Can you provide a concise overview of the most common adult and pediatric psychiatric disorders, their first‑line treatments, and typical exam‑style questions about the effects and side effects of commonly used medications?

MCCQE Psychiatric Disorders Quick Reference

ADULT PSYCHIATRIC DISORDERS

Major Depressive Disorder (MDD)

For acute MDD, both second-generation antidepressants and nonpharmacologic treatments (CBT, exercise) show similar efficacy as first-line options, though the certainty of evidence is low for most comparisons 1.

First-Line Treatment Options:

• SSRIs (selective serotonin reuptake inhibitors) - most commonly prescribed in primary care 1
• SNRIs (serotonin-norepinephrine reuptake inhibitors)
• Cognitive Behavioral Therapy (CBT)
• Exercise, acceptance and commitment therapy, integrative therapies 1

Second-Step Strategies (for non-responders):

• Switching antidepressants
• Augmentation with second medication or psychological intervention
• Different switching/augmentation strategies provide similar symptomatic relief 1

Key Facts for Exams:

• >60% of patients on second-generation antidepressants experience at least 1 adverse effect 1
• Up to 70% do not achieve remission during initial treatment 1
• Antidepressants have higher discontinuation rates due to adverse events compared to other treatments 1

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Anxiety Disorders (GAD, Panic, Social Anxiety)

SSRIs and SNRIs represent first-line pharmacotherapy for adult anxiety disorders 2.

First-Line:

• SSRIs - preferred initial choice 2
• SNRIs 2

Second-Line:

• Buspirone (azapirone) 3, 2
• Benzodiazepines 3, 2
• Second-generation antipsychotics (SGAs) 3, 2
• Pregabalin 2

Alternative Options:

• Anti-adrenergic medications 3
• Melatonin analogs 3
• Kava, lavender oil 3

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PEDIATRIC PSYCHIATRIC DISORDERS

Anxiety Disorders in Children/Adolescents

Both CBT and SSRIs have considerable empirical support as safe and effective short-term treatments for pediatric anxiety 4.

First-Line Treatment:

• Cognitive-Behavioral Therapy (CBT) 4
• SSRIs - first-line pharmacotherapy 4, 5, 3
• Psychotherapy enhances antidepressant response 3

Second-Line:

• SNRIs - limited role, some empirical support 4, 5

Epidemiology for Exams:

• Nearly 7% of youths have anxiety disorder at any given time 4
• Lifetime prevalence in US: 20-30% 4
• Specific phobia: 20%, Social anxiety: 9%, Separation anxiety: 8%, GAD/Panic/Agoraphobia: 2% each 4

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Depression in Children/Adolescents

SSRIs are the first-line psychopharmacologic intervention for youths with depressive disorders 5.

Treatment:

• SSRIs - first-line 5, 6
• SNRIs - more limited role 5
• Generally safe and well-tolerated 5

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ADHD in Children

Stimulants and nonstimulants can both be used as first-line interventions 6.

First-Line:

• Stimulants 6
• Nonstimulants 6

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COMMONLY TESTED MEDICATION SIDE EFFECTS

Stimulants (ADHD):

• Appetite suppression 7
• Initial insomnia 7

Nonstimulants (ADHD):

• Sedation 7

Antidepressants (SSRIs/SNRIs):

• Generally well-tolerated 7
• Behavioral activation early in treatment 7
• Treatment-emergent mania (rare) 7
• Suicidal ideation (rare) - key research need remains evaluating suicide risk in children/adolescents 4, 7
• >60% experience at least one adverse effect 1

Atypical Antipsychotics:

• Weight gain 7
• Metabolic syndrome 7
• Requires monitoring strategies 7

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CLINICAL PEARLS FOR MCCQE

Common Pitfalls:

• Do not assume all patients respond to first-line treatment - 70% of MDD patients fail initial antidepressant trial 1
• Antidepressants have higher discontinuation rates than other MDD treatments due to adverse events 1
• In pediatric anxiety, psychotherapy enhances medication response - consider combination therapy 3

Monitoring Requirements:

• Antipsychotics require metabolic monitoring (weight, glucose, lipids) 7
• Watch for behavioral activation when starting antidepressants in youth 7
• Monitor for treatment-emergent suicidal ideation, especially in adolescents 4, 7

Treatment Duration:

• Anxiety disorders in youth tend to be chronic with waxing and waning course 4
• Consider long-term management strategies beyond acute treatment 4