Psychiatry and Mental Health
Psychiatry and mental health tests recognition and safe first-line management of depression, anxiety, psychosis, somatisation, substance misuse and suicide risk in primary care. The exam emphasises risk assessment, differential diagnosis and when to refer urgently.
Core rules
- Screen for depression with a validated tool, but diagnose by criteria and functional impairment.
- Ask directly about suicidal thoughts, plans, means and protective factors; direct questions do not increase risk.
- Exclude bipolar disorder before prescribing an antidepressant alone.
- Psychosis, mania, severe self-neglect and high suicide risk need urgent specialist assessment.
- Benzodiazepines are short-term only; avoid in substance misuse and in older adults where possible.
- Exclude physical causes such as thyroid disease, B12 deficiency and substance withdrawal.
Worked example
A 30-year-old woman reports 6 weeks of low mood, insomnia, poor appetite and guilt. She says life is “not worth living” and has stockpiled tablets. The reasoning: this is moderate-to-severe depression with active suicidal ideation and available means. Ask about previous mania or psychosis. Do not simply start an SSRI and send her home. Arrange urgent mental health assessment, involve a trusted person with consent, remove or secure means, document risk, and provide a crisis plan.
Traps
Accepting “I’m fine” without a private risk interview; missing hypothyroidism or anaemia; overlooking postpartum psychosis; and continuing a benzodiazepine for months.