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Schizophrenia & Psychosis for MRCP Part 1

TL;DR:

Schizophrenia and related psychotic disorders are a reliable scoring area in MRCP Part 1 if you know definitions, timelines, symptom clusters, and antipsychotic adverse effects. Questions are usually clinical vignettes testing differentiation from mood disorders, delirium, and substance-induced psychosis. This article gives a focused, exam-ready framework with a mini-MCQ and a practical revision checklist.


Why schizophrenia & psychosis matter in MRCP Part 1

Psychiatry contributes a small but predictable proportion of the MRCP Part 1 paper. Schizophrenia and psychosis are favoured because they combine:

  • Clear diagnostic criteria

  • Classic symptom descriptions

  • High-yield pharmacology with testable adverse effects

Marks are often lost due to vague definitions, ignoring duration criteria, or missing organic causes.

For a broader exam structure and weighting, see the MRCP Part 1 overview:https://crackmedicine.com/mrcp-part-1/


Exam scope: what you are expected to know

You are not expected to manage complex psychiatric care. The exam focuses on:

  • Recognition of psychotic symptoms

  • Differentiation between primary and secondary psychosis

  • Core neurobiology (dopamine pathways)

  • First-line antipsychotics and major side effects

Psychotherapy models and service pathways are low yield.


High-yield core concepts (numbered list)

  1. Definition Schizophrenia is a chronic psychotic disorder with ≥1 month of characteristic symptoms and ≥6 months of overall disturbance.

  2. Positive symptoms Delusions, hallucinations (classically auditory), and formal thought disorder.

  3. Negative symptoms Avolition, alogia, anhedonia, flat affect. These predict poor functional outcome.

  4. First-rank (Schneiderian) symptoms Thought insertion, withdrawal, broadcasting; third-person auditory hallucinations.

  5. Cognitive impairment Executive dysfunction and working-memory deficits may precede overt psychosis.

  6. Duration-based differentials

    • <1 month: brief psychotic disorder

    • 1–6 months: schizophreniform disorder

    • ≥6 months: schizophrenia

  7. Neurobiology Dopamine excess in the mesolimbic pathway → positive symptoms; mesocortical hypoactivity → negative symptoms.

  8. First-line treatment Atypical antipsychotics (e.g. olanzapine, risperidone).

  9. Key adverse effects

    • EPS (more with typicals)

    • Hyperprolactinaemia

    • Metabolic syndrome

    • QT prolongation

  10. ClozapineUsed only in treatment-resistant schizophrenia due to agranulocytosis risk.

Five most tested subtopics

1. Positive vs negative symptoms

Questions often ask which feature predicts long-term disability. The answer is almost always negative symptoms.

2. Schizophrenia vs mood disorders

Psychosis occurring only during mood episodes suggests bipolar disorder or major depressive disorder with psychotic features.

3. Delirium vs psychosis

Fluctuating consciousness, inattention, and visual hallucinations point to delirium, not schizophrenia.

4. Drug-induced psychosis

Temporal association with substances (amphetamines, cocaine, steroids) is key.

5. Antipsychotic emergencies

Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability, raised CK.


MRCP Part 1 study setup with psychiatry notes and revision materials

Differentiating common exam diagnoses

Feature

Schizophrenia

Bipolar disorder with psychosis

Delirium

Onset

Insidious

Episodic

Acute

Mood symptoms

Absent/secondary

Prominent

Variable

Consciousness

Clear

Clear

Fluctuating

Hallucinations

Auditory

Mood-congruent

Often visual


Mini-MCQ (exam style)

Question A 24-year-old man has 7 months of social withdrawal, reduced speech, auditory hallucinations commenting on his actions, and emotional blunting. There is no history of mood disorder or substance use. Which feature is most strongly associated with poor prognosis?

A. Male sexB. Auditory hallucinationsC. Family history of schizophreniaD. Negative symptomsE. Age at onset

Correct answer: D. Negative symptoms

Explanation Negative symptoms correlate most strongly with long-term functional impairment and are less responsive to antipsychotic therapy than positive symptoms.

To practise similar questions, use the psychiatry section of the Crack Medicine Qbank:https://crackmedicine.com/qbank/


Common exam traps (5 bullets)

  • Diagnosing schizophrenia without checking duration

  • Missing delirium due to failure to assess attention/consciousness

  • Assuming atypical antipsychotics do not cause EPS

  • Forgetting metabolic monitoring requirements

  • Treating first-rank symptoms as pathognomonic (they are not)


Practical MRCP Part 1 study checklist

  • Memorise duration criteria and core definitions

  • Learn drug–side-effect associations cold

  • Practise vignette-based differentiation repeatedly

  • Review mistakes using short notes or lectures

  • Test recall under time pressure with a mock test:https://crackmedicine.com/mock-tests/

For structured teaching, see the psychiatry content in Crack Medicine Lectures:https://crackmedicine.com/lectures/


FAQs

Is schizophrenia high yield for MRCP Part 1?

Yes. It is one of the most frequently tested psychiatric topics due to clear diagnostic criteria and pharmacology.

Do I need DSM-5 or ICD-10 criteria in detail?

No. Only symptom clusters and duration thresholds are required.

Which antipsychotic side effects are most tested?

Extrapyramidal symptoms, metabolic syndrome, hyperprolactinaemia, and QT prolongation.

How can I reliably distinguish psychosis from delirium?

Look for fluctuating consciousness, inattention, and acute onset—these favour delirium.


Ready to start?

Consolidate this topic by attempting psychiatry questions in the Qbank and reviewing weak areas using our MRCP Part 1 overview and lecture resources.


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