SMLE Psychiatry Syllabus

Psychiatry syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Psychiatry in SMLE, not a summary of it.

1. 1

   Mood Disorders

   2 topics

   • Depression
   • Bipolar Disorder
2. 2

   Anxiety Disorders

   2 topics

   • Generalized Anxiety Disorder
   • Panic Disorder

Psychiatry flashcards for SMLE

21 of 49 cards from the Psychiatry deck — real questions with worked answers.

1. What is the DSM-5 minimum symptom count and duration required to diagnose Major Depressive Disorder (MDD)?

   At least 5 of 9 symptoms present during the same 2-week period, representing a change from previous functioning. At least one symptom must be either (1) depressed mood or (2) loss of interest/pleasure (anhedonia).

2. List the 9 diagnostic symptoms of Major Depressive Disorder (SIGECAPS mnemonic + mood).

   Depressed mood plus SIGECAPS: Sleep disturbance, loss of Interest (anhedonia), Guilt/worthlessness, low Energy/fatigue, poor Concentration, Appetite/weight change, Psychomotor agitation/retardation, Suicidal ideation.

3. What is the first-line pharmacologic treatment for Major Depressive Disorder?

   SSRIs (selective serotonin reuptake inhibitors), e.g., fluoxetine, sertraline, escitalopram. They are first-line due to efficacy and favorable side-effect/safety profile.

4. How long should an antidepressant be continued after remission of a first episode of MDD?

   Continue for 6 to 12 months after achieving remission to prevent relapse. Recurrent episodes may require maintenance therapy for years or indefinitely.

5. How long does it typically take for antidepressants (SSRIs) to produce a clinical antidepressant effect?

   Typically 4 to 6 weeks at an adequate dose for full therapeutic effect, although some improvement may begin within 1 to 2 weeks. An adequate trial is at least 4 to 8 weeks.

6. What defines Persistent Depressive Disorder (dysthymia) in adults?

   Depressed mood for most of the day, more days than not, for at least 2 years, plus at least 2 additional depressive symptoms, without being symptom-free for more than 2 months at a time.

7. Which serious medical/psychiatric emergency can occur when serotonergic drugs are combined (e.g., SSRI + MAOI)?

   Serotonin syndrome: triad of altered mental status, autonomic instability (hyperthermia, tachycardia), and neuromuscular abnormalities (clonus, hyperreflexia, tremor). Managed by stopping the agent, supportive care, and cyproheptadine.

8. What is the required washout period when switching between an MAOI and most SSRIs?

   At least 14 days (2 weeks) between stopping an MAOI and starting an SSRI, and vice versa. For fluoxetine, wait 5 weeks before starting an MAOI due to its long half-life.

9. What is the most effective treatment for severe, treatment-resistant, or psychotic depression, or when rapid response is needed?

   Electroconvulsive therapy (ECT). It is first-line for depression with psychotic features, catatonia, acute suicidality, or refusal to eat/drink.

10. Which class of antidepressants is most dangerous in overdose and why?

    Tricyclic antidepressants (TCAs). Overdose causes cardiotoxicity (QRS widening, arrhythmias), anticholinergic effects, seizures, and coma — the 'three Cs': Cardiotoxicity, Convulsions, Coma. Sodium bicarbonate is used for cardiotoxicity.

11. What antidepressant is preferred for a depressed patient with insomnia and poor appetite/weight loss, and why?

    Mirtazapine. As an alpha-2 antagonist it increases appetite/weight and is sedating, making it useful for depressed patients with insomnia and anorexia.

12. What antidepressant should be avoided in patients with a seizure disorder or eating disorder (bulimia/anorexia)?

    Bupropion. It lowers the seizure threshold and is contraindicated in seizure disorders and eating disorders. It has the advantage of no sexual dysfunction and can aid smoking cessation.

13. What is the black box warning associated with antidepressants, especially in young patients?

    Increased risk of suicidal ideation and behavior in children, adolescents, and young adults (up to age 24), particularly early in treatment. Close monitoring is required.

14. What is the DSM-5 duration criterion for a Major Depressive Episode versus a Manic Episode?

    Major Depressive Episode: at least 2 weeks. Manic Episode: at least 1 week (or any duration if hospitalization is required).

15. In postpartum depression versus 'baby blues,' what distinguishes them by timing and duration?

    Baby blues: mild, self-limited, onset within days and resolves by ~2 weeks postpartum. Postpartum depression: meets MDD criteria, onset within weeks to months, lasts longer than 2 weeks and impairs functioning; requires treatment.

16. Which laboratory or medical conditions must be excluded before diagnosing depression?

    Hypothyroidism (check TSH), anemia, vitamin B12/folate deficiency, and substance use. Depression is a diagnosis requiring exclusion of medical mimics.

17. Define a Manic Episode per DSM-5 (core criteria).

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

18. What does the mnemonic DIGFAST stand for in mania?

    Distractibility, Impulsivity/Indiscretion (risky activities), Grandiosity, Flight of ideas, increased goal-directed Activity, decreased need for Sleep, and Talkativeness (pressured speech).

19. What distinguishes Bipolar I Disorder from Bipolar II Disorder?

    Bipolar I: at least one full Manic episode (lasting at least 1 week or requiring hospitalization); depression not required. Bipolar II: at least one Hypomanic episode plus at least one Major Depressive episode, with NO full manic episode.

20. What are the duration and severity criteria that distinguish hypomania from mania?

    Hypomania: at least 4 consecutive days, no marked functional impairment, no psychosis, and no hospitalization. Mania: at least 1 week (or any if hospitalized), marked impairment, and/or psychosis may be present.

21. What is the first-line mood stabilizer and gold-standard treatment for Bipolar I Disorder?

    Lithium. It is first-line for acute mania and maintenance, and is notable for reducing suicide risk in bipolar disorder.

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Psychiatry (SMLE) FAQ