Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Behavioral Health, Psychiatry, and the Nervous System Syllabus

Behavioral Health, Psychiatry, and the Nervous System syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Behavioral Health, Psychiatry, and the Nervous System in Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), not a summary of it.

1. 1

   Mood, Anxiety, and Trauma Disorders

   4 topics

   • Depressive Disorders
     • Major depression and dysthymia
     • Suicide risk assessment
   • Bipolar and Related Disorders
     • Mania and mood stabilization
   • Anxiety and OCD-Related Disorders
     • Generalized anxiety and panic disorder
   • Trauma- and Stressor-Related Disorders
     • PTSD and acute stress disorder
2. 2

   Psychotic, Cognitive, and Other Disorders

   4 topics

   • Schizophrenia Spectrum
     • Positive and negative symptoms
     • Antipsychotic management
   • Neurocognitive Disorders
     • Delirium versus dementia
   • Personality and Somatic Symptom Disorders
     • Cluster A, B, and C personality disorders
   • Eating and Sleep Disorders
     • Anorexia and bulimia
     • Insomnia and sleep apnea
3. 3

   Substance Use and Addiction Medicine

   3 topics

   • Alcohol Use Disorder
     • Intoxication and withdrawal management
   • Opioid and Stimulant Use
     • Overdose and medication-assisted treatment
   • Screening and Behavioral Intervention
     • Motivational interviewing
4. 4

   Psychopharmacology and Therapy

   3 topics

   • Antidepressants and Anxiolytics
     • SSRIs, SNRIs, and serotonin syndrome
   • Mood Stabilizers and Antipsychotics
     • Lithium and atypical agents
   • Psychotherapeutic Modalities
     • Cognitive behavioral and supportive therapy

Behavioral Health, Psychiatry, and the Nervous System flashcards for Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA)

19 of 62 cards from the Behavioral Health, Psychiatry, and the Nervous System deck — real questions with worked answers.

1. What are the DSM-5 criteria for a Major Depressive Episode?

   At least 5 of 9 symptoms for >=2 weeks, including at least 1 of depressed mood or anhedonia. The SIG E CAPS symptoms: Sleep changes, loss of Interest (anhedonia), Guilt/worthlessness, low Energy, decreased Concentration, Appetite/weight change, Psychomotor changes, Suicidal ideation, plus depressed mood. Must cause distress/impairment and not be due to a substance/medical condition.

2. How is Persistent Depressive Disorder (dysthymia) distinguished from Major Depressive Disorder?

   Persistent depressive disorder is depressed mood for most of the day, more days than not, for >=2 years (>=1 year in children/adolescents), with >=2 additional symptoms and no symptom-free period >2 months. It is chronic and typically milder than MDD, though MDD episodes can be superimposed (double depression).

3. What is the first-line pharmacologic treatment for Major Depressive Disorder and how long until effect?

   SSRIs are first-line. Therapeutic effect typically takes 4-6 weeks; an adequate trial is at least 6-8 weeks at a therapeutic dose before switching. Continue for 6-12 months after remission for a first episode.

4. What features distinguish a Major Depressive Episode with atypical features?

   Mood reactivity (mood brightens to positive events) plus >=2 of: increased appetite/weight gain, hypersomnia, leaden paralysis, and long-standing interpersonal rejection sensitivity. Historically responsive to MAOIs.

5. How is postpartum depression differentiated from postpartum 'baby blues' and postpartum psychosis?

   Baby blues: mild mood lability resolving within ~2 weeks, no treatment needed. Postpartum depression: MDE with onset during pregnancy or within 4 weeks (DSM 'peripartum onset'), lasting weeks-months, needs treatment. Postpartum psychosis: delusions/hallucinations, risk of infanticide/suicide; a psychiatric emergency requiring hospitalization.

6. What are the DSM-5 criteria for a Manic Episode (Bipolar I)?

   A distinct period of abnormally elevated/expansive/irritable mood and increased energy lasting >=1 week (or any duration if hospitalization required), plus >=3 DIG FAST symptoms (Distractibility, Indiscretion/impulsivity, Grandiosity, Flight of ideas, Activity increase, decreased Sleep need, Talkativeness). Causes marked impairment, psychosis, or hospitalization.

7. How do Bipolar I and Bipolar II disorders differ?

   Bipolar I requires at least one manic episode (depression not required for diagnosis). Bipolar II requires at least one hypomanic episode AND at least one major depressive episode, with no history of a full manic episode.

8. What distinguishes a hypomanic episode from a manic episode?

   Hypomania lasts >=4 consecutive days, has the same symptom criteria, but causes NO marked impairment, NO psychosis, and does NOT require hospitalization. Mania lasts >=1 week, causes marked impairment, and may include psychosis/hospitalization.

9. What is cyclothymic disorder?

   For >=2 years (>=1 year in children), numerous periods of hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes, present at least half the time with no symptom-free period >2 months.

10. What is the first-line treatment for acute bipolar mania, and what must be avoided?

    Mood stabilizers (lithium, valproate) and/or second-generation antipsychotics are first-line for acute mania. Antidepressant monotherapy should be avoided in bipolar disorder because it can precipitate a manic switch or rapid cycling.

11. What are the DSM-5 criteria for Generalized Anxiety Disorder?

    Excessive anxiety/worry occurring more days than not for >=6 months about multiple events, difficult to control, with >=3 of 6 symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance). Only 1 symptom needed in children.

12. How is a panic attack defined and what characterizes Panic Disorder?

    A panic attack is an abrupt surge of intense fear peaking within minutes with >=4 somatic/cognitive symptoms (palpitations, sweating, trembling, dyspnea, chest pain, derealization, fear of dying, etc.). Panic Disorder = recurrent unexpected panic attacks plus >=1 month of worry about attacks or maladaptive behavioral change.

13. What is the first-line treatment for panic disorder, and what is the role of benzodiazepines?

    SSRIs/SNRIs plus CBT are first-line. Benzodiazepines provide rapid relief of acute attacks but are reserved for short-term/bridging use due to dependence risk; they are not preferred for chronic management.

14. What defines specific phobia versus social anxiety disorder?

    Specific phobia: marked fear of a specific object/situation (heights, animals, blood) for >=6 months with immediate anxiety and avoidance. Social anxiety disorder: marked fear of social situations involving possible scrutiny/negative evaluation, leading to avoidance, for >=6 months.

15. What are the DSM-5 criteria for Obsessive-Compulsive Disorder?

    Presence of obsessions (recurrent intrusive thoughts) and/or compulsions (repetitive behaviors/mental acts to reduce anxiety) that are time-consuming (>1 hr/day) or cause significant distress/impairment. Insight specifiers range from good to absent/delusional.

16. What is the first-line treatment for OCD and how does dosing differ from depression?

    SSRIs (often at higher doses than for depression) plus CBT with Exposure and Response Prevention (ERP) are first-line. Clomipramine (a TCA) is an effective second-line option. Response may take 8-12 weeks.

17. How does OCD differ from obsessive-compulsive personality disorder (OCPD)?

    OCD involves ego-dystonic intrusive obsessions and compulsions that the patient finds distressing. OCPD is an ego-syntonic pervasive pattern of perfectionism, orderliness, and control without true obsessions/compulsions; the person sees their traits as appropriate.

18. What are the DSM-5 criteria for Post-Traumatic Stress Disorder?

    Exposure to actual/threatened death, serious injury, or sexual violence, followed by >1 month of symptoms across 4 clusters: intrusion (flashbacks/nightmares), avoidance, negative alterations in cognition/mood, and alterations in arousal/reactivity (hypervigilance, startle). Causes impairment.

19. How is Acute Stress Disorder distinguished from PTSD?

    Acute stress disorder has the same type of trauma exposure and symptoms but the duration is 3 days to 1 month after the trauma. If symptoms persist beyond 1 month, the diagnosis becomes PTSD.

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