Psychiatry Syllabus

How is heritability conceptually defined?

The proportion of phenotypic variance in a population attributable to genetic variance: $$h^{2} = \frac{V_{G}}{V_{P}}$$ where $V_{G}$ is genetic variance and $V_{P}$ is total phenotypic variance.

What is the approximate lifetime risk of bipolar disorder in a first-degree relative of an affected individual compared with the general population?

About $5\text{–}10\%$ in first-degree relatives, versus roughly $1\%$ in the general population — a several-fold increased risk.

What are the core components a clinician assesses in the Mental State Examination (MSE)?

Appearance and behaviour; Speech; Mood and affect; Thought (form and content); Perception; Cognition; Insight; and Judgement.

Distinguish mood from affect in the clinical interview.

Mood is the patient's sustained, subjectively described emotional state ("how you feel"); affect is the clinician's objective observation of the moment-to-moment emotional expression (range, reactivity, congruence).

What is the difference between thought form and thought content disturbance? Give one example of each.

Thought form refers to how thoughts are organized/connected (e.g., loosening of associations); thought content refers to what the patient thinks (e.g., delusions).

Define insight in the psychiatric interview.

The patient's awareness and understanding that they have a mental illness, its nature, and the need for treatment; graded from full to absent.

What does the MMSE assess and what is its maximum score with the standard cutoff for cognitive impairment?

The Mini-Mental State Examination assesses global cognition (orientation, registration, attention, recall, language, visuospatial). Maximum score is $30$; a score below $24$ typically suggests cognitive impairment.

Name a commonly used rating scale for depression severity and one for anxiety.

Depression: Hamilton Rating Scale for Depression (HAM-D) or PHQ-9. Anxiety: Hamilton Anxiety Rating Scale (HAM-A) or GAD-7.

What is the difference between a projective and an objective psychometric test? Give an example of each.

Projective tests present ambiguous stimuli to elicit unconscious material (e.g., Rorschach inkblot, Thematic Apperception Test); objective tests use standardized items with fixed scoring (e.g., MMPI).

Define test reliability versus validity.

Reliability is the consistency/reproducibility of a measure (e.g., test-retest, inter-rater); validity is the extent to which a test measures what it claims to measure (e.g., construct, criterion validity).

Why is a physical examination and baseline investigation essential before starting psychiatric treatment?

To exclude organic causes mimicking psychiatric illness (e.g., thyroid disease, anemia, substance use) and to obtain baselines (ECG, metabolic panel, weight) for monitoring medication side effects such as QTc prolongation or metabolic syndrome.

Which physical/laboratory abnormality classically mimics depression and must be screened for?

Hypothyroidism (elevated TSH, low free $T_{4}$), which can present with low mood, fatigue, and psychomotor slowing.

State the DSM-5 minimum symptom count and duration required to diagnose a Major Depressive Episode.

At least 5 of 9 symptoms present during the same 2-week period, with at least one being depressed mood or loss of interest/pleasure (anhedonia).

List the nine DSM-5 symptoms of a Major Depressive Episode (mnemonic SIGECAPS + mood).

Depressed mood; anhedonia; and SIGECAPS — Sleep change, loss of Interest, Guilt/worthlessness, low Energy, poor Concentration, Appetite/weight change, Psychomotor agitation/retardation, Suicidality.

What is the first-line pharmacological treatment for Major Depressive Disorder and why?

SSRIs (selective serotonin reuptake inhibitors), because of favorable efficacy, tolerability, and safety in overdose compared with tricyclics and MAOIs.

Define a manic episode per DSM-5 (core features and duration).

A distinct period of abnormally elevated, expansive, or irritable mood plus increased energy/activity, lasting at least 1 week (or any duration if hospitalization is required), with at least 3 additional symptoms (4 if mood is only irritable) causing marked impairment.

Distinguish Bipolar I from Bipolar II disorder.

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

How does a hypomanic episode differ from a manic episode?

Hypomania lasts at least 4 consecutive days, causes an observable change in functioning but no marked impairment, no psychosis, and no hospitalization; mania lasts at least 1 week and causes marked impairment/psychosis/hospitalization.

What is the mnemonic DIGFAST for manic symptoms?

Distractibility, Insomnia (decreased need for sleep), Grandiosity, Flight of ideas, increased goal-directed Activity, pressured Speech, Thoughtlessness (risky/pleasurable activities).

Name the mood stabilizer considered gold-standard for bipolar disorder and one key toxicity monitoring parameter.

Lithium; therapeutic serum level is narrow (approximately $0.6\text{–}1.2\ \text{mmol/L}$), requiring monitoring of levels, renal function, and thyroid function due to a low toxic threshold.

Define Persistent Depressive Disorder (Dysthymia) including its duration criterion.

Chronically depressed mood for most of the day, more days than not, for at least 2 years in adults (1 year in children/adolescents), plus at least 2 additional symptoms, without a symptom-free period exceeding 2 months.

What is "double depression"?

A major depressive episode superimposed on pre-existing persistent depressive disorder (dysthymia), producing periods of more severe depression on a chronic low-grade baseline.

State the DSM-5 duration and core feature required to diagnose Generalized Anxiety Disorder.

Excessive anxiety and worry occurring more days than not for at least 6 months, difficult to control, about multiple events/activities, plus at least 3 of 6 physical/cognitive symptoms (restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance).

What is the first-line pharmacotherapy for Generalized Anxiety Disorder, and why are benzodiazepines avoided long-term?

SSRIs or SNInIs (e.g., venlafaxine) are first-line; benzodiazepines are avoided long-term due to tolerance, dependence, and withdrawal risk, being reserved for short-term/acute use.

Define a panic attack and give the DSM-5 threshold number of symptoms.

An abrupt surge of intense fear/discomfort peaking within minutes, with at least 4 of 13 physical/cognitive symptoms (e.g., palpitations, sweating, dyspnea, chest pain, derealization, fear of dying/losing control).

What distinguishes Panic Disorder from isolated panic attacks?

Panic Disorder requires recurrent unexpected panic attacks plus at least 1 month of persistent concern about further attacks or maladaptive behavioral change (e.g., avoidance) to prevent them.

What is agoraphobia and how does it relate to panic disorder?

Agoraphobia is marked fear/avoidance of at least two situations (public transport, open/enclosed spaces, crowds, being outside alone) where escape may be difficult; it is a separate DSM-5 diagnosis that frequently co-occurs with panic disorder.

Define Social Anxiety Disorder (Social Phobia) per DSM-5, including duration.

Marked, persistent fear of one or more social situations involving possible scrutiny, where the person fears acting in a way that will be humiliating or negatively evaluated; the situations are avoided or endured with distress, lasting at least 6 months and causing impairment.

Distinguish obsessions from compulsions in OCD.

Obsessions are recurrent, intrusive, unwanted thoughts, images, or urges causing anxiety; compulsions are repetitive behaviors or mental acts performed to reduce that anxiety or prevent a feared outcome, often ritualistic and not realistically connected to what they neutralize.

What are the first-line treatments for Obsessive-Compulsive Disorder?

SSRIs (often at higher doses than for depression) and Cognitive Behavioral Therapy with Exposure and Response Prevention (ERP); clomipramine is an effective second-line agent.

List the DSM-5 "Criterion A" symptoms of schizophrenia and the number required.

At least 2 of: delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, and negative symptoms — with at least one being delusions, hallucinations, or disorganized speech, present for a significant portion of 1 month.

What total illness duration is required to diagnose schizophrenia, and what is diagnosed if duration is shorter?

Continuous signs for at least 6 months (including at least 1 month of active-phase symptoms). If 1–6 months, diagnose schizophreniform disorder; if less than 1 month with full resolution, brief psychotic disorder.

Differentiate positive from negative symptoms of schizophrenia.

Positive symptoms are added/abnormal experiences (delusions, hallucinations, disorganized speech/behavior); negative symptoms are deficits (blunted affect, alogia, avolition, anhedonia, asociality).

How does Schizoaffective Disorder differ from schizophrenia with mood symptoms and from a mood disorder with psychosis?

Schizoaffective disorder requires a period of at least 2 weeks of psychotic symptoms (delusions/hallucinations) in the ABSENCE of a major mood episode, while mood episodes are present for the majority of the illness's total duration — distinguishing it from pure schizophrenia (mood symptoms minimal) and from mood disorder with psychosis (psychosis only during mood episodes).