongly triggered by disruptions to environmental cues (zeitgeibers, e.g., changing routines, shift work), which throw off biological clocks. Sleep deprivation is recognized as the common physiological pathway that triggers a manic switch.

Linehan’s Biosocial Model of BPD: What are the specific components of the biological vulnerability, the exact transactional nature of the invalidating environment, and the resulting clinical manifestation?

• Core Premise: BPD develops from a continuous, systemic transaction between a transactionally reinforcing Biological Vulnerability and an Invalidating Environment.

  • 1. Biological Vulnerability: Marked by an innate, hyper-reactive central nervous system characterized by: High sensitivity to emotional stimuli; High reactivity/intensity of emotional responses; A slow return to baseline emotional functioning.

  • 2. The Invalidating Environment: Caregivers consistently label the individual's private emotional experiences as wrong, invalid, or exaggerated. It teaches the individual to distrust their own internal experiences, and oscillate between emotional suppression and extreme, escalated behavioral outbursts (as escalation becomes the only way to elicit a response from an invalidating environment).

• Result: Pervasive emotional dysregulation that impairs identity, relationships, and behavior.

Fairburn's Transdiagnostic Model of Eating Disorders: What is the single core shared psychopathology, and how do restraint, bingeing, and compensatory behaviors construct the primary maintenance loop?

• Core Premise: Eating disorders share a singular, core psychopathology: the over-evaluation of eating, shape, and weight and their control. Individuals judge their self-worth almost exclusively by their shape and weight.

• The Maintenance Loop: Over-evaluation drives strict dietary restraint/rules. Strict restriction inevitably causes physiological/psychological vulnerability to binge eating. Binge eating triggers intense guilt and fear of weight gain, driving compensatory behaviors (purging, excessive exercise), which structurally reinforces the over-evaluation cycle.

• The "Transdiagnostic" View: This mechanism maintains AN, BN, and BED alike; patients frequently migrate between these diagnoses over time as behavioral expressions shift.

The Four Maintaining Mechanisms of the "Broad" CBT-E Model: What are the 4 external psychological barriers that interact with core eating disorder psychopathology and obstruct standard clinical recovery?

Fairburn identified four external maintaining mechanisms that interact with the core ED psychopathology and obstruct standard recovery:

1. Clinical Perfectionism: Relentless pursuing of personally demanding, self-imposed standards despite severe adverse consequences. Performance is tied entirely to self-worth; applied heavily to eating/shape control.

2. Core Low Self-Esteem: A pervasive, unyielding negative view of oneself that is independent of performance, making the individual rely entirely on weight/shape control for a sense of achievement.

3. Interpersonal Difficulties: Acute or chronic interpersonal stressors (family conflict, isolation) that disrupt mood and trigger eating disorder behaviors as a maladaptive coping mechanism.

4. Mood Intolerance: Inability to cope appropriately with intense emotional states (anxiety, anger, sadness), where bingeing, purging, or self-starvation is used to forcefully modulate or blunt affect.

Beck’s Cognitive Model of Substance Use Disorders: What are the 6 distinct sequential cognitive and behavioral steps that occur when a user is exposed to a substance-related trigger?

Core Framework: Substance use is maintained by a sequence of cognitive activations triggered by internal or external cues.

1. Activating Stimulus: Internal (anxiety, withdrawal) or external (places, people) cues.

2. Core Beliefs Activated: Dormant core schemas regarding substances are triggered ("I cannot cope without a drink", "Substances give me control").

3. Automatic Thoughts / Anticipatory Beliefs: Immediate predictions of reward or relief ("Using right now will make this pain go away").

4. Cravings & Urges: Physiological and psychological impulses to consume.

5. Instrumental Beliefs / Permission-Giving Thoughts: Cognitive justifications that override inhibitions ("I had a hard week, I deserve this just this once", "I'll quit tomorrow").

6. Behavioral Action: Substance use occurs, followed by a cycle of temporary reinforcement and subsequent cognitive self-blame.

Behavioral Model of Addiction Maintenance: How do cue-reactivity via classical conditioning, positive reinforcement, and negative reinforcement operate together to structurally maintain a substance use disorder?

• Classical Conditioning (Cue-Reactivity): Environmental cues (e.g., a specific bar, glassware, rolling paper) become conditioned stimuli (CS) through repeated pairing with drug administration (UCS). Exposure to these conditioned cues alone triggers powerful, conditioned physiological cravings (CR).

• Operant Conditioning (Dual Reinforcement):

  • Positive Reinforcement: The substance delivers immediate chemical euphoria, activation of reward pathways, or heightened social connection, increasing the likelihood of future use.

  • Negative Reinforcement: The substance successfully removes an aversive state (such as physical withdrawal symptoms, intense anxiety, or distressing traumatic intrusive memories), reinforcing the substance as a primary coping mechanism.

Treatment - Major Depressive Disorder (MDD): What is the gold-standard psychological treatment approach, and what are its primary behavioral and cognitive targets?

Best Treatment:

• Cognitive Behavioral Therapy (CBT) incorporating Behavioral Activation (BA).

Primary Targets:

• Behavioral: Disrupts the downward spiral of inactivity and withdrawal by systematically scheduling reinforcing, positive activities to restore a sense of mastery and pleasure.

• Cognitive: Identifies, challenges, and restructures automatic negative thoughts and rigid underlying schemas regarding the self, the world, and the future (Beck's Cognitive Triad).

Treatment - Panic Disorder: What is the gold-standard psychological treatment approach, and what are its primary physiological and behavioral targets?

Best Treatment:

• Cognitive Behavioral Therapy with Interoceptive Exposure (CBT-IE).

Primary Targets:

• Physiological: Targets the catastrophic misinterpretation of physical sensations (e.g., racing heart, dizziness) by deliberately inducing them in a safe environment to break the conditioned panic loop.

• Behavioral: Systematically identifies and eliminates subtle safety behaviors (e.g., carrying medication, scanning the body) and situational avoidance that prevent the client from learning that panic sensations are uncomfortable but not inherently dangerous.

Treatment - Post-Traumatic Stress Disorder (PTSD): What is the gold-standard psychological treatment approach, and what are its primary memory and cognitive targets?

Best Treatment:

• Trauma-Focused CBT (TF-CBT), specifically Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT).

Primary Targets:

• Memory Processing: Uses imaginal exposure (repeatedly narrating the trauma memory in the present tense) and in-vivo exposure (entering safely avoided real-world spaces) to emotionally process and integrate disorganized sensory trauma memories into past chronological history.

• Cognitive: Explicitly targets and restructures trauma-induced "stuck points"—shattered assumptions and distorted beliefs regarding safety, trust, power, control, esteem, and intimacy.

Treatment - Bipolar Disorder: What is the gold-standard adjunctive psychological approach alongside medication, and what are its primary biological and systemic targets?

Best Treatment:

• Interpersonal and Social Rhythm Therapy (IPSRT) combined with Group Psychoeducation and Family-Focused Therapy (FFT).

Primary Targets:

• Biological: Stabilizes daily circadian and social rhythms (sleep schedules, meal times, waking routines) using metric tracking to shield the fragile, hyper-reactive prefrontal-limbic circuit from triggering a manic or depressive switch.

• Systemic/Proactive: Teaches early warning sign (prodrome) detection to halt full mood cycles before onset, resolves interpersonal role transitions/grief, and reduces high Expressed Emotion (EE) in the family home to lower relapse rates.

Treatment - Psychosis & Schizophrenia: What are the gold-standard psychological interventions alongside antipsychotic medication, and what are their primary functional and cognitive targets?

Best Treatment:

• Cognitive Behavioral Therapy for Psychosis (CBTp) combined with Cognitive Remediation Therapy (CRT).

Primary Targets:

• Functional Distress: CBTp targets the emotional distress and daily impairment driven by positive symptoms (delusions and hallucinations) by using gentle Socratic questioning to lower their command power, normalize the experiences, and build active behavioral coping strategies rather than trying to eliminate the voices entirely.

• Cognitive Deficits: CRT targets neurocognitive impairment (attention, working memory, executive function) using repetitive brain training drill-and-practice exercises alongside transfer strategies to improve real-world workplace and educational functioning.

Treatment - Eating Disorders (AN, BN, BED): What is the gold-standard psychological treatment approach, and what are its primary behavioral and over-evaluation targets?

Best Treatment:

• Enhanced Cognitive Behavioral Therapy (CBT-E).

Primary Targets:

• Behavioral: Establishes regular, non-negotiable eating patterns to directly disrupt the restriction-binge-purge maintenance loop, while systematically dismantling extreme dietary rules and checking/avoidance behaviors.

• Core Psychopathology: Targets the over-evaluation of shape, weight, and food control by restructuring self-worth schemas, while utilizing specialized modules to target external maintaining barriers like clinical perfectionism, core low self-esteem, or mood intolerance if present.

Antipsychotic Classes: What are the primary structural differences between Typical (First-Generation) and Atypical (Second-Generation) antipsychotics regarding receptor binding mechanisms, clinical target symptoms, and their respective neurological vs. metabolic side effect profiles?

Receptor Mechanism:

• Typical: Strong, high-affinity, non-selective blockers of Dopamine D2 receptors across brain pathways.

• Atypical: More selective, lower-affinity Dopamine D2 receptor blockers that rapidly dissociate, combined with concurrent Serotonin (5-HT2A) receptor antagonism.

Clinical Target Symptoms:

• Typical: Highly effective at reducing positive symptoms (delusions, hallucinations, agitation) but largely ineffective for negative symptoms.

• Atypical: Successfully treats both positive and negative symptoms (avolition, flat affect, social withdrawal), and can assist with comorbid depressive/bipolar features.

Primary Side Effect Risk Profiles:

• Typical: High risk for severe Neurological/Extrapyramidal Side Effects (EPS), including muscle rigidity, tremors, acute dystonia, and long-term tardive dyskinesia.

• Atypical: Lower risk for EPS, but carries a high risk for Metabolic Syndrome, including profound weight gain, lipid changes, insulin resistance, and sedation.

Antidepressant - Selective Serotonin Reuptake Inhibitors (SSRIs): What is the specific synaptic mechanism of action, common drug examples, primary clinical usages, and key safety warnings?

• Mechanism of Action: Selectively blocks the presynaptic reuptake transporter for Serotonin (5-HT), increasing serotonin availability in the synaptic cleft.

• Common Examples: Sertraline, Escitalopram, Fluoxetine, Citalopram.

• Clinical Usage: First-line pharmacological treatment for Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and Panic Disorder.

• Key Warnings: Carries a critical manic switch warning (can precipitate an acute manic episode if given as monotherapy to an undiagnosed or unmanaged Bipolar patient). May cause discontinuation syndrome upon abrupt cessation.

Antidepressants - Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): What is the dual-action mechanism of action, common drug examples, primary clinical usages, and distinct physical side effect warnings?

• Mechanism of Action: Dual-action inhibitor that simultaneously blocks the presynaptic reuptake transporters for both Serotonin (5-HT) and Norepinephrine (NE).

• Common Examples: Venlafaxine, Duloxetine, Desvenlafaxine.

• Clinical Usage: Used for severe, melancholic, or treatment-resistant depression, GAD, and chronic pain conditions (such as fibromyalgia or diabetic neuropathy).

• Key Warnings: Norepinephrine activation can cause dose-dependent increases in blood pressure and heart rate. Requires careful monitoring in patients with pre-existing hypertension.

Antidepressants - Tricyclic Antidepressants (TCAs): What is the multi-receptor mechanism of action, common drug examples, primary clinical usages, and lethal overdose/side effect warnings?

• Mechanism of Action: Older agents that block Serotonin and Norepinephrine reuptake, but also inadvertently block histamine (H1), muscarinic cholinergic, and alpha-1 adrenergic receptors.

• Common Examples: Amitriptyline, Imipramine, Clomipramine.

• Clinical Usage: Second- or third-line choice for severe depression, chronic nerve pain, and treatment-resistant OCD (specifically Clomipramine).

• Key Warnings: Highly cardiotoxic in overdose due to sodium channel blockade (prolongs the QT interval, potentially causing lethal arrhythmias). Features severe anticholinergic side effects (e.g., severe dry mouth, blurred vision, urinary retention, constipation).

Antidepressants - Monoamine Oxidase Inhibitors (MAOIs): What is the enzymatic mechanism of action, common drug examples, primary clinical usages, and critical dietary/drug interaction restrictions?

• Mechanism of Action: Inhibits the mitochondrial enzyme monoamine oxidase, preventing the intracellular breakdown of serotonin, norepinephrine, and dopamine, drastically increasing overall monoamine storage and release.

• Common Examples: Phenelzine, Tranylcypromine, Moclobemide.

• Clinical Usage: Strictly reserved as a last-line treatment for highly treatment-resistant depression or atypical depression features.

• Key Warnings: Requires a strict low-tyramine diet (avoiding aged cheeses, cured meats, yeast extracts, and red wine) to prevent a life-threatening hypertensive crisis. Carries an exceptionally high risk of fatal Serotonin Syndrome if mixed with any other serotonergic medications, requiring strict washout periods.