Behavioral Sciences and Psychiatry: Recognition and Risk
What this domain tests
Questions cover mental state examination, psychosis, mood and anxiety disorders, suicide risk, substance use, psychotropic adverse effects, and doctor–patient communication. Organic causes must be excluded before labelling a patient as psychiatric.
Core rules
- Delirium is acute, fluctuating, and associated with inattention; it is a medical emergency.
- Assess suicide risk directly: ideation, plan, intent, means, previous attempts, and protective factors.
- Serotonin syndrome causes clonus, hyperreflexia, agitation, diarrhoea, and hyperthermia after serotonergic drugs.
- Neuroleptic malignant syndrome causes lead-pipe rigidity, bradyreflexia, altered consciousness, and raised creatine kinase.
- Antipsychotics can cause extrapyramidal effects, hyperprolactinaemia, and QT prolongation.
Worked example
A patient taking an SSRI and tramadol develops agitation, sweating, tremor, inducible clonus, and diarrhoea. The diagnosis is serotonin syndrome. Stop the serotonergic drugs, give benzodiazepines and supportive care, and consider cyproheptadine in moderate or severe cases. The reasoning is that clonus and hyperreflexia point to serotonin excess, unlike the rigidity and bradyreflexia of neuroleptic malignant syndrome.
Traps
Missing delirium in an elderly patient; treating akathisia by increasing antipsychotic dose; confusing serotonin syndrome with NMS; ignoring postpartum psychosis; assuming a patient is safe because they deny suicidal thoughts without asking about plans and means.
Exam strategy
First exclude medical causes, then assess risk, then choose the least restrictive safe management.