Psychiatry and Neurology
Core concepts
Psychiatry questions test diagnostic criteria, risk assessment, and first-line treatment. Know the core features of depression, bipolar disorder (mania vs hypomania), schizophrenia (positive vs negative symptoms, duration criteria), anxiety disorders, and substance use. Understand suicide risk assessment and involuntary admission criteria. Neurology questions cover stroke localization, seizure types and status epilepticus, headache red flags, meningitis, and the neurologic examination (cranial nerves, reflexes, cerebellar signs, upper vs lower motor neuron lesions).
Common traps
Distinguish delirium (acute, fluctuating, inattention) from dementia (chronic, progressive) - a frequent exam trap. In bipolar disorder, starting an antidepressant alone can precipitate mania. In neurology, upper motor neuron lesions show increased tone and hyperreflexia; lower motor neuron lesions show atrophy and fasciculations. Headache with thunderclap onset, fever and neck stiffness, or focal deficits requires urgent workup. Watch for questions on the difference between absence seizures (brief, no postictal state) and complex partial seizures.
Worked example
An elderly patient with sudden confusion and fluctuating attention after surgery. Rule of thumb: delirium is acute and fluctuating with inattention; find and treat the cause (infection, medication, metabolic) rather than starting antipsychotics routinely.
Rule of thumb
In psychiatry, assess safety (suicide/homicide risk) first; in neurology, localize the lesion before naming the disease.