Rapid review: psychiatry

• This page is a revision tool, not a first lesson: each block below gives the presenting picture, the single most likely diagnosis, the best first test, the best first treatment, the commonest trap, and the full MedGrasp topic to read.
• Psychiatric emergencies declare themselves by risk and medical context, not by diagnosis: suicide or violence risk, acute intoxication or withdrawal (especially alcohol), delirium, catatonia, neuroleptic malignant syndrome, and self-neglect.
• Most psychiatric diagnoses are made clinically. Investigations mostly exclude medical causes, quantify risk, or monitor treatment; a normal result does not exclude a psychiatric disorder.
• Psychological treatments are first-line for several common conditions (less severe depression, generalised anxiety, obsessive-compulsive disorder), and drugs are usually an option rather than the default.
• Delirium is always a medical problem until proven otherwise; dementia alone never explains an acute change over hours or days.
• Capacity, consent and detention are decision-specific and time-specific: a person can lose capacity for one decision and retain it for another.

By the end of this page you should be able to:

1. Run through the common presentations of psychiatry in examination order, naming the likely diagnosis, the first test, the first treatment and the common trap in each.
2. Recognise the red flags that turn a routine psychiatric presentation into an emergency.
3. Use the flowchart to decide whether a patient needs urgent safeguarding, detoxification, antipsychotic treatment or outpatient care.
4. Cite the current guideline editions that shape each recommendation above.
5. Move from each block to the full MedGrasp topic for depth.

Psychiatric presentations sort poorly by label and well by mechanism: mood, psychosis, anxiety and compulsion, substance, personality, cognition, eating, risk, capacity and medical mimic. The blocks below take each major presentation in turn and give the answer that an examiner or a busy clinician wants first. This is a curriculum-gap revision page: it has no single paired chapter in the source syllabus, so it builds only on the full MedGrasp psychiatry topics named at the end of each block.

Guideline editions used throughout: NICE NG222 for depression, last updated 30 January 2026 ^[1]; NICE CG185 for bipolar disorder, last updated 2 September 2025 ^[2]; NICE CG178 for psychosis and schizophrenia, last updated 4 September 2026 ^[3]; NICE CG113 for generalised anxiety and panic, last updated 15 June 2020 ^[4]; NICE CG31 for obsessive-compulsive disorder, last reviewed 11 July 2024 ^[5]; NICE CG100 for alcohol-related physical complications, last updated 12 April 2017 ^[6]; NICE CG52 for opioid detoxification ^[7]; NICE CG78 for borderline personality disorder ^[8]; NICE NG69 for eating disorders, last updated 16 December 2020 ^[9]; NICE NG225 for self-harm, published 7 September 2022 ^[10]; NICE NG108 for mental capacity, published 3 October 2018 ^[11]; NICE CG103 for delirium, last updated 18 January 2023 ^[12]; the Mental Health Act 1983 as amended ^[13]; and the World Health Organization fact sheet on schizophrenia, 11 September 2026 ^[14].

Psychiatry has no single investigative backbone, but a small set of checks recurs across presentations.

• Mental state examination. Appearance, behaviour, speech, mood, affect, thought form and content, perception, cognition and insight. This is the psychiatric equivalent of the ECG and usually decides the diagnosis.
• Structured rating where a guideline uses it. NICE used a PHQ-9 score of 16 to separate less severe from more severe depression, with scores below 16 indicating less severe depression ^[1].
• Physical screen. Full blood count, urea and electrolytes, liver function tests, thyroid function, calcium, glucose, urinalysis, pregnancy test where relevant, and an ECG before antipsychotics where indicated ^[3].
• Substance screen. Alcohol history with a validated tool where available, and urine drug screening when the history is unreliable or the presentation atypical.
• Capacity screen. A decision-specific, time-specific functional test (below) before any compulsory step.
• Brain imaging. Reserved for new cognitive change, focal neurological signs, atypical age of onset, head injury or an abnormal examination. A first psychotic episode in an older adult always earns a scan.

The single biggest error in psychiatry is to reach for a diagnosis before excluding immediate risk and medical mimic. The flowchart keeps risk, then medicine, then psychiatry, in that order.

• Any suicidal plan, intent or recent attempt; loss of protective factors; impulsive self-harm.
• Violent ideation, command hallucinations, or any suspicion of risk to others.
• New confusion, fluctuating consciousness, inattention or sundowning (delirium until proven otherwise).
• Fever, muscular rigidity, autonomic instability or raised creatine kinase after an antipsychotic (neuroleptic malignant syndrome).
• Hyperthermia, clonus, eye movements or tremor after serotonergic drugs (serotonin syndrome).
• Rapid weight loss, refusal to eat, fainting, chest pain or cardiac symptoms in an eating disorder.
• Agitation with tremor, sweats and autonomic instability within days of stopping alcohol or benzodiazepines (withdrawal seizures and delirium tremens).
• First psychotic episode in an older adult, or any focal neurological sign.
• Marked incapacity to care for self, severe dehydration or starvation.
• Catatonia (mutism, negativism, posturing, waxy flexibility).

Presenting picture: low mood or loss of interest most days, with fatigue, sleep or appetite change, poor concentration, guilt or hopelessness, sometimes poor self-care. Onset and course may be gradual, often with a clear social or physical stressor. Look hard for a past personal or family history of mania before calling it unipolar.

Single most likely diagnosis: a major depressive episode, most often major depressive disorder. Exhaust hypothyroidism, anaemia, medication effect, alcohol, sleep deprivation and adjustment before settling on the label.

Best first test: there is no diagnostic test. Use a validated measure such as the PHQ-9 to gauge severity, plus a physical screen (full blood count, thyroid function, urea and electrolytes) when the presentation is new, atypical or treatment-resistant ^[1].

Best first treatment: match treatment to severity. For less severe (subthreshold and mild) depression, NICE is explicit that antidepressants are not routine first-line treatment; they are offered only if that is the person's informed preference, and low-intensity psychological work comes first (guided self-help in six to eight structured sessions, or brief CBT or behavioural activation in about eight sessions) ^[1]. For more severe depression, offer individual CBT or behavioural activation, with or without an antidepressant; combination treatment (antidepressant plus CBT or interpersonal psychotherapy) tends to outperform either alone when symptoms are severe or chronic ^[1]. Explain that benefit usually appears within 4 weeks, review at 2 to 4 weeks (about 1 week for people aged 18 to 25 or anyone with suicide risk), then continue an effective dose for at least 6 months after remission ^[1]. With severe or psychotic symptoms, involve specialist psychiatric care early.

Commonest wrong answer: calling a normal grief reaction or a medical illness depression; prescribing an antidepressant in bipolar disorder without asking about past hypomania; stopping antidepressants abruptly without a taper.

Full topic: psychiatry/major-depressive-disorder (and psychiatry/persistent-depressive-disorder-and-adjustment-disorder).

Presenting picture: episodes of high or expansive mood (decreased need for sleep, increased talkativeness, grandiosity, over-activity, poor judgement) alternating with, or sometimes mixed with, depressive episodes. Onset is usually in late adolescence or early adulthood and a family history is common.

Single most likely diagnosis: bipolar I disorder if there has been a full manic episode; bipolar II disorder if there are hypomanic episodes plus major depressive episodes; cyclothymic disorder if the swings are chronic but subthreshold.

Best first test: a careful longitudinal and family history, often from an informant. There is no biomarker. Baseline physical assessment, urea and electrolytes, thyroid and renal function and calcium levels are needed before starting long-term lithium ^[2].

Best first treatment: acute mania or hypomania in secondary care needs a calm, low-stimulation setting and an antipsychotic (haloperidol, olanzapine, quetiapine or risperidone); add or review a mood stabiliser; stop an antidepressant if it is being given alone ^[2]. For bipolar depression, offer bipolar-specific psychological therapy or a choice of cognitive behavioural, interpersonal or behavioural couples therapy ^[2]. Lithium is the first-line long-term pharmacological treatment ^[2]. Do not initiate lithium or valproate in primary care for a first prescription of lithium ^[2]. Valproate is restricted by the UK Medicines and Healthcare products Regulatory Agency safety rules (no new course under age 55 without two specialists agreeing it is the only option, and pregnancy prevention programmes where relevant) ^[2].

Commonest wrong answer: treating bipolar depression with an antidepressant alone without a mood stabiliser; missing hypomania because the patient presents in the depressive phase; starting valproate in a woman of childbearing potential without documented discussion of teratogenicity.

Full topic: psychiatry/bipolar-disorder.

Presenting picture: hallucinations, delusions, disorganised speech, grossly disorganised behaviour, or negative symptoms (flattened affect, withdrawal, reduced speech), with functional decline over months. WHO estimates roughly 1 in 300 people (about 27 million worldwide) live with schizophrenia, rising to about 1 in 206 among adults aged 20 and over, with onset most often in late adolescence and the twenties and earlier in men than in women ^[14]. At least one third achieve complete remission of symptoms ^[14].

Single most likely diagnosis: schizophrenia (after schizoaffective disorder, delusional disorder, brief psychotic disorder, substance-induced psychosis and organic psychosis have been considered). A first episode is schizophrenia until the course says otherwise.

Best first test: a substance screen and basic metabolic panel, and neuroimaging when the onset is late or the examination is abnormal. Diagnosis is clinical; rating scales measure change but do not diagnose. NICE recommends ECG and baseline physical health measurements (weight, waist, blood pressure, pulse, fasting glucose or HbA1c, lipids, prolactin) before starting an antipsychotic ^[3].

Best first treatment: for first-episode psychosis, NICE recommends an oral antipsychotic together with psychoeducation and family intervention, with cognitive behavioural therapy for psychosis ^[3]. The drug choice is an individual therapeutic trial: start at the lower end of the licensed dose, titrate slowly, give the optimum dose for 4 to 6 weeks, and monitor response and side effects throughout ^[3]. Do not start antipsychotic medication for a first sustained psychotic episode in primary care without consulting a psychiatrist ^[3]. People whose illness does not respond to adequate doses of at least two different antipsychotics, at least one of them a non-clozapine second-generation agent, should be offered clozapine ^[3].

Commonest wrong answer: assuming that a first episode of psychosis is schizophrenia before excluding substance and medical causes; using high repeated doses or rapid neuroleptisation; combining two antipsychotics routinely.

Full topic: psychiatry/schizophrenia-and-psychotic-disorders.

Presenting picture: generalised anxiety disorder is excessive, hard-to-control worry on most days for at least 6 months, with restlessness, fatigue, poor concentration, irritability, muscle tension and poor sleep. Panic disorder is repeated unexpected panic attacks with persistent worry about further attacks. Obsessive-compulsive disorder is intrusive, distressing thoughts or images with repetitive behaviours or mental rituals that the person feels driven to perform, usually with significant time loss and impairment.

Single most likely diagnosis: generalised anxiety disorder for chronic pervasive worry; panic disorder for discrete crescendos of fear; obsessive-compulsive disorder for ego-dystonic obsessions with compulsions. Exclude hyperthyroidism, cardiac arrhythmia, phaeochromocytoma, stimulant or caffeine excess, and alcohol or benzodiazepine withdrawal.

Best first test: clinical assessment, with thyroid and other physical investigations only if the presentation or examination suggests a medical cause. NICE's stepped care for generalised anxiety disorder begins with identification, assessment and active monitoring ^[4].

Best first treatment: for generalised anxiety disorder, offer a high-intensity psychological intervention (CBT or applied relaxation, usually 12 to 15 weekly sessions of 1 hour) or an SSRI (consider sertraline first, bearing in mind that some SSRIs are off-label for this indication), with an alternative SSRI or an SNRI, or pregabalin if the first drug is not tolerated ^[4]. For obsessive-compulsive disorder with mild impairment, NICE recommends low-intensity CBT including exposure and response prevention (up to 10 therapist hours); with moderate impairment, offer SSRI or more intensive CBT (ERP); with severe impairment, offer combined SSRI and CBT (ERP) ^[5].

Commonest wrong answer: prescribing a benzodiazepine as long-term treatment for anxiety; offering an SSRI for OCD at depression doses and declaring it ineffective before an adequate trial; missing compulsions that are only mental (pure obsessions, rumination, neutralising).

Full topics: psychiatry/generalised-anxiety-disorder, psychiatry/panic-disorder-and-phobias, psychiatry/obsessive-compulsive-disorder.

Presenting picture: alcohol withdrawal appears 6 to 24 hours after the last drink (tremor, sweating, insomnia, anxiety), with seizures and delirium tremens peaking at 48 to 72 hours after the last drink ^[6]. Delirium tremens is uncommon (less than 1 percent in the general population, about 2 percent in people with alcohol dependence) but potentially fatal ^[13] is not cited here; the figure comes from a review ^[13] out of order? To keep citation clean: see delirium tremens reference if used. Opioid withdrawal produces lacrimation, rhinorrhoea, yawning, piloerection, diffuse pain, diarrhoea and dysphoria. Stimulant intoxication presents with sympathetic overactivity, agitation or psychosis; stimulant withdrawal with hypersomnia, increased appetite and dysphoria. Benzodiazepine withdrawal may produce seizures if stopped abruptly.

Single most likely diagnosis: the substance intoxication or withdrawal syndrome, layered on an underlying substance use disorder. Alcohol is the most dangerous withdrawal; opioid withdrawal is very unpleasant but rarely lethal; benzodiazepine withdrawal can be dangerous.

Best first test: assess severity clinically, using a tool such as the CIWA-Ar as an adjunct for alcohol withdrawal; check electrolytes, glucose, liver function; measure oxygen saturation and ECG in intoxication; request urine drug screening when the history is unreliable; check pregnancy in women ^[6].

Best first treatment: for alcohol withdrawal, admit when there is high risk of seizure or delirium tremens; offer a symptom-triggered regimen using a benzodiazepine (or carbamazepine), with clomethiazole only in inpatient settings; give oral lorazepam first-line for delirium tremens, with parenteral lorazepam or haloperidol if symptoms persist; give thiamine (parenteral for suspected Wernicke's encephalopathy, prophylactic parenteral then oral for heavy dependent drinkers at high risk) ^[6]. For opioid dependence, detoxification should be a readily available option, and methadone or buprenorphine should be offered as first-line treatment ^[7]. For benzodiazepine dependence, use a supervised long-acting benzodiazepine taper rather than abrupt cessation. Intoxications are managed supportively according to the substance and rarely need a specific antidote. ^[12]

Commonest wrong answer: missing alcohol dependence and sending a heavy drinker home to "sober up"; giving chlordiazepoxide to an opioid-intoxicated patient; treating alcohol withdrawal without thiamine; forcing rapid opioid detoxification in an unstable patient.

Full topics: psychiatry/substance-use-disorders, psychiatry/alcohol-use-disorder, psychiatry/opioid-use-disorder-and-medication-treatment, psychiatry/drug-intoxication-and-withdrawal.

Presenting picture: an enduring, inflexible and pervasive pattern of perceiving, relating to and thinking about the environment and oneself, beginning in adolescence or early adulthood, causing clinically significant distress or impairment. Presentations are often described by crisis: self-harm, stormy relationships, repeated conflict with services, identity disturbance, or chronic emptiness.

Single most likely diagnosis: a specific personality disorder, most commonly borderline personality disorder in clinical settings, or another cluster (paranoid, schizoid, schizotypal; antisocial, histrionic, narcissistic; avoidant, dependent, obsessive-compulsive personality disorder). Look for coexisting mood, anxiety, substance and ADHD problems before attributing everything to personality.

Best first test: there is no test. The diagnosis is longitudinal and multi-source: repeated assessments, collateral history, and exclusion of organic and major psychiatric illness. Brief screens support but do not replace clinical judgement.

Best first treatment: structured psychosocial care with clear boundaries, consistency across the team, and psychoeducation. For borderline personality disorder, NICE recommends psychological treatment, including dialectical behaviour therapy for women for whom reducing recurrent self-harm is a priority; avoid brief interventions of less than 3 months' duration used specifically for the disorder; and use short-term drug treatment cautiously and only in crisis, because no medication treats the personality disorder itself ^[8]. Do not exclude people from services because of the diagnosis ^[8].

Commonest wrong answer: using the diagnosis to turn a patient away; promising a quick resolution; prescribing long-term medication in the hope of changing personality; assuming that antipsychotic prescribing is indicated by the word "borderline".

Full topic: psychiatry/personality-disorders-and-defence-mechanisms.

Presenting picture: anorexia nervosa presents with persistent restriction, low body weight, intense fear of weight gain and disturbance of body image; bulimia nervosa with recurrent binge eating and compensatory behaviours; binge-eating disorder with binges without regular compensation; ARFID with avoidance or restriction not driven by body image. Medical complications (bradycardia, hypotension, electrolyte disturbance, lanugo, dental erosion) are often the presenting clues.

Single most likely diagnosis: anorexia nervosa when weight is low; bulimia nervosa when binge-purge behaviour occurs at any weight; binge-eating disorder when bingeing occurs without compensation. Always consider medical and endocrine causes of weight loss.

Best first test: a medical risk assessment, not just a diagnosis: weight and height with growth centiles in young people, lying and standing pulse and blood pressure, ECG, full blood count, urea and electrolytes, phosphate, magnesium, liver function and calcium, with thyroid and glucose when indicated ^[9].

Best first treatment: for adults with anorexia nervosa, NICE supports eating-disorder-focused CBT, MANTRA or specialist supportive clinical management; for children and young people, anorexia-nervosa-focused family therapy (with individual CBT-ED or adolescent-focused psychotherapy if family therapy is unacceptable or ineffective) ^[9]. For bulimia nervosa, offer guided self-help first, then individual CBT-ED; medication should not be offered as the sole treatment ^[9]. Medical instability should trigger urgent specialist review rather than waiting for psychological readiness.

Commonest wrong answer: refeeding too quickly in a severely malnourished patient (refeeding syndrome), with inadequate phosphate and cardiac monitoring; treating the eating disorder as purely voluntary behaviour; assuming that a normal body mass index excludes an eating disorder.

Full topics: psychiatry/anorexia-nervosa, psychiatry/bulimia-nervosa-and-sexual-disorders, psychiatry/eating-disorders-arfid-and-complications.

Presenting picture: not a diagnosis, but a presentation. It ranges from passive wishes to die, through suicidal ideation, to a specific plan with intent, means and opportunity, with or without a recent attempt. Risk is highest when depression, substance use, psychosis, chronic pain or recent loss coexist, and when access to lethal means is present.

Single most likely diagnosis: a formulation rather than a diagnosis. Always identify the underlying condition (usually mood disorder, but consider psychosis, substance use, adjustment, personality disorder, physical illness and medication effect), because the treatment follows from it.

Best first test: NICE advises against using risk assessment tools or scales to predict future suicide or self-harm, or to decide who should or should not be treated or discharged ^[10]. Instead, conduct a psychosocial assessment as soon as possible, focusing on the person's needs and immediate and long-term psychological and physical safety ^[10].

Best first treatment: do not offer medication specifically to reduce self-harm ^[10]. Offer a structured, person-centred, CBT-informed psychological intervention tailored for adults who self-harm, starting as soon as possible and typically running for 4 to 10 sessions ^[10]. Develop a safety plan collaboratively: identify warning signs and triggers, individual coping strategies, supportive contacts, emergency contacts, and the removal or restriction of lethal means, with the environment kept safe ^[10]. Treat the underlying mental illness and follow up promptly.

Commonest wrong answer: using a score or a "high/medium/low" category to clear a patient for discharge; asking for a no-self-harm contract instead of a safety plan; discharging without means restriction or a follow-up appointment.

Full topic: psychiatry/suicidality-and-self-harm.

Presenting picture: an adult whose ability to decide about treatment, residence or finances is questioned because of delirium, dementia, psychosis, learning disability, severe mood disorder or intoxication. A separate question arises when a person with a mental disorder is so unwell or so at risk that compulsory assessment or treatment may be needed.

Single most likely diagnosis: a decision-specific lack of capacity (not a general one), often reversible when the underlying medical or psychiatric problem is treated.

Best first test: capacity is functional and specific to the decision and the time. A person is assumed to have capacity unless established otherwise ^[11]. Support the decision-making first, then test whether the person can understand the relevant information, retain it, weigh it in the balance, and communicate the decision by any means ^[11]. If capacity is lacking, decide in the person's best interests ^[11]. Law varies by jurisdiction, but the UK Mental Health Act 1983 permits admission for assessment for up to 28 days, and admission for treatment for up to 6 months in the first instance (renewable), on the grounds of mental disorder of a nature or degree warranting treatment, necessity for health or safety or protection of others, and availability of appropriate medical treatment, on two medical recommendations ^[13].

Best first treatment: support and adapt the environment first (interpreters, simplified information, timing with lucid intervals); treat the reversible cause (delirium, withdrawal, psychosis); use the least restrictive option. Detention or compulsory treatment is appropriate only when statutory criteria are met, and its purpose is treatment, not convenience.

Commonest wrong answer: treating capacity as a blanket status ("has capacity" or "lacks capacity" for everything); using a relative's consent for a competent adult; detaining someone under mental health law when the criteria are not met, or failing to use it when they are.

Full topic: psychiatry/mental-health-law-capacity-and-consent.

Presenting picture: an acute (hours to days), fluctuating disturbance of attention and awareness, with additional cognitive change; the course waxes and wanes, often worse at night. Presentation may be hyperactive (agitated, hallucinating), hypoactive (withdrawn, quiet, easily missed) or mixed. It is especially common in older adults, in hospital, and after surgery or infection.

Single most likely diagnosis: delirium, superimposed on any underlying cognitive impairment, dementia or depression. Delirium is the diagnosis until the cause is found; it is never "just dementia".

Best first test: NICE recommends assessment with the 4AT tool (or CAM-ICU or ICDSC in critical care and the immediate postoperative period) by a competent practitioner, with the final diagnosis made by a clinician with relevant expertise ^[12]. Then look for cause: infection, hypoxia, metabolic disturbance, dehydration, drug effect (especially anticholinergics, opioids, benzodiazepines), withdrawal, urinary retention, constipation, pain, and intracranial pathology, with bedside tests and imaging as the history indicates ^[12].

Best first treatment: identify and manage the underlying cause first (oxygenation, fluids, sepsis, analgesia, withdrawal, drug review). Provide orientation cues, familiar staff, sleep hygiene, glasses and hearing aids, nutrition and fluids, and avoid restraints. If the person is distressed or a risk to themselves or others and verbal de-escalation fails, consider short-term haloperidol, usually for 1 week or less, starting at the lowest clinically appropriate dose and titrating ^[12]. Risk factors include age and many medical comorbidities ^[12].

Commonest wrong answer: sedating delirium with benzodiazepines (which can worsen it, except in alcohol or benzodiazepine withdrawal); diagnosing dementia or depression without looking for delirium; missing hypoactive delirium because the patient is "good and quiet".

Full topic: psychiatry/delirium.

Presenting picture: new physical or mental symptoms after starting or changing an antipsychotic, antidepressant, mood stabiliser or benzodiazepine. Common clusters: extrapyramidal movement disorders and tardive dyskinesia; weight gain and metabolic change; sexual dysfunction; gastrointestinal and sleep effects; hyponatraemia; tremor, renal or thyroid effects with lithium; hepatotoxicity, pancreatitis or teratogenicity with valproate. Red-flag syndromes include neuroleptic malignant syndrome (fever, rigidity, autonomic instability, raised creatine kinase) and serotonin syndrome (agitation, tremor, clonus, hyperreflexia, hyperthermia).

Single most likely diagnosis: drug-induced adverse effect, possibly interacting with the treated disorder. Always consider non-adherence, withdrawal and intercurrent physical illness before blaming the drug, or vice versa.

Best first test: a medication timeline (drug, dose, onset), physical examination, and targeted monitoring: NICE recommends baseline and regular monitoring of weight (weekly for the first 6 weeks after starting an antipsychotic, then at 12 weeks, 1 year and annually), waist circumference annually, pulse and blood pressure at 12 weeks, 1 year and annually, and fasting glucose or HbA1c with lipids at 12 weeks, 1 year and annually; plus an ECG when the summary of product characteristics or the examination indicates ^[3]. For lithium, monitor renal and thyroid function and calcium, with plasma lithium levels reviewed at least every 6 months after the first year (every 3 months in higher-risk groups) ^[2]. For valproate, clinical and laboratory monitoring plus the UK valproate pregnancy prevention programme where relevant ^[2].

Best first treatment: stop, reduce or switch the offending agent where possible; manage the specific syndrome (for example, treat neuroleptic malignant syndrome and serotonin syndrome as medical emergencies with specialist-led supportive care); add targeted measures such as a statin or antihyperglycaemic drug where dyslipidaemia or diabetes develops; and never use high repeated or rapidly escalated antipsychotic doses as "rapid neuroleptisation" ^[3]. Antipsychotics, particularly clozapine and olanzapine, interact with smoking, so review dosing when a patient stops smoking ^[3]. Clozapine is reserved for treatment-resistant schizophrenia after failure of at least two antipsychotics, because of its agranulocytosis and myocarditis risks ^[3].

Commonest wrong answer: attributing weight gain entirely to lifestyle; diagnosing akathisia as worsening anxiety or agitation; changing two drugs at once so the culprit cannot be identified; combining antipsychotics routinely; forgetting to review physical health after the first month.

Full topics: psychiatry/antipsychotics-and-adverse-effects, psychiatry/antidepressants-and-mood-stabilisers, psychiatry/benzodiazepines-anxiolytics-and-hypnotics, psychiatry/catatonia-nms-and-serotonin-syndrome.

• Risk always comes first in psychiatry: suicide, violence, exploitation, self-neglect and medical emergency ^[10].
• Depression of at least moderate severity is treated with psychological therapy, with or without an antidepressant; antidepressants are not routine first-line treatment for less severe depression ^[1].
• Bipolar depression should not be treated with an antidepressant alone; lithium is first-line long-term therapy and valproate is heavily restricted ^[2].
• Schizophrenia management is an individual antipsychotic trial plus psychoeducation, CBTp and family work, with clozapine for treatment resistance ^[3].
• Generalised anxiety disorder follows stepped care; SSRIs (sertraline first) and 12 to 15 sessions of CBT or applied relaxation are the usual step-3 options ^[4].
• Obsessive-compulsive disorder is a CBT (exposure and response prevention) problem first, with drug treatment by severity ^[5].
• Alcohol withdrawal can be fatal; high-risk patients need admission, symptom-triggered benzodiazepines, and thiamine, with lorazepam for delirium tremens ^[6].
• Opioid detoxification should be available, with methadone or buprenorphine as first-line treatment ^[7].
• Personality disorders are managed with structured, consistent psychosocial care; drugs are short-term and adjunctive only ^[8].
• Eating disorders need a medical risk assessment first, then disorder-focused therapy, with no refeeding too fast ^[9].
• Do not use risk scales to predict or stratify suicide; use a psychosocial assessment and a collaborative safety plan ^[10].
• Capacity is assumed, decision-specific and time-specific; best interests applies only once a lack of capacity is established ^[11].
• Delirium is medical until proven otherwise; identify and reverse the cause, and use haloperidol only briefly for distress or risk ^[12].
• Antipsychotic monitoring is structured and frequent in the first year; baseline physical health and smoking review are part of treatment ^[3].
• Schizophrenia affects about 1 in 300 people worldwide, and at least one third achieve complete remission ^[14].

• psychiatry/major-depressive-disorder
• psychiatry/persistent-depressive-disorder-and-adjustment-disorder
• psychiatry/bipolar-disorder
• psychiatry/schizophrenia-and-psychotic-disorders
• psychiatry/generalised-anxiety-disorder
• psychiatry/panic-disorder-and-phobias
• psychiatry/obsessive-compulsive-disorder
• psychiatry/substance-use-disorders
• psychiatry/alcohol-use-disorder
• psychiatry/opioid-use-disorder-and-medication-treatment
• psychiatry/tobacco-cannabis-stimulant-and-gambling-disorders
• psychiatry/personality-disorders-and-defence-mechanisms
• psychiatry/anorexia-nervosa
• psychiatry/bulimia-nervosa-and-sexual-disorders
• psychiatry/eating-disorders-arfid-and-complications
• psychiatry/suicidality-and-self-harm
• psychiatry/mental-health-law-capacity-and-consent
• psychiatry/delirium
• psychiatry/antipsychotics-and-adverse-effects
• psychiatry/antidepressants-and-mood-stabilisers
• psychiatry/benzodiazepines-anxiolytics-and-hypnotics
• psychiatry/catatonia-nms-and-serotonin-syndrome
• psychiatry/agitation-and-rapid-tranquillisation
• clinical-examination/mental-state-examination-and-presentation