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

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.

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.

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.

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.

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.

What is the recommended first-line treatment for PTSD?

Trauma-focused psychological therapy: trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR). Drug treatment (e.g. SSRI such as sertraline, or venlafaxine) is offered if the patient prefers it or therapy is unavailable/insufficient.

What characterises obsessive-compulsive disorder (OCD)?

Recurrent obsessions (intrusive, unwanted thoughts/images causing anxiety) and/or compulsions (repetitive behaviours/mental acts performed to reduce anxiety), recognised by the patient as their own and excessive. First-line treatment: CBT with exposure and response prevention (ERP) and/or an SSRI.

Distinguish somatic symptom disorder, illness anxiety disorder and conversion (functional neurological) disorder.

Somatic symptom disorder: distressing physical symptoms with excessive thoughts/behaviours about them. Illness anxiety disorder (hypochondriasis): preoccupation with having a serious illness despite minimal/no symptoms. Conversion disorder: neurological symptoms (e.g. paralysis, seizures) inconsistent with disease, not intentionally produced.

Differentiate factitious disorder from malingering.

Factitious disorder (Munchausen): intentional feigning/induction of symptoms for the psychological role of being a patient (internal/primary gain). Malingering: intentional feigning of symptoms for an external incentive (e.g. money, avoiding work/court) — not a psychiatric diagnosis.

What are Schneider's first-rank symptoms of schizophrenia?

(1) Auditory hallucinations: thought echo, running commentary, third-person voices. (2) Thought interference: insertion, withdrawal, broadcasting. (3) Passivity phenomena: made actions/feelings/impulses (delusions of control). (4) Delusional perception. Their presence is suggestive but not pathognomonic.

Differentiate positive and negative symptoms of schizophrenia.

Positive symptoms (added experiences): delusions, hallucinations, thought disorder, disorganised behaviour. Negative symptoms (lost functions): blunted affect, alogia (poverty of speech), avolition, anhedonia, social withdrawal. Negative symptoms respond less well to treatment and predict poorer prognosis.

What is the ICD/DSM duration requirement to diagnose schizophrenia, and name good prognostic factors.

Symptoms typically present for ≥1 month (ICD-10) / ≥6 months including prodrome (DSM-5). Good prognostic factors: acute/sudden onset, presence of a precipitant, mood disturbance, female sex, married/good support, later onset, predominance of positive symptoms, good premorbid function.

Distinguish typical (first-generation) from atypical (second-generation) antipsychotics.

Typical (e.g. haloperidol, chlorpromazine): predominantly D2 antagonists; higher risk of extrapyramidal side effects (EPSEs) and hyperprolactinaemia. Atypical (e.g. olanzapine, risperidone, quetiapine): act on D2 and 5-HT2A; fewer EPSEs but greater metabolic side effects (weight gain, diabetes, dyslipidaemia).

List the four types of extrapyramidal side effects (EPSEs) of antipsychotics.

(1) Acute dystonia (e.g. oculogyric crisis) — hours to days; treat with procyclidine. (2) Akathisia (motor restlessness). (3) Parkinsonism (bradykinesia, tremor, rigidity). (4) Tardive dyskinesia (late, repetitive choreoathetoid movements, often irreversible).

What is neuroleptic malignant syndrome (NMS) and its key features?

A rare, life-threatening reaction to antipsychotics. Features: fever/hyperthermia, lead-pipe muscle rigidity, autonomic instability, altered consciousness, and raised creatine kinase (CK). Management: stop the antipsychotic, supportive care/cooling, IV fluids; consider dantrolene or bromocriptine.

When is clozapine used and what is its most dangerous side effect?

Clozapine is reserved for treatment-resistant schizophrenia (failure of ≥2 antipsychotics, one atypical). Its most dangerous side effect is agranulocytosis/neutropenia, mandating regular FBC monitoring. Other risks: myocarditis, seizures, constipation (can be fatal ileus), hypersalivation, weight gain.

List common organic and drug-related causes of psychosis.

Organic: temporal lobe epilepsy, delirium, dementia, brain tumour, encephalitis, SLE, Huntington's, B12 deficiency, endocrine (Cushing's, thyroid). Drug-induced: stimulants (cocaine, amphetamines), cannabis, hallucinogens (LSD), alcohol withdrawal, corticosteroids, dopamine agonists.

What features suggest an organic rather than primary psychiatric cause of psychosis?

Acute onset, fluctuating consciousness/confusion, disorientation, visual (rather than auditory) hallucinations, abnormal vital signs, focal neurology, age >40 at first presentation, and absence of personal/family psychiatric history.

Define one unit of alcohol and state UK low-risk drinking guidance.

One UK unit = 10 mL (8 g) of pure alcohol. Units = (volume in mL × ABV%) ÷ 1000. UK guidance: no more than 14 units per week for both men and women, spread over ≥3 days with several drink-free days.

What questionnaire screens for alcohol dependence, and what does it stand for?

The CAGE questionnaire: Cut down (felt you should?), Annoyed (by criticism of your drinking?), Guilty (about drinking?), Eye-opener (drink first thing in the morning?). Two or more 'yes' answers suggest problematic drinking. (AUDIT is a more detailed screening tool.)

What are the features and timeline of alcohol withdrawal, including delirium tremens?

6–12 h: tremor, sweating, anxiety, nausea. 12–24 h: visual/tactile hallucinations. 24–48 h: withdrawal seizures. 48–72 h: delirium tremens — confusion, agitation, coarse tremor, autonomic instability, hallucinations; medical emergency with significant mortality. Treat with benzodiazepines (e.g. chlordiazepoxide).

Distinguish Wernicke's encephalopathy from Korsakoff's syndrome.

Both result from thiamine (B1) deficiency. Wernicke's encephalopathy: acute, reversible triad of confusion, ataxia and ophthalmoplegia/nystagmus — treat urgently with IV thiamine (Pabrinex). Korsakoff's syndrome: chronic, often irreversible anterograde amnesia with confabulation if Wernicke's is untreated.

Match these drugs of misuse to their key withdrawal/overdose treatments: opioids, benzodiazepines.

Opioid overdose: reverse with naloxone (short-acting; may need repeated doses). Opioid dependence maintenance: methadone or buprenorphine. Benzodiazepine overdose: flumazenil (used cautiously due to seizure risk); withdrawal managed with a gradual tapering of a long-acting benzodiazepine.

What are the core ICD-10 features of a dependence syndrome (applies to alcohol and drugs)?

Three or more of: (1) strong desire/compulsion to use; (2) impaired control over use; (3) tolerance; (4) physiological withdrawal state; (5) neglect of other interests/salience; (6) persistent use despite harmful consequences.

What is a behavioural addiction, and give the recognised example in ICD-11/DSM-5?

A behavioural addiction is compulsive engagement in a rewarding non-substance behaviour despite harm, sharing features of substance dependence (salience, loss of control, withdrawal-like distress). Gambling disorder is the formally recognised example; gaming disorder is recognised in ICD-11.

Compare anorexia nervosa and bulimia nervosa.

Anorexia nervosa: restriction leading to significantly low body weight (BMI typically <17.5/18.5), intense fear of weight gain, distorted body image. Bulimia nervosa: recurrent binge eating with compensatory behaviours (vomiting, laxatives, exercise), usually normal or near-normal weight.

What biochemical and physical complications occur in anorexia nervosa?

Hypokalaemia, hypoglycaemia, hyponatraemia; bradycardia and hypotension; amenorrhoea (low oestrogen/LH/FSH); osteoporosis; raised cortisol and growth hormone; low T3; anaemia. Most blood markers tend to be low ('everything low'), but cholesterol, cortisol, GH and carotenaemia are raised.

What is refeeding syndrome and its hallmark electrolyte abnormality?

A potentially fatal shift of fluids/electrolytes when nutrition is reintroduced to a malnourished patient. The hallmark is hypophosphataemia (also hypokalaemia, hypomagnesaemia, thiamine deficiency, fluid overload). Prevent by slow refeeding, electrolyte monitoring and thiamine/vitamin supplementation.

What are the three clusters of personality disorders and give an example of each?

Cluster A ('odd/eccentric'): paranoid, schizoid, schizotypal. Cluster B ('dramatic/emotional'): antisocial, borderline (emotionally unstable), histrionic, narcissistic. Cluster C ('anxious/fearful'): avoidant, dependent, obsessive-compulsive (anankastic).

What are the core features of emotionally unstable (borderline) personality disorder, and the first-line treatment?

Unstable relationships, fear of abandonment, identity disturbance, impulsivity, recurrent self-harm/suicidality, chronic emptiness, affective instability, and transient stress-related paranoia. First-line treatment: structured psychotherapy, e.g. dialectical behaviour therapy (DBT); medication is not first-line.

What is the first-line pharmacological treatment for ADHD in children, and key monitoring?

Methylphenidate (a stimulant) is first-line after behavioural interventions. Monitor height and weight (growth suppression), pulse and blood pressure, and watch for appetite suppression and sleep disturbance. A 6-week trial assesses response.

What perinatal psychiatric conditions must be distinguished from each other, and which is an emergency?

Baby blues (days 3–10, transient, self-limiting, ~50–75%); postnatal depression (onset within weeks–months, ~10%, treat with CBT/SSRI); and puerperal (postpartum) psychosis (rapid onset within ~2 weeks, ~0.2%) — a psychiatric emergency needing urgent admission, ideally to a mother-and-baby unit.

Which SSRI is preferred during breastfeeding, and which mood stabiliser is teratogenic and must be avoided in pregnancy?

Sertraline (and paroxetine) are preferred SSRIs in breastfeeding due to low milk transfer. Sodium valproate is highly teratogenic (neural tube defects, neurodevelopmental harm) and must be avoided in women of childbearing potential; lithium also carries risk (Ebstein's anomaly).

Compare delirium and dementia across onset, course, consciousness and attention.

Delirium: acute onset (hours–days), fluctuating course, impaired/clouded consciousness, markedly impaired attention, often reversible. Dementia: insidious onset (months–years), slowly progressive, clear consciousness (until late), attention relatively preserved early, generally irreversible.

Distinguish hyperactive from hypoactive delirium and name common precipitants.

Hyperactive delirium: agitation, restlessness, hallucinations. Hypoactive delirium: lethargy, withdrawal, drowsiness (often missed). Common precipitants (PINCH ME): Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment. Management: treat the cause and optimise environment; antipsychotics only if severe distress/risk.