Glossary of Terms

The dose of a medication at which therapeutic effects occurred when tested in clinical trials in a comparable population of subjects. This dose will differ for each medication and may need to be adjusted in an individual patient to address factors that would influence drug absorption, metabolism, elimination, or other pharmacokinetic properties.

A reduction in symptoms as a result of treatment that is associated with clinically significant benefit in functioning and/or quality of life. A reduction in symptoms of 50% or more is sometimes used as a threshold for adequacy of response.

One of a group of medications used in the treatment of psychosis. Some of the antipsychotic medications are also approved for use in other conditions such as mood disorders or Tourette’s syndrome. The first-generation antipsychotic (FGA) medications, sometimes referred to as typical antipsychotic medications, were the initial medications to be discovered. The FGAs include, but are not limited to, chlorpromazine, droperidol, fluphenazine, haloperidol, loxapine, molindone, perphenazine, pimozide, thioridazine, thiothixene, and trifluoperazine. The second-generation antipsychotic (SGA) medications, sometimes referred to as atypical antipsychotic medications, include, but are not limited, to aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. In terms of the Neuroscience-based Nomenclature (www.nbn2.org), antipsychotic medications are categorized as follows:

• Dopamine D₂ receptor antagonists: fluphenazine, haloperidol, perphenazine, pimozide

• D₂ and serotonin type 2 (5-HT₂) receptor antagonists: chlorpromazine, iloperidone, loxapine, lurasidone, olanzapine, thioridazine, trifluoperazine, ziprasidone

• D₂ and 5-HT_1A receptor partial agonist and 5-HT2A receptor antagonist: aripiprazole, brexpiprazole

• 5-HT₂, D₂, and norepinephrine (NE) α₂ receptor antagonist: asenapine

• D₂, 5-HT₂, and NE α₂ receptor antagonists: clozapine, paliperidone, risperidone

• D₂ and 5-HT₂ receptor antagonist and NE transporter reuptake inhibitor: quetiapine

Within each group of antipsychotic medications, there is significant variability in the pharmacological properties and side-effect profiles of specific drugs.

The process of obtaining information about a patient through any of a variety of methods, including face-to-face interview, review of medical records, physical examination (by the psychiatrist, another physician, or a medically trained clinician), diagnostic testing, or history taking from collateral sources (American Psychiatric Association 2016a).

The ability of an individual, when faced with a specific clinical or treatment-related decision, “to communicate a choice, to understand the relevant information, to appreciate the medical consequences of the situation, and to reason about treatment choices” (Appelbaum 2007, p. 1835).

A plan of treatment that is developed as an outgrowth of the psychiatric evaluation and is modified as clinically indicated. A comprehensive treatment plan can include nonpharmacological treatments, pharmacological treatments, or both. It is individualized to the patient’s clinical presentation, safety-related needs, concomitant medical conditions, personal background, relationships, life circumstances, and strengths and vulnerabilities. There is no prescribed format that a comprehensive treatment plan must follow. The breadth and depth of the initial treatment plan will depend on the amount of time and extent of information that are available, as well as the needs of the patients and the care setting. Additions and modifications to the treatment plan are made as additional information accrues (e.g., from family, staff, medical records, and other collateral sources) and the patient’s responses to clinical interventions are observed.

A situation in which a drug or procedure should not be used because it may be harmful to the patient.

A false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not ordinarily accepted by other members of the person’s culture or subculture (i.e., it is not an article of religious faith) (American Psychiatric Association 2013e). The content of a delusion may include a variety of themes (e.g., persecutory, referential, somatic, religious, grandiose) (American Psychiatric Association 2013a).

Disorganized thinking (also referred to as formal thought disorder) is typically inferred from the individual’s speech and must be severe enough to substantially impair effective communication. The individual may switch from one topic to another (derailment or loose associations), provide answers to questions in an obliquely related or completely unrelated fashion (tangentiality), or exhibit severely disorganized and nearly incomprehensible speech that resembles receptive aphasia in its linguistic disorganization (incoherence or “word salad”) (adapted from American Psychiatric Association 2013a).

Grossly disorganized or abnormal motor behavior may manifest itself in a variety of ways, ranging from childlike “silliness” to unpredictable agitation. Problems may be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living. Catatonic behavior is another manifestation of abnormal motor behavior and can range from resistance to instructions (negativism); to maintaining a rigid, inappropriate, or bizarre posture; to a complete lack of verbal and motor responses (mutism and stupor). It can also include purposeless and excessive motor activity without obvious cause (catatonic excitement). Other features are repeated stereotyped movements, staring, grimacing, mutism, and the echoing of speech (adapted from American Psychiatric Association 2013a).

Perception-like experiences that occur without an external stimulus. Hallucinations are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modality (American Psychiatric Association 2013a).

Deterioration of liver function that results in coagulation abnormality (usually an international normalized ratio greater than or equal to 1.5) and any degree of mental alteration (encephalopathy). Although there is no identifiable cause in approximately 15% of cases of acute hepatic failure, typical etiologies include drug-induced liver injury, viral hepatitis, autoimmune liver disease, and shock or hypoperfusion (Lee et al. 2011).

Inability of the liver to function normally; typically defined in severity according to laboratory values and clinical characteristics as reflected by the Child-Pugh score or the Model for End-Stage Liver Disease (MELD) score (Ghany and Hoofnagle 2018; U.S. Food and Drug Administration 2003).

Feeling of despair about the future out of the belief that there is no possibility of a solution to current problems or a positive outcome.

A statistical estimate of the proportion of the variance that is due to heterogeneity.

Acting on the spur of the moment in response to immediate stimuli, acting on a momentary basis without a plan or consideration of outcomes, difficulty establishing and following plans, or having a sense of urgency and exhibiting self-harming behavior under emotional distress (American Psychiatric Association 2013f).

A comprehensive assessment of a patient that has the following aims: identify the reason that the patient is presenting for evaluation; establish rapport with the patient; understand the patient’s background, relationships, current life circumstances, and strengths and vulnerabilities; establish whether the patient has a psychiatric condition; collect information needed to develop a differential diagnosis and clinical formulation; identify immediate concerns for patient safety; and develop an initial treatment plan or revise an existing plan in collaboration with the patient. Relevant information may be obtained by interviewing the patient; reviewing prior records; or obtaining collateral information from treating clinicians, family members, or others involved in the patient’s life. Physical examination, laboratory studies, imaging, psychological or neuropsychological testing, or other assessments may also be included. The psychiatric evaluation may occur in a variety of settings, including inpatient or outpatient psychiatric settings and other medical settings. The evaluation is usually time intensive. The amount of time spent depends on the complexity of the problem, the clinical setting, and the patient’s ability and willingness to cooperate with the assessment. Several meetings with the patient (and family or others) over time may be necessary. Psychiatrists may conduct other types of evaluations that have other goals (e.g., forensic evaluations) or that may be more focused and circumscribed than a psychiatric evaluation as defined here. Guidelines are not intended to address such evaluations (American Psychiatric Association 2016a).

Negative symptoms can be prominent in schizophrenia and can include diminution of emotional expression (eye contact; intonation of speech; and movements of the hand, head, and face), decrease in motivated self-initiated purposeful activities (avolition), diminution of speech output (alogia), decrease in the ability to experience pleasure from positive stimuli (anhedonia), or apparent lack of interest in social interactions (asociality) (adapted from American Psychiatric Association 2013a).

Drugs or supplements that can be bought without a prescription.

Care that is respectful of and responsive to individual preferences, needs, and values and ensures that an individual’s values guide all clinical decisions; sometimes referred to as patient-centered care (Institute of Medicine Committee on Quality of Health Care in America 2001). In person-centered care, patients, families, and other persons of support are provided with information that allows them to make informed decisions (Institute of Medicine 2006). Evidence-based interventions should be adapted to meet individual needs and preferences where possible (van Dulmen et al. 2015), and shared decision-making and self-management approaches are encouraged (Institute of Medicine 2006). Person-centered care is achieved through a dynamic and collaborative relationship among individuals, families, other persons of support, and treating clinicians that supports the individual’s realistic health and life goals and informs decision-making to the extent that the individual desires (American Geriatrics Society Expert Panel on Person-Centered Care 2016).

Inability of the kidney(s) to function normally, typically described in terms of reductions in creatinine clearance or estimated glomerular filtration rate (eGFR). An eGFR of 60–89 mL/min/1.73 m² indicates mildly reduced kidney function; an eGFR of 30–59 mL/min/1.73 m² indicates moderately reduced kidney function; an eGFR of 15–29 mL/min/1.73 m² indicates severely reduced kidney function; and an eGFR of less than 15 mL/min/1.73 m² indicates a very severe reduction in kidney function or end-stage renal disease (Kidney Disease: Improving Global Outcomes [KDIGO] CKD Work Group 2013).

Thoughts of serving as the agent of one’s own death.

Death caused by self-directed injurious behavior with any intent to die as a result of the behavior (Crosby et al. 2011).

A nonfatal, self-directed, potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury (Crosby et al. 2011). It may be aborted by the individual or interrupted by another individual.

Subjective expectation and desire for a self-injurious act to end in death.

The instrument or object used to engage in self-inflicted injurious behavior with any intent to die as a result of the behavior.

The mechanism used to engage in self-inflicted injurious behavior with any intent to die as a result of the behavior.

Delineation of the method, means, time, place, or other details for engaging in self-inflicted injurious behavior with any intent to die as a result of the behavior.

A characteristic of the relationship between the patient and clinician that describes the sense of collaboration in pursuing therapeutic goals as well as the patient’s sense of attachment to the clinician and perception of whether the clinician is helpful (Gabbard 2009).

A history of events in the patient’s life with the potential to have been emotionally traumatic, including but not limited to exposure to actual or threatened death, serious injury, illness, or sexual violence. Exposure may occur through direct experience or by observing an event in person or through technology (e.g., television, audio or video recording) or by learning of an event that occurred to a close family member or close friend. Trauma could also include early adversity, neglect, maltreatment, emotional abuse, physical abuse, or sexual abuse occurring in childhood; exposure to natural or man-made disasters; exposure to combat situations; being a victim of a violent crime; involvement in a serious motor vehicle accident; or having serious or painful or prolonged medical experiences (e.g., intensive care unit stay).

Treatment that is consistent with care received for a specific condition in a real-world nonresearch context. Treatment as usual, sometimes referred to as usual care or standard care, is often used as an active comparison condition for studies of new interventions. Elements of treatment as usual are heterogeneous and differ with each study but can include medication treatment, medication management, case management, rehabilitation services, and psychotherapy (McDonagh et al. 2017).