CPR APPLICATIONS FOUNDATION · CHAPTER 17 · ABNORMAL
Abnormal Foundations of Psychiatry & Behavioral Science
Organize the chapter before drilling into individual CPR concepts.
Supplemental foundation map: this page orients the detailed CPR Applications for Chapter 17. It is not part of the canonical CPR object inventory.
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Normal Foundations
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Treatment Foundations
17.6 · SOURCE CPR FOUNDATION
Concept
Psychiatric syndromes are defined by duration, impairment, reality testing, and exclusion of medical or substance causes. Step 1 rarely asks for a symptom label alone. It asks whether the pattern qualifies as primary psychiatric disease and what safer explanation must be ruled out first.
Pattern
Step 1 contrasts days versus weeks versus months, episodic versus persistent symptoms, preserved versus impaired reality testing, and primary disorder versus substance/medical cause. Acute fluctuating symptoms usually point away from primary psychiatric disease and toward medical evaluation.
Rule
- Anchor on duration and impairment. The same symptom becomes different diagnoses depending on time and dysfunction.
- Assess reality testing. Obsessions, worries, overvalued ideas, and delusions are not the same.
- Treat acute confusion as medical until proven otherwise. Delirium, intoxication, withdrawal, and medication effects must be considered.
Applications
- Low mood anhedonia 2 weeks → major depressive episode
- A distinct period of elevated or irritable mood with increased energy and severe impairment or hospitalization attributable to the episode → consider mania after excluding substance or medical causes
- Panic symptoms unexpected recurrent → panic disorder
- Hallucinations only during depression → MDD with psychotic features
- Persistent psychotic illness with qualifying active-phase symptoms, functional decline, and at least six months of continuous disturbance → consider schizophrenia after excluding other causes
- Acute confusion after new medication → medication or delirium cause
- Tip: Primary psychiatric diagnosis requires exclusion of better causes
CPR APPLICATIONS · ACTIVE REASONING
Classify time course, attention, and altered behavior
Psychiatric presentations require the time course, functional change, and medical or substance context. Do not infer a diagnosis from one symptom. Select a response before checking the explanation. If scripting is unavailable, expand a worked answer. Responses are not stored or transmitted.
Reveal worked answer and transfer
Best answer: Delirium with investigation for medical, medication, and environmental causes. Acute fluctuation and impaired attention are core clues to delirium, requiring assessment of underlying precipitants.
Change one variable: Would finding asymptomatic bacteriuria alone establish the cause of delirium? Why not?
Reveal worked answer and transfer
Best answer: Mania requiring assessment for psychiatric, substance-related, and medical causes. The severity and psychosis support a manic syndrome; the differential still includes substances and medical causes.
Change one variable: How would the syndrome differ if similar symptoms lacked psychosis and marked impairment and lasted only several days?
Reveal worked answer and transfer
Best answer: Alcohol withdrawal with increased excitatory tone after chronic CNS adaptation. Chronic alcohol exposure changes inhibitory/excitatory signaling; abrupt withdrawal may cause autonomic activation, seizures, and delirium tremens.
Change one variable: Which new findings, such as seizures or confusion, would escalate the clinical urgency?
Change the mechanism
Review the comparison without scripts
- Abrupt fluctuating inattention: Evaluate delirium and reversible precipitants; do not label it baseline dementia without assessment.
- Psychosis during elevated mood with major impairment: Mania is supported; investigate drugs and medical mimics as appropriate.
- Autonomic hyperactivity after alcohol cessation: Assess withdrawal severity and seizure/delirium risk urgently.
Explain it back: For one decision, state the mechanism, a specific counterexample, and the finding that would change your conclusion.
Unscored educational practice; not psychometrically validated and not patient-specific medical advice.
How to use this foundation map
- Identify the organizing mechanism.
- Recognize the pattern.
- Restate the rule without looking.
- Test transfer with applications and question practice.
Pair CPR with the 5P Approach™ when solving cases and questions.