Psychiatry and Behavioral Health
Core concepts
Depression, anxiety disorders, bipolar disorder, psychosis, substance misuse, and suicide risk assessment are core. Know the diagnostic criteria, first-line treatments, and when to refer to specialist mental health services.
Question traps
- Depression vs bipolar. Always screen for mania/hypomania before starting an antidepressant; treating bipolar depression with an antidepressant alone can precipitate mania. First-line for bipolar is a mood stabiliser.
- Suicide risk. Direct questioning does not increase risk. Ask about intent, plan, means, and previous attempts; the presence of a plan with means is a high-risk feature requiring urgent referral.
- SSRIs. Know the delayed onset (2–4 weeks), the risk of serotonin syndrome, and that they may transiently increase suicidal ideation in young people.
- Anxiety. First-line is psychological therapy (CBT); SSRIs are first-line pharmacotherapy. Benzodiazepines are short-term only due to dependence.
- Psychosis. First-episode psychosis requires urgent specialist referral; antipsychotics are initiated by specialists.
Worked rule of thumb
For any psychiatric stem, run a risk assessment first. If the stem mentions self-harm, suicidal ideation, or harm to others, the correct answer almost always includes urgent referral and safety planning, regardless of the primary diagnosis.
Communication
Use non-judgmental, open questions. In substance misuse, motivational interviewing is preferred over confrontation.