Psychiatry and Behavioral Medicine
Mental health problems fill primary care: depression, anxiety, somatisation, harmful alcohol or substance use, and the first episode of psychosis. The Board tests recognition, suicide risk assessment, safe first-line prescribing and knowledge of when compulsory care is lawful.
Core rules
- Screen with validated tools: PHQ-9 for depression, GAD-7 for anxiety, AUDIT-C for alcohol. A score supports but does not replace clinical assessment.
- Depression: core symptoms are low mood and anhedonia for at least two weeks with sleep, appetite, energy, concentration and psychomotor change. Mild cases: guided self-help and psychological therapy. Moderate to severe: an SSRI plus psychological therapy. Continue treatment for at least six months after remission, longer if recurrent. Warn about transient early anxiety and gastrointestinal upset.
- Suicide risk: ask directly about thoughts, plans, means, previous attempts and protective factors. High risk with a plan and access to means needs urgent specialist referral and removal of means; do not leave the patient alone.
- Psychosis: first episode needs urgent referral; antipsychotics should not be started in primary care without a plan and baseline investigations.
- Bipolar disorder: screen for past manic episodes before starting an antidepressant, which can trigger mania.
- Medically unexplained symptoms: explain the mechanism, schedule regular brief appointments, avoid repeated unnecessary investigations, and treat comorbid anxiety or depression.
- Egypt's mental health legislation governs involuntary admission; detention requires the legally defined procedures and a psychiatric report.
Worked example
A 45-year-old woman attends monthly with headache, fatigue and abdominal pain; all investigations are normal and she is tearful, with early waking and 6 kg weight loss. Reasoning: this is likely depression presenting with somatic symptoms. Use PHQ-9, ask about suicide, stop repeating imaging, explain the diagnosis, start an SSRI with a review in two weeks, and arrange talking therapy.
Traps that cost marks
- Not asking about suicide for fear of prompting it; asking does not increase risk.
- Starting an antidepressant in unrecognised bipolar disorder.
- Stopping an SSRI as soon as the patient feels better.