NR606 / NR 606 Midterm Exam 2026 | Diagnosis & Management in Psychiatric Mental Health II | Chamberlain University | Questions & Answers with Detailed Rationales | PMHNP | Psychiatric Diagnosis & Psychopharmacology PDF

INSTANT PDF DOWNLOAD — This is the comprehensive Midterm Exam preparation guide for NR606 / NR 606 - Diagnosis & Management in Psychiatric Mental Health II (2026 Update) at Chamberlain University, featuring questions and answers with detailed rationales. Designed for Psychiatric Mental Health Nurse Practitioner (PMHNP) students, this resource consolidates the critical diagnostic and management concepts required to master the NR606 Midterm Exam and excel in advanced psychiatric mental health practice. The guide is meticulously aligned with Chamberlain University curriculum, DSM-5-TR diagnostic criteria, ANCC PMHNP-BC® certification blueprints, and current evidence-based psychiatric management guidelines. This verified resource provides comprehensive coverage of key NR606 Psychiatric Mental Health II Midterm Exam topics, including: DSM-5-TR Diagnostic Criteria Mastery (diagnostic hierarchy, differential diagnosis, rule-out criteria, specifiers, severity ratings, cultural formulation interview (CFI), assessment measures (cross-cutting symptom measures (CCSM), disorder-specific severity measures (Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS), Altman Self-Rating Mania Scale (ASRM), Young Mania Rating Scale (YMRS), Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), PTSD Checklist for DSM-5 (PCL-5), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), Columbia-Suicide Severity Rating Scale (C-SSRS), Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS)), diagnostic criteria changes from DSM-5 to DSM-5-TR (prolonged grief disorder (PGD) added as new diagnosis (criterion: persistent, pervasive grief response lasting 12 months for adults, 6 months for children and adolescents, with yearning/longing for deceased, intense emotional pain, identity disruption, disbelief, avoidance, intense emotional responses, feeling of meaninglessness, loneliness, functional impairment), criterion A for major depressive disorder unchanged, but added specifier "with mixed features" clarification, criterion A for bipolar I disorder unchanged, bipolar II disorder hypomania criteria unchanged but added clarification on duration and functional impairment, PTSD criteria unchanged but added dissociative subtype specifier clarification, autism spectrum disorder criteria unchanged but added specifier "with or without accompanying intellectual impairment" and "with or without accompanying language impairment," gender dysphoria criteria unchanged but removed "disorder" language from descriptive text), Mood Disorder Differential Diagnosis (major depressive disorder (MDD) vs persistent depressive disorder (dysthymia) vs premenstrual dysphoric disorder (PMDD) vs disruptive mood dysregulation disorder (DMDD) (children up to age 12) vs bipolar depression vs adjustment disorder with depressed mood vs MDD with peripartum onset vs MDD with seasonal pattern (seasonal affective disorder—SAD) vs depression due to another medical condition (hypothyroidism, Cushing's, Parkinson's, stroke, multiple sclerosis, TBI, pancreatic cancer, vitamin B12 deficiency, folate deficiency, vitamin D deficiency, iron deficiency anemia, sleep apnea, chronic kidney disease, liver failure, HIV, syphilis, Lyme disease) vs substance/medication-induced depressive disorder (alcohol, benzodiazepine withdrawal, stimulant withdrawal, corticosteroids, isotretinoin, interferon-alpha, ribavirin, mefloquine, efavirenz, varenicline, propranolol, reserpine, methyldopa, some anticonvulsants (topiramate, zonisamide, levetiracetam), antipsychotics (clozapine, olanzapine, quetiapine—not common but possible), oral contraceptives (especially progestin-only), GnRH agonists (leuprolide, goserelin), aromatase inhibitors (anastrozole, letrozole, exemestane), tamoxifen, methotrexate, cyclosporine, disulfiram, metoclopramide, baclofen, tizanidine, levodopa, amantadine, donepezil, memantine, antiepileptics, barbiturates, benzodiazepines—both use and withdrawal), MDD diagnostic criteria (≥5 of 9 symptoms present for ≥2 weeks including depressed mood or anhedonia: depressed mood most of day nearly every day (subjective or observed), markedly diminished interest or pleasure (anhedonia) in all or almost all activities most of day nearly every day, significant weight loss when not dieting or weight gain (≥5% body weight in 1 month) or decrease/increase in appetite nearly every day, insomnia or hypersomnia nearly every day, psychomotor agitation or retardation nearly every day (observed by others, not just subjective feelings), fatigue or loss of energy nearly every day, feelings of worthlessness or excessive/inappropriate guilt nearly every day, diminished ability to think or concentrate or indecisiveness nearly every day (subjective or observed by others), recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt, or specific plan for suicide), MDD specifiers (with anxious distress (presence of ≥2 of: feeling keyed up/tense, unusually restless, difficulty concentrating due to worry, fear something awful will happen, feeling of loss of control—mild (2 symptoms), moderate (3), moderate-severe (4-5), severe (4-5 with motor agitation)), with mixed features (≥3 manic/hypomanic symptoms during depressive episode—elevated/expansive mood, grandiosity, increased talkativeness/pressured speech, flight of ideas/racing thoughts, increased energy/goal-directed activity, excessive involvement in pleasurable activities with high risk for painful consequences, decreased need for sleep), with melancholic features (loss of pleasure in all activities or lack of reactivity to usually pleasurable stimuli, plus ≥3 of: quality of depressed mood different from grief, worse in morning, early morning awakening (2 hours before usual wake time), marked psychomotor agitation/retardation, significant anorexia/weight loss, excessive/inappropriate guilt), with atypical features (mood reactivity (mood brightens in response to positive events) plus ≥2 of: significant weight gain or increased appetite, hypersomnia, leaden paralysis (heavy feeling in arms/legs), long-standing pattern of interpersonal rejection sensitivity (not limited to mood episodes) resulting in significant social/occupational impairment), with psychotic features (mood-congruent delusions/hallucinations (themes of personal inadequacy, guilt, disease, death, nihilism, deserved punishment) vs mood-incongruent (persecutory, referential, thought insertion/withdrawal/broadcasting, delusions of control, bizarre delusions without depressive content), with catatonia (catatonia specifier—≥3 of: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypies, agitation not influenced by external stimuli, grimacing, echolalia, echopraxia), with peripartum onset (onset during pregnancy or within 4 weeks postpartum—APA extends to within 4 weeks, but clinically often up to 12 months, especially in breastfeeding mothers, differential includes postpartum psychosis (emergency—delusions, hallucinations, disorganization, usually bipolar spectrum), postpartum blues (transient, mild, days 3-5 postpartum, resolves within 2 weeks, no treatment needed beyond support/education), postpartum depression (MDD peripartum onset)), with seasonal pattern (regular temporal relationship between onset of major depressive episodes and time of year (most commonly fall/winter), full remissions (or change from depression to mania/hypomania) at characteristic time of year (spring), at least 2 episodes in past 2 years with no non-seasonal episodes in that period, seasonal episodes substantially outnumber non-seasonal episodes over lifetime), bipolar I disorder diagnostic criteria (manic episode: distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy lasting at least 1 week and present most of day nearly every day (or any duration if hospitalization required), plus ≥3 of (4 if mood only irritable): inflated self-esteem or grandiosity, decreased need for sleep (feels rested after only few hours of sleep), more talkative than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, distractibility (attention too easily drawn to unimportant/irrelevant external stimuli), increase in goal-directed activity (socially, at work/school, sexually) or psychomotor agitation, excessive involvement in activities that have high potential for painful consequences (buying sprees, sexual indiscretions, foolish business investments, reckless driving, substance use), marked impairment in social/occupational functioning or hospitalization required to prevent harm to self/others or psychotic features, not attributable to substance use or another medical condition, bipolar II disorder diagnostic criteria (hypomanic episode: distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity/energy lasting at least 4 consecutive days and present most of day nearly every day, plus ≥3 of same criteria as mania (4 if irritable mood only), unequivocal change in functioning not characteristic of person when not symptomatic, impairment in functioning observable to others but not severe enough to cause marked impairment in social/occupational functioning or hospitalization, no psychotic features, plus at least one major depressive episode (≥2 weeks), never have had a manic episode, cyclothymic disorder (for at least 2 years (1 year children/adolescents), numerous periods with hypomanic symptoms and numerous periods with depressive symptoms not meeting full criteria for hypomanic or major depressive episode, symptoms present at least half the time and never without symptoms for 2 months, criteria for MDD, manic, or hypomanic never met, significant distress/impairment), Anxiety Disorder Differential Diagnosis (generalized anxiety disorder (GAD) vs panic disorder vs agoraphobia vs social anxiety disorder (social phobia) vs specific phobia vs separation anxiety disorder vs selective mutism vs anxiety disorder due to another medical condition (hyperthyroidism, pheochromocytoma, hypoglycemia, cardiac arrhythmias, COPD, asthma, pulmonary embolism, mitral valve prolapse, carcinoid syndrome, vestibular disorders, seizure disorders (especially temporal lobe), CNS disorders (stroke, MS, Huntington's, Parkinson's), vitamin B12 deficiency, porphyria) vs substance/medication-induced anxiety disorder (caffeine intoxication, cocaine, amphetamines, cannabis, hallucinogens, PCP, MDMA, synthetic cathinones, alcohol withdrawal, benzodiazepine withdrawal, opioid withdrawal, nicotine withdrawal, corticosteroids, albuterol, theophylline, thyroid hormone overdose, decongestants (pseudoephedrine, phenylephrine), stimulants (methylphenidate, amphetamine salts), bupropion (high dose), SSRIs/SNRIs (initial weeks—activation syndrome), levodopa, anticholinergics, cycloserine, interferons, antimalarials (mefloquine), antipsychotics (akathisia), withdrawal from antihypertensives (beta-blockers, clonidine), GAD diagnostic criteria (excessive anxiety and worry occurring more days than not for at least 6 months about a number of events/activities (work, school, health, finances, family), difficulty controlling worry, associated with ≥3 of (≥1 in children): restlessness or feeling keyed up/on edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance (difficulty falling/staying asleep, restless unsatisfying sleep), clinically significant distress/impairment, not attributable to substance/medical condition, not better explained by another mental disorder, panic disorder diagnostic criteria (recurrent unexpected panic attacks (abrupt surge of intense fear/discomfort peaking within minutes, with ≥4 of: palpitations/pounding heart/accelerated heart rate, sweating, trembling/shaking, sensations of shortness of breath/smothering, feeling of choking, chest pain/discomfort, nausea/abdominal distress, feeling dizzy/unsteady/lightheaded/faint, chills or heat sensations, paresthesias (numbness/tingling), derealization (feelings of unreality) or depersonalization (detached from self), fear of losing control or going crazy, fear of dying), at least one attack followed by ≥1 month of persistent concern about additional attacks or worry about consequences of attack (losing control, heart attack, "going crazy") or significant maladaptive change in behavior related to attacks, not attributable to substance/medical condition, not better explained by another mental disorder, agoraphobia diagnostic criteria (marked fear or anxiety about ≥2 of: using public transportation (automobiles, buses, trains, ships, planes), being in open spaces (parking lots, marketplaces, bridges), being in enclosed spaces (shops, theaters, cinemas), standing in line or being in a crowd, being outside of home alone, fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of panic-like symptoms or other incapacitating/embarrassing symptoms (fear of falling in elderly, fear of incontinence), agoraphobic situations almost always provoke fear/anxiety, actively avoided, require presence of companion, or endured with intense fear/anxiety, fear/anxiety out of proportion to actual danger, duration ≥6 months, significant distress/impairment, not attributable to substance/medical condition, if another medical condition present (inflammatory bowel disease, Parkinson's), fear is clearly excessive, not better explained by another mental disorder (specific phobia—situational type may mimic agoraphobia but specific phobia is fear of situation itself not fear of inability to escape/get help for panic-like symptoms), social anxiety disorder (social phobia) diagnostic criteria (marked fear or anxiety about ≥1 social situations in which person exposed to possible scrutiny by others (social interactions (conversations, meeting unfamiliar people), being observed (eating, drinking), performing in front of others (giving speech)), fears will act in way or show anxiety symptoms that will be negatively evaluated (humiliated, embarrassed, rejected, offend others), social situations almost always provoke fear/anxiety, avoided or endured with intense fear/anxiety, fear/anxiety out of proportion to actual threat, duration ≥6 months, significant distress/impairment, not attributable to substance/medical condition, not better explained by another mental disorder (panic disorder (panic attacks may occur in social situations but person does not fear social situations per se, fears having panic attack), autism spectrum disorder (social deficits but not driven by fear of negative evaluation), body dysmorphic disorder (fear of negative evaluation about imagined defect), agoraphobia (fear of inability to escape, not fear of negative evaluation), specific phobia (fear of specific object/situation not social evaluation)), specify if performance only (fear restricted to speaking or performing in public, often does not impair non-performance occupational/social functioning), Obsessive-Compulsive and Related Disorders Differential Diagnosis (OCD vs body dysmorphic disorder (BDD) vs hoarding disorder vs trichotillomania (hair-pulling disorder) vs excoriation (skin-picking) disorder vs substance/medication-induced obsessive-compulsive and related disorder vs OCD due to another medical condition (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), Sydenham's chorea, Tourette's syndrome, Huntington's disease, traumatic brain injury, encephalitis, carbon monoxide poisoning, stroke), OCD diagnostic criteria (presence of obsessions, compulsions, or both: obsessions (recurrent persistent intrusive unwanted thoughts/urges/images that cause marked anxiety/distress, person attempts to ignore/suppress or neutralize with compulsion), compulsions (repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that person feels driven to perform in response to obsession or according to rigid rules, aimed at preventing/reducing anxiety or preventing dreaded event/situation but not realistically connected to what they are designed to neutralize or clearly excessive), obsessions/compulsions time-consuming (1 hour/day) or cause significant distress/impairment, not attributable to substance/medical condition, not better explained by another mental disorder (GAD (worry about real-life problems, not ego-dystonic intrusive thoughts), MDD (rumination may be present but not typically with compulsive rituals), body dysmorphic disorder (preoccupation with appearance, not other obsessions), tic disorders (tics are involuntary, not driven by obsession), hoarding disorder (persistent difficulty discarding possessions, not driven by obsession typically), BDD diagnostic criteria (preoccupation with ≥1 perceived defect or flaw in physical appearance that is not observable or appears slight to others, repetitive behaviors (mirror checking, excessive grooming, skin picking, seeking reassurance) or mental acts (comparing appearance to others) in response to appearance concerns, clinically significant distress/impairment, not better explained by eating disorder (body dysmorphic disorder can be comorbid but if preoccupation is body fat/weight and meets anorexia nervosa criteria, both may be diagnosed), specify muscle dysmorphia (preoccupation with being too small or insufficiently muscular, despite normal build or even very muscular, compulsive exercise, dietary manipulation, substance use (anabolic steroids)), insight specifiers (with good/fair insight (recognizes beliefs about appearance are definitely or probably not true or not shared by others), with poor insight (thinks beliefs are probably true), with absent insight/delusional beliefs (completely convinced beliefs are true, cannot be distinguished from delusional disorder, somatic type), hoarding disorder diagnostic criteria (persistent difficulty discarding or parting with possessions regardless of actual value, perceived need to save items and distress associated with discarding, accumulation of possessions that congest/clutter active living areas and substantially compromise intended use (if living areas uncluttered only due to third-party intervention (family, housekeeper, authorities), individual still meets criteria), clinically significant distress/impairment (including maintaining safe environment for self/others), not attributable to another medical condition (brain injury, cerebrovascular disease, Prader-Willi syndrome, frontotemporal dementia), not better explained by another mental disorder (OCD—hoarding may occur in OCD but is typically ego-dystonic and unwanted, in hoarding disorder behavior is ego-syntonic and pleasurable to acquire/save items, hoarding may also occur in MDD (energy/motivation), psychosis (disorganization, delusions), dementia (cognitive impairment), autism spectrum disorder (restricted interests), specify with excessive acquisition (if difficulty discarding accompanied by excessive acquisition of unneeded items (buying, stealing, collecting free items), level of insight (good/fair, poor, absent/delusional beliefs), Trauma and Stressor-Related Disorders Differential Diagnosis (PTSD vs acute stress disorder (ASD) vs adjustment disorder vs reactive attachment disorder (RAD) vs disinhibited social engagement disorder (DSED) vs prolonged grief disorder, PTSD diagnostic criteria (exposure to actual or threatened death, serious injury, or sexual violence (direct experience, witnessing in person, learning that event occurred to close family member/friend (if actual/threatened death must have been violent or accidental), repeated/extreme exposure to aversive details (first responders collecting body parts, police repeatedly exposed to child abuse details)—not through electronic media/TV/movies unless work-related), presence of ≥1 intrusion symptom associated with event after event: recurrent involuntary distressing memories, recurrent distressing dreams, dissociative reactions (flashbacks—feeling or acting as if event recurring), intense prolonged psychological distress at exposure to cues resembling aspect of event, marked physiological reactions to cues, persistent avoidance of ≥1 of: distressing memories/thoughts/feelings about or closely associated with event, external reminders (people, places, conversations, activities, objects, situations), negative alterations in cognition/mood associated with event (≥2): inability to remember important aspect (dissociative amnesia), persistent negative beliefs about self/world (I am bad, no one can be trusted, world is completely dangerous), persistent distorted blame of self/others for cause/consequences, persistent negative emotional state (fear, horror, anger, guilt, shame), markedly diminished interest/participation in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions (happiness, satisfaction, love), alterations in arousal/reactivity (≥2): irritable behavior/anger outbursts (with little/no provocation) typically verbal/physical aggression, reckless/self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance, duration 1 month, clinically significant distress/impairment, not attributable to substance/medical condition, specify if with dissociative symptoms (depersonalization (feeling detached from own mental processes/body—out of body, time slowing, pain tolerance) or derealization (unreality of world—dreamlike, distant, distorted)), with delayed expression (full criteria not met until ≥6 months after event, although onset of symptoms may be immediate), acute stress disorder (ASD) same symptom clusters as PTSD but duration 3 days to 1 month after trauma exposure, onset either during or immediately after event, clinically significant distress/impairment, not attributable to substance/medical condition, adjustment disorder diagnostic criteria (emotional/behavioral symptoms in response to identifiable stressor(s) occurring within 3 months of onset of stressor, symptoms or behaviors clinically significant as evidenced by marked distress out of proportion to severity/intensity of stressor (considering external context and cultural factors) or significant impairment in social/occupational/academic functioning, once stressor or its consequences terminated, symptoms do not persist for more than 6 months, not better explained by another mental disorder or normal bereavement, specify type (with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, unspecified), prolonged grief disorder diagnostic criteria (NEW in DSM-5-TR): death of someone close to individual at least 12 months ago (6 months for children/adolescents), persistent pervasive grief response characterized by ≥3 of following nearly every day for last month: identity disruption (sense of self), marked sense of disbelief about death, avoidance of reminders that person is dead, intense emotional pain (anger, bitterness, sorrow) related to death, difficulty reintegrating (making friends, pursuing interests), emotional numbness, feeling life is meaningless, intense loneliness, grief response causes clinically significant distress/impairment, not better explained by MDD, PTSD, or other mental disorder, Somatic Symptom and Related Disorders Differential Diagnosis (somatic symptom disorder (SSD) vs illness anxiety disorder (IAD) vs conversion disorder (functional neurological symptom disorder) vs factitious disorder (imposed on self or another) vs psychological factors affecting other medical conditions (PFAOMC), somatic symptom disorder diagnostic criteria (≥1 somatic symptom that is distressing or results in significant disruption of daily life (may be specific symptom (fatigue, pain, shortness of breath) or nonspecific (generalized weakness, whole body tiredness)), excessive thoughts, feelings, or behaviors related to somatic symptoms or associated health concerns as manifested by ≥1 of: disproportionate persistent thoughts about seriousness of symptoms, persistently high level of anxiety about health or symptoms, excessive time/energy devoted to symptoms or health concerns, symptom duration ≥6 months (though specific symptoms may change over time), specify severity (mild (1 symptom), moderate (2 or more), severe (2 or more plus multiple somatic complaints or very severe symptoms)), illness anxiety disorder diagnostic criteria (preoccupation with having or acquiring serious illness, somatic symptoms are absent or if present only mild in intensity, high level of anxiety about health, easily alarmed about personal health status, performs excessive health-related behaviors (checks body for signs of illness) or maladaptive avoidance (avoids doctor appointments/hospitals), illness preoccupation present for ≥6 months (specific feared illness may change over time), not better explained by another mental disorder (somatic symptom disorder—symptoms present; GAD—worry not restricted to illness; OCD—obsessions about illness may have compulsions (checking rituals) but insight often present that obsessions are irrational; panic disorder—fear of having panic attack not illness), specify care-seeking type (frequently uses medical services, may overutilize) vs care-avoidant type (rarely uses medical services, avoids due to fear of diagnosis), conversion disorder (functional neurological symptom disorder) diagnostic criteria (≥1 symptom of altered voluntary motor or sensory function (weakness/paralysis, abnormal movements (tremor, dystonia, myoclonus, gait disorder), abnormal swallowing/globus, speech symptoms (dysphonia, slurred speech, stuttering), seizure-like episodes (PNES—psychogenic nonepileptic seizures, dissociative seizures), anesthesia/sensory loss, special sensory symptoms (vision loss, double vision, blindness, hearing loss, tinnitus, olfactory/gustatory hallucinations)), clinical findings provide evidence of incompatibility between symptom and recognized neurological or medical condition (Hoover's sign for leg weakness, tremor entrainment/distractibility, Jacksonian march not present in PNES, preservation of pupillary light reflex in blindness, normal startle response in deafness), symptom not better explained by another medical/mental disorder (malingering or factitious disorder requires evidence of external incentive or deception), causes clinically significant distress/impairment or warrants medical evaluation, specify symptom type (with weakness/paralysis, with abnormal movements, with swallowing symptoms, with speech symptom, with attacks/seizures, with anesthesia/sensory loss, with special sensory symptom, with mixed symptoms), specify if acute episode (6 months) or persistent (≥6 months), with or without psychological stressor (specify if stressor present), factitious disorder diagnostic criteria (falsification of physical/psychological signs/symptoms, or induction of injury/disease, associated with identified deception, presents self to others as ill, impaired, or injured, deceptive behavior evident even in absence of obvious external rewards, not better explained by another mental disorder (delusional disorder, somatic symptom disorder—no deception), specify single episode vs recurrent episodes (≥2 events of falsification/induction of illness), factitious disorder imposed on another (FDIA, Munchausen by proxy): perpetrator falsifies illness in another (typically child, elderly, disabled adult, pet), presents victim to healthcare providers as ill/injured, perpetrator not motivated by external reward, perpetrator deceives healthcare providers, child/victim may be subjected to unnecessary tests/procedures/surgery/hospitalizations, risk of iatrogenic harm, significant morbidity/mortality, perpetrator often has factitious disorder themselves (imposed on self), diagnosis assigned to perpetrator not victim (child protective services involvement, removal from perpetrator's care may be necessary), Schizophrenia Spectrum and Other Psychotic Disorders Differential Diagnosis (schizophrenia vs schizoaffective disorder vs schizophreniform disorder vs brief psychotic disorder vs delusional disorder vs psychotic disorder due to another medical condition vs substance/medication-induced psychotic disorder vs catatonia associated with another mental disorder vs catatonic disorder due to another medical condition vs unspecified catatonia, schizophrenia diagnostic criteria (≥2 of following for significant portion of time during 1-month period (or less if successfully treated), at least one must be 1,2, or 3: delusions, hallucinations, disorganized speech (frequent derailment or incoherence), grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression or avolition), continuous signs of disturbance persist for ≥6 months, including ≥1 month of active-phase symptoms (or less if treated) and may include prodromal or residual periods (negative symptoms or attenuated forms of positive symptoms), schizoaffective disorder (uninterrupted period of illness during which there is major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms), delusions or hallucinations for ≥2 weeks in absence of major mood episode (during lifetime), mood symptoms present for majority of total duration of active and residual portions of illness, not attributable to substance/medical condition, specify type (bipolar type (mania) vs depressive type), schizophreniform disorder (same Criterion A as schizophrenia but duration ≥1 month but 6 months, if symptoms resolve before 6 months, specify without good prognostic features vs with good prognostic features (acute onset (within 4 weeks of first noticeable change in usual behavior), good premorbid functioning, confusion/perplexity at height of episode, absence of blunted/flat affect)), brief psychotic disorder (≥1 of delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, duration ≥1 day but 1 month with eventual full return to premorbid functioning, not better explained by major depressive or bipolar disorder with psychotic features, not attributable to substance/medical condition, specify if with marked stressor (brief reactive psychosis), without marked stressor, with postpartum onset (within 4 weeks postpartum)), delusional disorder (≥1 delusions for ≥1 month, never met Criterion A for schizophrenia (hallucinations if present are not prominent and related to delusional theme, tactile/olfactory may be present), functioning not markedly impaired, behavior not obviously bizarre or odd, if mood episodes have occurred concurrently with delusions, total duration of mood episodes brief relative to total duration of delusional periods, not attributable to substance/medical condition, specify type (erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified), specify with bizarre delusions (content clearly implausible, not understandable, not derived from ordinary life experiences), Antipsychotic Medication Management (first-generation (typical) antipsychotics (FGAs): mechanism (dopamine D2 receptor antagonism (mesolimbic reduces positive symptoms, mesocortical may worsen negative symptoms/cognition), potency (high potency—haloperidol, fluphenazine, trifluoperazine, thiothixene, pimozide (low doses needed for effect, high EPS risk, low anticholinergic, low antihistamine, low alpha-1), medium potency (perphenazine, loxapine, molindone), low potency (chlorpromazine, thioridazine, mesoridazine—high doses needed, low EPS risk, high anticholinergic, high antihistamine, high alpha-1 (orthostatic hypotension, sedation, weight gain))), dosing equivalence (chlorpromazine 100 mg ≈ haloperidol 2 mg ≈ fluphenazine 2 mg ≈ perphenazine 8-10 mg ≈ loxapine 10-15 mg ≈ thioridazine 100 mg ≈ trifluoperazine 5 mg), oral to long-acting injectable (LAI) conversion (haloperidol decanoate: multiply total daily oral haloperidol dose by 10-15 for monthly IM dose (e.g., 10 mg/day oral × 30 days = 300 mg per month, but typical starting dose 50-100 mg IM q4weeks, titrate based on response and tolerability), fluphenazine decanoate: multiply total daily oral fluphenazine dose by 8-12 for monthly IM dose, risperidone microspheres (Risperdal Consta) 25-50 mg IM q2weeks (requires oral overlap for 3 weeks), paliperidone palmitate (Invega Sustenna, Invega Trinza, Invega Hafyera) loading doses (day 1 234 mg, day 8 156 mg, then monthly 39-234 mg based on prior oral paliperidone/risperidone dose), aripiprazole monohydrate (Abilify Maintena) 300-400 mg IM q4weeks (14-day oral overlap), aripiprazole lauroxil (Aristada) 441-1064 mg IM q4weeks or q6weeks (higher doses), olanzapine pamoate (Zyprexa Relprevv) 210-405 mg IM q2weeks or q4weeks (post-injection delirium/sedation syndrome (PDSS) risk—must monitor in certified healthcare facility for 3 hours after injection, Black Box Warning), second-generation antipsychotics (SGAs): mechanism (combined D2 antagonism (variable potency) and 5-HT2A antagonism (reduces EPS risk, improves negative symptoms, may improve cognition), some have partial agonism (D2 partial agonist—aripiprazole, brexpiprazole, cariprazine), some have D1 agonism (dihydrexidine derivatives), some have 5-HT1A partial agonism (aripiprazole, brexpiprazole, cariprazine, ziprasidone, lurasidone—may improve anxiety/depression/cognition), some have 5-HT2C antagonism (weight gain, metabolic effects—clozapine, olanzapine, quetiapine, risperidone, paliperidone, iloperidone, asenapine, zotepine), some have histamine H1 antagonism (sedation, weight gain—clozapine, olanzapine, quetiapine risperidone, paliperidone, iloperidone, asenapine, ziprasidone, lurasidone, aripiprazole, brexpiprazole, cariprazine), alpha-1 antagonism (orthostatic hypotension, dizziness, reflex tachycardia—clozapine, quetiapine, iloperidone, risperidone, paliperidone, olanzapine, asenapine, ziprasidone, lurasidone, aripiprazole, brexpiprazole, cariprazine), muscarinic M1 antagonism (anticholinergic—clozapine (very strong), olanzapine (moderate), quetiapine (low to moderate), risperidone (low), asenapine (low), ziprasidone (very low), lurasidone (negligible), aripiprazole (negligible), brexpiprazole (negligible), cariprazine (negligible), iloperidone (negligible), paliperidone (negligible)), prolactin elevation (risperidone (most), paliperidone (most), haloperidol, fluphenazine, perphenazine, loxapine, high-potency FGAs, minimal prolactin elevation (clozapine, quetiapine, olanzapine, asenapine, ziprasidone, lurasidone, aripiprazole, brexpiprazole, cariprazine (D2 partial agonists may even lower prolactin)), metabolic syndrome risk (clozapine (highest), olanzapine (highest), quetiapine (moderate-high), risperidone (moderate), paliperidone (moderate), iloperidone (moderate), asenapine (low-moderate), lurasidone (low), ziprasidone (low), aripiprazole (low), brexpiprazole (low), cariprazine (low)), FDA-approved indications (schizophrenia (all SGAs except asenapine not approved for maintenance?), bipolar mania (aripiprazole, asenapine, cariprazine, olanzapine, quetiapine, risperidone, ziprasidone, paliperidone, iloperidone? only approved for schizophrenia, lurasidone? approved for schizophrenia and bipolar depression, not mania), bipolar depression (lurasidone, quetiapine, olanzapine-fluoxetine combination (OFC), cariprazine (adjunctive), bipolar maintenance (aripiprazole, olanzapine, quetiapine, risperidone LAI? not oral, paliperidone LAI), treatment-resistant depression adjunct (aripiprazole, brexpiprazole, quetiapine, olanzapine-fluoxetine (OFC)), irritability in autism (risperidone, aripiprazole), Tourette's disorder (aripiprazole, haloperidol, pimozide), agitation (IM olanzapine, IM ziprasidone, IM aripiprazole, IM haloperidol, IM droperidol, IM midazolam, IM lorazepam), clozapine (treatment-resistant schizophrenia (failure of ≥2 antipsychotics at adequate dose and duration (≥6 weeks each), reduces suicidality, reduces aggression/hostility, improves negative symptoms/cognition, mechanism (D4 antagonism, 5-HT2A antagonism, alpha-2 antagonism, M1 agonism (sialorrhea—drooling, GI effects), H1 antagonism (sedation, weight gain), alpha-1 antagonism (orthostatic hypotension, tachycardia), minimal EPS (no tardive dyskinesia), minimal prolactin elevation (can even reduce prolactin), Black Box Warnings: severe neutropenia/agranulocytosis (absolute neutrophil count (ANC) monitoring required weekly for first 6 months, then q2weeks for next 6 months, then monthly thereafter if ANC remains in normal range, ANC must be ≥1500/mm³ to initiate or continue treatment, if ANC drops to modify treatment (hold, monitor daily, restart when ANC returns to ≥1500), if ANC 1000 discontinue permanently, clozapine REMS (Risk Evaluation and Mitigation Strategy) program required for prescribing and dispensing), seizures (dose-dependent, risk 1-2%