High-Yield Psychiatry for Medical Exams: Revision Guide

Psychiatry questions blend diagnosis, pharmacology, risk and ethics. Many stems hinge on a single detail: how long symptoms have lasted, whether there is psychosis, or which drug the patient recently started. This guide is exam revision based on widely used classification systems and guidelines.

The mental state examination

Appearance and behaviour, speech, mood and affect, thought form, thought content, perception, cognition and insight. Exams often describe one domain and ask you to name it.

Depression

Diagnosis

Low mood or loss of interest for at least two weeks, plus other symptoms: sleep and appetite change, fatigue, poor concentration, guilt or worthlessness, psychomotor change, suicidal thoughts. Exclude physical causes (hypothyroidism, anaemia, medication) and bipolar disorder.

Treatment themes

• Less severe depression: guided self-help, psychological therapies, physical activity.
• More severe depression: psychological therapy combined with an antidepressant; SSRIs are commonly first line.
• Continue an antidepressant for at least six months after remission to reduce relapse.
• Electroconvulsive therapy for severe, life-threatening depression or catatonia.

Serotonin syndrome: agitation, hyperthermia, hyperreflexia, clonus, diarrhoea after combining serotonergic drugs. Discontinuation syndrome: stopping abruptly (especially paroxetine and venlafaxine) causes dizziness, irritability and flu-like symptoms; taper.

Bipolar disorder

• Mania: elevated or irritable mood, reduced need for sleep, grandiosity, pressured speech, risk-taking, lasting at least a week or needing admission; psychosis may occur.
• Hypomania: milder, without psychosis or severe impairment.
• Acute mania: antipsychotic or mood stabiliser; stop antidepressants.
• Long-term: lithium is commonly first line for prevention.

Lithium

Valproate is highly teratogenic and is avoided in women who could become pregnant unless strict conditions are met.

Schizophrenia and psychosis

Positive symptoms (delusions, hallucinations, thought disorder) and negative symptoms (apathy, flat affect, poverty of speech, social withdrawal), lasting a defined period depending on the classification used. Exclude organic causes and substances.

Clozapine is used for treatment-resistant schizophrenia after adequate trials of at least two other antipsychotics.

Neuroleptic malignant syndrome vs serotonin syndrome

Anxiety and related disorders

Benzodiazepines are not recommended for long-term anxiety management because of dependence.

Eating disorders

• Anorexia nervosa: restriction, low weight, fear of weight gain. Complications: bradycardia, hypotension, hypokalaemia, osteoporosis, amenorrhoea. Risk of refeeding syndrome (low phosphate) when feeding restarts.
• Bulimia nervosa: binge eating with compensatory behaviour; weight often normal; hypokalaemic metabolic alkalosis with vomiting, parotid swelling, dental erosion, calluses on knuckles.

Delirium vs dementia

Delirium management: find and treat the cause, non-drug measures (orientation, sleep, hearing aids and glasses, mobilisation), and avoid sedatives where possible.

Dementia types

• Alzheimer's disease: most common; memory loss first; cholinesterase inhibitors for mild to moderate disease.
• Vascular: stepwise decline, vascular risk factors.
• Lewy body: fluctuating cognition, visual hallucinations, parkinsonism; severe sensitivity to antipsychotics.
• Frontotemporal: younger onset, personality change, disinhibition.

Substance use and withdrawal

Wernicke encephalopathy: confusion, ataxia and ophthalmoplegia; give parenteral thiamine before glucose.

Risk assessment

Suicide risk factors include previous attempts, male sex, older age, living alone, unemployment, chronic illness, substance misuse, psychiatric illness, recent loss, and specific plans with access to means. Protective factors include family support, children at home and engagement with care. Exams test asking directly about suicidal thoughts (asking does not increase risk), safety planning and appropriate referral. Mental health legislation differs by country, so exams usually test principles: capacity, least restrictive option and the role of senior or specialist assessment.

Personality disorders and other topics

• Emotionally unstable (borderline): unstable relationships, self-harm, fear of abandonment; dialectical behaviour therapy.
• Antisocial: disregard for others, conduct problems from childhood.
• Somatic symptom and factitious disorders vs malingering: factitious disorder is deliberate symptom production for the sick role; malingering is for external gain.
• ADHD: inattention, hyperactivity, impulsivity across settings; stimulant medication with growth and heart rate monitoring.

Common exam traps

• Starting an antidepressant alone in someone with a history of mania.
• Missing hyponatraemia from an SSRI in an older patient.
• Giving antipsychotics in Lewy body dementia.
• Forgetting thiamine before glucose in alcohol-dependent patients.
• Confusing NMS with serotonin syndrome.
• Missing lithium toxicity after a new NSAID or diuretic.

How to revise

Psychiatry is largely pattern recognition plus pharmacology. Make tables of durations and drug adverse effects, then test yourself. MediFlow Exam Prep includes psychiatry vignettes with explanations. Pair this with high-yield pharmacology and medical ethics and law.

Summary

• Diagnosis rests on symptom pattern and duration; exclude physical causes.
• Know signature adverse effects of SSRIs, lithium, antipsychotics and clozapine.
• Delirium is acute, fluctuating and physical until proven otherwise.
• Alcohol withdrawal: benzodiazepines and thiamine.
• Ask directly about suicidal thoughts and plan for safety.