The psychiatry shelf feels different from other rotations. There’s less anatomy. Less labs. Less imaging. Instead, it’s heavy on diagnostic nuance + medication management + safety decisions. If you master those three pillars, your score improves quickly.

The Big 7 That Show Up Every Time 1

1. Mood Disorders: you must confidently differentiate between:

• Major Depressive Disorder.

• Persistent Depressive Disorder (Dysthymia).

• Bipolar I vs Bipolar II.

• Cyclothymic Disorder.

• PMDD.

• DMDD (peds).

2. Anxiety and Trauma Disorders: know clean distinctions between:

• GAD.

• Panic disorder.

• Social anxiety.

• OCD vs OCPD.

• PTSD vs Acute Stress Disorder.

3.Psychotic Disorders:

• Schizophrenia vs schizoaffective.

• Brief psychotic disorder.

• Delusional disorder.

• Substance-induced psychosis.

4.Personality Disorders: they test behavioral patterns and the appropriate management.

5.Substance Use Disorders:

• Alcohol withdrawal timeline.

• Opioid intoxication vs withdrawal.

• Cocaine toxicity.

• Wernicke encephalopathy.

• PCP, MDMA and Inhalant abuse.

6.Pharmacology: side effects are heavily tested. The big medications to know are:

Antidepressants

• SSRIs (first line for most).

• SNRIs.

• Bupropion (avoid in eating disorders).

• Mirtazapine (weight gain + sleep).

• TCAs (anticholinergic + cardiotoxic).

Mood Stabilisers

• Lithium (renal + thyroid + toxicity).

• Valproate.

• Carbamazepine.

Antipsychotics

• First-gen vs second gen.

• EPS vs tardive dyskinesia.

• Neuroleptic malignant syndrome.

Emergencies

• Serotonin syndrome.

• Lithium toxicity.

• NMS.

7.Know Risk Assessment Cold: you should confidently answer:

• When do you hospitalise?

• What makes a patient high risk for suicide?

• What is an involuntary hold?

• How do you assess decision-making capacity?

Suicide risk questions are very high yield.

Study strategies that worked well for me:

• UWorld first pass: focus on why wrong answers are wrong.

• Amboss Practice Questions: these were the most similar to the actual shelf exam.

• NBME practice exams: review every explanation carefully.

Psych questions can feel deceptively easy, so don’t rush the question stem, make sure to read through. The shelf is less about brute memorisation and more about recognising the pattern fast.