Master Psychiatry
for DHA

Core Concepts

Psychiatry integrates the biopsychosocial model to understand mental illness, considering biological (genetics, neurochemistry), psychological (thoughts, emotions), and social (environment, culture) factors. A comprehensive Mental Status Examination (MSE) is crucial for objective assessment of appearance, behavior, speech, mood, affect, thought process/content, perception, cognition, insight, and judgment. Psychiatric emergencies (e.g., acute risk of harm to self/others, severe agitation, acute psychosis) require immediate recognition and intervention to ensure safety. Familiarity with neurobiology, particularly neurotransmitter systems (dopamine, serotonin, norepinephrine, GABA), is foundational for understanding psychopharmacology. Building a strong therapeutic alliance is key for patient engagement, adherence, and successful treatment outcomes.

Clinical Presentation

• Depression: Persistent low mood, anhedonia, fatigue, changes in sleep/appetite, concentration difficulties, feelings of worthlessness/guilt, suicidal ideation (SIG E CAPS).
• Bipolar Disorder: Episodes of mania (elevated/irritable mood, grandiosity, decreased need for sleep, pressured speech, flight of ideas, increased goal-directed activity, impulsivity) alternating with depressive episodes.
• Schizophrenia: Positive symptoms (hallucinations – often auditory, delusions, disorganized speech/behavior), negative symptoms (alogia, avolition, anhedonia, flat affect), cognitive deficits.
• Generalized Anxiety Disorder (GAD): Excessive, uncontrollable worry about multiple events/activities for >6 months, associated with restlessness, fatigue, irritability, muscle tension, sleep disturbance.
• Panic Disorder: Recurrent unexpected panic attacks (intense fear, palpitations, sweating, tremor, shortness of breath, chest pain, fear of dying/losing control), followed by persistent worry about future attacks.
• Obsessive-Compulsive Disorder (OCD): Recurrent, intrusive thoughts (obsessions) leading to repetitive behaviors or mental acts (compulsions) aimed at reducing distress.
• Post-Traumatic Stress Disorder (PTSD): Exposure to trauma, followed by intrusion symptoms (flashbacks, nightmares), avoidance, negative alterations in cognition/mood, and hyperarousal/reactivity changes.
• Substance Use Disorders: Impaired control over substance use, social impairment, risky use, pharmacological criteria (tolerance/withdrawal).
• Delirium: Acute onset, fluctuating course, global cognitive impairment (attention, awareness, memory, disorientation), often due to underlying medical condition.
• Dementia: Progressive decline in cognitive function (memory, language, executive function) sufficient to interfere with daily activities, in clear consciousness.
• Personality Disorders: Enduring, pervasive, inflexible patterns of inner experience and behavior deviating from cultural expectations, causing distress or impairment (e.g., Borderline Personality Disorder: instability in relationships, self-image, affects; impulsivity).
• Anorexia Nervosa: Restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, disturbance in body weight/shape experience.

Diagnosis (Gold Standard)

Diagnosis primarily relies on a comprehensive clinical interview including detailed history (presenting complaint, past psychiatric history, medical history, family history, social history, substance use), combined with a thorough Mental Status Examination (MSE). Collateral information from family or caregivers (with patient consent) is often invaluable. It is crucial to exclude medical or substance-induced causes for psychiatric symptoms through targeted lab tests (e.g., thyroid function, B12, electrolytes, urine drug screen) and imaging (e.g., CT/MRI brain) when indicated. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides the gold standard criteria for classifying mental disorders based on symptom clusters and duration.

Management (First Line)

First-line management is multimodal. Pharmacotherapy: SSRIs (e.g., escitalopram, sertraline) are first-line for depression and anxiety disorders. SNRIs (venlafaxine, duloxetine) are also used. For Bipolar Disorder, mood stabilizers (lithium, valproate, lamotrigine) and atypical antipsychotics (quetiapine, olanzapine) are key. Atypical antipsychotics (risperidone, olanzapine, aripiprazole) are preferred for psychosis (e.g., schizophrenia) due to improved side effect profiles. For acute agitation, benzodiazepines (lorazepam) or antipsychotics (haloperidol) may be used. Psychotherapy: Cognitive Behavioral Therapy (CBT) is highly effective for depression, anxiety, OCD, and PTSD. Dialectical Behavior Therapy (DBT) is the gold standard for Borderline Personality Disorder. Supportive, psychodynamic, and family therapies also play a role. Crisis intervention focuses on ensuring safety for suicidal/homicidal ideation, severe agitation, or acute psychosis, often requiring hospitalization. Psychoeducation for patients and families, alongside lifestyle modifications, is integral to recovery and relapse prevention.

Exam Red Flags