100+ Free ABPN Psychiatry Practice Questions

Mood Disorders & Psychopharmacology

MDD (PHQ-9), persistent depressive disorder, PMDD, DMDD, bipolar I vs II, cyclothymia, mixed features, peripartum depression/psychosis, seasonal pattern. SSRIs first-line, SNRIs, bupropion (AVOID in seizure disorder or eating disorder), mirtazapine (weight gain, appetite stimulation), TCAs, MAOIs (tyramine-restricted diet). Lithium (0.6-1.2 mEq/L, monitor TSH, creatinine; toxicity — tremor, diarrhea, confusion). Valproate (LFTs, hyperammonemia, PCOS, teratogen — avoid in pregnancy). Lamotrigine (first-line bipolar depression; slow titration for SJS risk). Esketamine/ketamine for TRD. ECT, rTMS, VNS.

Psychotic Disorders & Antipsychotics

Schizophrenia DSM-5-TR (6-month duration with ≥1 month active symptoms — delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms), schizoaffective, schizophreniform (1-6 months), brief psychotic (<1 month), delusional disorder. Typical antipsychotics — EPS (parkinsonism, acute dystonia, akathisia, tardive dyskinesia). Atypicals — metabolic syndrome monitoring (weight, HbA1c, lipids at baseline/3mo/annual). Clozapine — treatment-resistant schizophrenia, ANC monitoring (weekly × 6 months, then biweekly, then monthly), myocarditis, sialorrhea, seizures. Aripiprazole partial D2 agonist; ziprasidone QTc; lurasidone, cariprazine, lumateperone.

Anxiety, OCD & Trauma-Related Disorders

GAD, panic disorder, social anxiety disorder, specific phobia, separation anxiety. OCD — SSRIs at higher doses plus exposure-response prevention (ERP). BDD, hoarding disorder. PTSD DSM-5-TR criteria — intrusion, avoidance, negative alterations in cognitions/mood, marked alterations in arousal/reactivity, duration >1 month. SSRIs first-line (sertraline, paroxetine FDA-approved); prazosin for trauma-related nightmares; trauma-focused CBT (TF-CBT), EMDR, prolonged exposure (PE), cognitive processing therapy (CPT). Acute stress disorder, adjustment disorder, somatic symptom disorder, illness anxiety, functional neurologic symptom (conversion) disorder, factitious disorder.

Substance Use Disorders

DSM-5-TR SUD criteria (11 items; mild 2-3, moderate 4-5, severe ≥6). Alcohol withdrawal — CIWA-Ar benzodiazepine symptom-triggered taper; thiamine BEFORE glucose to prevent Wernicke-Korsakoff. AUD pharmacotherapy — naltrexone, acamprosate, disulfiram. OUD — methadone (opioid treatment programs), buprenorphine/naloxone sublingual (X-waiver eliminated with 2022 MAT Act — any DEA-licensed clinician may prescribe), naltrexone XR injection. Stimulant use disorder — no FDA-approved pharmacotherapy, contingency management. Tobacco — varenicline, bupropion, NRT. Benzodiazepine withdrawal (seizure risk).

Neurocognitive Disorders

Delirium — CAM (acute change, inattention, disorganized thinking, altered consciousness), hyperactive vs hypoactive, reversible causes (infection — UTI/pneumonia, medications — anticholinergics/opioids/benzos, electrolytes, hypoxia). Manage underlying cause first; low-dose haloperidol or olanzapine for severe agitation; AVOID benzodiazepines except for alcohol/BZD withdrawal. Major NCD (dementia) — Alzheimer (MMSE/MoCA, cholinesterase inhibitors — donepezil/rivastigmine/galantamine; memantine for moderate-severe; anti-amyloid lecanemab/donanemab). Vascular. Lewy body — visual hallucinations, REM behavior disorder, parkinsonism; EXTREME neuroleptic sensitivity — AVOID typical antipsychotics. Frontotemporal, Huntington, CJD.

Child & Adolescent Psychiatry

ADHD — stimulants first-line school-age (methylphenidate vs amphetamine classes); non-stimulants atomoxetine, guanfacine ER, clonidine ER; per AAP 2019 guidelines, behavioral interventions (parent training) are first-line in children under age 6. Autism spectrum disorder — risperidone and aripiprazole FDA-approved for irritability/aggression. Conduct disorder, oppositional defiant disorder, Tourette disorder. Pediatric anxiety/OCD/depression — fluoxetine FDA-approved down to age 8 for MDD; escitalopram from age 12. Pediatric bipolar disorder — lithium, risperidone, aripiprazole, olanzapine. Early-onset eating disorders.

Psychiatric Assessment & DSM-5-TR

Comprehensive psychiatric interview — HPI, past psychiatric history, substance use, medical, family, social/developmental, trauma history. Mental status examination (MSE) — appearance, behavior, speech, mood/affect, thought process/content, perceptions (hallucinations), cognition (orientation, memory, MMSE/MoCA), insight, judgment. Differential diagnosis, provisional vs rule-out. Cultural Formulation Interview (CFI) for cultural concepts of distress. Severity and course specifiers. DSM-5 eliminated the five-axis system. DSM-5-TR (2022) added prolonged grief disorder and updated criteria; suicidal behavior and non-suicidal self-injury remain conditions for further study.

Personality & Geriatric Psychiatry

DSM-5 personality disorder clusters — A (paranoid, schizoid, schizotypal — odd/eccentric); B (antisocial, borderline, histrionic, narcissistic — dramatic/erratic); C (avoidant, dependent, obsessive-compulsive — anxious/fearful). BPD — dialectical behavior therapy (DBT) first-line; pharmacotherapy only for comorbid symptoms. Late-onset depression — medical comorbidities, higher suicide risk in older men; Geriatric Depression Scale screening. Dementia-related behavioral symptoms — non-pharmacologic interventions FIRST; atypical antipsychotics carry BLACK BOX warning for increased mortality in older adults with dementia-related psychosis. Elder abuse, fall risk from psychotropics, Beers Criteria (avoid benzodiazepines, anticholinergics, long-acting hypnotics).

Eating, Sleep & Reproductive Psychiatry

Anorexia nervosa — nutritional rehabilitation (watch for refeeding syndrome — hypophosphatemia, hypokalemia, hypomagnesemia, thiamine depletion), olanzapine may help, SSRIs not helpful in acute low-weight state; complications — bradycardia, QTc prolongation, osteoporosis. Bulimia nervosa — fluoxetine 60 mg FDA-approved; CBT-E. Binge-eating disorder — lisdexamfetamine FDA-approved. Insomnia — CBT-I first-line; trazodone, low-dose doxepin, BZRAs cautiously; suvorexant/lemborexant (orexin antagonists). OSA, narcolepsy (modafinil, pitolisant, sodium oxybate). PMDD — SSRI continuous or luteal phase. Peripartum depression — sertraline preferred in breastfeeding; brexanolone IV and zuranolone PO FDA-approved.

Psychotherapy & Evidence-Based Interventions

CBT — cognitive triad, cognitive distortions (all-or-nothing, catastrophizing), behavioral activation for depression, exposure for anxiety/phobias. DBT (Linehan) — mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness — first-line for BPD and chronic suicidality. Interpersonal therapy (IPT) — grief, role transitions, interpersonal disputes, interpersonal deficits. Psychodynamic — transference/countertransference, mature vs immature defense mechanisms (sublimation/humor vs projection/splitting/denial). Motivational interviewing (OARS — open questions, affirmations, reflections, summaries) for ambivalence. MBT, TF-CBT, PE, CPT, family therapy, supportive therapy.

Emergency, Ethics & Neurostimulation

Suicide risk assessment — Columbia Suicide Severity Rating Scale (C-SSRS) — ideation/plan/intent/means; acute interventions — safety planning, means restriction (firearms, medications), voluntary vs involuntary hospitalization. Violence risk (history of violence is strongest predictor). Acute agitation — verbal de-escalation first; then IM olanzapine, ziprasidone, or haloperidol plus lorazepam. Serotonin syndrome — hyperreflexia, clonus (lower > upper), hyperthermia — supportive, cyproheptadine. NMS — lead-pipe rigidity, hyperthermia, altered mental status, autonomic instability, CK elevation — stop antipsychotic, supportive care, dantrolene, bromocriptine. Tarasoff duty to warn/protect (CA 1976). Capacity vs competency, informed consent. NGRI M'Naghten test. ECT, rTMS, VNS, phototherapy.