UK Medical Licensing Assessment (UKMLA) Mental Health and Behavioural Medicine Syllabus

Mental Health and Behavioural Medicine syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Mental Health and Behavioural Medicine in UK Medical Licensing Assessment (UKMLA), not a summary of it.

1. 1

   Assessment and the Mental State

   3 topics

   • Psychiatric history and mental state examination
     • Components of the mental state examination
     • Risk assessment of self and others
     • Cognitive assessment
   • Mental Health Act and legal frameworks
     • Sections for assessment and treatment
     • Emergency holding powers
     • Capacity in the context of mental illness
   • Suicide and self-harm
     • Risk factors and assessment
     • Management of self-harm
     • Safety planning
2. 2

   Mood, Anxiety and Stress-Related Disorders

   4 topics

   • Depressive disorders
     • Diagnosis and severity assessment
     • Pharmacological and psychological treatment
     • Treatment-resistant depression and ECT
   • Bipolar affective disorder
     • Mania and hypomania
     • Mood stabilisers and monitoring
   • Anxiety disorders
     • Generalised anxiety and panic disorder
     • Phobias and OCD
     • Post-traumatic stress disorder
   • Somatic symptom and stress-related disorders
3. 3

   Psychosis and Severe Mental Illness

   3 topics

   • Schizophrenia and psychotic disorders
     • Positive and negative symptoms
     • First-episode psychosis
   • Antipsychotic treatment
     • Typical and atypical antipsychotics
     • Side effects and extrapyramidal symptoms
     • Neuroleptic malignant syndrome and clozapine monitoring
   • Organic and drug-induced psychosis
4. 4

   Substance Misuse and Addiction

   3 topics

   • Alcohol use disorder
     • Screening and dependence
     • Withdrawal and Wernicke's encephalopathy
     • Detoxification and relapse prevention
   • Drug misuse
     • Opioid dependence and substitution therapy
     • Stimulant and novel psychoactive substances
   • Behavioural addictions
5. 5

   Specific Populations and Disorders

   5 topics

   • Eating disorders
     • Anorexia and bulimia nervosa
     • Medical complications and refeeding syndrome
   • Personality disorders
   • Child and adolescent mental health
     • Emotional and conduct disorders
     • Neurodevelopmental presentations
   • Perinatal psychiatry
     • Postnatal depression
     • Puerperal psychosis
   • Delirium versus dementia in older adults

Mental Health and Behavioural Medicine flashcards for UK Medical Licensing Assessment (UKMLA)

25 of 55 cards from the Mental Health and Behavioural Medicine deck — real questions with worked answers.

1. What are the key components of the Mental State Examination (MSE)?

   Appearance and behaviour; Speech (rate, rhythm, volume); Mood and affect; Thought (form and content, including delusions); Perception (hallucinations, illusions); Cognition; Insight and judgement. Mnemonic: ASEPTIC (Appearance/behaviour, Speech, Emotion, Perception, Thought, Insight, Cognition).

2. In an MSE, what is the difference between mood and affect?

   Mood is the patient's subjectively reported, sustained emotional state ('the climate'). Affect is the objectively observed, moment-to-moment emotional expression ('the weather') — described by range/reactivity (e.g. blunted, flat, reactive) and congruence with mood.

3. Define a delusion and name the requirement for it to be classed as such.

   A delusion is a fixed, false belief held with absolute conviction, out of keeping with the person's social/cultural background, and not amenable to reasoning or contrary evidence. It is a disorder of thought content.

4. What is the difference between a hallucination, an illusion and a pseudohallucination?

   Hallucination: perception in the absence of any external stimulus, experienced in external space. Illusion: misperception of a real external stimulus. Pseudohallucination: perceived in internal/subjective space (e.g. 'inside my head'), with preserved insight that it is not real.

5. Under the Mental Health Act 1983 (England & Wales), what does Section 2 allow and for how long?

   Section 2 permits compulsory admission for assessment (and some treatment) for up to 28 days, not renewable. Requires two doctors (one Section 12 approved) plus an Approved Mental Health Professional (AMHP).

6. Under the Mental Health Act 1983, what does Section 3 allow and for how long?

   Section 3 permits compulsory admission for treatment for up to 6 months, renewable (6 months, then yearly). Requires two doctors plus an AMHP, and a known diagnosis/treatment plan.

7. Compare Section 5(2) and Section 5(4) of the Mental Health Act 1983.

   Section 5(2): doctor's holding power for an already-admitted inpatient, lasting up to 72 hours. Section 5(4): nurse's holding power, lasting up to 6 hours. Both are emergency holds pending formal assessment and cannot be used in A&E (outpatient).

8. What are Sections 135 and 136 of the Mental Health Act 1983?

   Section 135: warrant allowing police to enter a private property to remove a person to a place of safety. Section 136: police power to remove a person from a public place to a place of safety. Both last up to 24 hours (extendable by 12).

9. State the five statutory principles of the Mental Capacity Act 2005.

   1) Presumption of capacity. 2) Support individuals to make their own decision. 3) Unwise decisions do not equal lack of capacity. 4) Acts/decisions must be in the person's best interests. 5) Choose the least restrictive option.

10. What are the four components of the functional test of capacity under the Mental Capacity Act 2005?

    To have capacity a person must be able to: (1) Understand the relevant information, (2) Retain it long enough to decide, (3) Use/weigh it in the decision, and (4) Communicate the decision. Failure of any one (with an impairment of mind/brain) means lack of capacity.

11. List major high-risk factors for completed suicide.

    Male sex; older age; previous self-harm/attempts; mental illness (especially depression, psychosis, alcohol/drug misuse); a clear plan or note; violent method; social isolation; unemployment; chronic physical illness; recent bereavement. Mnemonic: SAD PERSONS.

12. What does the SAD PERSONS scale stand for in suicide risk assessment?

    Sex (male), Age, Depression, Previous attempt, Ethanol/substance use, Rational thinking loss (psychosis), Social support lacking, Organised plan, No spouse, Sickness (chronic illness).

13. Distinguish self-harm from a suicide attempt in intent.

    Self-harm is intentional self-injury without primary intent to die (often to relieve distress); a suicide attempt is self-injury with intent to end life. However, any self-harm raises suicide risk and both require risk assessment — self-harm is the strongest single predictor of future suicide.

14. According to ICD-10/DSM-5, how many core and additional symptoms are needed to diagnose depression, and for how long?

    Symptoms must persist for at least 2 weeks. Core symptoms: low mood, anhedonia, low energy/fatigue. Diagnosis requires a combination of core plus additional symptoms (sleep change, appetite/weight change, guilt, poor concentration, psychomotor change, suicidal ideation).

15. List the biological ('somatic') symptoms of depression.

    Early morning waking (≥2 h early); diurnal mood variation (worse in mornings); anhedonia; loss of appetite and weight loss; loss of libido; psychomotor retardation or agitation; constipation.

16. What is the first-line pharmacological treatment for moderate-to-severe depression, and name an example?

    A selective serotonin reuptake inhibitor (SSRI), e.g. sertraline or citalopram. SSRIs are first-line due to a favourable safety/side-effect profile; effect typically takes 2–4 weeks.

17. What is serotonin syndrome and its classic triad of features?

    A potentially life-threatening reaction to excess serotonergic activity. Triad: (1) neuromuscular excitation (clonus, hyperreflexia, tremor, rigidity), (2) autonomic instability (hyperthermia, tachycardia, sweating), (3) altered mental state (agitation, confusion). Management: stop the drug, supportive care, consider cyproheptadine.

18. Define bipolar affective disorder and distinguish type I from type II.

    A mood disorder with recurrent episodes of mania/hypomania and depression. Bipolar I: at least one full manic episode (often with depression). Bipolar II: at least one hypomanic episode plus at least one major depressive episode, with no full mania.

19. Differentiate mania from hypomania.

    Mania: elevated/irritable mood ≥1 week, marked functional impairment, may have psychotic features, often needs hospitalisation. Hypomania: similar but milder, lasting ≥4 days, no psychosis, and without marked functional impairment or need for admission.

20. What is the first-line long-term mood stabiliser for bipolar disorder, and what monitoring does it require?

    Lithium. Requires baseline and monitoring of U&Es/renal function and thyroid (TFTs), plus serum lithium levels (target 0.6–0.8 mmol/L). Check levels 12 h post-dose, weekly until stable then every 3 months; monitor renal and thyroid function every 6 months.

21. List early features of lithium toxicity.

    Lithium toxicity (level >1.5 mmol/L): coarse tremor, ataxia, dysarthria, nausea/vomiting, diarrhoea, confusion. Severe (>2.0): seizures, renal failure, coma. Precipitants: dehydration, NSAIDs, ACE inhibitors, thiazide diuretics, renal impairment.

22. What is the difference between generalised anxiety disorder (GAD) and panic disorder?

    GAD: persistent, excessive, free-floating worry about multiple domains for ≥6 months, with restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance. Panic disorder: recurrent, unexpected, discrete panic attacks (peak within minutes) plus persistent worry about further attacks.

23. What is the first-line treatment for generalised anxiety disorder?

    Low-intensity psychological intervention initially; for treatment, an SSRI (e.g. sertraline) first-line, with CBT. Benzodiazepines should generally be avoided except short-term crisis use due to dependence risk.

24. Define a specific phobia, social anxiety disorder and agoraphobia.

    Specific phobia: marked fear of a particular object/situation. Social anxiety disorder: fear of scrutiny/embarrassment in social situations. Agoraphobia: fear of situations where escape is difficult or help unavailable (crowds, public transport, open spaces), often leading to avoidance.

25. What are the core symptom clusters of post-traumatic stress disorder (PTSD)?

    Four clusters: (1) Re-experiencing (flashbacks, nightmares, intrusive memories); (2) Avoidance of reminders; (3) Hyperarousal (hypervigilance, exaggerated startle, irritability); (4) Negative alterations in cognition/mood. Symptoms persist >1 month with functional impairment.

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