Psychiatry

Psychiatry is one of the highest-yield-per-hour subjects in NEET PG and INI-CET. It is small in volume yet disproportionately rewarding: a focused candidate can convert almost every Psychiatry question correctly because the discipline is definition-driven, criteria-driven, and drug-driven. Unlike Medicine or Surgery, where a single question may demand layered clinical reasoning, most Psychiatry MCQs reward precise recall of a diagnostic threshold, a classic clinical vignette, a first-line drug, or a defence mechanism. This makes Psychiatry the textbook example of a subject where "studying smart" beats "studying long."

This mother page is built around the six examined groups in the NEET-Nerve blueprint — Mood Disorders, Psychotic Disorders, Anxiety, Substance Use, Childhood (child & adolescent psychiatry), and Organic disorders — and stitches them together with cross-subject integration, recent guideline shifts, a study roadmap, and rapid-fire revision material.

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How Psychiatry Is Tested

Weightage and exam footprint

Psychiatry typically contributes 6–10 questions in NEET PG (roughly 3–5% of the paper) and a slightly higher relative share in INI-CET, where AIIMS/PGI-style examiners love clinical-vignette psychopharmacology and forensic-psychiatry crossovers. Although the absolute count is modest, the return on investment is the highest of any clinical subject because the topics repeat year after year with minimal variation.

In the new pattern, expect:

• Single-best-answer clinical vignettes ("A 24-year-old presents with…") — the dominant format.
• First-line / drug-of-choice questions — extremely common and almost always scorable.
• "Which of the following is NOT…" criterion questions — testing diagnostic checklists.
• Image/description-based (e.g., a tremor description, a movement disorder, EEG burst-suppression in delirium).
• One-liner association recall (e.g., "delusion of infidelity = ?").

Recurring question styles

Style	What it tests	Example stem
Diagnostic threshold	Duration/number criteria	"Low mood for how many weeks defines a depressive episode?"
Drug of choice	First-line pharmacotherapy	"DOC for OCD?"
Side-effect / toxicity	Pharmacology overlap	"Earliest sign of lithium toxicity?"
Classic eponym/sign	Phenomenology	"Mirror sign is seen in?"
Defence mechanism	Psychodynamics	"A doctor diagnosed with cancer reads all journals on it = ?"
Emergency management	Acute psychiatry	"Management of serotonin syndrome?"

The recurring traps are: confusing delirium vs dementia, serotonin syndrome vs NMS, akathisia vs anxiety, schizophreniform vs brief psychotic vs schizophrenia (all duration-based), and typical vs atypical antipsychotic side-effect profiles.

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Foundations You Must Lock First

Before the disorder groups, three "infrastructure" areas underpin half the paper:

Signs, symptoms and phenomenology

• Delusion = fixed, false, firmly held belief, not amenable to logic, not in keeping with sociocultural background.
• Hallucination = perception without a stimulus (true hallucination has the quality of a real percept and is in objective space).
• Illusion = misperception of a real stimulus.
• Pseudohallucination = perceived in inner subjective space, insight relatively preserved.

Term	Definition / association
Thought broadcasting / insertion / withdrawal	First-rank symptoms (Schneider) of schizophrenia
Echo de la pensée (thought echo)	First-rank symptom
Delusional perception	Schneiderian first-rank
Knight's move thinking	Loosening of associations (schizophrenia)
Flight of ideas	Mania (associations preserved but rapid)
Clang association	Mania
Circumstantiality	Reaches goal eventually (epilepsy, OCD)
Tangentiality	Never reaches goal
Neologism	New word coinage (schizophrenia)
Word salad / schizophasia	Incoherent speech
Confabulation	Korsakoff / amnestic syndrome
Perseveration	Frontal lobe / organic
Echolalia / echopraxia	Catatonia, autism
Waxy flexibility (cerea flexibilitas)	Catatonia

Defence mechanisms (psychodynamics)

A perennial favourite. Group them by maturity:

• Mature: sublimation, altruism, humour, suppression, anticipation.
• Neurotic: repression, displacement, reaction formation, intellectualization, isolation, undoing, rationalization.
• Immature: projection, denial, regression, acting out, somatization, passive aggression.
• Psychotic: denial of external reality, distortion, delusional projection.

Classic stems: intellectualization = a physician with leukaemia studies its molecular biology; reaction formation = unconscious hatred expressed as exaggerated love; undoing = compulsive hand-washing to neutralize a guilty thought; displacement = scolded at work, shouts at spouse at home; identification with the aggressor = abused child later becomes a bully.

Psychometrics and rating scales

Scale	Used for
HAM-D (Hamilton) / MADRS	Depression severity
YMRS	Mania
PANSS / BPRS	Schizophrenia symptom severity
Y-BOCS	OCD
MMSE / MoCA	Cognitive screening (dementia/delirium)
AIMS	Tardive dyskinesia
CAGE / AUDIT	Alcohol use screening
MMPI	Personality (objective)
Rorschach / TAT	Projective tests
WAIS / Binet-Kamat (Indian)	Intelligence (IQ)

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Mood Disorders

Mood disorders are the single most tested group. Expect 1–3 questions, usually mixing diagnosis and pharmacology.

Depression — must-know criteria

A major depressive episode requires ≥2 weeks of depressed mood and/or anhedonia plus associated symptoms (sleep, interest, guilt, energy, concentration, appetite, psychomotor change, suicidality — mnemonic SIG-E-CAPS). Cardinal biological symptoms tested: early morning awakening, diurnal mood variation (worse in morning), weight/appetite loss, loss of libido.

High-yield points:

• Most common psychiatric disorder overall and the leading cause of disability worldwide (and a recurring Community Medicine/PSM overlap).
• Depression with psychotic features: mood-congruent delusions (guilt, nihilism, poverty). Cotard syndrome = nihilistic delusion ("I am dead / my organs are rotting").
• Suicide risk highest in: elderly, male, single/widowed, prior attempt, substance use, chronic illness, recent loss. Risk paradoxically rises in early recovery (energy returns before mood lifts).
• Masked depression, somatic presentation common in Indian primary-care settings.

Pharmacology (the scoring zone):

Class	Examples	Pearls
SSRIs (first-line)	Fluoxetine, sertraline, escitalopram	Sexual dysfunction common; fluoxetine longest t½; sertraline safe in cardiac/pregnancy-preferred
SNRIs	Venlafaxine, duloxetine	Duloxetine good for comorbid neuropathic pain
TCAs	Imipramine, amitriptyline	Anticholinergic + cardiotoxic (QRS widening in overdose → 3As: anti-Adrenergic, anti-Histaminic, anti-cholinergic)
MAOIs	Phenelzine, tranylcypromine	Tyramine → hypertensive crisis (cheese reaction); washout before SSRIs
Atypical	Mirtazapine, bupropion, agomelatine	Mirtazapine → weight gain + sedation (good in cachectic/insomniac elderly); bupropion lowers seizure threshold, contraindicated in eating disorders & seizures, but no sexual side effects

• Onset of antidepressant action: 2–4 weeks; adequate trial = 4–6 weeks at therapeutic dose.
• ECT is the fastest, most effective treatment and the DOC for severe depression with high suicidal risk, psychotic depression, catatonia, refractory depression, and depression in pregnancy (often preferred). Bilateral ECT is more effective; unilateral non-dominant causes less cognitive impairment. Main side effect: anterograde + retrograde memory impairment (usually transient). The only absolute contraindication classically taught is raised intracranial pressure (space-occupying lesion).

Bipolar disorder & mania

• Mania = ≥1 week of elevated/irritable mood + ≥3 (or 4 if irritable) symptoms — DIGFAST (Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness). Hospitalization or psychosis → automatically manic (not hypomanic).
• Hypomania = ≥4 days, no marked impairment, no psychosis, no hospitalization → Bipolar II (hypomania + depression). Bipolar I = at least one full manic episode.
• Cyclothymia = ≥2 years of fluctuating sub-threshold highs and lows.

Mood stabilizers — heavily tested:

Drug	Key facts
Lithium	DOC for acute mania prophylaxis & only proven anti-suicidal agent. Narrow therapeutic index: therapeutic 0.6–1.2 mEq/L, toxicity >1.5, life-threatening >2.0. Monitoring: thyroid, renal, ECG. Earliest toxicity sign = coarse tremor/GI upset; severe = ataxia, seizures, coma. Ebstein anomaly if used in pregnancy. Avoid NSAIDs, thiazides, ACEi (raise levels).
Valproate	DOC for mixed episodes & rapid cycling; teratogenic (neural tube defects), avoid in pregnancy & young women; hepatotoxic, weight gain, PCOS, alopecia
Carbamazepine	Enzyme inducer; SJS (HLA-B*1502), agranulocytosis, hyponatremia (SIADH)
Lamotrigine	Best for bipolar depression; risk of SJS/TEN (slow titration)

Atypical antipsychotics (olanzapine, quetiapine, risperidone, aripiprazole) are also first-line for acute mania.

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Psychotic Disorders

Schizophrenia — the centrepiece

• Diagnostic duration: symptoms ≥6 months (DSM) with ≥1 month of active-phase symptoms; ICD requires ~1 month of characteristic symptoms. This duration distinction is a classic trap.
• Duration spectrum (memorize cold):

Disorder	Duration
Brief psychotic disorder	1 day – <1 month
Schizophreniform	1 – 6 months
Schizophrenia	≥6 months (DSM)
Schizoaffective	Mood + psychosis, but ≥2 weeks of psychosis without mood symptoms

• Positive symptoms: delusions, hallucinations (auditory most common, esp. third-person commentary), disorganized speech/behaviour.
• Negative symptoms (the 6 A's): Affective flattening, Alogia, Avolition, Anhedonia, Asociality, Attention deficit — these predict poor prognosis.
• First-rank symptoms (Schneider): thought alienation (insertion/withdrawal/broadcasting), passivity/made phenomena, delusional perception, third-person auditory hallucinations, thought echo. Not pathognomonic but highly suggestive.
• Good prognostic factors: acute onset, late onset, precipitating stressor, mood symptoms, married, good premorbid function, paranoid subtype, positive symptoms predominant. Poor: insidious, young, negative symptoms, family history, single, poor support.
• Neurochemistry: dopamine hyperactivity (mesolimbic) → positive symptoms; hypofunction (mesocortical) → negative. Glutamate (NMDA hypofunction) theory increasingly tested.

Antipsychotics — the highest-yield pharmacology in the subject

Group	Examples	Receptor / pearls
Typical (FGA)	Haloperidol, chlorpromazine, fluphenazine	Strong D2 block → EPS prominent; haloperidol high-potency, chlorpromazine low-potency (more sedation, hypotension, corneal/lens deposits, photosensitivity)
Atypical (SGA)	Risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone	5-HT2A + D2; fewer EPS, more metabolic syndrome (weight gain, dyslipidemia, diabetes)
Clozapine	—	DOC for treatment-resistant schizophrenia & reduces suicidality; agranulocytosis (mandatory CBC monitoring), myocarditis, seizures, sialorrhea, weight gain; no/low EPS

Extrapyramidal side effects (EPS) — sequence and antidotes:

EPS	Timing	Management
Acute dystonia (oculogyric crisis, torticollis)	Hours–days	IV/IM anticholinergic (promethazine/benztropine)
Akathisia (restlessness — mistaken for anxiety!)	Days–weeks	Propranolol / benzodiazepine; reduce dose
Parkinsonism	Weeks	Anticholinergic, reduce dose
Tardive dyskinesia	Months–years	Often irreversible; stop/switch to clozapine; VMAT2 inhibitors (valbenazine)

• Hyperprolactinemia: most with risperidone (galactorrhea, amenorrhea, gynecomastia); aripiprazole is prolactin-sparing (partial D2 agonist).
• Neuroleptic Malignant Syndrome (NMS) vs Serotonin Syndrome — a guaranteed exam favourite:

Feature	NMS	Serotonin syndrome
Trigger	Antipsychotic (D2 block); also abrupt L-dopa stop	Serotonergic drugs (SSRI + MAOI/tramadol/triptan)
Onset	Days–weeks (slow)	Hours (fast)
Reflexes	Hyporeflexia, lead-pipe rigidity	Hyperreflexia, clonus, myoclonus
Pupils	Normal	Mydriasis
Treatment	Dantrolene, bromocriptine, supportive	Cyproheptadine, supportive, stop drug
Lab	↑CK, ↑WBC, myoglobinuria	↑CK possible

Delusional disorder and others

• Delusional disorder: ≥1 month of non-bizarre delusion, otherwise high functioning. Subtypes: persecutory (commonest), grandiose, erotomanic (de Clérambault — belief a famous person loves you), jealous (Othello syndrome — delusion of infidelity, alcoholic males, dangerous), somatic.
• Folie à deux (shared psychotic disorder): delusion transferred to a close associate.
• Capgras = familiar person replaced by an impostor; Fregoli = stranger is a familiar person in disguise.

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Anxiety, OCD, Stress & Somatoform Disorders

This group bundles the disorders most influenced by the DSM-5 reorganization, so read the "Recent updates" section alongside it.

Anxiety spectrum

Disorder	Hallmark	First-line treatment
Generalized anxiety disorder (GAD)	Excessive worry ≥6 months, free-floating	SSRI/SNRI; buspirone (non-sedating, no dependence); short-term BZD
Panic disorder	Recurrent unexpected panic attacks + anticipatory anxiety + agoraphobia	SSRI first-line; BZD for acute attack
Specific phobia	Cued fear of object/situation	Exposure/systematic desensitization (behaviour therapy)
Social anxiety disorder	Fear of scrutiny	SSRI; performance type → beta-blocker
Agoraphobia	Fear of places where escape is hard	SSRI + CBT

• Panic attack physiology: surge of autonomic symptoms peaking in ~10 minutes; lactate infusion and CO2 inhalation provoke attacks (classic question).

OCD

• Obsessions (intrusive, ego-dystonic thoughts) + compulsions (repetitive acts to reduce anxiety). Insight usually preserved.
• DOC = SSRIs at high doses (higher than for depression) and clomipramine (TCA, most serotonergic). Add-on: CBT with exposure and response prevention (ERP).
• OCD is now in its own DSM-5 chapter ("Obsessive-Compulsive and Related Disorders") — includes body dysmorphic disorder, hoarding, trichotillomania, excoriation.

Trauma- and stressor-related

• Acute stress disorder: 3 days–1 month after trauma.
• PTSD: symptoms >1 month — re-experiencing (flashbacks/nightmares), avoidance, hyperarousal, negative cognitions. First-line SSRI + trauma-focused CBT/EMDR; prazosin for nightmares.
• Adjustment disorder: maladaptive reaction within 3 months of an identifiable stressor, resolves within 6 months of stressor ending.

Somatic symptom & dissociative disorders

Disorder	Key feature
Somatic symptom disorder	Distressing somatic symptoms + excessive thoughts/behaviour
Illness anxiety (hypochondriasis)	Preoccupation with having disease, minimal symptoms
Conversion (functional neurological)	Neurological deficit incompatible with disease; la belle indifférence
Factitious (Munchausen)	Intentional production for sick role (internal gain)
Malingering	Intentional for external gain (money, leave) — not a psychiatric disorder
Dissociative amnesia/fugue	Memory loss for personal info, often post-trauma

Trap: Factitious = unconscious psychological need (sick role); malingering = conscious external incentive. Conversion = not intentionally produced.

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Substance Use Disorders

A reliable 1–2 question zone, dense with antidotes and withdrawal syndromes.

Alcohol — the most tested substance

• Screening: CAGE (≥2 positive), AUDIT.
• Intoxication → CNS depression; withdrawal timeline:

Time after last drink	Syndrome
6–12 h	Tremors, anxiety, autonomic hyperactivity
12–24 h	Alcoholic hallucinosis (clear sensorium)
24–48 h	Withdrawal seizures (rum fits)
48–72 h+	Delirium tremens (clouded sensorium, autonomic storm, mortality up to 5%)

• DT treatment: benzodiazepines (chlordiazepoxide/lorazepam — lorazepam preferred in liver disease) + thiamine before glucose.
• Wernicke encephalopathy (thiamine deficiency): triad of confusion, ophthalmoplegia, ataxia → if untreated → Korsakoff psychosis (irreversible anterograde amnesia + confabulation). Always give thiamine before dextrose to prevent precipitating Wernicke.
• Anti-craving / deterrent agents: Disulfiram (blocks aldehyde dehydrogenase → acetaldehyde accumulation → flushing, vomiting; deterrent), acamprosate (NMDA modulator), naltrexone (opioid antagonist, reduces craving). Baclofen useful in hepatic patients.

Opioids

• Intoxication: pinpoint pupils (miosis), respiratory depression, drowsiness → antidote naloxone.
• Withdrawal (not life-threatening but distressing): lacrimation, rhinorrhea, yawning, piloerection, mydriasis, diarrhea, cramps. Managed with clonidine, buprenorphine, methadone.
• Maintenance/substitution: methadone (full agonist), buprenorphine (partial agonist) — central to harm-reduction and India's NACO opioid substitution therapy.

Other substances

Substance	Intoxication	Withdrawal/antidote
Benzodiazepines	Sedation, ataxia	Antidote flumazenil; withdrawal → seizures
Cannabis	Conjunctival injection, ↑appetite, anxiety, amotivational syndrome	Mild
Cocaine/amphetamine	Sympathomimetic, mydriasis, formication ("cocaine bugs"), psychosis	Crash: depression, hypersomnia
LSD/hallucinogens	Perceptual distortions, flashbacks	—
Inhalants	Common in street children (whitener, glue)	—
Nicotine	—	DOC varenicline (partial nicotinic agonist), bupropion, NRT

Concepts: Tolerance (need more for same effect), dependence, withdrawal, craving. Korsakoff = the only "true" amnestic confabulation classic.

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Childhood & Adolescent Psychiatry

A growing area in the new pattern, with developmental milestones overlapping Pediatrics.

Neurodevelopmental disorders

• Autism Spectrum Disorder (ASD): onset before 3 years; dyad of (1) persistent deficits in social communication/interaction and (2) restricted, repetitive behaviours/interests. Associated with intellectual disability in many, but not all. M>F. Echolalia, lack of eye contact, lack of joint attention, insistence on sameness. DSM-5 merged Asperger's and PDD-NOS into ASD.
• ADHD: inattention + hyperactivity-impulsivity, onset before 12 years (DSM-5 raised it from 7), symptoms in ≥2 settings. DOC = methylphenidate (stimulant); non-stimulant atomoxetine (selective NA reuptake inhibitor). Stimulants paradoxically calm; side effects: appetite/growth suppression, insomnia.
• Intellectual disability: IQ-based severity (mild 50–69, moderate 35–49, severe 20–34, profound <20). DSM-5 emphasizes adaptive functioning over IQ alone.
• Specific learning disorder: dyslexia (reading), dysgraphia (writing), dyscalculia (maths) with normal IQ.
• Tic disorders / Tourette: motor + ≥1 vocal tic >1 year; associated with OCD/ADHD; treat with clonidine, risperidone, haloperidol.

Childhood behavioural & emotional disorders

Disorder	Pearl
Enuresis	Involuntary urination ≥5 yrs; DOC behavioural (bell-and-pad alarm), then imipramine/desmopressin
Encopresis	Faecal soiling ≥4 yrs
Conduct disorder	Violation of others' rights/societal norms; precursor to antisocial personality
Oppositional defiant disorder	Defiant, hostile to authority, without major rights violation
Separation anxiety	Excessive distress on separation from caregiver
Selective mutism	Fails to speak in specific social situations
Rett syndrome	Girls, regression, hand-wringing stereotypy, MECP2 gene

Trap: ODD (argues with authority) vs conduct disorder (aggression, theft, cruelty, destruction). Conduct disorder before 15 + age ≥18 → antisocial personality disorder.

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Organic & Other High-Yield Areas

"Organic" covers cognitive disorders, sleep, eating, sexual, personality disorders and psychiatric emergencies — a broad bucket of frequently asked one-liners.

Delirium vs Dementia — the most repeated comparison in the subject

Feature	Delirium	Dementia
Onset	Acute (hours–days)	Insidious (months–years)
Course	Fluctuating, worse at night (sundowning)	Progressive, stable over a day
Consciousness	Impaired/clouded	Clear (until late)
Attention	Markedly impaired	Relatively preserved early
Reversibility	Usually reversible	Usually irreversible
EEG	Diffuse slowing	Often normal early
Hallmark	Acute confusional state	Memory loss with preserved consciousness

• Delirium is a medical emergency — find the cause (infection, electrolytes, drugs, hypoxia, withdrawal). Manage agitation with low-dose haloperidol (avoid BZDs except in alcohol/BZD withdrawal, where BZDs are the treatment).
• Dementia types: Alzheimer's (commonest, amyloid plaques + neurofibrillary tau tangles; DOC donepezil/rivastigmine/galantamine — cholinesterase inhibitors, plus memantine NMDA antagonist for moderate-severe), vascular (stepwise), Lewy body (visual hallucinations + parkinsonism + fluctuation + neuroleptic sensitivity), frontotemporal (Pick — early personality/behaviour change).

Sleep, eating, sexual disorders

• Narcolepsy: tetrad — excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations; ↓orexin/hypocretin; REM-onset sleep. Treat with modafinil; cataplexy with sodium oxybate/SNRI.
• Sleep architecture: deep sleep (slow-wave) disorders → sleepwalking, night terrors, enuresis (in NREM/stage N3); nightmares in REM.
• Anorexia nervosa: BMI low, fear of weight gain, distorted body image, amenorrhea; complications — lanugo, bradycardia, refeeding syndrome (hypophosphatemia), highest mortality of any psychiatric disorder. Bulimia nervosa: normal/high weight, binge + purge, Russell's sign (knuckle callus), parotid swelling, hypokalemic alkalosis, dental erosion. DOC for bulimia = fluoxetine; bupropion contraindicated.

Personality disorders (clusters)

Cluster	Members	Theme
A ("Mad/odd")	Paranoid, schizoid, schizotypal	Eccentric, withdrawn
B ("Bad/dramatic")	Antisocial, borderline, histrionic, narcissistic	Emotional, erratic
C ("Sad/anxious")	Avoidant, dependent, obsessive-compulsive (anankastic)	Fearful, anxious

• Borderline: unstable relationships, impulsivity, self-harm, splitting, fear of abandonment; DBT (dialectical behaviour therapy) is the evidence-based treatment.
• Antisocial: disregard for others' rights; cannot be diagnosed <18 yrs.

Psychiatric emergencies

Suicide, violence, NMS, serotonin syndrome, delirium tremens, lithium toxicity, acute dystonia, catatonia. Catatonia DOC = lorazepam (challenge test); refractory → ECT.

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Cross-Subject Integration

Psychiatry is heavily interlinked, and examiners exploit this:

• Pharmacology: antidepressant/antipsychotic mechanisms, receptor profiles, drug interactions (MAOI + tyramine, lithium + thiazide), antidotes (naloxone, flumazenil, cyproheptadine, dantrolene). Roughly half of Psychiatry MCQs are really pharmacology questions.
• Medicine/Neurology: Wernicke-Korsakoff, dementia subtypes, neuroleptic-sensitive Lewy body disease, hepatic encephalopathy vs delirium, thyroid disease mimicking depression/anxiety, SIADH (carbamazepine, SSRIs).
• Forensic Medicine & Law (very high-yield in INI-CET):
  • Mental Healthcare Act (MHCA) 2017 — replaced the 1987 Act; decriminalized attempted suicide (presumed under severe stress), introduced Advance Directive, Nominated Representative, Mental Health Review Boards, and the right to community living.
  • McNaughten rule — legal test of insanity (did not know nature/wrongfulness of act). Corresponds to Section 84 IPC (now Section 22 of the BNS, 2023 — "act of a person of unsound mind").
  • Testamentary capacity, fitness to stand trial, restraint.
• Pediatrics: developmental milestones, autism, ADHD, intellectual disability, enuresis.
• Obstetrics: postpartum blues (transient, days) vs postpartum depression (weeks) vs postpartum psychosis (emergency, often bipolar spectrum, risk of infanticide); teratogenic psychotropics (lithium-Ebstein, valproate-NTD).
• Community Medicine: National Mental Health Programme (NMHP, 1982) and District Mental Health Programme (DMHP); depression/suicide epidemiology; substance-use surveys.

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Recent Update Themes and Guideline Shifts

Examiners increasingly test changes from DSM-5 / DSM-5-TR and ICD-11, plus Indian statutory updates:

• DSM-5 structural changes: removal of the multiaxial system; autism spectrum disorder subsumes Asperger's; bipolar separated from depressive disorders; OCD-related and trauma-related disorders given their own chapters; gender dysphoria replaces "gender identity disorder"; ADHD onset age moved to <12 years; somatoform → "somatic symptom and related disorders."
• ICD-11 (in force): integrates a dimensional model for personality disorders (severity + trait domains rather than rigid categories); reorganizes mood and psychotic disorders; introduces complex PTSD and prolonged grief disorder.
• Mental Healthcare Act 2017 (India) — repeatedly tested: decriminalization of suicide, advance directives, nominated representative, rights-based framework, ban on unmodified ECT and on ECT in minors without specific safeguards.
• Bharatiya Nyaya Sanhita (BNS) 2023 replacing IPC: insanity defence shifts from IPC Section 84 to BNS Section 22.
• Newer drugs: esketamine (intranasal) for treatment-resistant depression; brexanolone for postpartum depression; VMAT2 inhibitors (valbenazine, deutetrabenazine) for tardive dyskinesia; cariprazine, lumateperone among newer antipsychotics; lemborexant/suvorexant (orexin antagonists) for insomnia.

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Study Roadmap

Phase 1 — Build the skeleton (Week 1)

Master phenomenology, defence mechanisms, and the duration/criteria tables. These appear in nearly every paper and underpin diagnosis. Make a single A4 sheet of the duration spectrum (brief psychotic → schizophrenia) and the delirium-vs-dementia table.

Phase 2 — Disorder groups (Weeks 2–3)

Go group by group exactly as on this page: Mood → Psychotic → Anxiety → Substance → Childhood → Organic. For each, fix (a) one-line definition, (b) diagnostic criterion, (c) first-line drug, (d) the classic trap.

Phase 3 — Pharmacology overlay (Week 3–4)

Because ~50% of questions are drug-based, dedicate focused time to antidepressant classes, antipsychotic EPS/metabolic profiles, lithium monitoring, antidotes, and withdrawal management. Integrate with your Pharmacology revision rather than treating it separately.

Phase 4 — Integration & PYQs (Week 4 onward)

Solve previous-year NEET PG/INI-CET/AIIMS questions — Psychiatry repeats more than any other subject. Add the forensic/MHCA-2017 crossover and the obstetric/pediatric overlaps.

Last-week revision strategy

• Revise only your one-page tables and one-liners — do not start new sources.
• Re-do every PYQ you previously got wrong.
• Drill the four "must-not-confuse" pairs: NMS vs serotonin syndrome, delirium vs dementia, factitious vs malingering, hypomania vs mania.
• Memorize all antidotes and first-line drugs as a flash list (highest marks-per-minute).
• Skim the recent guideline shifts (DSM-5/ICD-11/MHCA 2017/BNS) the night before — these are favourite "current" items.

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High-Yield Mnemonics

• Depression — SIG E CAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.
• Mania — DIG FAST: Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity, Sleep ↓, Talkativeness.
• Schizophrenia negatives — 6 A's: Affective flattening, Alogia, Avolition, Anhedonia, Asociality, Attention deficit.
• TCA toxicity — 3 C's: Cardiotoxicity, Convulsions, Coma (+ anticholinergic).
• Wernicke triad — COA: Confusion, Ophthalmoplegia, Ataxia.
• Opioid withdrawal — wet symptoms: lacrimation, rhinorrhea, sweating, diarrhea (vs dry-mouth intoxication with miosis).
• Personality clusters: A = "weird" (Mad), B = "wild" (Bad), C = "worried" (Sad).

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Rapid-Fire One-Liners

1. DOC for OCD — SSRIs (high dose) / clomipramine; add ERP.
2. Only proven anti-suicidal mood stabilizer — lithium.
3. Earliest sign of lithium toxicity — coarse tremor / GI upset; therapeutic range 0.6–1.2 mEq/L.
4. DOC for treatment-resistant schizophrenia — clozapine (watch for agranulocytosis).
5. Serotonin syndrome antidote — cyproheptadine; NMS — dantrolene + bromocriptine.
6. Wernicke encephalopathy — give thiamine before glucose; Korsakoff = irreversible amnesia + confabulation.
7. Delirium tremens treatment — benzodiazepines (+ thiamine).
8. Othello syndrome — delusion of marital infidelity; de Clérambault (erotomania) — belief a famous person loves you.
9. Cotard syndrome — nihilistic delusion ("I am dead"); seen in severe depression.
10. DOC for ADHD — methylphenidate (stimulant); non-stimulant = atomoxetine.
11. Highest mortality psychiatric disorder — anorexia nervosa; watch for refeeding syndrome (hypophosphatemia).
12. MHCA 2017 — decriminalized attempted suicide, introduced advance directives and nominated representatives.

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Master the tables, the antidotes, and the duration criteria, and Psychiatry becomes the most efficient mark-scoring subject in your entire preparation.