What are the key topics to focus on when preparing for a psychiatry board interview?

Key Topics for Psychiatry Board Interview Preparation

Focus your preparation on demonstrating competency in conducting comprehensive psychiatric assessments, managing acute psychiatric emergencies, understanding psychopharmacology principles, and recognizing medical conditions that mimic psychiatric disorders.

Core Clinical Assessment Skills

The Psychiatric Interview Structure

• Master the structured diagnostic interview format that systematically covers chief complaint, history of present illness, past psychiatric history, substance use history, medical history, family history, social history, and mental status examination 1, 2
• Demonstrate ability to adapt interview techniques for different populations, including simplifying questions and allowing extra processing time for patients with cognitive limitations 1
• Show proficiency in gathering collateral information from knowledgeable informants across multiple settings to construct baseline functioning and identify symptom changes 1
• Practice eliciting both factual information and emotional content while maintaining appropriate interview control 3

Mental Status Examination

• Be prepared to perform and document a complete mental status examination assessing appearance, behavior, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, and judgment 1, 4
• Demonstrate ability to distinguish developmentally appropriate behaviors from psychiatric symptoms, particularly when evaluating patients with intellectual disabilities 1
• Show competence in assessing for suicidal ideation, homicidal ideation, and risk assessment 5, 6

Medical Clearance and Differential Diagnosis

Determining Medical Stability

• Understand that "medical stability" is preferred terminology over "medical clearance" - you are determining whether medical conditions require acute treatment, not providing blanket clearance 4
• Obtain and interpret vital signs as abnormal vitals may indicate underlying medical causes of psychiatric symptoms 4
• Perform targeted physical examination focusing on neurologic, cardiac, and respiratory systems rather than routine comprehensive exams 4

Laboratory Testing Approach

• Order laboratory tests based on clinical findings from history and physical examination, not as routine screening 1, 4
• Recognize that false positive results are 8 times more common than true positives when ordering indiscriminate testing 4
• Understand that most abnormal results can be predicted from history and physical examination 4

High-Risk Populations Requiring Enhanced Evaluation

• Identify patients requiring more extensive workup: elderly patients, those with substance abuse, patients without prior psychiatric history, and those with new medical complaints 4
• Recognize medical conditions that masquerade as psychiatric disorders including neurologic disorders, metabolic/endocrine disorders, respiratory conditions, and medication effects 4

Acute Psychiatric Emergencies

Agitation Management

• Know pharmacologic options for acute agitation, including benzodiazepines and antipsychotics, with understanding of their comparative efficacy and side effect profiles 1
• Demonstrate ability to attempt verbal de-escalation before proceeding to pharmacologic intervention 1
• Understand that most agitation studies were conducted in patients with known psychiatric diagnoses 1

Substance Intoxication Assessment

• Base psychiatric evaluation initiation on the patient's cognitive abilities rather than specific blood alcohol levels 1
• Understand that no evidence supports delaying psychiatric evaluation for predetermined blood alcohol concentrations if the patient is alert with appropriate cognition 1
• Consider using observation periods to determine if psychiatric symptoms resolve as intoxication resolves 1

Drug Screening Utility

• Recognize that routine urine toxicology screening does not affect management in alert, cooperative patients with normal vital signs and noncontributory history and physical examination 1
• Understand that drug screening results rarely lead to justified changes in management plans 1

Psychopharmacology Principles

Antidepressant Selection and Management

• Match antidepressants to specific symptom profiles: sedating agents (mirtazapine, trazodone) for insomnia and anxiety; activating agents (bupropion, fluoxetine) for fatigue and psychomotor retardation 7
• Understand that most second-generation antidepressants have similar efficacy for moderate depression 1, 7
• Know that adequate trials require appropriate dosing for 6-8 weeks before determining efficacy 7

Medication Monitoring

• Assess therapeutic response and adverse effects within 1-2 weeks of starting therapy 7
• Continue treatment for 4-9 months after satisfactory response for first-episode depression; longer for recurrent depression 7
• Monitor for activation of mania or hypomania, particularly in patients with risk factors for bipolar disorder 8

Augmentation Strategies

• Know that aripiprazole 2-20 mg/day can be added for inadequate response to antidepressant monotherapy after 6-8 weeks of optimized therapy 9
• Monitor metabolic parameters (weight, glucose, lipids) when using augmentation strategies 9

Common Adverse Effects and Safety Concerns

• Counsel patients about discontinuation syndrome symptoms including dizziness, headache, nausea, paresthesia, and irritability 8
• Recognize serotonin syndrome risk with concomitant use of multiple serotonergic agents 8
• Understand increased bleeding risk with combined use of antidepressants and NSAIDs, aspirin, or anticoagulants 8
• Monitor for orthostatic hypotension, particularly during initial treatment and dose escalation 8

Special Populations

Pediatric Considerations

• Implement medication trials using adequate dose and duration appropriate for the child's size and age 1
• Obtain informed consent/assent discussing benefits, risks, and alternatives with both patient and family 1
• Base expectations for behavior on developmental level rather than chronological age 1

Patients with Intellectual Disabilities

• Assess environmental and psychosocial factors including changes in routine, educational placement appropriateness, and stressors 1
• Recognize increased vulnerability to trauma, abuse, and bullying in this population 1
• Avoid "diagnostic overshadowing" - attributing all symptoms to the underlying intellectual disability 1

Documentation Standards

Critical Documentation Elements

• Document "medically stable for psychiatric evaluation" rather than "medically cleared" 4
• Record thorough neurological examination findings 4
• Clearly document rationale for any laboratory or imaging studies ordered 4

Common Pitfalls to Avoid

• Never order routine laboratory panels for all psychiatric patients regardless of clinical presentation 4
• Never fail to document a thorough neurological examination 4
• Never assume younger patients cannot have medical causes of psychiatric symptoms 4
• Never use inadequate medication doses or insufficient trial duration before declaring treatment failure 7
• Never ignore medical comorbidities and potential drug interactions when selecting psychotropic medications 7
• Never overlook patient preferences and tolerability issues in treatment planning 7