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2026 Statistics

Key Facts: Atestace z Psychiatrie Exam

100 Questions

Practice Vignette Bank Single-Best-Answer MCQs

Věstník MZ ČR & ČPS ČLS JEP Curriculum

500 CZK

Official Standard Board Examination Fee (250 + 250 CZK)

Nařízení vlády č. 324/2018 Sb.

5 Years

Postgraduate Residency Training Duration (Kmen + Výcvik)

Zákon č. 95/2004 Sb. / Věstník MZ ČR

Min. 3 Members

Statutory Board Examination Committee Quorum

Vyhláška č. 282/2019 Sb.

Practical + Oral

Official Two-Part Examination Structure

Vyhláška č. 282/2019 Sb.

EU Directive

European Mutual Qualification Recognition

Directive 2005/36/EC

The Czech Medical Specialty Board Examination in Psychiatry (Atestační zkouška v oboru Psychiatrie) is the final licensing board examination administered under Zákon č. 95/2004 Sb. and Vyhláška č. 282/2019 Sb. before an at least 3-member committee. It evaluates candidate competency across 5 core pillars: Schizophrenia & Psychotic Disorders (25%), Mood & Affective Disorders (25%), Anxiety, OCD & Trauma-Related Disorders (15%), Substance Use & Addictive Disorders (15%), and Organic Mental Disorders, Child/Geriatric Psychiatry & Psychopharmacology (20%). This practice bank offers 100 comprehensive clinical vignette practice MCQs in an English-language study adaptation.

Sample Atestace z Psychiatrie Practice Questions

Try these sample questions to test your Atestace z Psychiatrie exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 22-year-old university student is brought to the outpatient psychiatric clinic by his parents due to a 2-month history of progressive social withdrawal, bizarre persecutory delusions that intelligence agencies are transmitting radio waves into his teeth, and audible running commentary voices discussing his movements. Physical and toxicology screenings are unremarkable. According to ICD-10 criteria (F20.0), what is the minimum duration of characteristic psychotic symptoms required to establish a definitive diagnosis of schizophrenia?

A.At least 1 month

B.At least 3 months

C.At least 6 months

D.At least 12 months

Explanation: Under ICD-10 (F20), the diagnostic criteria for schizophrenia require characteristic psychotic symptoms (such as Schneiderian first-rank symptoms, thought echo/insertion, delusions of control, or running commentary hallucinatory voices) to be clearly present for the major part of a period of at least 1 month. In contrast, DSM-5-TR requires continuous signs of the disturbance to persist for at least 6 months (with at least 1 month of active-phase symptoms). Czech national psychiatric practice historically follows ICD-10 (with gradual transition to ICD-11, which also specifies a 1-month threshold for schizophrenia).

2A 24-year-old male presents with a first episode of non-affective psychosis (paranoid schizophrenia). Somatic and neurological examinations are normal. According to the recommended clinical guidelines of the Czech Psychiatric Society (ČPS ČLS JEP) and European Psychiatric Association (EPA), what is the first-line pharmacological strategy?

A.Immediate initiation of clozapine combined with sodium valproate

B.Monotherapy with a second-generation (atypical) antipsychotic at the lower-to-middle recommended therapeutic dose

C.High-dose haloperidol combined with prophylactic trihexyphenidyl

D.Simultaneous combination of two first-generation antipsychotics with oral diazepam

Explanation: Czech ČPS ČLS JEP and EPA guidelines recommend second-generation antipsychotic (SGA) monotherapy (e.g., risperidone, aripiprazole, olanzapine, or quetiapine) as first-line treatment for first-episode psychosis. First-episode patients demonstrate heightened neurochemical sensitivity and elevated vulnerability to extrapyramidal symptoms, making lower-to-middle dose ranges optimal. Polypharmacy and first-generation high-potency agents should be avoided as initial choices.

3A 29-year-old woman with paranoid schizophrenia has failed two sequential, adequate 6-week monotherapy trials of atypical antipsychotics (risperidone 6 mg/day and olanzapine 20 mg/day) with verified treatment adherence. She remains tormented by continuous imperative auditory hallucinations and persecutory delusions. What is the evidence-based next step in management according to Czech and international consensus?

A.Add a third-generation partial agonist (aripiprazole) to olanzapine

B.Switch to high-potency first-generation depot fluphenazine

C.Initiate clozapine monotherapy with mandatory hematological monitoring

D.Refer immediately for bilateral prefrontal stereotactic leucotomy

Explanation: This patient meets the validated consensus criteria for treatment-resistant schizophrenia (TRS): lack of satisfactory clinical response despite two adequate trials of different antipsychotics at therapeutic doses for at least 4 to 6 weeks with confirmed adherence. Under ČPS ČLS JEP and international guidelines, clozapine is the gold-standard, evidence-based medication for TRS and should be initiated promptly rather than delaying with sequential ineffective trials. Mandatory absolute neutrophil count (ANC) monitoring is required to detect life-threatening agranulocytosis.

4A 34-year-old patient with treatment-resistant schizophrenia is receiving clozapine 400 mg daily. During routine weekly hematological surveillance in month 2 of therapy, his absolute neutrophil count (ANC) drops to 1.2 × 10^9/L (1,200/µL), while his total white blood cell (WBC) count is 2.8 × 10^9/L. He is afebrile and asymptomatic. According to standard clozapine safety protocols, what action is required?

A.Continue clozapine at the same dose and recheck ANC in one month

B.Immediately interrupt clozapine therapy, perform daily hematological monitoring, and avoid bone-marrow suppressing agents

C.Increase clozapine to 600 mg daily and administer prophylactic broad-spectrum oral amoxicillin

D.Switch immediately to chlorpromazine 800 mg daily without hematological monitoring

Explanation: An ANC between 1.0 and 1.49 × 10^9/L corresponds to moderate neutropenia (or severe leukopenia under older thresholds). Under Czech and international clozapine monitoring protocols, an ANC below 1.5 × 10^9/L mandates immediate cessation of clozapine to prevent progression to fulminant agranulocytosis (ANC < 0.5 × 10^9/L). Daily hematological monitoring must be instituted until hematological recovery is verified, and hematology consultation should be obtained.

5A 26-year-old man with paranoid schizophrenia who achieved symptom stabilization on oral aripiprazole experiences repeated relapses due to medication non-adherence following discharge. The psychiatric treatment team proposes switching to a long-acting injectable (LAI) antipsychotic. Which clinical practice principle is paramount when establishing an LAI regimen in the Czech healthcare framework?

A.Oral tolerability to the specific active substance or class must be established prior to the first depot injection

B.Depot injections should be administered into the deltoid muscle exclusively using a 14-gauge needle without aspiration

C.Oral antipsychotics must always be permanently discontinued 2 weeks prior to administering the first LAI dose

D.Long-acting injectables are legally restricted to patients placed under involuntary protective psychiatric treatment (ochranné léčení)

Explanation: Before initiating any long-acting injectable (LAI) antipsychotic, oral tolerability to the respective molecule (or parent drug) must be proven to ensure the patient does not experience severe idiosyncratic hypersensitivity, acute dystonia, or neuroleptic malignant syndrome while a long-lasting depot remains in muscle tissue. For aripiprazole LAI, oral aripiprazole must also be continued for 14 consecutive days after the initial injection to maintain therapeutic blood levels until depot release stabilizes.

6Forty-eight hours after increasing haloperidol from 5 mg to 15 mg daily, a 28-year-old male becomes acutely confused, mute, and diaphoretic. Physical examination reveals severe generalized 'lead-pipe' muscle rigidity, blood pressure of 175/105 mmHg, heart rate of 124 bpm, and temperature of 39.4°C. Laboratory workup reveals serum creatine kinase (CK) of 18,500 IU/L and marked leukocytosis (16.2 × 10^9/L). What is the primary diagnosis and immediate intervention?

A.Serotonin syndrome; administer cyproheptadine and continue haloperidol

B.Neuroleptic malignant syndrome (NMS); immediately discontinue haloperidol, institute intensive supportive care, and consider dantrolene or bromocriptine

C.Acute anticholinergic delirium; administer high-dose biperiden intravenously

D.Catatonic stupor of schizophrenia; initiate high-dose fluphenazine intramuscularly

Explanation: This patient exhibits the classic tetrad of Neuroleptic Malignant Syndrome (NMS): hyperthermia, extreme muscular rigidity (lead-pipe), autonomic instability (tachycardia, labile blood pressure, diaphoresis), and altered mental status, accompanied by marked elevation of serum CK and leukocytosis. The immediate management requires prompt cessation of all antidopaminergic agents, intensive medical care (hydration, active cooling), and specific pharmacotherapy with dopamine agonists (bromocriptine) or direct muscle relaxants (dantrolene).

7A 21-year-old male with acute psychosis is treated with intramuscular haloperidol 5 mg. Two hours later, he develops sudden, painful sustained upward deviation of the eyes (oculogyric crisis) and involuntary twisting of the neck (torticollis). He is conscious and distressed. What is the definitive acute pharmacological treatment?

A.Intravenous or intramuscular anticholinergic agent (e.g., biperiden 5 mg)

B.Oral propranolol 40 mg

C.Subcutaneous apomorphine 2 mg

D.Intramuscular flumazenil 0.5 mg

Explanation: The clinical presentation represents an acute dystonic reaction, a common early extrapyramidal side effect resulting from acute dopamine D2 receptor blockade in the nigrostriatal pathway, leading to relative cholinergic excess. The definitive emergency treatment is a parenteral anticholinergic (central muscarinic antagonist) such as biperiden (5 mg IM or slow IV), which promptly restores the dopamine-acetylcholine balance within minutes.

8A 38-year-old woman treated with risperidone 4 mg daily complains of an unbearable inner subjective sense of motor restlessness, compelling her to constantly pace the room, rock from foot to foot while standing, and cross and uncross her legs. She denies anxiety or worsening psychotic thoughts. What is this syndrome, and what is the recommended initial intervention?

A.Psychotic agitation; increase risperidone to 8 mg daily

B.Neuroleptic-induced akathisia; lower the antipsychotic dose if clinically feasible and initiate a beta-blocker (propranolol) or short-term benzodiazepine

C.Restless legs syndrome; prescribe pramipexole and discontinue all psychotropics

D.Tardive dyskinesia; initiate high-dose tetrabenazine immediately

Explanation: Akathisia is characterized by a distressing subjective drive to move accompanied by objective motor restlessness (pacing, shifting weight, inability to sit still). It is an extrapyramidal adverse effect linked to dopamine D2 blockade in the ventral striatum and mesocortical pathways. First-line management consists of reducing the antipsychotic dose, switching to an agent with lower D2 occupancy/affinity, or adding a lipophilic beta-blocker such as propranolol (20–80 mg/day) or a short-term low-dose benzodiazepine.

9A 52-year-old female with a 20-year history of schizophrenia managed with chlorpromazine and flupenthixol develops involuntary, repetitive stereotypic movements of the tongue, smacking of the lips, and choreiform movements of the fingers. The abnormal movements persist when her attention is diverted and disappear during sleep. What is the underlying pathophysiology of tardive dyskinesia (TD)?

A.Acute supersensitivity of postsynaptic dopamine D2 receptors and neuroplastic synaptic alterations in the basal ganglia following chronic D2 blockade

B.Excessive destruction of cholinergic interneurons in the substantia nigra pars compacta

C.Central upregulation of serotonin 5-HT2A receptors in the occipital cortex

D.Autoimmune antibodies targeting NMDA glutamate receptor subunits

Explanation: Tardive dyskinesia (TD) develops after prolonged exposure (at least months or years) to dopamine receptor blocking agents. The primary pathophysiological mechanism involves chronic blockade of striatal dopamine D2 receptors leading to compensatory upregulation and dopamine receptor supersensitivity, accompanied by mal-adaptive neuroplastic changes and oxidative stress within the cortico-striato-thalamo-cortical motor loop. Treatment involves switching to clozapine or quetiapine, or utilizing vesicular monoamine transporter 2 (VMAT2) inhibitors.

10A 23-year-old patient diagnosed with schizophrenia becomes completely immobile, stuporous, and mute. On passive physical manipulation of his limbs, his arms remain fixed in an awkward, suspended posture for over 20 minutes (catalepsy and waxy flexibility / flexibilitas cerea). He exhibits negativism and autonomic fluctuations. What is the immediate pharmacological diagnostic and therapeutic challenge?

A.Intravenous lorazepam challenge (1 to 2 mg)

B.High-dose intramuscular haloperidol (10 mg)

C.Intravenous infusion of sodium nitroprusside

D.Oral administration of carbidopa/levodopa

Explanation: The clinical scenario illustrates catatonic syndrome (F06.1 or F20.2), characterized by immobility, mutism, catalepsy, waxy flexibility, and negativism. The definitive first-line diagnostic and therapeutic step is the lorazepam challenge test: administration of 1 to 2 mg of IV or sublingual lorazepam typically produces marked, rapid temporary or sustained alleviation of catatonic signs within 15–30 minutes by potentiating GABA-A transmission. Electroconvulsive therapy (ECT) is the treatment of choice for lorazepam-resistant or malignant catatonia.

About the Atestace z Psychiatrie Exam

The Atestační zkouška v oboru Psychiatrie is the Czech specialty examination under Zákon č. 95/2004 Sb. and Vyhláška č. 282/2019 Sb. The current program requires at least 54 months of training, submitted written work, practical psychiatric patient assessment, and a theoretical examination including expert questions and defense of that work before an appointed committee. Statutory fees are set by Nařízení vlády č. 324/2018 Sb. This independent English-language MCQ bank is not an official translation or format simulation and does not substitute for written-work, oral, or clinical preparation.

Assessment

Performance-based assessment

Time Limit

No fixed total duration is published; oral preparation is at least 30 minutes, with practical assessment as required by the specialty program.

Passing Score

Consensus 'prospěl' (passed) evaluation by the examination committee (at least 3 members) in both practical and theoretical parts under Vyhláška č. 282/2019 Sb.

Exam Fee

500 CZK (250 CZK practical, 250 CZK theoretical; 3,500 CZK 1st retake; 5,000 CZK 2nd retake under Nařízení vlády č. 324/2018 Sb.) (Ministerstvo zdravotnictví České republiky (MZ ČR) / Institut postgraduálního vzdělávání ve zdravotnictví (IPVZ) / Lékařské fakulty)

Atestace z Psychiatrie Exam Content Outline

Not published

Schizophrenia & Psychotic Disorders

Explores the diagnostic criteria, psychopathology, neurobiology, and clinical staging of schizophrenia spectrum disorders under ICD-10 (F20) and ICD-11 (6A20); first-episode psychosis management and early intervention protocols; differential diagnosis of acute and transient psychotic disorders (F23), schizoaffective disorder (F25), and delusional disorder (F22); second- and third-generation antipsychotic pharmacotherapy, receptor occupancy profiles (D2 antagonism, 5-HT2A antagonism, partial D2/D3 agonism), dose titration, and long-acting injectable (LAI) formulations; treatment-resistant schizophrenia protocols, clozapine indications, mandatory absolute neutrophil count (ANC) surveillance, myocarditis risk, and metabolic monitoring; recognition and emergency treatment of neuroleptic malignant syndrome, acute dystonia, akathisia, and tardive dyskinesia; and community rehabilitation models under the Czech Mental Health Care Reform (Reforma péče o duševní zdraví, Centra duševního zdraví - CDZ).

Not published

Mood & Affective Disorders

Encompasses unipolar depressive disorder (F32, F33) across severity strata, clinical assessment of suicidal ideation and acute crisis intervention; treatment-resistant depression algorithms according to ČPS ČLS JEP guidelines, including antidepressant switching, lithium augmentation, atypical antipsychotic augmentation (quetiapine, aripiprazole), esketamine nasal spray, and neuromodulation techniques (electroconvulsive therapy - ECT, repetitive transcranial magnetic stimulation - rTMS); Bipolar affective disorder (F31), distinguishing Bipolar I and Bipolar II phenotypes, mixed features, rapid cycling, and cyclothymia; acute antimanic pharmacotherapy (lithium, valproate, atypical antipsychotics) and long-term prophylactic maintenance; therapeutic drug monitoring of lithium (target trough 0.6–0.8 mmol/L maintenance, 0.8–1.0 mmol/L acute, signs of intoxication), valproate safety and strict contraindication in females of childbearing potential without pregnancy prevention program; and management of peripartum and post-partum psychiatric episodes.

Not published

Anxiety, OCD & Trauma-Related Disorders

Focuses on panic disorder with and without agoraphobia (F41.0), generalized anxiety disorder (F41.1), social anxiety disorder (F40.1), and specific phobias; first-line pharmacotherapies (SSRIs, SNRIs, pregabalin) and the strict limitation of benzodiazepines to short-term bridging; Obsessive-Compulsive Disorder (F42) phenomenology (obsessions vs compulsions), neurocircuitry (cortico-striato-thalamo-cortical loops), high-dose SSRI pharmacotherapy, clomipramine, antipsychotic augmentation, and Exposure with Response Prevention (ERP); Acute Stress Reaction (F43.0), Post-Traumatic Stress Disorder (F43.1), Complex PTSD (ICD-11), trauma-focused cognitive behavioral therapy, and EMDR; and Dissociative (conversion) disorders (F44) and Somatoform disorders (F45), differential diagnosis with somatic illnesses, and multidisciplinary psychosomatic management.

Not published

Substance Use & Addictive Disorders

Covers alcohol dependence syndrome (F10.2), neurobiology of GABAergic and glutamatergic dysregulation; acute alcohol withdrawal syndrome, monitoring with CIWA-Ar, pharmacotherapy with benzodiazepines (diazepam) or clomethiazole; alcohol withdrawal delirium (delirium tremens), adrenergic hyperactivity, fluid resuscitation, and emergency protocols; prevention and emergency management of Wernicke encephalopathy and Korsakoff syndrome (parenteral high-dose thiamine prior to glucose infusion); relapse prevention pharmacotherapy (anticraving agents acamprosate, naltrexone, and aversive disulfiram); opioid use disorder (F11.2), acute overdose reversal with naloxone, substitution maintenance therapy (methadone, buprenorphine, buprenorphine/naloxone); methamphetamine (pervitin) intoxication, toxic psychosis, and management of stimulant use disorder; and non-substance behavioral addictions (gambling disorder F63.0).

Not published

Organic Mental Disorders, Child/Geriatric Psychiatry & Psychopharmacology

Evaluates delirium (F05) etiology (metabolic, infectious, structural, pharmacological), non-pharmacological delirium prevention, and cautious use of low-dose antipsychotics (haloperidol, quetiapine, tiapride); major neurocognitive disorders (dementias F00–F03), differential diagnosis between Alzheimer's disease, vascular dementia, dementia with Lewy bodies (extreme neuroleptic sensitivity), frontotemporal lobar degeneration, and normal pressure hydrocephalus; cognitive enhancers (cholinesterase inhibitors donepezil, rivastigmine, galantamine; NMDA antagonist memantine); behavioral and psychological symptoms of dementia (BPSD); child and adolescent psychiatry (ADHD diagnostics and stimulants/atomoxetine, adolescent mood and anxiety disorders, eating disorders); clinical psychopharmacology, cytochrome P450 enzyme interactions (CYP2D6, CYP3A4, CYP1A2 inhibitors and inducers), QTc prolongation and torsades de pointes risk, serotonin syndrome vs neuroleptic malignant syndrome; catatonia evaluation (Bush-Francis scale) and treatment (lorazepam challenge, ECT); and Czech legal framework including involuntary admission and court notification under Zákon o zdravotních službách č. 372/2011 Sb.

How to Pass the Atestace z Psychiatrie Exam

What You Need to Know

Passing score: Consensus 'prospěl' (passed) evaluation by the examination committee (at least 3 members) in both practical and theoretical parts under Vyhláška č. 282/2019 Sb.
Assessment: Performance-based assessment
Time limit: No fixed total duration is published; oral preparation is at least 30 minutes, with practical assessment as required by the specialty program.
Exam fee: 500 CZK (250 CZK practical, 250 CZK theoretical; 3,500 CZK 1st retake; 5,000 CZK 2nd retake under Nařízení vlády č. 324/2018 Sb.)

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Atestace z Psychiatrie Study Tips from Top Performers

1Master Czech Psychiatric Society (ČPS ČLS JEP) Clinical Guidelines: Pay specific attention to published national algorithms for treatment-resistant depression, bipolar maintenance, and schizophrenia management, including the integration of modern Community Mental Health Centers (Centra duševního zdraví - CDZ).

2Memorize Psychotropic Therapeutic Drug Monitoring (TDM) Ranges: Know exact therapeutic blood levels for lithium (0.6–0.8 mmol/L maintenance, 0.8–1.0 mmol/L acute mania, >1.2 mmol/L toxic), valproate (50–100 mg/L), carbamazepine (4–12 mg/L), and clozapine (>350 ng/mL).

3Understand Involuntary Placement and Detenční řízení: Memorize the legal thresholds under Zákon č. 372/2011 Sb. (§ 38), the 24-hour court notification requirement, and the 7-day initial court hearing deadline under the Civil Procedure Code (Zákon o zvláštních řízeních soudních č. 292/2013 Sb.).

4Review Neuroleptic Malignant Syndrome vs Serotonin Syndrome: Differentiate lead-pipe muscle rigidity, hyporeflexia, and severe CK elevation in NMS from hyperreflexia, clonus (ocular/spontaneous/inducible), tremor, and rapid onset in serotonin syndrome.

5Be Fluent in Alcohol Withdrawal and Addictions: Differentiate complicated withdrawal, delirium tremens, and Wernicke encephalopathy. Always emphasize parenterally administered high-dose thiamine before carbohydrate/glucose administration to avoid precipitation of irreversible Korsakoff syndrome.

6Practice Clinical Vignette Problem-Solving: Work through all 100 questions in this study bank to test your differential diagnostic synthesis, somatic workup instincts, and psychopharmacological titration safety.

Frequently Asked Questions

What is the official statutory basis of the Atestační zkouška v oboru Psychiatrie?

The examination is governed by Zákon č. 95/2004 Sb. on the conditions for obtaining and recognizing professional qualifications of physicians, dentists, and pharmacists, and Ministry of Health Decree Vyhláška č. 282/2019 Sb. on examinations of doctors. It certifies that the physician has attained specialized competence (specializovaná způsobilost) to practice independently as an attending psychiatrist in the Czech Republic and across the European Union under EU Directive 2005/36/EC.

How is the examination committee structured under Czech law?

Under Vyhláška č. 282/2019 Sb., the atestační zkouška is held before an examination committee (zkušební komise) composed of at least 3 members appointed by the Ministry of Health. Committee members include leading academic and clinical psychiatrists (professors, docents, and chief physicians from university medical faculties and psychiatric hospitals), chaired by an appointed board chairperson.

What are the two mandatory parts of the examination?

The examination consists of: (1) A practical clinical examination (praktická část), where the candidate conducts an independent psychiatric examination of a patient, prepares a formal written clinical case report (chorobopis), formulates a differential diagnosis, proposes comprehensive biological, psychotherapeutic, and social treatment plans, and defends the findings before the committee; and (2) An oral theoretical examination (teoretická část), where the candidate draws three thematic question topics covering psychopathology, specialized clinical psychiatry, and biological psychiatry/organization of mental health services.

What are the examination fees under Czech government regulations?

The examination fees are established by Government Decree Nařízení vlády č. 324/2018 Sb. The standard primary examination fee is 500 CZK (split as 250 CZK for the practical part and 250 CZK for the theoretical part). If a candidate fails and retakes the exam, the fee is 3,500 CZK for the first retake and 5,000 CZK for the second retake.

How does this English-language practice question bank adapt the Czech board examination?

While the official statutory examination in the Czech Republic is an oral board exam and practical clinical patient examination conducted in the Czech language, this preparation platform provides an English-language multiple-choice question adaptation. The questions are directly mapped to the official educational program (vzdělávací program) published in Věstník MZ ČR, recommended diagnostic and therapeutic algorithms of the Czech Psychiatric Society (ČPS ČLS JEP), and European psychiatric guidelines (EPA, CINP), providing comprehensive clinical vignette training.

What are the requirements for involuntary psychiatric hospitalization under Czech law?

Under Zákon o zdravotních službách č. 372/2011 Sb. (§ 38), a patient may be hospitalized without consent only if they show signs of mental disorder and actively endanger themselves or their surroundings, or if their condition requires life-saving emergency care. The healthcare facility must notify the competent district court within 24 hours of admission, and the court must decide on the legality of the detention within 7 days (detenční řízení).