Psychiatry for PLAB 1: Risk, Drugs and the Mental Health Act

Scope and time budget

Eleven questions means about eleven minutes. Mental health stems are usually shorter and more narrative than physical medicine stems, with less data to read. They test judgement: how to assess risk, how to communicate, when to involve others and which drug is safe. Because the content is smaller, a week of focused work can bring most candidates to a reliable level.

What is tested

• Mood and anxiety. Depression assessment, risk and NICE-based treatment, bipolar disorder and lithium monitoring, anxiety disorders, panic disorder, OCD, post-traumatic stress disorder and acute stress reaction.
• Psychosis and personality. Schizophrenia and first-episode psychosis, personality disorders, somatic symptom disorders and functional neurological disorder.
• Substance and eating problems. Alcohol dependence, withdrawal and Wernicke's encephalopathy, substance misuse and opioid substitution, eating disorders and refeeding risk.
• Risk and age groups. Self-harm and suicide risk assessment, delirium versus dementia versus depression in older adults, perinatal mental health and postpartum psychosis, child and adolescent mental health and capacity of under-18s.
• Drugs. Adverse effects of antipsychotics, antidepressants and mood stabilisers, neuroleptic malignant syndrome and serotonin syndrome.
• Law. The Mental Health Act 1983, sections 2, 3, 5, 135 and 136.

UK points to anchor your answers

The NHS summary of the Mental Health Act 1983, checked on 21 October 2026, gives these facts.

People detained have a right to appeal to the Mental Health Tribunal or hospital managers and a right to an independent mental health advocate (IMHA). Reforms agreed in 2025 will roll out over several years, so rely on the established framework. The Mental Capacity Act 2005 governs capacity in England and Wales, and the GMC 0-18 years guidance covers capacity and confidentiality of children and young people. We could not read the Act or the NICE guidelines for this page, so confirm the capacity test and treatment steps at source.

How the questions are framed

Psychiatry stems often describe a person in distress and ask for the safest first response. Typical tasks include assessing risk of self-harm, deciding whether a person needs informal admission or detention, choosing the first-line treatment, spotting a drug adverse effect and giving the right advice about monitoring. Several items concern the interface between mental health and physical health: delirium in a medical ward, an overdose, alcohol withdrawal, or the physical cause of a psychiatric picture.

Questions also test communication. The best answer is usually the one that listens, explores risk openly, involves the patient in decisions and documents clearly. Avoid answers that promise confidentiality you cannot keep, or that dismiss the patient's concerns.

What examiners ask about each group

• Depression and risk. Grade severity, ask about suicidal ideas directly, choose treatment step by step, and know when to refer to specialist services urgently.
• Bipolar disorder and lithium. Know the monitoring, the toxicity features and the interactions that raise levels.
• Psychosis. Recognise first presentation, exclude organic and substance causes, and know antipsychotic adverse effects, including metabolic and movement problems.
• Alcohol and substances. Recognise withdrawal, give thiamine before glucose where the guidance says so, and know opioid substitution basics.
• Older adults. Separate delirium from dementia and depression. Look for a trigger such as infection, drugs, retention or constipation.
• Legal frameworks. Choose the correct section, duration and who may use it.

Time and exam technique

Mental health questions are short, so use the extra seconds to read the options carefully. Several will sound compassionate and reasonable, and the best one will be safe, lawful and patient-centred. Check three things: has risk been assessed, is the patient's capacity and consent respected, and is the law applied to the right person? Where a question names a section, confirm who can use it, for how long and in which place before you choose.

Prescribing items deserve a second look. Antipsychotics, antidepressants and mood stabilisers have interactions and monitoring needs that the stem may hint at through another drug, a blood result or a new symptom. Learn the pattern: a new drug, a rise in a level, a physical sign such as rigidity or tremor, and then the unwanted syndrome.

Three typical traps

1. Using the wrong Mental Health Act section. Section 2 is assessment and section 3 is treatment. Section 5(2) is for inpatients and is made by the doctor in charge of care, not by nurses or police. Section 136 applies in a public place, while section 135 needs a warrant for premises.
2. Missing the physical cause. A new confusion in a hospital patient is delirium until proved otherwise. Choose the search for a cause, not a psychiatric label.
3. Promising absolute confidentiality. If there is serious risk, the GMC allows disclosure without consent in defined circumstances. The best answer explains the limits of confidentiality honestly and involves the patient where possible.

How to revise it

1. Memorise the MHA table above and test it with trigger phrases: "assessment", "inpatient", "public place".
2. Build a drug adverse effect table for lithium, antipsychotics, antidepressants and mood stabilisers, with the monitoring and the emergency (serotonin syndrome, neuroleptic malignant syndrome).
3. Practise risk assessment aloud. Rehearse the questions you would ask about intent, plans, protective factors and means.
4. Link to capacity. Revise capacity and consent in the professional domain, then apply them to patients with mental illness.
5. Do 20-question timed blocks and review wording as well as content.

Link this domain to professional practice for capacity and confidentiality, to neurosciences for delirium and dementia, and to obstetrics for perinatal illness.