TEP Psiquiatria common mistakes
TEP Psiquiatria · Understand the traps and how to avoid them.
When asked to describe a patient's mental state, candidates list symptoms (e.g. 'depressed mood, insomnia, anhedonia') instead of systematically covering the standard MSE domains (appearance/behaviour, speech, mood and affect, thought form and content, perception, cognition, insight, risk).
Candidates conflate the mental state examination with the symptom checklist used for diagnosis, so they jump straight to DSM/ICD criteria and omit domains such as thought form, perceptual disturbance, and formal cognitive testing that the examiner is specifically scoring.
What to do instead
Practise a fixed 8-10 domain MSE template and rehearse it aloud on every clinical vignette, explicitly separating 'mood' (patient's reported state) from 'affect' (observed expression), and always stating thought form, perceptual phenomena, cognition and insight/risk even when normal.
Candidates treat a positive screening score (e.g. PHQ-9, GAD-7, AUDIT, MMSE cut-off) as diagnostic and answer the question as if the diagnosis were established, rather than describing the next diagnostic step.
Exam questions often embed a scale score to test whether the candidate understands that screening instruments estimate probability and severity, not diagnosis; candidates over-value the number and under-value the clinical interview and differential.
What to do instead
State the instrument's purpose (screening/severity monitoring), its cut-off and limitations (false positives, somatic items, cultural and educational effects), and then describe the structured clinical assessment and differential that must follow before any diagnosis is made.
In bipolar-spectrum questions, candidates diagnose major depressive disorder in a patient with past hypomanic or mixed features because the current episode is depressive, and they fail to ask about prior elevated-mood episodes, family history, age at onset, and antidepressant-induced switching.
The presenting complaint anchors attention on depression, and hypomania is often experienced as ego-syntonic and not volunteered; candidates also under-use collateral history.
What to do instead
Adopt a rule: before finalising any depressive diagnosis, screen explicitly for lifetime manic/hypomanic episodes (including duration and functional impact), mixed features, postpartum and seasonal patterns, and treatment-emergent activation; document the screen as negative if so.
Candidates answer anxiety, OCD and trauma questions by naming the disorder from the content of the worry (e.g. contamination thoughts = OCD) without testing the functional relationship between intrusive thoughts, appraisals, rituals, avoidance and impairment, and without distinguishing normal intrusions from obsessions.
Surface content matching feels efficient under time pressure, and candidates under-learn the cognitive-behavioural models (appraisal, neutralisation, safety behaviours) that distinguish these overlapping presentations.
What to do instead
For each vignette, explicitly map trigger, intrusion, appraisal, emotional response, neutralising behaviour, and time/impairment; check whether the behaviour is ego-dystonic and functionally linked to the intrusion, and screen specifically for a Criterion A trauma before any PTSD diagnosis.
In psychotic-disorder questions, candidates diagnose schizophrenia from the presence of hallucinations or delusions alone, without assessing duration, functional decline, mood-episode overlap, substance/medication causation, and medical contributors.
Psychotic symptoms are salient and candidates memorise them as pathognomonic, neglecting the temporal and exclusion criteria that do most of the discriminating between schizophrenia, schizophreniform, brief psychotic disorder, schizoaffective disorder, mood disorder with psychotic features, and substance/medical psychosis.
What to do instead
Use a fixed timeline-and-exclusion checklist: total duration of illness and of active symptoms, functional change, relationship to mood episodes, substance/medication timing, and medical work-up (including delirium screen); state each criterion explicitly in the answer.
Candidates answer substance-use questions with a generic 'advise to stop and refer to rehab', omitting assessment of withdrawal risk and timing, intoxication/overdose risk, and the specific evidence-based pharmacological and psychosocial options for that substance.
Candidates learn dependence criteria but not the management algorithms, so they default to vague advice; they also underestimate the lethality of alcohol and benzodiazepine withdrawal and the role of supervised detoxification.
What to do instead
For each substance, rehearse a fixed answer: screening and severity, withdrawal syndrome and its timeline and risk, medical stabilisation and substitution where indicated, relapse-prevention medication, and matched psychosocial intervention; state that abrupt cessation of alcohol or benzodiazepines can be dangerous.
Candidates label an acute confusional or behavioural presentation in an older patient as 'dementia' or as a primary psychiatric relapse, missing delirium and its underlying cause.
Delirium is under-recognised because it mimics functional disorders and because candidates do not routinely apply the core features (acute onset, fluctuating course, inattention, altered level of consciousness) or consider the full medical differential.
What to do instead
Apply a delirium screen to every acute or fluctuating cognitive/behavioural presentation: establish baseline cognition, test attention and arousal formally, review medications and recent changes, and list the investigations needed to find the cause; describe delirium as a medical emergency requiring cause-directed treatment.
In psychopharmacology questions, candidates select a drug class correctly but fail to specify the practical prescribing details the question is testing: titration and target dose, monitoring parameters and timing, expected time to response, key interactions, and discontinuation or switching strategy.
Revision focuses on mechanisms and indications rather than on monitoring schedules and switching, and candidates conflate 'which drug' with 'how to use it safely'.
What to do instead
For each major drug, memorise a compact prescribing card: starting and target dose, titration interval, baseline and follow-up monitoring (e.g. metabolic, cardiac, haematological, renal, thyroid), time to effect, common and dangerous adverse effects, interactions, and a safe switch/taper plan; include ECT indications, consent, work-up and cognitive monitoring.
In forensic, ethics and mental-health-law questions, candidates give the clinically desirable answer rather than the legally correct one, for example assuming a detained patient can be treated involuntarily for any condition, or that confidentiality ends whenever a third party is at risk.
Candidates learn law as a list of acts without applying the specific criteria (mental disorder, risk, necessity, least restrictive option) to vignettes, and they mix up capacity, voluntariness and legal detention.
What to do instead
For each vignette, separate the four questions: does the patient have capacity for this decision, is there a legal ground for detention or involuntary treatment, what is the least restrictive option, and what are the limits of confidentiality; answer each explicitly with reference to the relevant criteria rather than to clinical preference.
In consultation-liaison and emergency questions, candidates complete the psychiatric formulation but omit the medical work-up, the interaction between physical illness and psychotropic drugs, and the immediate risk-management and disposition plan.
Candidates compartmentalise psychiatry from general medicine and treat the emergency question as a diagnostic one, whereas these questions usually test safe disposition, medical clearance and communication with the treating team.
What to do instead
End every liaison or emergency answer with a structured plan: medical causes excluded and investigations ordered, medication review and interaction risks, immediate safety measures (observation level, environment, restraint criteria), communication with the referrer, and a documented follow-up and disposition decision.