Psychiatry and Behavioral Sciences
Psychiatry and Behavioral Sciences tests depression, anxiety, suicide risk, psychosis, bipolar disorder, substance misuse, and cognitive disorders. The exam emphasizes safe assessment and avoiding treatment that worsens an underlying condition.
Core rules
- Depression: use a validated scale such as PHQ-9, screen for bipolar disorder before starting an antidepressant, and assess suicide risk directly.
- Bipolar disorder: an antidepressant alone can precipitate mania; a mood stabilizer is the foundation.
- Serotonin syndrome: agitation, clonus, hyperreflexia, and fever after serotonergic drugs; stop the agent and seek urgent care.
- Delirium is acute, fluctuating, and inattentive; dementia is chronic and progressive. Look for infection, drugs, and metabolic causes.
- Benzodiazepines are for short-term use only and are risky in older adults.
Worked example
A 40-year-old man has 6 weeks of low mood, anhedonia, poor sleep, and PHQ-9 score 18. He denies elation, reduced sleep, or racing thoughts. Reasoning: this is moderate-to-severe depression without bipolar features. Start a selective serotonin reuptake inhibitor with talking therapy, provide a safety plan, and review in 1–2 weeks. If there were a history of mania, an antidepressant alone would be wrong.
Traps
- Starting an antidepressant in bipolar depression.
- Missing a physical cause such as hypothyroidism.
- Treating delirium with a new sedative.
- Accepting a negative answer to a vague question about suicide.