Psychiatry Shelf Exam High-Yield Topics You Must Master

At first glance, the psychiatry shelf exam may seem more manageable than other clinical shelf exams. For example, compared with Internal Medicine or Pediatrics, it covers a narrower range of material. However, success still depends on mastering DSM-5 diagnostic criteria, treatment guidelines, and first-line pharmacologic and non-pharmacologic interventions, as well as their associated adverse effects. With this in mind, we’ve compiled the highest-yield topics and the best resources to help you maximize your score and ace the exam.

General Study Strategies and Advice for the Psychiatry Shelf Exam

1. Prioritize Practice Questions

In general, we recommend that you aim to complete all UWorld or AMBOSS questions 1 to 2 weeks prior to your shelf examination. This will then give you time to work on practice tests and refining material you struggle with. Focus on understanding answer explanations rather than memorizing answers.

2. Master DSM-5 Diagnostic Criteria

This recommendation is a must! Many psychiatry shelf exam questions test your ability to differentiate between very similar disorders. Too often, students will say “this sounds more like schizophrenia than bipolar disorder” – this is insufficient! You need to recognize the specific diagnostic criteria that distinguish conditions with overlapping features. This will make you a much stronger test taker!

3. Know First-Line Treatments and Side Effects

The psychiatry shelf heavily emphasizes pharmacology. First, be confident in the first-line treatments for common conditions. This includes both pharmacologic and non-pharmacologic options. In addition, understand their common side effects, which are often numerous. Finally, be sure to recognize important medication contraindications.

4. Use Active Recall and Spaced Repetition

Flashcards (e.g., Anki decks) can help reinforce key high-yield psychiatry shelf exam concepts –  especially diagnostic criteria and drug mechanisms.

5. Don’t Ignore Ethics Questions!

Notably, legal and ethical scenarios appear frequently on the psychiatry shelf exam. This is because psychiatry addresses complex topics such as capacity, guardianship, voluntary versus involuntary commitment, and mandatory reporting laws. Although these questions may seem easy at first glance, they are often some of the most challenging on the test.

High-Yield Psychiatry Shelf Exam Topics

Below are a few of the most high-yield topics that we recommend you learn. This is list is not exhaustive by any means, but it will mention some of the most commonly tested concepts.

1. Schizophrenia and Psychotic Disorders

• Diagnostic criteria for schizophrenia (keeping in mind positive, negative, and cognitive symptoms)
• Recognize the time from symptom onset as this differentiates schizophrenia from schizophreniform disorder from brief psychotic disorder
• Be able to differentiate schizophrenia, schizoaffective disorder, schizotypal personality disorder, delusional disorder, and mood disorder with psychotic features
• First-generation vs. second-generation antipsychotics (side effects, mechanisms)
• Cannot miss side effects including neuroleptic malignant syndrome and acute dystonia

2. Mood Disorders

• Major depressive disorder 
  • SIG E CAPS, ≥2 weeks
  • SSRIs, SNRIs, TCA, Atypicals, MAOI
  • Serotonin syndrome, Hypertensive Crisis, TCA toxicity
• Bipolar disorder types I and II 
  • Mood stabilizers
  • Lithium toxicity signs
• Persistent depressive disorder vs. cyclothymic disorder
• Suicide risk assessment
  • SAD PERSONS scale
• Peripartum mood disorders (postpartum blues, MDD with peripartum onset, postpartum psychosis)

3. Anxiety Disorders

• Generalized anxiety disorder vs. panic disorder vs. specific phobias
• Post traumatic stress disorder vs. acute stress disorder (timing differences)
• Pros/cons of Benzodiazepine use (short- vs. long-acting, dependence risks)
• Obsessive-Compulsive Disorder vs Obsessive-Compulsive Personality Disorder (ego-dystonic vs. ego-syntonic)

4. Personality Disorders

• Clusters A, B, and C (Weird, Wild, Worried mnemonic)
  • A: Paranoid, Schizoid, Schizotypal
  • B: Antisocial, Borderline, Histrionic, Narcissistic
  • C: Avoidant, Obsessive-Compulsive, Dependent
• Antisocial personality disorder vs. conduct disorder (age differentiation)
• Malingering vs. Factitious Disorder

5. Substance Use Disorders

• Alcohol withdrawal (Delirium tremens timeline, treatment with benzodiazepines or phenobarbital)
• Opioid withdrawal vs. intoxication (pupillary response, respiratory rate, GI, and treatment with methadone, buprenorphine)
• Stimulants vs. hallucinogens (cocaine intoxication vs. LSD effects)
• CAGE questionnaire for alcohol use disorder

6. Child and Adolescent Psychiatry

• ADHD (stimulant vs. non-stimulant treatments, diagnostic criteria)
• Autism spectrum disorder (early signs, social communication deficits)
• Oppositional defiant disorder vs. conduct disorder (high yield!)

7. Neurocognitive Disorders

• Delirium vs. dementia (waxing/waning confusion vs. progressive decline)
• Alzheimer’s vs. Lewy body dementia vs. vascular dementia
• Parkinson’s disease dementia vs. Huntington’s disease (age of onset, symptoms, family history)
• Wernicke-Korsakoff syndrome (thiamine deficiency, classic triad of confusion, ataxia, and ophthalmoplegia)

8. Psychopharmacology and Non-pharmacologic therapies

• Psychotherapy
• Stimulants
• SSRI/SNRI/TCA/MAOI
• Antipsychotics
• Benzodiazepenes
• Lithium
• Atypicals
• Opioids

9. Medical Conditions Mimicking Psychiatric Disorders

• Hypothyroidism-induced depression
• UTI and Stroke causing altered mental status
• Cushing’s syndrome and psychiatric symptoms (or steroid induced psychosis)
• Wilson’s disease and psychiatric manifestations

10. Legal and Ethical Issues in Psychiatry

• Competency vs. capacity (decision-making ability in psychiatric patients)
  • Physicians determine capacity, NOT competency
• Involuntary commitment criteria
• Confidentiality exceptions (harm to self or others)

Best Resources for the Psychiatry Shelf Exam

1. UWorld/AMBOSS Psychiatry Questions

UWorld and AMBOSS are the gold standards for shelf exam preparation. Their psychiatry section covers high-yield psychiatry shelf exam questions with detailed explanations that reinforce key concepts. As mentioned above, complete all questions 1-2 weeks prior to your shelf (if possible)

2. NBME practice shelf exams

You should try and complete at least one, but preferably, all practice shelf examinations available for purchase online one to two weeks prior to your exam date. These tests will simulate test day with great accuracy and will help you identify your strengths and weaknesses.

3. First Aid for the Psychiatry Clerkship

This book is an excellent concise resource covering diagnostic criteria, treatment options, and key clinical pearls for the psychiatry shelf exam. We recommend not reading this cover to cover; rather, using this (or some other textbook) as a reference for specific topics.

4. OnlineMedEd Videos

Clear, high-quality video lectures that break down key psychiatry topics into simple, memorable frameworks. These videos are ideal for reviewing core material in an easy-to-follow format.

5. Clinical Rotations Cheat Sheets

Maximize your study efficiency with our own clinical rotations cheat sheets! These concise guides summarize key diagnoses, treatments, and clinical pearls for the psychiatry shelf exam.

Enter your email below to receive the free Clinical Rotations Cheat Sheets!

Final Thoughts

Doing well on the psychiatry shelf exam requires a clear plan that combines high-yield topics, active learning, and reliable study resources. By focusing on core psychiatric conditions, DSM-5 criteria, and psych medications with key side effects, you’ll be ready to take the exam with confidence! Download our Clinical Rotations Cheat Sheets for a simple one to two page sheet to help guide you through our most high yield recommendations!