17. Psychiatry
Learning Objectives
- Identify the major categories of psychiatric disorders using DSM-5 diagnostic criteria
- Distinguish between mood, anxiety, psychotic, and substance use disorders by their clinical features
- Apply the biopsychosocial model to understand psychiatric illness across the lifespan
- Evaluate patients for psychiatric emergencies including suicidality and acute psychosis
- Select appropriate pharmacological and psychotherapeutic interventions for common conditions
- Recognize how child and adolescent psychiatry differs from adult practice
- Integrate US clinical guidelines (NIMH, APA, FDA) into safe, evidence-based psychiatric care
Quick Answer
Psychiatry is the medical specialty dedicated to diagnosing, treating, and preventing mental, emotional, and behavioral disorders. It draws on neuroscience, psychology, and medicine to understand conditions ranging from depression and schizophrenia to substance use disorders and developmental conditions in children. Psychiatrists use tools such as the DSM-5, structured clinical interviews, and rating scales alongside pharmacotherapy and psychotherapy. For USMLE purposes, mastering the major diagnostic categories, first-line treatments, and emergency management principles forms the core of what you need to know.
Topics at a Glance
| Topic | Key Focus | Importance |
|---|---|---|
| Introduction to Psychiatry | History, key concepts, diagnostic frameworks, essential skills | Foundation — establishes vocabulary and approach |
| Mood Disorders | MDD, bipolar disorder, dysthymia; neurotransmitter basis; pharmacotherapy | High-yield for USMLE Steps 1 and 2 |
| Anxiety Disorders | GAD, panic disorder, social anxiety, OCD; CBT and pharmacotherapy | Very common in clinical practice and board questions |
| Psychotic Disorders | Schizophrenia, schizoaffective disorder, brief psychosis; antipsychotics | Critical for understanding severe mental illness |
| Child and Adolescent Psychiatry | ADHD, ASD, conduct disorder; developmental context | Increasing board relevance; distinct treatment considerations |
| Substance Abuse Disorders | SUD classification, DSM-5 criteria, MAT, behavioral therapies | Major US public health priority; high board yield |
| Psychiatric Emergencies | Suicidality, agitation, acute psychosis; risk assessment, de-escalation | Patient safety; tested in clinical scenarios |
Key Terms
| Term | Definition | Related Concept |
|---|---|---|
| DSM-5 | Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; the standard US classification system for psychiatric diagnoses | ICD-11, diagnostic criteria |
| Psychosis | A mental state involving loss of contact with reality, characterized by hallucinations or delusions | Schizophrenia, schizoaffective disorder |
| Affect | The observable expression of emotion during a clinical encounter; can be flat, blunted, labile, or restricted | Mood, mental status examination |
| Neurotransmitter | Chemical messengers (serotonin, dopamine, norepinephrine) that regulate mood, cognition, and behavior | Psychopharmacology, mood disorders |
| Biopsychosocial model | A framework integrating biological, psychological, and social factors in understanding and treating mental illness | George Engel, holistic care |
| Mood stabilizer | Medications such as lithium or valproate used to prevent manic and depressive episodes in bipolar disorder | Bipolar disorder, lithium toxicity |
| Cognitive-Behavioral Therapy (CBT) | A structured psychotherapy targeting maladaptive thought patterns and behaviors | Anxiety disorders, depression, OCD |
| Substance Use Disorder (SUD) | A DSM-5 diagnosis based on a problematic pattern of substance use causing clinically significant impairment | Tolerance, withdrawal, addiction |
| Suicidality | A spectrum of thoughts and behaviors related to self-harm or ending one's life; requires immediate risk assessment | Psychiatric emergencies, safety planning |
| Antipsychotic | Medications that reduce psychotic symptoms; classified as first-generation (typical) or second-generation (atypical) | Dopamine hypothesis, schizophrenia |
| Negative symptoms | Features of schizophrenia reflecting loss of normal function — flat affect, alogia, anhedonia, avolition | Positive symptoms, schizophrenia |
| SSRI | Selective serotonin reuptake inhibitor; first-line pharmacotherapy for depression and many anxiety disorders | Fluoxetine, sertraline, MDD |
Related Topics
Prerequisites: Basic neuroscience and neuroanatomy, pharmacology fundamentals, general internal medicine, medical interviewing skills
Related Topics: Neurology (especially epilepsy and dementia overlap), Pediatrics (developmental milestones), Geriatrics (late-life depression, dementia), Emergency medicine (overdose, agitation management), Endocrinology (thyroid disorders mimicking mood disorders)
Next Topics: Advanced psychopharmacology, Forensic psychiatry, Addiction medicine, Consultation-liaison psychiatry, Child and adolescent psychiatry subspecialty training