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Psychiatry

A phase-wise clinical reference from foundational psychopathology to advanced management. Phases 1 and 2 establish the language, examination and risk framework needed for all later disorder-based learning.

Clinical editorial standard: This module has been re-audited for disease-specific reasoning. Diagnosis, investigations and management are intended to follow the physiology and clinical problem rather than a repeated generic template. High-yield boxes are used only where they add a distinct bedside decision, pitfall or escalation point.
✓ Phase 1 is FREE FOR ALL VISITORS — no login or Premium subscription required.
PHASE 1 COMPLETE

Core Concepts & Foundations

01. Foundations of Psychiatry

Core framework

  • Mental health is more than absence of illness: it includes adaptive emotional, cognitive, social and occupational functioning.
  • Judge symptoms by distress, dysfunction, danger, duration, context and cultural appropriateness—not unusual behaviour alone.
  • Biopsychosocial model: biological vulnerability + psychological processes + social environment interact dynamically.
  • Stress–vulnerability model: illness emerges when vulnerability and stress exceed coping/protective capacity.
  • Always identify predisposing, precipitating, perpetuating and protective (4P) factors.
  • A psychiatric diagnosis describes a syndrome; formulation explains this patient.
02. Brain–Behaviour & Neurobiology
Prefrontal cortexExecutive function, planning, inhibition, working memoryLimbic circuitsEmotion, motivation, salienceAmygdalaThreat/fear processingHippocampusMemory/contextBasal gangliaMovement, habit, reward circuitsHypothalamusSleep, appetite, autonomic/endocrine integration

Clinical pearl: psychiatric syndromes are network disorders; avoid reducing a disorder to a single transmitter or brain region.

03. Neurotransmitters — Clinical Map
DopaminePsychosis, reward, motivation, movement; D2 blockade links efficacy to EPS/prolactin effects.SerotoninMood, anxiety, sleep, appetite, sexual function.NoradrenalineArousal, vigilance, attention, mood.GABAMajor inhibitory system; anxiety, sedation, withdrawal physiology.GlutamateMajor excitatory system; learning, plasticity, NMDA models of psychosis.AcetylcholineAttention/memory; anticholinergic burden can worsen confusion.HistamineWakefulness/appetite; H1 blockade contributes sedation/weight gain.
04. Psychopathology: Mental Functions

Assess systematically: consciousness → attention → orientation → appearance/behaviour → psychomotor activity → speech → mood/affect → thought → perception → cognition → insight → judgment.

Rule: describe the observed phenomenon first; diagnose only after integrating chronology, context, substances, medical causes and functional change.
05. Perception
  • Illusion: misinterpretation of a real external stimulus.
  • Hallucination: perception-like experience without an external stimulus, experienced with perceptual quality.
  • Hypnagogic / hypnopompic: around sleep onset / awakening; may occur without psychiatric disease.
  • Auditory: common in primary psychosis; characterize person, number, content, location, controllability and commands.
  • Visual/tactile: actively consider neurological, toxic, withdrawal and delirium causes.
  • Functional hallucination: hallucination occurs simultaneously with a real stimulus in the same modality.
06. Thought

Form / stream

Flight of ideas • loosening of associations • tangentiality • circumstantiality • blocking • perseveration • neologism • incoherence.

Content

Delusions • obsessions • overvalued ideas • phobias • depressive cognitions • suicidal/homicidal ideas.

Possession

Thought insertion • withdrawal • broadcasting. Clarify the patient’s exact experience rather than leading them.

Delusion: assess conviction, preoccupation, impact, cultural context and resistance to counter-evidence—not bizarreness alone.
07. Mood, Affect, Insight & Judgment
  • Mood: sustained subjective emotional state. Affect: observed expression of emotion.
  • Describe affect by range, intensity, stability, reactivity and congruence.
  • Anhedonia = diminished interest/pleasure; apathy = diminished motivation.
  • Insight: awareness of symptoms/illness, attribution, need for treatment and consequences.
  • Judgment: ability to make safe, adaptive decisions; assess personal/social judgment in real context.
08. Classification & Formulation
  • Use current diagnostic systems as structured clinical languages, not substitutes for judgment.
  • Exclude substance/medication and medical causes when clinically indicated.
  • Formulate across biological + psychological + social domains using the 4Ps.
  • Always add risk, function, strengths/protective factors and management priorities.

Diagnosis asks “what syndrome?” Formulation asks “why this person, why now, what maintains it, what protects them, and what should we do next?”

09. Defence Mechanisms
DenialProjectionDisplacementRationalizationReaction formationRegressionRepressionSublimationIntellectualizationSplittingActing outIdentification

Use defence mechanisms to understand coping and interpersonal patterns; do not label a patient from a single behaviour.

10. Do Not Confuse
Delirium vs dementiaAcute/fluctuating attention disturbance vs usually chronic progressive cognitive decline.Delusion vs obsessionFixed belief vs intrusive unwanted thought usually recognized as one’s own.Hallucination vs illusionNo external stimulus vs misperceived real stimulus.Mood vs affectSubjective sustained state vs observed emotional expression.Depersonalization vs derealizationUnreality/detachment from self vs surroundings.Flight of ideas vs looseningRapid understandable associative shifts vs impaired logical association.Insight vs judgmentUnderstanding illness vs making adaptive decisions.
11. Expanded Descriptive Psychopathology

Expanded coverage of consciousness, attention, speech/language, psychomotor phenomena, catatonic signs and disturbances of self-experience.

12. Delusions, Obsessions & Belief Phenomena — Advanced Map

Primary delusional experiences, major delusional themes, passivity/control phenomena, thought alienation, and the distinctions between obsession, overvalued idea and delusion.

13. Neurocircuitry, Stress Biology & Neuroplasticity

Executive-control, salience, default-mode and reward networks; HPA-axis stress biology; neuroplasticity; complex polygenic and developmental vulnerability.

Modern psychiatric neurobiology is network-based—not a simplistic single “chemical imbalance” model.

14. Sleep & Circadian Foundations

Sleep disturbance as symptom, precipitant and treatment target; insomnia/hypersomnia; circadian disruption; and the crucial distinction between insomnia and reduced need for sleep.

15. Development, Temperament, Attachment & Personality Foundations

Developmental context, temperament, enduring personality patterns, attachment, early adversity, learned coping and state-versus-trait distinction.

16. Learning, Conditioning & Cognitive Models

Classical conditioning, operant conditioning, negative reinforcement/avoidance, observational learning, automatic thoughts, assumptions and core beliefs.

17. Culture, Context, Grief & Normality

Cultural formulation, explanatory models, spirituality, culturally sanctioned experiences, adaptive grief and contextual interpretation of unusual beliefs or behaviour.

18. Capacity, Consent, Competence & Confidentiality — Core Concepts

Decision- and time-specific capacity, consent, legal competence terminology, confidentiality principles and why psychiatric diagnosis or treatment refusal does not automatically imply incapacity.

19. Organic–Psychiatric Interface: First Principles
Do not prematurely label an atypical presentation psychiatric. Consider delirium, neurological disease, endocrine/metabolic disturbance, infection, intoxication/withdrawal and medication effects.

Acute/fluctuating onset, impaired attention or consciousness, focal neurology, autonomic instability, major cognitive change or atypical late onset are important warning features.

20. High-Yield Foundation Checkpoints

Core reminders: phenomenology before diagnosis; diagnosis ≠ formulation; hallucination ≠ illusion; obsession ≠ delusion; mood ≠ affect; reduced need for sleep ≠ insomnia; psychiatric illness ≠ incapacity; always consider medical/substance causes, culture, risk, function and protective factors.

Core terminology quick bank

AffectAgitationAlogiaAmbivalenceAmnesiaAnhedoniaAnxietyApathyAttentionAutomatic obedienceAvolitionBlockingCatalepsyCatatoniaClang associationCompulsionConfabulationDelusionDepersonalizationDerealizationDisinhibitionEcholaliaEchopraxiaFlight of ideasHallucinationIllusionInsightJudgmentMannerismMutismNegativismNeologismObsessionOrientationOvervalued ideaPerseverationPhobiaPressure of speechPsychomotor retardationStereotypyTangentialityThought broadcastingThought insertionThought withdrawalWaxy flexibility
21. Free Clinical Integration — Symptom, Syndrome or Diagnosis?
  • Symptom: an individual experience such as low mood, insomnia, hallucination or anxiety.
  • Syndrome: a clinically meaningful cluster with a characteristic pattern and course.
  • Diagnosis: a syndrome interpreted after chronology, impairment, exclusions and context are considered.
  • A hallucination alone does not equal schizophrenia; reduced sleep alone does not equal mania; sadness alone does not equal major depression.

Clinical pearl: The most important psychiatric skill is disciplined phenomenology before diagnostic labeling.

22. Free Clinical Integration — Organic Psychiatry Red Flags
Reconsider a primary psychiatric diagnosis when presentation is unusually acute, fluctuating, neurologically abnormal, cognitively impaired, medication/toxin related, or accompanied by systemic illness.
  • New late-onset psychosis or major personality change.
  • Fluctuating attention or consciousness.
  • New focal neurological signs, seizures or autonomic instability.
  • Strong temporal relationship to medication, substance, withdrawal or medical illness.

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