Psychiatry: Assessment, Risk and Treatment Principles
Core content
Psychiatry questions test the mental state examination, classification of disorders, risk assessment and treatment principles. You must recognise the features of depression, anxiety disorders, psychosis, bipolar disorder, substance misuse, delirium and dementia. Understand the difference between delirium and dementia, the principles of capacity assessment, and the safe use of psychotropic medication.
Traps and discriminations
- Delirium versus dementia. Delirium has acute onset, fluctuating course and impaired attention; dementia is chronic and progressive with preserved consciousness until late.
- Risk assessment. Always ask about suicidal ideation, intent, plan and protective factors. A stem that omits risk assessment is a common distractor.
- Psychosis versus bipolar disorder. Psychotic symptoms in mood disorder occur with mood episodes; timing matters.
- Capacity. Capacity is decision-specific and assessed at the time; a diagnosis of mental illness does not automatically remove capacity.
- Medication safety. Know the risks of antipsychotics, lithium monitoring and serotonin syndrome.
Worked example: the capacity rule of thumb
A patient with psychosis refuses a medical procedure. Rule of thumb: assess the four elements of capacity, namely understanding, retention, weighing and communication. If capacity is intact, the refusal must be respected even if others disagree. The exam trap is assuming that a psychiatric diagnosis automatically overrides refusal.
Treatment principles
Know the first-line psychological and pharmacological options for common conditions, the importance of the therapeutic relationship, and when urgent referral or admission is required. Always consider physical causes of psychiatric symptoms, and screen for substance use.