Mental health: what the exam actually tests

Psychiatric items reduce to a handful of presentations, sorted by how fast they can hurt someone.

Suicide risk Assess by asking directly about intent, plan, means, and access. Risk can rise as depression begins to lift, because energy returns before mood does. Direct questioning is always the correct first action, and it does not plant the idea.

Mania The immediate concerns are physical, not psychological: no sleep, no food, no rest, and dangerous impulsivity. Offer finger foods and fluids the patient can carry, reduce environmental stimulation, and set firm, consistent limits without arguing.

Schizophrenia Added experiences such as hallucinations and delusions, and subtracted capacities such as flat affect, poverty of speech, and social withdrawal. Do not argue with a delusion and do not reinforce it. Acknowledge the feeling, present reality once, and redirect to something concrete.

Anxiety and panic As anxiety rises the perceptual field narrows, until at panic level learning and problem solving are impossible. Stay with the patient, speak in short simple sentences, and reduce stimulation. Teaching happens after the anxiety comes down, never during.

Alcohol withdrawal Tremor, anxiety, and autonomic arousal within the first day. Seizure risk in the first two days. Withdrawal delirium with confusion, fever, and autonomic instability at roughly two to three days. This is the physiological emergency hiding inside a psychiatric admission, and it can be fatal.

Eating disorders The danger is cardiac and electrolytic, not cosmetic. Refeeding too aggressively causes dangerous electrolyte shifts. Supervise meals and the hour afterward, and weigh on a set schedule with the patient's back to the scale.

Trauma response Intrusive memories, avoidance, hyperarousal, and an exaggerated startle response, with triggers that are often environmental. Control and choice are themselves therapeutic, so ask permission before touching and explain before acting.

Cognitive change Delirium arrives over hours with a fluctuating course and an identifiable physiological cause. Dementia arrives over months and does not fluctuate that way. A sudden change in an older adult's cognition is delirium until a cause is excluded.

Margin notesafety first, insight later.

Watch outuntreated alcohol withdrawal delirium carries real mortality and is a medical admission, not a behavioral one.

TakeawayIn every psychiatric item the physical safety concern outranks the therapeutic one.

→ BOOK 14 · P3 for the disorders in depth · → BOOK 14 · P7 for the technique bank · → P21