Psychiatry is 10% of the Emirates Medical Residency Entrance Examination, across 13 blueprint topics. Try twelve questions from Axiota's EMREE pack, which has 181 cards on this section.
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Non-pharmacologic Management · Geriatrics — Confusion, Cognition, Falls and the Fractured Hip
What major adverse neurological event is risked by abrupt cessation of long-term benzodiazepines?
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Gradually, and with agreement. Abrupt cessation risks withdrawal including seizures, so the dose is tapered slowly with the patient's understanding of why — the fall risk, the cognitive effects, the delirium risk. Non-drug measures for insomnia and anxiety are put in place before the taper rather than after it, since the symptom that led to the prescription still exists.
Clinical Features · Pre-eclampsia, Labour, and the Mood and Anxiety Disorders
How many associated symptoms (e.g. restlessness, fatigue, muscle tension) are required for a diagnosis of GAD?
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Restlessness, fatigability, problems concentrating, irritability, muscle tension and difficulty with sleep — at least three are required. Patients often present with the physical complaints rather than the worry, which is why chronic tension headache, unexplained fatigue and insomnia deserve a question about worry.
Clinical Features · Psychiatry II — Obsessions, Trauma, Attention, Sleep and Self-Harm
What is the minimum duration symptoms must persist following a trauma to meet diagnostic criteria for post-traumatic stress disorder rather than acute stress disorder?
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The DSM-5 identifies four: re-experiencing, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. The ICD-11 uses a simpler three-component framework — re-experiencing, avoidance, and a heightened sense of threat. Symptoms must persist for longer than one month after the trauma, which is what distinguishes PTSD from acute stress disorder lasting less than a month.
Pharmacologic Therapies · Therapeutics IV — Insulin, Acid, Dopamine and the Narrow Margin
Which haematological adverse effect necessitates routine complete blood count monitoring for clozapine?
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Agranulocytosis. Clozapine requires routine laboratory monitoring of complete blood counts every one to four weeks, because a sudden loss of neutrophils leaves the patient defenceless against infection and is not predictable from dose or duration. The monitoring is the condition of supply, and a fever in a patient on clozapine is treated as possible agranulocytosis until the count is known.
Non-pharmacologic Management · Pre-eclampsia, Labour, and the Mood and Anxiety Disorders
Which psychological therapy is the first-line choice for generalised anxiety disorder?
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Cognitive behavioural therapy is widely regarded as the first-line psychological therapy for treating GAD, with SSRIs as the key pharmacological option; a combination of both CBT and medication is generally seen as the most desirable approach. Benzodiazepines are conspicuously not first line — they work quickly and create dependence in a chronic condition.
Clinical Features · Psychiatry II — Obsessions, Trauma, Attention, Sleep and Self-Harm
According to diagnostic criteria for ADHD, several symptoms must be present before what age?
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Inattention, hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive. Symptoms must be present in at least two settings — social, school, work or home — and must directly interfere with or reduce quality of functioning. Several symptoms must have been present before age 12. Behaviour confined to one setting points to something about that setting rather than to ADHD.
Clinical Features · Pre-eclampsia, Labour, and the Mood and Anxiety Disorders
What feature distinguishes panic disorder from isolated panic attacks?
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Recurrence and anticipation. A panic attack is an isolated episode; people experiencing repeated, persistent attacks or severe anxiety about having another attack are said to have panic disorder. A single attack under stress is common and needs explanation, not a diagnosis.
Non-pharmacologic Management · Psychiatry II — Obsessions, Trauma, Attention, Sleep and Self-Harm
What is the first-line treatment for chronic insomnia?
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Cognitive behavioural therapy for insomnia, not a hypnotic. Cognitive behavioral therapy is considered the first-line treatment for chronic insomnia. Sleep hygiene and lifestyle changes are also recommended, though their efficacy is not definitely established — which is why hygiene advice alone is a supplement rather than the treatment.
Diagnoses & Investigations · Pre-eclampsia, Labour, and the Mood and Anxiety Disorders
What is the minimum duration of pervasive low mood required to diagnose major depressive disorder?
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Major depressive disorder. Diagnosis requires at least two weeks of pervasive low mood and loss of interest or pleasure in normally enjoyable activities, with five out of the nine specific symptoms present for more than two weeks, and at least one of them must be depressed mood or loss of interest or pleasure. Duration and symptom count are what separate the disorder from understandable unhappiness.
Diagnoses & Investigations · Psychiatry II — Obsessions, Trauma, Attention, Sleep and Self-Harm
What is the minimum duration symptoms must last after trauma to meet the diagnosis of PTSD?
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Not yet — the duration criterion is not met. The symptoms of PTSD last for more than a month after the event. Before that, this is an acute stress reaction, and prevention may be possible when counselling is targeted at those with early symptoms, but is not effective when provided to all trauma-exposed individuals regardless of symptoms.
Pharmacologic Therapies · Pre-eclampsia, Labour, and the Mood and Anxiety Disorders
Which treatment modality is preferred over medication for depression in patients under 18?
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Antidepressant medication is recommended as an initial treatment choice in people with mild, moderate or severe major depression. Psychotherapy is the treatment of choice over medication for people under 18. In older adults the same treatments apply — age is a reason to treat carefully, not a reason to withhold treatment.
Diagnoses & Investigations · Psychiatry II — Obsessions, Trauma, Attention, Sleep and Self-Harm
Under DSM-5 criteria, what is the minimum symptom duration required for a diagnosis of ADHD?
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It argues against it as it stands. Under DSM-5 symptoms must be present for six months or more to a degree that is impairing, and the difficulty is distinguishing normal levels of symptoms from levels that cause significant impairment in major life activities. Impairment confined to one setting points instead to something in that setting — the classroom, the teaching, or an unrecognised learning difficulty.