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Psychiatry Common Traps & Fixes: Criteria & Principles for MRCP Part 1

TL;DR


Psychiatry questions in MRCP Part 1 are less about storytelling and more about precision: timelines, symptom counts, exclusions, and first-line principles. This article breaks down the most tested psychiatry areas, highlights common examiner traps, and shows you exactly how to avoid them with rules you can apply under exam pressure.

Psychiatry is often underestimated by MRCP candidates. The questions look “soft”, but the marking is unforgiving: a single missed time criterion or management principle can flip a correct answer into a wrong one. Unlike some specialties, psychiatry in MRCP Part 1 repeatedly tests definitions, criteria, and conceptual clarity rather than rare syndromes.

This article is written from a clinician–examiner perspective and is designed to support your core revision for the MRCP Part 1 exam. It complements the main hub page here:👉 https://www.crackmedicine.com/mrcp-part-1/


Why psychiatry questions are tricky in MRCP Part 1

Most errors happen because candidates:

  • Recognise the condition but ignore duration thresholds

  • Confuse overlapping diagnoses (e.g. schizophrenia vs mood disorder with psychotic features)

  • Choose management based on familiarity rather than exam-first principles

  • Forget that psychiatry heavily tests capacity, risk, and safety

The examiners know these weak points—and they target them repeatedly.


The 5 most tested psychiatry subtopics

1. Mood disorders (depression & bipolar disorder)

This is the single highest-yield area.

What examiners test

  • Duration of episodes

  • Symptom number

  • Risk of antidepressants in bipolar disorder

Key rules

  • Major depressive episode: ≥2 weeks

  • Hypomania: ≥4 days

  • Mania: ≥1 week, or any duration if hospitalisation is required

  • Antidepressant monotherapy in bipolar disorder = classic trap

2. Psychotic disorders

Candidates often overdiagnose schizophrenia.

Key principle

  • Psychosis outside mood episodes → schizophrenia spectrum

  • Psychosis only during mood episodes → mood disorder with psychotic features

The timing of psychosis matters more than the type of delusion.

3. Anxiety disorders, OCD & PTSD

These questions are timeline-heavy.

High-yield distinctions

  • PTSD: symptoms >1 month

  • Acute stress disorder: 3 days–1 month

  • GAD: excessive worry for ≥6 months

  • OCD: intrusive obsessions ± compulsions recognised as irrational

4. Substance misuse & withdrawal

Management questions dominate here.

Exam principle

  • Treat the withdrawal syndrome, not the behaviour

  • Alcohol withdrawal → benzodiazepines first-line

  • Antipsychotics alone in withdrawal = unsafe

5. Delirium, dementia & capacity

This is where ethics meets medicine.

Core rule

  • Delirium = acute, fluctuating, impaired attention

  • Dementia = chronic, progressive, stable attention early on

  • Capacity is decision-specific, not diagnosis-specific


Psychiatry criteria at a glance

Condition

Core discriminator

Exam tip

Major depression

≥2 weeks + symptom count

Exclude substances & grief

Hypomania

≥4 days, no marked impairment

No psychosis

Mania

≥1 week or hospitalised

Psychosis allowed

PTSD

>1 month

Shorter = acute stress

GAD

≥6 months

Not episodic

Delirium

Acute + fluctuating

Always reversible cause

MRCP Part 1 candidate revising psychiatry with notes and study materials

Mini-case (exam style)

Question A 32-year-old woman has elevated mood, reduced need for sleep, pressured speech, and increased spending for 5 days. She remains socially functional and has no psychotic symptoms. What is the most likely diagnosis?

Answer: Hypomania

Explanation The duration (≥4 days), absence of marked impairment, and lack of psychosis exclude mania. Many candidates overcall mania based on symptom intensity rather than duration and function.


The 5 most common psychiatry traps (and how to fix them)

  1. Ignoring time criteria Fix: Write the duration in your head before choosing.

  2. Calling schizophrenia too early Fix: Ask whether psychosis exists outside mood episodes.

  3. Using antidepressants unsafely Fix: Assume bipolar until proven otherwise.

  4. Confusing capacity with diagnosis Fix: Apply the four functional tests: understand, retain, weigh, communicate.

  5. Treating agitation instead of withdrawal Fix: Benzodiazepines first in alcohol withdrawal.


Practical MRCP Part 1 psychiatry checklist

Use this before every psychiatry question:

  • □ Identify the timeline (days / weeks / months)

  • □ Count symptoms explicitly

  • □ Exclude substances and medical causes

  • □ Check for psychosis outside mood episodes

  • □ Choose the safest first-line option

  • □ Prioritise risk over preference

To practise these under pressure, use mixed psychiatry blocks from:👉 https://www.crackmedicine.com/qbank/

Then simulate exam conditions with:👉 https://www.crackmedicine.com/mock-tests/


How this fits into your overall MRCP strategy

Psychiatry is ideal for rule-based learning. Once you master the criteria and principles, your accuracy rises quickly. Pair this article with:


Frequently Asked Questions

Is psychiatry heavily weighted in MRCP Part 1?

It’s a moderate but consistent component. The marks are reliable if you know criteria and first-line principles.

Do I need DSM-5 or ICD-10 definitions word for word?

No. You need durations, exclusions, and management priorities—not textbook phrasing.

What’s the fastest way to improve psychiatry scores?

Focus on timelines and management traps using a question bank with immediate review.

How is capacity tested in the exam?

Through vignettes. Apply functional criteria, not diagnostic labels.


Ready to start?

If you want to convert psychiatry from a guessy subject into a high-scoring, rule-based win in MRCP Part 1, don’t stop at reading.

👉 Practise these traps and fixes immediately with real exam-style questions: Start solving psychiatry MCQs here: https://www.crackmedicine.com/qbank/

👉 Test yourself under exam pressure and track weak areas: Take a full mock test: https://www.crackmedicine.com/mock-tests/

👉 Consolidate concepts fast with clinician-led explanations:

Watch psychiatry video lectures: https://www.crackmedicine.com/lectures/


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