Psychiatry – MCCQE1 High-Yield Notes

Psychiatry is highly emphasized in the MCCQE1, covering diagnosis criteria, pharmacotherapy, and ethical/legal issues. Understanding DSM-5 criteria and Canadian mental health law is critical.

🔑 Key Topics for MCCQE1

Major Depressive Disorder: DSM-5 criteria (SIG E CAPS), PHQ-9 screening
Bipolar disorder: manic vs hypomanic episode, mood stabilizers (lithium, valproate)
Schizophrenia: positive vs negative symptoms, antipsychotics (risperidone, clozapine)
Anxiety disorders: GAD, panic disorder, social anxiety – CBT + SSRI first-line
PTSD: trauma + 1 month, 4 clusters, SSRI + trauma-focused CBT
OCD: obsessions + compulsions, ERP therapy, SSRI (high dose), clomipramine
ADHD in adults: inattention, hyperactivity, methylphenidate or amphetamines
Eating disorders: anorexia (restricting), bulimia (purging), ARFID
Substance use disorders: alcohol withdrawal (CIWA), opioid withdrawal (COWS)
Suicide risk assessment: risk factors, protective factors, intent, plan, means
Mental Health Act (Canada): involuntary admission criteria
Capacity assessment: understand, appreciate, reason, communicate a decision
Antidepressants: SSRIs, SNRIs, side effects, serotonin syndrome
Antipsychotic side effects: EPS, tardive dyskinesia, metabolic syndrome, NMS
Dementia vs delirium vs depression (3D): key differentiating features

⚠️ High-Yield Clinical Pearls

Serotonin syndrome: Agitation + hyperthermia + clonus → stop serotonergic agents, cyproheptadine
NMS: Rigidity + fever + altered consciousness after antipsychotic → stop drug, dantrolene
Lithium toxicity: Level >1.5 → tremor, ataxia, confusion; >2.0 → seizures, cardiac
Alcohol withdrawal: Seizures peak at 24–48h, delirium tremens at 72h → lorazepam
Capacity: Has capacity until proven otherwise, even if decision seems unwise
Clozapine: Only for treatment-resistant schizophrenia – monitor WBC for agranulocytosis

📊 Quick Reference Table

Disorder	First-line Treatment	Key Consideration
MDD	SSRI (sertraline/fluoxetine)	4-6 weeks for full effect
Bipolar Mania	Lithium or Valproate	Check renal/thyroid for lithium
Schizophrenia	Atypical antipsychotic	Clozapine for resistant cases
Panic Disorder	SSRI + CBT	Avoid benzodiazepine long-term
OCD	SSRI (high dose) + ERP	Clomipramine if SSRI fails

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