Psychiatry: Phenomenology, Risk, and Safe Prescribing
Psychiatry questions blend descriptive psychopathology with risk assessment and pharmacology. Learn to describe symptoms precisely: mood versus affect, delusions versus hallucinations, obsessions versus compulsions, and delirium versus dementia.
High-yield areas
- Mood disorders: major depression criteria; bipolar disorder requires ruling out mania before starting antidepressants.
- Psychosis: first-episode workup excludes organic causes; antipsychotics differ in side-effect profiles.
- Anxiety and OCD: SSRIs are first-line; CBT is effective.
- Substance use: withdrawal syndromes and their timelines; alcohol withdrawal can be life-threatening.
- Risk assessment: always ask about suicidal and homicidal ideation, plan, intent, and means.
Traps
Antidepressants can precipitate mania in bipolar disorder - a classic distractor. Serotonin syndrome versus neuroleptic malignant syndrome is frequently tested: the former has clonus and hyperreflexia with a serotonergic trigger; the latter has rigidity, hyperthermia, and elevated creatine kinase with dopamine antagonists. Delirium is acute and fluctuating with inattention; dementia is chronic and progressive. Do not miss medical mimics such as hypothyroidism, B12 deficiency, and substance intoxication.
Rule of thumb
Before treating a psychiatric symptom, exclude a medical cause, especially in first episodes, older adults, and patients with acute change in mental status.
Worked example
A patient on an SSRI develops agitation, tremor, clonus, and hyperreflexia after starting another serotonergic drug. This is serotonin syndrome - stop the offending agents and provide supportive care, not antipsychotics.