Can you hrlp me to prepare psychiatry for my fmge

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FMGE psychiatry high yield topics 2025 2026 exam pattern

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https://fmgeprep.com/fmge-subjects/psychiatry

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Now I have enough material to build a thorough, well-structured FMGE psychiatry study plan. Let me compile it.

FMGE Psychiatry - Full Study Plan (Beginner Level)

Overview

Psychiatry carries 4-6% weightage = approximately 16-24 questions out of 300. Questions are mostly clinical vignettes - a patient is described and you pick the diagnosis or treatment. Since the pattern is predictable, you can realistically score 90-100% in psychiatry with targeted preparation.

Primary textbook to use: Kaplan & Sadock's Synopsis of Psychiatry (available in your library)

How FMGE Tests Psychiatry

A short clinical scenario is given → you identify the diagnosis (using DSM-5 criteria)
Or: a drug is described → you identify the side effect
Or: a medicolegal situation → McNaughten's rules / testamentary capacity
Rarely: pure recall questions (name of a scale, duration criterion)

Study Plan - 8 High-Yield Topics

Work through these in order - they are ranked by frequency in FMGE.

1. SCHIZOPHRENIA (Highest yield)

What to know:

Schneiderian First-Rank Symptoms (FRS): Thought insertion, thought withdrawal, thought broadcasting, thought echo, voices arguing, voices commenting, made actions/feelings/impulses, delusional perception. These are ICD-10 hallmark features.
DSM-5 criteria: ≥2 symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms), at least 1 must be from the first 3, lasting ≥6 months
ICD-10 vs DSM-5: ICD-10 duration is 1 month; DSM-5 is 6 months
Subtypes (ICD-10): Paranoid (most common), Hebephrenic (worst prognosis, young age), Catatonic, Undifferentiated, Residual
Negative symptoms (4 A's): Alogia, Anhedonia, Avolition, Affect (blunted)
Treatment: First-line = atypical antipsychotics (risperidone, olanzapine). Clozapine = for treatment-resistant schizophrenia (monitor for agranulocytosis - weekly CBC).

High-yield side effects to memorize:

Drug	Key Side Effect
Haloperidol (typical)	Tardive dyskinesia, EPS
Clozapine	Agranulocytosis, seizures, weight gain
Olanzapine	Metabolic syndrome, weight gain
Risperidone	Hyperprolactinemia
Chlorpromazine	Photosensitivity, corneal deposits
Thioridazine	Pigmentary retinopathy

Source: Kaplan and Sadock's Synopsis of Psychiatry, block 5

2. MOOD DISORDERS (Depression & Mania)

Major Depressive Episode (DSM-5) - mnemonic SIG E CAPS (for 2 weeks, ≥5 symptoms, must include depressed mood OR anhedonia):

Sleep (insomnia or hypersomnia)
Interest (anhedonia)
Guilt / worthlessness
Energy (fatigue)
Concentration (poor)
Appetite (weight loss or gain)
Psychomotor (agitation or retardation)
Suicidal ideation

Manic Episode (≥1 week, ≥3 symptoms if elevated mood; ≥4 if irritable mood) - mnemonic DIG FAST:

Distractibility, Impulsivity/Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep decreased, Talkativeness (pressured speech)

Bipolar I vs II:

Bipolar I = at least 1 full manic episode (hospitalization may be needed)
Bipolar II = hypomania + at least 1 MDE (no full mania)

Treatment:

MDD first-line: SSRIs (fluoxetine, sertraline). Tricyclics (amitriptyline) → anticholinergic side effects + dangerous in overdose.
Bipolar (mood stabilizers): Lithium (first choice - monitor thyroid, renal, toxicity: tremor, ataxia, confusion), Valproate, Carbamazepine
Lithium toxicity: nausea/vomiting at therapeutic range; coarse tremor, confusion, coma at toxic levels

3. ANXIETY DISORDERS

Disorder	Key Feature	First-line Treatment
Panic Disorder	Recurrent unexpected panic attacks, anticipatory anxiety	SSRIs + CBT
GAD	Excessive worry most days ≥6 months, ≥3 somatic symptoms	SSRIs, buspirone, CBT
Social Anxiety Disorder	Fear of social situations, performance anxiety	SSRIs, beta-blockers (for performance)
Specific Phobia	Fear of specific objects/situations	Systematic desensitization (CBT)
PTSD	After traumatic event, ≥1 month: re-experiencing, avoidance, negative cognition, hyperarousal	SSRIs (sertraline, paroxetine) + trauma-focused CBT
OCD	Obsessions (intrusive thoughts) + Compulsions (acts to neutralize them), ego-dystonic	SSRIs (highest dose) + ERP (Exposure and Response Prevention)

Source: Kaplan and Sadock's Synopsis of Psychiatry, block 6

4. SUBSTANCE USE DISORDERS

Alcohol Withdrawal Timeline (very high yield - memorize this table):

Severity	Symptom	Time After Last Drink
Mild	Tremulousness, anxiety, sweating	6-8 hours
Moderate	Perceptual disturbances (hallucinations)	8-12 hours
Severe	Seizures (grand mal)	12-24 hours
Life-threatening	Delirium tremens (DTs)	Within 72 hours

DTs: Confusion, autonomic hyperactivity (fever, tachycardia, hypertension), vivid hallucinations
Treatment of withdrawal: Benzodiazepines (diazepam/lorazepam) - these are GABA agonists, same mechanism as alcohol
Wernicke's encephalopathy: Triad = confusion + ataxia + ophthalmoplegia (nystagmus/lateral gaze palsy) → treat with IV thiamine BEFORE glucose
Korsakoff's syndrome: Confabulation, anterograde amnesia (chronic thiamine deficiency)

Opioid withdrawal (not life-threatening unlike alcohol):

Symptoms: yawning, lacrimation, rhinorrhea, piloerection ("goose bumps"), mydriasis, muscle aches, diarrhea
Treatment: Methadone (maintenance) or Buprenorphine/naloxone (Suboxone); Clonidine for symptomatic relief
Opioid overdose: Pin-point pupils, respiratory depression, coma → Naloxone (antidote)

5. PERSONALITY DISORDERS

Cluster A (Odd/Eccentric - "MAD"):

Paranoid - suspicious, distrustful
Schizoid - socially detached, no desire for relationships
Schizotypal - magical thinking, odd speech, near-psychotic

Cluster B (Dramatic/Emotional - "BAD"):

Borderline - emotional instability, self-harm, fear of abandonment, splitting
Antisocial - disregard for others, conduct disorder before age 15 (most FMGE favorite)
Histrionic - attention-seeking, theatrical, seductive
Narcissistic - grandiosity, lack of empathy

Cluster C (Anxious/Fearful - "SAD"):

Avoidant - social inhibition, fears rejection
Dependent - clinging, submissive
Obsessive-Compulsive - perfectionism, rigidity (NOT the same as OCD)

High-yield: Antisocial personality = conduct disorder in childhood + criteria met after age 18.

6. ECT (Electroconvulsive Therapy)

Indications:

Severe/treatment-resistant depression (best response)
Acute suicidality (fastest treatment)
Severe mania
Catatonic schizophrenia
Depression in pregnancy (safest option)
Psychotic depression

Absolute contraindications: Raised intracranial pressure (space-occupying lesion) Relative contraindications: Recent MI, severe hypertension, cerebral aneurysm

Mechanism: Generalized seizure via electrical stimulation; works by increasing serotonin, dopamine, BDNF

Source: Kaplan and Sadock's Synopsis of Psychiatry, block 10

7. CHILD PSYCHIATRY

Disorder	Key Feature	Onset
Autism Spectrum Disorder	Social communication deficits + restricted/repetitive behaviors; NO language regression after normal development	Before age 3
ADHD	Inattention and/or hyperactivity-impulsivity in ≥2 settings; symptoms before age 12	Childhood
Conduct Disorder	Repetitive rule violation, aggression toward people/animals	Childhood/adolescence
Oppositional Defiant Disorder	Defiance, anger directed at known people; less severe than conduct disorder	Childhood
Separation Anxiety	Excessive fear of separation from attachment figures	Childhood
Enuresis	Involuntary urination ≥2x/week after age 5	After age 5

ADHD treatment: Methylphenidate (first-line stimulant) or Atomoxetine (non-stimulant, good for co-occurring anxiety or tic disorders)

8. FORENSIC PSYCHIATRY

McNaughten's Rules (Insanity Defense):

At the time of the act, due to mental disease, the person either:
1. Did not know the nature and quality of the act, OR
2. Did not know that what they were doing was wrong
Cognitive test only - does not consider impulse control

Testamentary capacity (ability to make a valid will) - the person must know:

The nature of making a will
The nature and extent of their property
The natural heirs (those who would naturally inherit)
How these relate together to form the will

Fitness to stand trial (Dusky standard): Ability to understand proceedings and assist in own defense.

Psychotherapy - Quick Reference

Therapy	Used For	Mechanism
CBT (Cognitive Behavioral Therapy)	Depression, anxiety, OCD	Identify and change negative thought patterns
Exposure and Response Prevention (ERP)	OCD	Face the obsession without performing compulsion
Systematic Desensitization	Specific phobias	Gradual exposure + relaxation
Flooding	Phobias	Immediate full exposure
Dialectical Behavior Therapy (DBT)	Borderline PD	Distress tolerance, emotional regulation
Motivational Interviewing	Substance use	Enhance intrinsic motivation to change

Suggested 2-Week Study Schedule

Days	Focus
Day 1-2	Schizophrenia - criteria, subtypes, antipsychotic side effects
Day 3-4	Mood disorders - depression + mania criteria, treatment, lithium toxicity
Day 5-6	Anxiety disorders - GAD, panic, OCD, PTSD (criteria + treatment)
Day 7	Substance use - alcohol withdrawal timeline, opioid overdose/withdrawal
Day 8	Personality disorders - cluster A/B/C, antisocial PD
Day 9	ECT indications + contraindications, psychotherapy types
Day 10	Child psychiatry - autism, ADHD, conduct disorder
Day 11	Forensic psychiatry - McNaughten's, testamentary capacity
Day 12-14	Revision - practice MCQs, clinical vignettes

Quick Exam Tips

Duration criteria are always tested: Schizophrenia = 6 months (DSM-5) / 1 month (ICD-10); Brief psychotic disorder = <1 month; Schizophreniform = 1-6 months
Always identify the drug's worst/most unique side effect - not the most common one
Clozapine = only drug for treatment-resistant schizophrenia - always check WBC
Alcohol withdrawal is life-threatening; opioid withdrawal is not
Lithium is the gold standard for bipolar maintenance and suicide prevention
SSRIs are first-line for almost every anxiety disorder and depression
In depression + pregnancy: ECT is safe; SSRIs cautiously; avoid valproate (teratogenic)

Want me to go deep on any specific topic from this plan? I can pull detailed notes, diagnostic criteria tables, or drug comparison charts from Kaplan & Sadock's Synopsis directly for any section.

Can you continue

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I now have solid textbook content to cover all the remaining major FMGE psychiatry topics. Here is the complete continuation:

FMGE Psychiatry - Continued (All Remaining Topics in Detail)

9. DELIRIUM vs DEMENTIA (High Yield)

This comparison is one of the most commonly tested differentials in FMGE psychiatry.

Delirium - Key Features

Delirium is an acute decline in consciousness and cognition with particular impairment in attention. Key points:

Hallmark: impaired attention/awareness - fluctuates throughout the day
Sudden onset (hours to days)
Rapid improvement once cause is removed (resolves in 3-7 days)
Memory, orientation, perception all affected
Can have hallucinations (usually visual), delusions, psychomotor changes
EEG shows diffuse slowing (helps distinguish from psychiatric causes)

Delirium Subtypes:

Hyperactive: Agitation, hallucinations, combativeness (easier to spot)
Hypoactive: Quiet, withdrawn, looks like depression (most missed clinically)
Mixed: Fluctuates between both

Delirium vs Dementia - The Most Tested Table

Feature	Delirium	Dementia
Onset	Sudden (hours-days)	Gradual/insidious
Level of consciousness	Impaired, fluctuates	Usually alert
Attention	Severely impaired	Relatively intact early
Course	Fluctuating, reversible	Progressive, irreversible
Duration	Days to weeks	Months to years
EEG	Diffuse slowing	Normal early
Hallucinations	Common (visual)	Less common early
Reversibility	Usually YES (if cause treated)	Usually NO

Delirium vs Schizophrenia

Schizophrenia: hallucinations/delusions are constant and organized; orientation and consciousness normal
Delirium: hallucinations fluctuate; consciousness always impaired

Treatment of Delirium:

Treat the underlying cause first
Haloperidol (low dose) for agitation/psychosis in delirium - most studied
Benzodiazepines only if cause is alcohol/sedative withdrawal
Supportive: familiar environment, clocks/calendars for orientation, family at bedside, lighting at night

Source: Kaplan and Sadock's Synopsis of Psychiatry, block 4

10. SOMATOFORM / SOMATIC SYMPTOM DISORDERS

These disorders involve physical symptoms that are either unexplained or associated with excessive distress/health anxiety. DSM-5 removed the requirement that symptoms must be medically unexplained (DSM-IV required this; ICD-10 still does).

DSM-5 Classification

DSM-5 Disorder	Core Feature	Old DSM-IV Name
Somatic Symptom Disorder	≥1 somatic symptom + excessive thoughts/feelings/behaviors about it for ≥6 months	Somatization disorder
Illness Anxiety Disorder	Preoccupation with having a serious illness; minimal/no somatic symptoms	Hypochondriasis
Conversion Disorder (FND)	Neurological symptom (weakness, seizure, blindness) not explained by neurology	Conversion disorder
Factitious Disorder	Faking illness to assume the sick role (no external gain)	Munchausen syndrome
Malingering	Faking illness for external gain (money, avoiding jail)	Malingering

High-Yield Points:

La belle indifférence: Patient is strangely unconcerned about a major neurological deficit - classically described in Conversion Disorder (but not pathognomonic)
Primary gain (Conversion Disorder): Symptom keeps an internal conflict out of awareness
Secondary gain (both Conversion and Malingering): External benefits (attention, avoiding work)
Factitious Disorder vs Malingering: Factitious = sick role (no external gain); Malingering = tangible external gain
Munchausen by Proxy (now "Factitious Disorder Imposed on Another"): Caregiver induces illness in another person (usually a child)
Management: Regular scheduled appointments with one physician, avoid unnecessary tests, treat comorbid depression/anxiety

11. DISSOCIATIVE DISORDERS

All involve disruption of consciousness, memory, identity, or perception.

Disorder	Key Feature
Dissociative Amnesia	Inability to recall important autobiographical information; usually related to trauma
Dissociative Fugue	Sudden travel away from home with inability to recall one's past; may assume a new identity
Dissociative Identity Disorder (DID)	≥2 distinct personality states take control; gaps in memory; associated with childhood trauma/abuse
Depersonalization/Derealization Disorder	Feeling detached from one's own mind/body (depersonalization) or surroundings (derealization); reality testing remains intact

Key Distinctions:

Fugue: Patient travels, doesn't remember who they are; may develop a new identity
DID: Multiple identities (alters) with distinct personalities; each may have their own name, voice, mannerisms; associated with severe childhood trauma
Depersonalization: Patient feels like they are watching themselves from outside ("out of body") - but they know it is not real (reality testing intact - unlike psychosis)
Treatment: Psychotherapy (trauma-focused), no specific drug; antidepressants for comorbid depression/anxiety

Source: Kaplan and Sadock's Synopsis of Psychiatry, block 6

12. EATING DISORDERS

Disorder	Core Feature	Distinguishing Point
Anorexia Nervosa	Restriction of food intake → significantly low body weight; intense fear of gaining weight; distorted body image	BMI <17.5; patient denies illness
Bulimia Nervosa	Recurrent binge eating + compensatory behavior (purging, fasting, excessive exercise)	Normal or above normal weight; patient aware of problem
Binge Eating Disorder	Recurrent binge eating WITHOUT compensatory behavior	No purging; associated with obesity

Anorexia - FMGE Favorites:

Restricting type vs Binge-purge type
Medical complications: Lanugo hair (fine body hair), amenorrhea, bradycardia, hypotension, osteoporosis, electrolyte imbalances
Refeeding syndrome: Dangerous hypophosphatemia when nutrition reintroduced too quickly
Highest mortality of ALL psychiatric disorders
Treatment: Weight restoration first, then psychotherapy; olanzapine for weight gain; SSRIs less effective in anorexia

Bulimia - FMGE Favorites:

Russell's sign: Calluses on dorsum of hand (from self-induced vomiting)
Chipmunk facies: Parotid gland enlargement from repeated vomiting
Dental erosion, metabolic alkalosis, hypokalemia (from vomiting)
Treatment: Fluoxetine (only FDA-approved drug for bulimia - high dose 60mg) + CBT

13. IMPULSE CONTROL DISORDERS

These are now spread across DSM-5 categories but appear in FMGE:

Disorder	Unable to Resist Impulse to...	Key Point
Kleptomania	Steal objects not needed	Tension before, relief after; objects discarded
Pyromania	Set fires	Fascination with fire; no financial motive
Trichotillomania	Pull out own hair	Tension before, relief after; hair loss patterns
Intermittent Explosive Disorder	Aggressive outbursts	Disproportionate to provocation
Pathological Gambling	Gamble	Classified under "Substance-Related and Addictive Disorders" in DSM-5

Pattern: Tension building → Act → Brief relief/pleasure → Guilt (ego-dystonic)

14. PSYCHOTIC DISORDERS - Spectrum (Duration Comparison - Very High Yield)

Disorder	Duration	Key Feature
Brief Psychotic Disorder	<1 month	Sudden onset; often triggered by stress; full recovery
Schizophreniform Disorder	1-6 months	Same criteria as schizophrenia but shorter
Schizophrenia	≥6 months	Chronic; functional decline
Schizoaffective Disorder	≥6 months	Psychosis + mood episodes (depression or mania); mood episode present for majority of duration
Delusional Disorder	≥1 month	Fixed, non-bizarre delusions; NO hallucinations; NO functional decline; person seems normal otherwise
Shared Psychotic Disorder (Folie à deux)	Variable	One person develops delusion from close contact with another who has a delusion

Delusional Disorder Types (high-yield for FMGE):

Erotomanic: Believes famous person is in love with them
Grandiose: Believes they have special power/identity
Jealous: Believes partner is unfaithful (Othello syndrome)
Persecutory: Most common - believes being conspired against
Somatic: Believes they have a physical disease or deformity

15. SLEEP DISORDERS

Disorder	Key Feature	Treatment
Insomnia Disorder	Difficulty initiating/maintaining sleep, ≥3 nights/week, ≥3 months	Sleep hygiene + CBT-I (first-line); zolpidem/zopiclone short term
Narcolepsy	Excessive daytime sleepiness + cataplexy (sudden muscle weakness triggered by emotion) + hypnagogic hallucinations + sleep paralysis	Modafinil (wakefulness); sodium oxybate (cataplexy)
Obstructive Sleep Apnea	Snoring, apneic episodes, daytime somnolence; confirmed by polysomnography	CPAP (first-line)
REM Sleep Behavior Disorder	Acting out dreams during REM sleep; loss of normal REM atonia; associated with Parkinson's disease / Lewy body dementia	Clonazepam; melatonin
Restless Legs Syndrome	Urge to move legs, worse at rest and night, relieved by movement	Dopamine agonists (pramipexole)
Sleepwalking (Somnambulism)	Complex behaviors during NREM sleep (Stage 3); no memory of episode	Reassurance; benzodiazepines if severe
Night Terrors	Sudden arousal from NREM sleep with intense fear/screaming; no memory	Children; reassurance; usually self-limiting
Nightmare Disorder	Frightening dreams during REM sleep; remembered; distressing	Prazosin (if PTSD-related); psychotherapy

Key sleep stages to know:

Stage 1-3: NREM (non-rapid eye movement)
Stage 3 = Slow wave (deep) sleep - sleepwalking, night terrors, enuresis happen here
REM sleep: Dreaming, nightmares, REM behavior disorder; occurs ~90 min after sleep onset

16. SEXUAL DISORDERS

Category	Disorder	Key Point
Sexual Dysfunction	Erectile Disorder	PDE-5 inhibitors (sildenafil) - contraindicated with nitrates
Sexual Dysfunction	Female Orgasmic Disorder	Most common female sexual dysfunction
Sexual Dysfunction	Premature Ejaculation	SSRIs (side effect of delayed ejaculation used therapeutically)
Sexual Dysfunction	Hypoactive Sexual Desire Disorder	Low libido
Paraphilic Disorders	Pedophilic Disorder	Sexual attraction to prepubescent children; criminal; CBT + anti-androgens
Paraphilic Disorders	Exhibitionistic	Exposing genitals to unsuspecting strangers
Paraphilic Disorders	Voyeuristic	Watching unsuspecting people undress/have sex
Paraphilic Disorders	Fetishistic	Sexual arousal from inanimate objects
Paraphilic Disorders	Masochism	Sexual arousal from being humiliated/hurt
Paraphilic Disorders	Sadism	Sexual arousal from humiliating/hurting others
Gender	Gender Dysphoria	Incongruence between experienced/expressed gender and assigned gender at birth

17. PSYCHIATRIC RATING SCALES (Frequently Tested)

Scale	Measures	Notes
Hamilton Rating Scale for Depression (HAM-D / HRSD)	Severity of depression	Clinician-administered; gold standard
Beck Depression Inventory (BDI)	Depression severity	Self-report
Hamilton Anxiety Rating Scale (HAM-A)	Anxiety severity	Clinician-administered
Brief Psychiatric Rating Scale (BPRS)	Overall psychopathology	Used in schizophrenia
Positive and Negative Syndrome Scale (PANSS)	Positive + negative symptoms of schizophrenia	Gold standard for schizophrenia trials
Mini-Mental State Examination (MMSE)	Cognitive function	Max 30 points; <24 = cognitive impairment
Montreal Cognitive Assessment (MoCA)	Mild cognitive impairment	More sensitive than MMSE
CAGE Questionnaire	Alcohol use disorder	4 questions; ≥2 = significant
AUDIT	Alcohol use screening	WHO tool; 10 questions
Yale-Brown OCD Scale (Y-BOCS)	OCD severity	Gold standard for OCD
CIWA-Ar	Alcohol withdrawal severity	Guides benzodiazepine dosing

CAGE mnemonic (≥2 = suspect alcohol use disorder):

C - Cut down (ever felt you should?)
A - Annoyed (people criticize your drinking?)
G - Guilty (felt bad about drinking?)
E - Eye-opener (drink first thing in morning?)

18. IMPORTANT DRUG MECHANISMS (High Yield)

Antipsychotics - Mechanism

Typical (1st gen): Block D2 receptors - e.g., Haloperidol, Chlorpromazine, Fluphenazine
Atypical (2nd gen): Block D2 + 5-HT2A receptors - e.g., Clozapine, Olanzapine, Risperidone, Quetiapine, Aripiprazole
Aripiprazole: Partial D2 agonist (unique - least weight gain among atypicals)

Antidepressants

SSRIs: Fluoxetine, Sertraline, Paroxetine, Citalopram - block serotonin reuptake
SNRIs: Venlafaxine, Duloxetine - block serotonin + norepinephrine reuptake; good for pain
TCAs: Amitriptyline, Imipramine - block serotonin + NE reuptake + anticholinergic + antihistamine; dangerous in OD (cardiac arrhythmia)
MAOIs: Phenelzine, Tranylcypromine - block MAO; risk of hypertensive crisis with tyramine-containing foods (aged cheese, wine, cured meats)
Mirtazapine: Blocks alpha-2, 5-HT2, H1; sedating; good for insomnia + weight loss
Bupropion: Blocks DA + NE reuptake; good for smoking cessation; lowers seizure threshold; no sexual side effects

Mood Stabilizers

Drug	Monitoring	Key Toxicity
Lithium	Serum level, TFTs, renal function	Narrow therapeutic index: tremor → ataxia → coma; nephrogenic DI
Valproate	LFTs, CBC	Hepatotoxicity, teratogenic (spina bifida - neural tube defects)
Carbamazepine	CBC, LFTs	Agranulocytosis, Stevens-Johnson syndrome, induces CYP450
Lamotrigine	Rash monitoring	Stevens-Johnson syndrome if titrated too fast

19. SUICIDE RISK ASSESSMENT (Frequently Tested in Vignettes)

Risk factors (SAD PERSONS mnemonic):

S - Sex (male - higher completion rate; female - higher attempt rate)
A - Age (elderly men - highest risk; adolescents)
D - Depression / other psychiatric illness
P - Previous attempt (strongest single predictor)
E - Ethanol / substance use
R - Rational thinking lost (psychosis)
S - Social support lacking
O - Organized plan
N - No spouse (divorced, widowed, separated)
S - Sickness (chronic medical illness)

Protective factors: Religious beliefs, family support, children at home, treatment engagement, sense of purpose

Immediate management: Hospitalization if imminent risk, remove means, psychiatric evaluation. ECT is the fastest treatment for severe suicidal depression.

20. NEUROCOGNITIVE DISORDERS (Dementia Types)

Type	Key Feature	Pathology
Alzheimer's Disease	Most common; gradual memory loss; personality change late	Beta-amyloid plaques + neurofibrillary tangles (tau protein)
Vascular Dementia	Stepwise decline; follows strokes; focal neurological signs	Multiple infarcts
Lewy Body Dementia	Fluctuating cognition + visual hallucinations + Parkinsonism	Lewy bodies (alpha-synuclein) in cortex
Frontotemporal Dementia (Pick's)	Personality change + behavior disinhibition BEFORE memory loss; young onset	Pick bodies (tau) in frontal/temporal lobes
Normal Pressure Hydrocephalus	Classic triad: Wet (incontinence) + Wobbly (gait) + Wacky (dementia)	Treatable - shunting

Alzheimer's treatment:

Mild-moderate: Donepezil (cholinesterase inhibitor) - first-line
Moderate-severe: Memantine (NMDA antagonist) - alone or with donepezil
Rivastigmine patch - also used; approved for Parkinson's dementia

Complete Topic Coverage - Summary Checklist

#	Topic	Status
1	Schizophrenia	✅ (Part 1)
2	Mood Disorders	✅ (Part 1)
3	Anxiety Disorders	✅ (Part 1)
4	Substance Use Disorders	✅ (Part 1)
5	Personality Disorders	✅ (Part 1)
6	ECT	✅ (Part 1)
7	Child Psychiatry	✅ (Part 1)
8	Forensic Psychiatry	✅ (Part 1)
9	Delirium vs Dementia	✅ (Part 2)
10	Somatic Symptom Disorders	✅ (Part 2)
11	Dissociative Disorders	✅ (Part 2)
12	Eating Disorders	✅ (Part 2)
13	Impulse Control Disorders	✅ (Part 2)
14	Psychotic Spectrum (duration)	✅ (Part 2)
15	Sleep Disorders	✅ (Part 2)
16	Sexual Disorders & Paraphilias	✅ (Part 2)
17	Rating Scales	✅ (Part 2)
18	Drug Mechanisms	✅ (Part 2)
19	Suicide Risk Assessment	✅ (Part 2)
20	Neurocognitive Disorders	✅ (Part 2)

That covers the entire FMGE psychiatry syllabus from basics to exam-ready detail. For practice, focus on clinical vignettes - a typical question will describe a patient and ask you to either name the diagnosis or pick the correct treatment. If you want, I can generate a set of practice MCQs to test yourself on all these topics.

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