Psychiatry Differentials and Mnemonics for NEET PG
1. Acute confusional states and cognitive disorders
| Feature | Delirium | Dementia | Depression with pseudodementia |
|---|
| Onset | Acute, hours to days | Insidious, months to years | Often subacute |
| Course | Fluctuating, worse at night | Progressive, relatively stable during day | Variable |
| Consciousness | Impaired | Clear until late | Clear |
| Attention | Impaired early | Usually preserved early | May appear impaired due to poor effort |
| Orientation | Disoriented early | Disoriented late | Usually intact |
| Hallucinations | Common, especially visual | Uncommon until late | Absent |
| Sleep-wake cycle | Disturbed | Usually preserved early | May have early morning awakening |
| Patient response | Often unconcerned or confused | May confabulate | Emphasizes deficits: “I don’t know” |
| Reversibility | Usually reversible if cause treated | Usually irreversible/progressive | Reversible with treatment |
Mnemonic: Delirium = “D-A-V-E”
- Disturbed attention
- Acute onset
- Visual hallucinations
- Ebbing and flowing course
CAM: Confusion Assessment Method
- Acute onset and fluctuating course
- Inattention
- Disorganized thinking
- Altered level of consciousness
Diagnosis: 1 + 2 + either 3 or 4.
2. Delirium tremens vs alcohol hallucinosis vs Wernicke encephalopathy
| Feature | Delirium tremens | Alcoholic hallucinosis | Wernicke encephalopathy |
|---|
| Typical timing after stopping alcohol | 48-96 hours | 12-24 hours | During malnutrition/chronic alcohol use |
| Sensorium | Clouded | Clear | Confused |
| Hallucinations | Visual/tactile, often insects | Predominantly auditory | Not typical |
| Autonomic overactivity | Marked: tremor, sweating, tachycardia, fever | Mild or absent | May occur |
| Key signs | Agitation, tremulousness, seizures possible | Patient may retain insight | Ophthalmoplegia/nystagmus, ataxia |
| Treatment principle | Benzodiazepines + thiamine | Antipsychotic if needed, manage withdrawal | IV thiamine before glucose |
Mnemonic: Wernicke = “CAN”
- Confusion
- Ataxia
- Nystagmus/ophthalmoplegia
Korsakoff syndrome: severe anterograde amnesia + confabulation, due to thiamine deficiency, commonly follows untreated Wernicke encephalopathy.
3. Major depressive episode vs grief vs adjustment disorder
| Feature | Major depressive disorder | Normal grief/bereavement | Adjustment disorder |
|---|
| Trigger | May occur with or without trigger | Death/loss | Identifiable stressor |
| Mood | Persistent depressed mood/anhedonia | Comes in waves or “pangs” | Distress related to stressor |
| Duration | At least 2 weeks | Gradually improves | Begins within 3 months of stressor |
| Self-esteem | Worthlessness, excessive guilt | Usually preserved | Usually preserved |
| Suicidality | May be present | Thoughts of joining deceased may occur, but pervasive death wish suggests MDD | Variable |
| Psychomotor retardation | May occur | Uncommon | Uncommon |
| Function | Markedly impaired | Variable | Impaired but does not meet criteria for another disorder |
Mnemonic: Depression = “SIGECAPS”
- Sleep change
- Interest loss
- Guilt/worthlessness
- Energy loss
- Concentration poor
- Appetite/weight change
- Psychomotor change
- Suicidal ideation
For MDD: at least 5 symptoms, including depressed mood or anhedonia, for at least 2 weeks.
4. Melancholic depression vs atypical depression
| Feature | Melancholic features | Atypical features |
|---|
| Mood reactivity | Absent | Present |
| Anhedonia | Marked | Less prominent |
| Sleep | Early morning awakening | Hypersomnia |
| Appetite | Decreased | Increased |
| Weight | Loss | Gain |
| Psychomotor activity | Agitation or retardation | May have leaden paralysis |
| Diurnal variation | Worse in morning | Often worse in evening |
| Sensitivity to rejection | Not characteristic | Prominent |
Mnemonic: Atypical = “LASH”
- Leaden paralysis
- Appetite increased
- Sleep increased
- Hypersensitivity to rejection
5. Unipolar depression vs bipolar depression
| Feature | Unipolar depression | Bipolar depression |
|---|
| Age at onset | Usually later | Earlier onset |
| Family history | Depression | Bipolar disorder |
| Episodes | Fewer, longer | More frequent, often shorter |
| Psychotic features | Less frequent | More frequent |
| Atypical symptoms | Less common | Hypersomnia, hyperphagia common |
| Antidepressant response | Usually safe with monitoring | May trigger mania/hypomania |
| History of mania/hypomania | Absent | Present |
Exam clue: Before prescribing an antidepressant in depression, screen for past mania/hypomania, family history of bipolar disorder, antidepressant-induced activation, and episodic increased energy with reduced sleep.
6. Mania vs hypomania
| Feature | Mania | Hypomania |
|---|
| Minimum duration | At least 1 week, or any duration if hospitalized | At least 4 consecutive days |
| Severity | Marked functional impairment | No marked impairment |
| Hospitalization | May be required | Not required |
| Psychosis | May be present | Absent by definition |
| Functional state | Severe disruption | Observable change but functioning not severely impaired |
Mnemonic: Mania = “DIG FAST”
- Distractibility
- Indiscretion/impulsivity
- Grandiosity
- Flight of ideas
- Activity increased/agitation
- Sleep need decreased
- Talkativeness/pressured speech
7. Panic attack vs panic disorder vs GAD
| Feature | Panic attack | Panic disorder | Generalized anxiety disorder |
|---|
| Core feature | Sudden intense fear/discomfort | Recurrent unexpected panic attacks | Excessive, difficult-to-control worry |
| Time course | Peaks within minutes | At least 1 month of concern/behavioral change after attacks | At least 6 months |
| Trigger | May be expected or unexpected | Attacks are unexpected | Multiple everyday concerns |
| Symptoms | Palpitations, dyspnea, chest pain, fear of dying | Same plus anticipatory anxiety/avoidance | Tension, irritability, fatigue, poor concentration |
| Key exam point | A symptom, not necessarily a disorder | Recurrent and unexpected attacks | Persistent free-floating anxiety |
Panic attack symptoms: “CHILLS”
- Choking/chest pain
- Hot flushes
- Intense fear of dying/losing control
- Light-headedness
- Lack of breath
- Sweating, shaking, sense of unreality
GAD mnemonic: “RESTLESS”
- Restlessness
- Easily fatigued
- Sleep disturbance
- Tension in muscles
- Lack of concentration
- Easily irritable
- Six months
- Several domains of worry
8. OCD vs obsessive-compulsive personality disorder
| Feature | OCD | OCPD |
|---|
| Symptoms | Obsessions and/or compulsions | Perfectionism, orderliness, control |
| Ego-dystonic or ego-syntonic? | Ego-dystonic | Ego-syntonic |
| Insight | Usually present | Often poor |
| Anxiety | Marked anxiety from intrusive thoughts | Anxiety when control/order is disrupted |
| Compulsions | Repetitive acts to neutralize anxiety | No true compulsions |
| Example | “I know hand washing is excessive, but cannot stop.” | “My method is correct. Others are careless.” |
| Treatment | CBT with exposure-response prevention, SSRI | Psychotherapy, address personality traits |
Mnemonic:
- OCD = “Ouch, I Can’t stop Doing it.” It is distressing and unwanted.
- OCPD = “Order, Control, Perfectionism, Discipline.”
9. PTSD vs acute stress disorder vs adjustment disorder
| Feature | Acute stress disorder | PTSD | Adjustment disorder |
|---|
| Stressor | Trauma involving actual/threatened death, serious injury, or sexual violence | Same | Any identifiable stressor |
| Onset/duration | 3 days to 1 month after trauma | More than 1 month | Within 3 months of stressor |
| Symptoms | Intrusion, negative mood, dissociation, avoidance, arousal | Intrusion, avoidance, negative cognition/mood, arousal | Distress or impaired functioning without full ASD/PTSD criteria |
| Dissociation | Particularly prominent | May occur, not essential | Not typical |
| Diagnosis after 1 month | PTSD if criteria fulfilled | PTSD | May persist up to 6 months after stressor ends |
Mnemonic: PTSD = “R-A-N-A”
- Re-experiencing
- Avoidance
- Negative cognition/mood
- Arousal/reactivity
Timing pearl:
- < 1 month: acute stress disorder
- > 1 month: PTSD
10. Dissociative fugue vs dissociative amnesia vs malingering
| Feature | Dissociative fugue | Dissociative amnesia | Malingering |
|---|
| Memory loss | Autobiographical memory loss | Important autobiographical information | Claimed, intentional |
| Travel/wandering | Present | Absent | May be fabricated |
| New identity | May occur | Absent | Not genuine |
| External incentive | None | None | Present, such as money, avoidance of work/legal duty |
| Intentional production | No | No | Yes |
Mnemonic: Fugue = “Flight from identity.”
11. Somatic symptom disorder vs illness anxiety disorder vs conversion disorder
| Feature | Somatic symptom disorder | Illness anxiety disorder | Conversion disorder |
|---|
| Somatic symptoms | One or more distressing symptoms are present | Absent or mild | Neurological-type symptom |
| Main preoccupation | Symptoms and their consequences | Fear of having/acquiring serious illness | Functional neurological deficit |
| Health anxiety | Present | Marked, central symptom | May show relative indifference |
| Examples | Chronic pain with excessive thoughts and behaviors | Repeated fear of cancer despite reassurance | Non-anatomical paralysis, psychogenic blindness |
| Intentional production | No | No | No |
Mnemonic:
- Somatic symptom disorder: “Symptoms are substantial.”
- Illness anxiety disorder: “Illness fear is substantial.”
- Conversion disorder: “Function is converted into a neurological deficit.”
12. Schizophrenia vs brief psychotic disorder vs schizophreniform disorder
| Feature | Brief psychotic disorder | Schizophreniform disorder | Schizophrenia |
|---|
| Duration | At least 1 day, less than 1 month | 1-6 months | At least 6 months |
| Recovery | Full return to premorbid functioning | May or may not recover | Often chronic functional decline |
| Functional decline | Not necessary | Not necessary | May occur |
| Psychotic symptoms | Delusions, hallucinations, disorganized speech/behavior | Same | Same, with duration criterion |
Mnemonic: “1 day, 1 month, 6 months”
- Brief psychotic disorder: 1 day to <1 month
- Schizophreniform: 1-6 months
- Schizophrenia: ≥6 months
13. Schizophrenia vs mood disorder with psychotic features vs schizoaffective disorder
| Feature | Schizophrenia | Mood disorder with psychotic features | Schizoaffective disorder |
|---|
| Mood episode | May occur but is brief relative to psychosis | Present throughout illness | Present for majority of illness |
| Psychosis without mood symptoms | Present | Absent | Present for at least 2 weeks |
| Main illness pattern | Predominantly psychotic | Predominantly mood disorder | Both significant mood and psychotic illness |
Mnemonic: Schizoaffective = “2 weeks psychosis alone.”
14. Delusion vs overvalued idea vs obsession
| Feature | Delusion | Overvalued idea | Obsession |
|---|
| Belief | False, fixed, not culturally shared | Unreasonable but understandable belief | Recurrent intrusive thought/impulse/image |
| Conviction | Absolute | Strong but potentially modifiable | Patient recognizes it as irrational |
| Resistance | No resistance | Minimal resistance | Actively resisted |
| Ego-dystonic | No | Usually no | Yes |
| Example | “Neighbors control my thoughts.” | “Organic food is the only safe food.” | “My hands are contaminated despite knowing they are clean.” |
Mnemonic: Obsession = “Intrusive, Irrational, Insightful.”
15. Delusional perception vs hallucination vs illusion
| Phenomenon | Definition | Example |
|---|
| Illusion | Misinterpretation of a real external stimulus | Sees a rope and mistakes it for a snake |
| Hallucination | Perception without external stimulus | Hears a voice when nobody is present |
| Delusional perception | A normal perception given a sudden, false, idiosyncratic meaning | Sees a red car and believes it proves he is the chosen one |
Mnemonic:
- Illusion: “Input exists, interpretation is wrong.”
- Hallucination: “No input exists.”
- Delusional perception: “Input is normal, meaning is delusional.”
16. Common hallucination patterns
| Disorder/condition | Typical hallucination |
|---|
| Delirium | Visual, often small animals/insects |
| Alcohol withdrawal | Visual and tactile, formication |
| Schizophrenia | Auditory, third-person voices, running commentary |
| Depression with psychosis | Mood-congruent auditory hallucinations |
| Parkinson disease/Lewy body dementia | Visual hallucinations |
| Charles Bonnet syndrome | Visual hallucinations in visual impairment, insight preserved |
| Peduncular hallucinosis | Vivid visual hallucinations due to midbrain/thalamic lesion |
Mnemonic: “Visual = organic until proven otherwise.”
17. Antipsychotic adverse effects: differentiation
| Adverse effect | Typical onset | Clinical features | Key management |
|---|
| Acute dystonia | Hours to days | Torticollis, oculogyric crisis, laryngospasm | Anticholinergic: benztropine/trihexyphenidyl |
| Akathisia | Days to weeks | Inner restlessness, inability to sit still | Reduce dose, propranolol, benzodiazepine |
| Drug-induced parkinsonism | Weeks to months | Tremor, rigidity, bradykinesia | Anticholinergic or amantadine |
| Tardive dyskinesia | Months to years | Orofacial choreoathetoid movements | Reduce/switch drug, VMAT2 inhibitor |
| Neuroleptic malignant syndrome | Days to weeks | Fever, rigidity, autonomic instability, raised CK | Stop drug, supportive care, dantrolene/bromocriptine |
Mnemonic: “D-A-P-T” for EPS timing
- Dystonia: Days
- Akathisia: Around weeks
- Parkinsonism: Prolonged weeks-months
- Tardive dyskinesia: Takes years
NMS = “FARM”
- Fever
- Autonomic instability
- Rigidity
- Mental-status change
18. NMS vs serotonin syndrome vs malignant hyperthermia
| Feature | NMS | Serotonin syndrome | Malignant hyperthermia |
|---|
| Trigger | Dopamine antagonist or withdrawal of dopaminergic drug | Serotonergic drugs | Succinylcholine or volatile anesthetics |
| Onset | Days to weeks | Hours | During/soon after anesthesia |
| Neuromuscular signs | Lead-pipe rigidity, hyporeflexia | Hyperreflexia, clonus, tremor | Generalized rigidity |
| GI symptoms | Less prominent | Diarrhea, hyperactive bowel sounds common | Not typical |
| Antidote | Dantrolene, bromocriptine | Cyproheptadine | Dantrolene |
Mnemonic:
- Serotonin syndrome = “Wet and twitchy”: sweating, diarrhea, clonus.
- NMS = “Dry and rigid.”
19. Postpartum blues vs postpartum depression vs postpartum psychosis
| Feature | Postpartum blues | Postpartum depression | Postpartum psychosis |
|---|
| Onset | 2-3 days after delivery | Usually within weeks to months | Often within 2 weeks |
| Frequency | Very common | Common | Rare |
| Symptoms | Tearfulness, irritability, emotional lability | MDD symptoms, impaired bonding, guilt | Delusions, hallucinations, mania/depression, confusion |
| Duration | Resolves within 2 weeks | More than 2 weeks | Acute emergency |
| Management | Reassurance/support | Psychotherapy, antidepressant as indicated | Urgent psychiatric admission and treatment |
Mnemonic: “Blues are brief, psychosis is perilous.”
20. Anorexia nervosa vs bulimia nervosa vs binge-eating disorder
| Feature | Anorexia nervosa | Bulimia nervosa | Binge-eating disorder |
|---|
| Weight | Low body weight | Usually normal weight | Often overweight/obesity |
| Binge eating | May occur in binge-purge subtype | Present | Present |
| Compensatory behavior | May occur | Present: vomiting, laxatives, fasting, exercise | Absent |
| Body image disturbance | Present | Present | Usually present |
| Physical signs | Bradycardia, amenorrhea, lanugo | Dental enamel erosion, parotid enlargement, Russell sign | Metabolic complications |
| Key risk | Highest mortality among psychiatric disorders | Electrolyte disturbance, especially hypokalemia | Obesity-related complications |
Mnemonic: Bulimia = “Binge, then Behaviors to compensate.”
21. Antisocial personality disorder vs conduct disorder
| Feature | Conduct disorder | Antisocial personality disorder |
|---|
| Age | Childhood/adolescence | Age 18 years or older |
| Core pattern | Repetitive violation of rights/rules | Disregard for and violation of others’ rights |
| Requirement for ASPD | Not applicable | Evidence of conduct disorder before age 15 |
| Examples | Aggression, property destruction, theft, serious rule violations | Deceitfulness, impulsivity, irresponsibility, lack of remorse |
Mnemonic: ASPD requires “18 + CD before 15.”
Rapid NEET PG one-liners
| Question clue | Likely answer |
|---|
| Acute onset, fluctuating attention, visual hallucinations | Delirium |
| Memory loss with wandering and new identity | Dissociative fugue |
| Normal perception assigned bizarre meaning | Delusional perception |
| Psychosis lasting 1-6 months | Schizophreniform disorder |
| Psychosis alone for 2 weeks plus mood episodes for much of illness | Schizoaffective disorder |
| Trauma symptoms for less than 1 month | Acute stress disorder |
| Panic attacks plus 1 month worry/avoidance | Panic disorder |
| Ego-syntonic perfectionism and control | OCPD |
| Intrusive unwanted thoughts relieved by rituals | OCD |
| Fever, lead-pipe rigidity, elevated CK after antipsychotic | NMS |
| Hyperreflexia and clonus after serotonergic drug | Serotonin syndrome |
| Emotional lability within days of delivery and resolving by 2 weeks | Postpartum blues |
| Binge eating with purging at normal body weight | Bulimia nervosa |