Psychiatry
What OMRSE tests
Psychiatry tests the mental status examination, depression, mania, psychosis, anxiety, suicide risk, substance use, and delirium. The exam expects medical causes to be excluded before a primary psychiatric diagnosis is made.
Core rules
- Assess risk of suicide and violence at every psychiatric contact; ask directly and document the plan, means, and protective factors.
- Delirium is acute, fluctuating, and inattentive; it is a medical emergency, not a primary psychosis.
- Mania requires elevated or irritable mood plus increased energy for at least a week, or hospitalization, with symptoms such as decreased sleep, grandiosity, and pressured speech.
- Do not use antidepressant monotherapy in bipolar disorder; it can trigger mania or rapid cycling.
Worked example
A 22-year-old is brought by family with 5 days of little sleep, grandiose plans, rapid speech, and hearing voices. He has no fever, no substance use, and normal thyroid function. This is bipolar I disorder, manic with psychotic features. Admit for safety, start a mood stabilizer plus an antipsychotic, and avoid an antidepressant alone. Monitor hydration, sedation, and metabolic effects. Ask about suicide and access to weapons.
Traps that cost marks
- Missing hyperthyroidism, steroids, or substance-induced mania.
- Sedating an elderly patient with delirium instead of finding the cause.
- Not asking about suicide because the patient seems cheerful.
- Starting an SSRI alone in a patient with a history of mania.