Professional and Linguistic Assessments Board (PLAB) Psychiatry and Mental Health Syllabus

Psychiatry and Mental Health syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Psychiatry and Mental Health in Professional and Linguistic Assessments Board (PLAB), not a summary of it.

1. 1

   Mood and Anxiety Disorders

   4 topics

   • Depression
     • Assessment and severity grading
     • Antidepressant choice and review
     • Treatment-resistant depression
   • Bipolar Affective Disorder
     • Mania recognition
     • Mood stabiliser management
   • Anxiety Disorders
     • Generalised anxiety and panic disorder
     • OCD and PTSD
   • Self-Harm and Suicide Risk
     • Risk assessment
     • Safety planning and referral
2. 2

   Psychotic and Organic Disorders

   4 topics

   • Schizophrenia
     • Positive and negative symptoms
     • Antipsychotic management and monitoring
   • Acute Behavioural Disturbance
     • Rapid tranquillisation
     • De-escalation techniques
   • Delirium and Dementia
     • Delirium assessment and causes
     • Dementia subtypes and cognitive testing
   • Substance Misuse
     • Alcohol dependence and withdrawal
     • Opioid dependence and overdose
3. 3

   Mental Health Law and Risk

   4 topics

   • Mental Health Act
     • Sections 2, 3 and 5
     • Detention and appeal rights
   • Mental Capacity Act
     • Capacity assessment
     • Best interests and DoLS
   • Eating Disorders
     • Anorexia and bulimia nervosa
     • Refeeding syndrome and medical risk
   • Perinatal and Old Age Psychiatry
     • Postnatal depression and puerperal psychosis
     • Late-life depression and psychosis

Psychiatry and Mental Health flashcards for Professional and Linguistic Assessments Board (PLAB)

22 of 51 cards from the Psychiatry and Mental Health deck — real questions with worked answers.

1. According to ICD-10/DSM-5, what are the three core symptoms of depression, and how many must be present (with associated symptoms) for at least 2 weeks for a diagnosis?

   Core symptoms: (1) persistent low mood, (2) anhedonia (loss of interest/pleasure), (3) low energy/fatigue (anergia). At least 2 core symptoms plus associated symptoms must be present most days for ≥2 weeks.

2. How does ICD-10 grade the severity of a depressive episode by symptom count?

   Mild: 2 core + 2 other symptoms. Moderate: 2 core + 3–4 other symptoms. Severe: all 3 core + ≥4 other symptoms (severe may have psychotic features such as nihilistic/mood-congruent delusions).

3. List the biological ('somatic') symptoms of depression that suggest a more severe/melancholic picture.

   Early morning waking (≥2 h before usual), diurnal mood variation (worse in mornings), loss of appetite and weight loss, psychomotor retardation or agitation, loss of libido, and marked anhedonia.

4. What is the first-line pharmacological treatment for moderate-to-severe depression in UK practice, and which agent is typically preferred?

   An SSRI is first line; sertraline or citalopram are commonly preferred. Sertraline is favoured post-MI/cardiac disease due to a more favourable safety profile.

5. How long should an antidepressant be continued after remission of a first depressive episode, and how long for recurrent depression?

   Continue for at least 6 months after remission for a first episode; for recurrent depression continue for at least 2 years at the treatment dose.

6. What is serotonin syndrome and name three of its characteristic clinical features?

   A potentially life-threatening reaction to excess serotonergic activity. Features fall into three groups: neuromuscular (clonus, hyperreflexia, rigidity, tremor), autonomic (hyperthermia, tachycardia, sweating, diarrhoea), and altered mental state (agitation, confusion).

7. Which SSRI carries a dose-dependent QT-prolongation warning, and what is the maximum recommended adult dose?

   Citalopram (and escitalopram) prolong the QT interval. Maximum adult citalopram dose is 40 mg/day (20 mg in the elderly or those with hepatic impairment); escitalopram max is 20 mg/day (10 mg in elderly).

8. In bipolar affective disorder, what minimum duration distinguishes a manic episode from a hypomanic episode, and what additional feature defines mania?

   Mania lasts ≥1 week (or any duration if hospitalisation is required) and includes marked functional impairment and/or psychotic features. Hypomania lasts ≥4 days with milder symptoms and no psychosis or significant functional impairment.

9. What is the diagnostic distinction between Bipolar I and Bipolar II disorder?

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

10. What is the first-line long-term mood stabiliser for bipolar disorder, and what therapeutic serum level range is targeted?

    Lithium is first-line for prophylaxis. Target therapeutic range is $0.6\text{–}0.8\ \text{mmol/L}$ (up to $\sim 1.0\ \text{mmol/L}$ in acute mania or poor responders).

11. Name four clinical features of lithium toxicity and the serum level above which toxicity typically occurs.

    Toxicity is usually seen above $1.5\ \text{mmol/L}$. Features: coarse tremor (fine tremor is a normal side effect), ataxia, dysarthria, drowsiness/confusion, vomiting, diarrhoea, and at higher levels seizures, renal failure and coma.

12. What baseline and ongoing monitoring is required for a patient on lithium?

    Baseline: U&Es/eGFR, thyroid function (TFTs), calcium, ECG, weight/BMI. Lithium levels checked ~1 week after starting/dose change (12 h post-dose), then every 3 months. TFTs and U&Es every 6 months; calcium periodically.

13. Why is sodium valproate contraindicated in women of childbearing potential, and what programme governs its use?

    Valproate is highly teratogenic, causing neural tube defects and neurodevelopmental disorders. It must not be used in girls/women of childbearing potential unless under the Pregnancy Prevention Programme (highly effective contraception and specialist sign-off).

14. In Generalised Anxiety Disorder (GAD), what is the minimum symptom duration required for diagnosis, and what is the first-line drug treatment?

    GAD requires excessive, difficult-to-control worry on most days for at least 6 months. First-line drug treatment is an SSRI (e.g. sertraline); SNRI or pregabalin are alternatives.

15. What is the recommended stepped-care first-line management of GAD before pharmacotherapy?

    Step 1: education and active monitoring. Step 2: low-intensity psychological interventions (guided self-help, psychoeducational groups). Step 3: high-intensity CBT or drug treatment (SSRI). Step 4: specialist referral for refractory/complex cases.

16. Differentiate a panic attack from panic disorder.

    A panic attack is a discrete episode of intense fear with somatic symptoms (palpitations, sweating, dyspnoea, chest pain, fear of dying) peaking within minutes. Panic disorder is recurrent unexpected panic attacks with persistent worry about further attacks or maladaptive behaviour change.

17. What is the first-line treatment for moderate-to-severe OCD, and which class of drugs is used?

    First-line is CBT incorporating exposure and response prevention (ERP) and/or an SSRI. SSRIs are the drug class of choice; clomipramine (a TCA) is a second-line option.

18. How are benzodiazepines used in anxiety disorders, and why is long-term use discouraged?

    They may be used only short-term (≤2–4 weeks) for acute, severe anxiety/crisis. Long-term use is discouraged due to tolerance, dependence, and a withdrawal syndrome (rebound anxiety, insomnia, seizures).

19. What features increase the risk of completed suicide following an episode of self-harm (the 'SAD PERSONS' high-risk factors)?

    Male Sex, older Age, Depression, Previous attempts, Ethanol/substance use, Rational thinking loss (psychosis), lack of Social support, Organised plan, No spouse, Sickness (chronic illness). Higher scores indicate higher risk.

20. After an episode of self-harm, what assessment must be performed before discharge, and what are key protective factors?

    A psychosocial risk assessment of suicide intent, mental state, and ongoing risk. Protective factors include strong social/family support, dependent children, religious beliefs, future-orientated plans, and engagement with help.

21. In paracetamol overdose, when is the plasma paracetamol level most reliably interpreted on the treatment nomogram, and what is the antidote?

    The level is plotted on the nomogram from 4 hours post-ingestion onwards (levels before 4 h are unreliable). The antidote is N-acetylcysteine (NAC). Treat staggered/uncertain-time overdoses with NAC regardless of level.

22. What are the Schneiderian first-rank symptoms of schizophrenia?

    Auditory hallucinations (thought echo, running commentary, third-person voices), thought interference (insertion, withdrawal, broadcasting), passivity phenomena/delusions of control, and delusional perception.

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