By Ravish Amin

Preparing well for the psychiatry shelf exam requires studying multiple resources such as board review books, reference texts (for reading up on your patients’ specific conditions), and practice questions from USMLE-Rx.com to master core concepts. Psychopharmacology is essential high-yield content for shelf exams. Most common psychiatric symptoms such as anxiety, dementia, depression, psychosis, and delirium, are learned by a multifaceted approach. Reading, doing practice questions, studying board review books, and (perhaps most importantly) developing interview techniques to obtain relevant information from your patients will help you excel on your psych rotation.

  1. Psychopharmacology: Mechanisms of action, indications, side effects, and other high-yield facts are efficiently reviewed by organizing treatments with diseases on flashcards and grouping drugs by classes. As an example, psychotic diseases are often treated with first- and/or second-generation antipsychotic medications. You’ll need to review the pharmacology, administration, and comparative side effects, as well as acute and maintenance treatment. Compare and contrast medicines for treating a specific psychiatric condition. For depression, this should include monoamine oxidase inhibitors (MAOIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitor (SSRI) antidepressants. Treatment of bipolar disease requires studying pharmacotherapy for acute mania, mixed episodes, and hypomania as well as supportive psychotherapy. Become adept in choosing treatment for patient scenarios and spend time memorizing the class to which a given drug belongs (i.e. SSRI, MAOIs, SNRIs, etc.). I suggest you review the FIRST AID for USMLE Step 1 psychiatry section. Other resources you might consider include: FIRST AID for the Psychiatry Clerkship, Crush Step 2, and Case Files Psychiatry.
  2. Patient Approach Techniques: Reviewing each patient’s history in detail and developing a strong relationship with him/her will help you to be more effective at interviewing psych patients on the wards. Reading board review books will help you to master the classical presentations of common psych patient scenarios. Don’t forget to review the Folstein mini mental status exam.
  3. Study And Compare  – Do not skip topics such as factitious disorder, Munchausen syndrome, hypochondriasis, and somatization, as these are easily confused. Also, make sure you review eating disorders, personality disorders, dissociative disorders and impulse control disorders in order to maximize your score. You may also want to develop comparisons between disease treatment for conditions like anorexia nervosa, binge-eating disorder and bulimia nervosa.
  4. Develop Differential Diagnoses – Many questions on the psych shelf attempt to test your ability to differentiate between conditions with similar features, such as generalized anxiety disorder and obsessive-compulsive disorder, panic disorder and posttraumatic stress disorder, or social anxiety disorder and phobias. Review cases and vignettes (like those found in USMLE-Rx Qmax for Step 2) to test your knowledge. You can enhance your studying by classifying symptoms as differentiating or common between disease types. For example, you should know the negative and positive symptoms of schizophrenia and how they differ from the symptoms of mania or hypomania.

Got a trick you use(d) to study for the psychiatry shelf exam? Share it below!