Step 1 Psychiatry
Psychiatry on USMLE Step 1 covers diagnosis, pathophysiology, and pharmacology across mood disorders, psychotic disorders, anxiety/OCD-spectrum conditions, substance use, personality disorders, child psychiatry, somatic disorders, sleep, eating disorders, and psychopharmacology. The content is dense and heavily cross-referenced — knowing DSM-5 criteria matters less than understanding how diagnoses are separated from each other by one or two distinguishing features. For anyone studying high-yield psychiatry topics for Step 1, duration thresholds and drug contraindications are the two areas that generate the most questions.
Most questions are clinical vignettes where the task is differential diagnosis or next-step management. A patient presents with two weeks of low mood — is it MDD, adjustment disorder, or bipolar depression? Students consistently miss the bipolar screen: giving an SSRI without a mood stabilizer to a patient with unrecognized bipolar depression can trigger a manic episode. Knowing the exact duration thresholds, symptom counts, and exclusion criteria is what separates right answers from wrong ones.
The tricky parts of Step 1 psychiatry cluster around a few themes: confusing disorders that share surface features (schizophrenia vs schizoaffective, OCD vs OCPD, somatic symptom disorder vs factitious vs malingering), applying the wrong drug to the right diagnosis, and getting fooled by overlapping presentations (Wernicke vs Korsakoff, PTSD vs acute stress disorder, delirium vs dementia). Another common misconception: students reach for antipsychotics in catatonia, when lorazepam is both the diagnostic challenge and first-line treatment, and antipsychotics can actually precipitate NMS. USMLE psychopharmacology questions focus on mechanisms, side effects, and contraindications rather than brand names.
Major Depressive Disorder (MDD)
Symptom count, duration, and how psychotic features or treatment resistance change the management approach.
- Confuses 'at least one of depressed mood or anhedonia' with requiring both as mandatory anchors
- Omits antipsychotic augmentation when treating MDD with psychotic features
Persistent Depressive Disorder (Dysthymia)
Two-year low-grade depression that can coexist with full MDD episodes and responds to the same pharmacotherapy.
- Confuses PDD's 2-year duration requirement with MDD's 2-week threshold
- Unaware that double depression (PDD plus superimposed MDD) is a recognized and common presentation
Bipolar I Disorder
Full manic episodes define this diagnosis, and antidepressant monotherapy risks triggering one.
- Confuses the 7-day manic episode duration with MDD's 2-week threshold
- Overlooks the risk of antidepressant-induced mania when treating bipolar depression
Bipolar II Disorder
Hypomania plus depression — one true manic episode upgrades the diagnosis and changes everything.
- Applies the 7-day manic episode duration to hypomania in Bipolar II
- Unaware that one manic episode converts a Bipolar II diagnosis to Bipolar I
Cyclothymic Disorder
Subthreshold mood swings persisting two years without meeting full hypomanic or depressive episode criteria.
- Confuses cyclothymia's 2-year adult duration with the 1-year pediatric threshold
- Confuses cyclothymia's subthreshold symptom requirement with Bipolar II's full hypomanic and depressive episodes
Seasonal Affective Disorder / MDD with Seasonal Pattern
Atypical depressive symptoms recurring in a seasonal pattern, with morning light therapy as first-line.
- Applies typical MDD neurovegetative symptoms to seasonal MDD instead of recognizing its atypical profile
- Unaware that light therapy is first-line for seasonal MDD and is most effective when used in the morning
Generalized Anxiety Disorder (GAD)
Six months of uncontrollable worry about multiple domains, treated first with SSRIs or SNRIs, not benzodiazepines.
- Confuses GAD's 6-month duration requirement with shorter mood disorder thresholds
- Confuses buspirone's delayed onset with the rapid relief provided by benzodiazepines
Panic Disorder
Recurrent attacks plus anticipatory anxiety — SSRIs maintain, benzodiazepines only abort acutely.
- Diagnoses panic disorder based on recurrent attacks alone without requiring the anticipatory anxiety criterion
- Treats agoraphobia as a subtype of panic disorder rather than an independent diagnosis
Specific Phobia
Exposure-based CBT treats this; medication does not, and the diagnosis requires six months plus functional impairment.
- Defaults to pharmacotherapy for specific phobia instead of exposure-based CBT
- Overlooks the 6-month duration and functional impairment requirements for diagnosing specific phobia
Social Anxiety Disorder
Fear of negative evaluation in social situations — performance-only subtype gets propranolol, not SSRIs.
- Applies SSRI therapy to performance-only social anxiety instead of as-needed beta-blocker use
- Confuses social anxiety disorder's fear of negative evaluation with agoraphobia's fear of being in public spaces
Post-Traumatic Stress Disorder (PTSD)
Four symptom clusters lasting over a month after trauma, treated with SSRIs and prazosin for nightmares.
- Confuses PTSD duration requirement with acute stress disorder's shorter window
- Selects benzodiazepines for PTSD instead of SSRIs
Acute Stress Disorder
Same cluster profile as PTSD but resolves within a month — benzodiazepines worsen long-term outcomes.
- Misidentifies the duration boundaries separating acute stress disorder from PTSD
- Recommends benzodiazepines for acute stress disorder despite evidence they worsen long-term outcomes
Adjustment Disorder
Disproportionate distress after an identifiable stressor, resolving within six months, treated with psychotherapy first.
- Misses the 3-month onset window requirement for adjustment disorder
- Overlooks the 6-month resolution rule for adjustment disorder once the stressor resolves
Obsessive-Compulsive Disorder (OCD)
Ego-dystonic obsessions driving compulsions, requiring high-dose SSRIs and exposure with response prevention therapy.
- Confuses ego-dystonic OCD with ego-syntonic OCPD
- Underestimates the dose and duration of SSRI therapy required for OCD
Body Dysmorphic Disorder
Preoccupation with perceived appearance flaws — SSRIs and CBT treat it; surgical referral is contraindicated.
- Incorrectly considers surgical or cosmetic referral as a treatment option for body dysmorphic disorder
- Selects antipsychotics over SSRIs as first-line pharmacotherapy for BDD
Hoarding, Trichotillomania, Excoriation
Hoarding, hair-pulling, and skin-picking are separate OC-related diagnoses, each with distinct behavioral first-line treatments.
- Classifies hoarding disorder as a subtype of OCD rather than a separate diagnosis
- Selects SSRIs as first-line treatment for trichotillomania instead of habit reversal training
Schizophrenia
Six-month illness with one month of active psychosis, explained by four dopamine pathways, treated with second-generation antipsychotics.
- Confuses the 1-month active-phase requirement with the full 6-month duration criterion for schizophrenia
- Fails to differentiate the four dopamine pathways and their distinct roles in schizophrenia symptoms and antipsychotic side effects
Schizophreniform Disorder
Duration of one to six months defines this intermediate diagnosis — most cases eventually reclassify as schizophrenia or schizoaffective disorder.
- Applies schizophrenia's 6-month threshold to schizophreniform disorder
- Unaware that most schizophreniform cases are eventually reclassified as schizophrenia or schizoaffective disorder
Brief Psychotic Disorder
Psychosis lasting less than a month, often stress-triggered, not requiring indefinite antipsychotic maintenance.
- Confuses the upper duration limit of brief psychotic disorder with the onset threshold of schizophreniform disorder
- Recommends indefinite antipsychotic maintenance for brief psychotic disorder
Schizoaffective Disorder
Independent psychotic episodes outside of mood disturbance define the diagnosis — paliperidone is the only FDA-approved agent.
- Diagnoses schizoaffective disorder based on co-occurring psychosis and mood symptoms without requiring a standalone psychosis window
- Confuses mood disorder with psychotic features with schizoaffective disorder based on temporal co-occurrence
Delusional Disorder
Fixed delusions for one month with preserved functioning and no other psychotic features — subtypes matter for vignettes.
- Confuses delusional disorder with schizophrenia by expecting functional impairment and negative symptoms
- Reverses the directionality of the erotomanic delusion subtype
Cluster A — Paranoid, Schizoid, Schizotypal
Odd or eccentric patterns — schizoid wants isolation, avoidant wants connection but fears it; antipsychotics play a minor role.
- Confuses schizoid (indifferent to relationships) with avoidant (desires but fears relationships)
- Overestimates the role of antipsychotics in schizotypal PD management
Cluster B — Antisocial, Borderline, Histrionic, Narcissistic
Dramatic cluster — antisocial requires prior conduct disorder, borderline is treated with DBT, splitting is an unconscious defense.
- Misses the age ≥18 requirement and mandatory childhood conduct disorder precursor for antisocial PD
- Misattributes splitting to intentional manipulation rather than an unconscious defense mechanism
Cluster C — Avoidant, Dependent, OCPD
Anxious cluster — OCPD is ego-syntonic rigidity, OCD is ego-dystonic, and psychotherapy outweighs medication for all three.
- Confuses OCPD (ego-syntonic rigidity) with OCD (ego-dystonic obsessions/compulsions)
- Conflates avoidant PD (fears rejection, withdraws) with dependent PD (fears abandonment, clings)
Alcohol Use Disorder — Intoxication, Withdrawal, Maintenance
Withdrawal stages peak at DTs around 48–96 hours — give thiamine before glucose, then titrate benzodiazepines.
- Misplaces delirium tremens onset in the early withdrawal window instead of 48–96 hours
- Reverses the correct order of thiamine before glucose in alcoholic patients
Stimulant Use — Cocaine, Amphetamines, MDMA
Sympathomimetic toxidrome with cocaine-specific risk of unopposed alpha stimulation if beta-blockers are used.
- Incorrectly applies beta-blockers to cocaine chest pain, missing the unopposed alpha-stimulation risk
- Overestimates the medical danger of stimulant withdrawal compared with alcohol/benzo withdrawal
Opioid Use — Intoxication, Withdrawal, Maintenance
Classic triad of pinpoint pupils, CNS depression, and respiratory depression — naloxone dosing matters for long-acting agents.
- Overestimates the lethality of opioid withdrawal relative to alcohol/benzo withdrawal
- Assumes one naloxone dose is adequate for long-acting opioid overdose without recognizing re-narcotization risk
Benzodiazepine Use — Intoxication, Withdrawal, Flumazenil
Withdrawal parallels alcohol and is potentially lethal — flumazenil precipitates seizures in dependent patients.
- Overlooks flumazenil's seizure-precipitating risk in benzo-dependent patients or TCA co-ingestion
- Underestimates the severity of benzodiazepine withdrawal relative to alcohol withdrawal
Hallucinogens — LSD, PCP, Ketamine
LSD and PCP share perceptual distortion but PCP adds nystagmus, analgesia, and violence — ketamine treats resistant depression.
- Conflates LSD and PCP intoxication, missing PCP's nystagmus, analgesia, and violent dissociation
- Incorrectly selects antipsychotics over benzodiazepines for PCP-induced agitation
Cannabis Use
Synthetic cannabinoids cause far greater toxicity than natural cannabis, and withdrawal syndrome is real.
- Underestimates the toxicity of synthetic cannabinoids compared with natural cannabis
- Denies the existence of a clinically significant cannabis withdrawal syndrome
Nicotine Use and Cessation
Varenicline is a partial nicotinic agonist; bupropion lowers seizure threshold, which is its key contraindication.
- Confuses varenicline's partial agonist action with pure antagonism at nicotinic receptors
- Misidentifies bupropion as inappropriate for cessation rather than recognizing its seizure-risk contraindication
Caffeine Intoxication and Withdrawal
Intoxication is stimulant, not sedating — withdrawal headache peaks around 20–48 hours after cessation.
- Confuses caffeine intoxication with a sedating toxidrome rather than a stimulant one
- Underestimates the onset delay of caffeine withdrawal headache
Inhalant Use Disorder
Sudden sniffing death is cardiac arrhythmia, not respiratory depression; toluene causes leukoencephalopathy; nitrous inactivates B12.
- Attributes sudden sniffing death to respiratory depression rather than catecholamine-induced cardiac arrhythmia
- Confuses nitrous oxide's functional B12 inactivation with impaired GI absorption
Attention-Deficit / Hyperactivity Disorder (ADHD)
DSM-5 onset is before age 12; behavioral therapy is first-line under age 6; routine ECG before stimulants is not required.
- Applies the outdated DSM-IV age-7 onset criterion instead of the DSM-5 age-12 criterion
- Overlooks that behavioral therapy, not stimulants, is first-line for preschool ADHD
Autism Spectrum Disorder
Two diagnostic domains replace the old triad — regression and absent joint attention are red flags; atypical antipsychotics treat irritability.
- Applies the outdated DSM-IV three-domain model instead of the DSM-5 two-domain model for autism
- Confuses SSRIs with atypical antipsychotics as FDA-approved treatments for autism-related irritability
Conduct Disorder and Oppositional Defiant Disorder
ODD becomes conduct disorder when aggression and rule violations escalate; antisocial PD is the adult endpoint.
- Incorrectly attributes physical aggression and property destruction to ODD rather than conduct disorder
- Skips conduct disorder as the intermediate step in the ODD-to-antisocial personality disorder progression
Tourette Syndrome and Tic Disorders
Both motor and vocal tics for one year with an allowable break — ADHD and OCD are the dominant comorbidities driving treatment.
- Incorrectly requires uninterrupted tic presence for 1 year, missing the allowable 3-month tic-free interval
- Selects haloperidol as first-line pharmacotherapy for Tourette syndrome instead of alpha-2 agonists
Separation Anxiety Disorder
Four-week criterion applies to children; adults require six months — CBT precedes medication in the treatment hierarchy.
- Applies the pediatric 4-week duration criterion to adults instead of the required 6-month threshold
- Prioritizes SSRIs over CBT as first-line treatment for childhood separation anxiety disorder
Enuresis and Encopresis
Enuresis diagnosis requires age 5 and urine alarm is first-line; encopresis requires disimpaction before behavioral work.
- Applies too young an age threshold for enuresis diagnosis, missing the required age of 5
- Selects desmopressin over the urine alarm as first-line therapy for nocturnal enuresis
Intellectual Disability
Severity grading relies on adaptive functioning, not IQ alone — Down syndrome is the most common chromosomal cause.
- Relies on IQ cutoffs rather than adaptive functioning domains to grade intellectual disability severity per DSM-5
- Diagnoses intellectual disability on low IQ alone, missing the required concurrent adaptive functioning deficit
Child Abuse and Neglect
Posterior rib and classic metaphyseal fractures raise abuse concern more than spiral fractures — report on reasonable suspicion, not certainty.
- Confuses spiral fracture as the hallmark abuse fracture rather than classic metaphyseal or posterior rib fractures
- Expects external head injury in shaken baby syndrome, missing the classic triad of subdural hematoma, retinal hemorrhages, and encephalopathy
Developmental Milestones (Infant and Child)
Walking red flags at 18 months, not 12 — receptive language delay is more serious than expressive delay.
- Sets the red-flag cutoff for independent walking too early (12 months instead of 15–18 months)
- Conflates receptive and expressive language milestones, missing that receptive delay is the more serious red flag
Intermittent Explosive Disorder
Impulsive reactive outbursts disproportionate to the trigger, diagnosable after age 6, treated with SSRIs plus CBT.
- Unaware of the DSM-5 minimum age of 6 years for IED diagnosis
- Confuses the impulsive reactive aggression of IED with the premeditated aggression of antisocial personality disorder
Catatonia
Lorazepam challenge is both diagnostic and first-line — antipsychotics are contraindicated and can precipitate NMS.
- Incorrectly anchors catatonia to schizophrenia rather than recognizing mood disorders as the most common psychiatric cause
- Misses that the lorazepam challenge is simultaneously diagnostic and the initiation of first-line therapy
Delirium
Acute fluctuating attention is the key feature — hypoactive form is most missed; treat the cause before reaching for haloperidol.
- Uses reversibility as the primary delirium-dementia distinction rather than acuity of onset and fluctuating attention
- Anchors delirium to hyperactive presentation, missing that hypoactive delirium is more common and more often overlooked
Suicide Risk Assessment and Risk Factors
Prior attempts are the strongest predictor — men complete more, women attempt more, and direct questioning is safe.
- Conflates attempt rate with completion rate, not knowing women attempt more while men complete more
- Avoids direct suicide inquiry out of fear of planting the idea, when direct questioning is safe and necessary
Anorexia Nervosa
Refeeding syndrome causes hypophosphatemia, not hyperphosphatemia — SSRIs lack evidence in active anorexia.
- Applies the outdated DSM-IV amenorrhea criterion to anorexia nervosa diagnosis
- Confuses the direction of phosphate shift in refeeding syndrome, expecting hyperphosphatemia instead of hypophosphatemia
Bulimia Nervosa
Purging causes metabolic alkalosis, hypokalemia, and dental erosion — fluoxetine 60 mg is first-line; bupropion is contraindicated.
- Predicts the wrong acid-base disturbance in purging bulimia, expecting acidosis instead of metabolic alkalosis
- Considers bupropion for bulimia without knowing it is contraindicated due to markedly increased seizure risk
Binge Eating Disorder
Recurrent binges without compensatory behaviors define this — lisdexamfetamine is the only FDA-approved pharmacotherapy.
- Distinguishes binge eating disorder from bulimia by frequency alone, missing that absence of compensatory behaviors is the defining criterion
- Missing that lisdexamfetamine is the only FDA-approved medication for binge eating disorder
Somatic Symptom Disorder
Significant physical symptoms plus excessive health-related thoughts — diagnosis depends on cognitive response, not symptom origin.
- Applies the outdated 'medically unexplained' requirement to somatic symptom disorder, missing that the diagnosis is defined by the cognitive response, not symptom etiology
- Recommends refusing further workup in somatic symptom disorder rather than structured visits with validation and judicious investigation
Illness Anxiety Disorder (Hypochondriasis)
Minimal or absent physical symptoms with persistent disease preoccupation — reassurance doesn't resolve it.
- Confuses illness anxiety disorder with somatic symptom disorder by assuming both require significant physical complaints
- Assumes medical reassurance effectively resolves illness anxiety, when it characteristically does not
Conversion Disorder (Functional Neurologic Symptom Disorder)
Neurologic symptoms incompatible with anatomy — positive clinical signs make the diagnosis; confrontation worsens outcomes.
- Treats conversion disorder as a diagnosis of exclusion rather than one requiring positive incompatibility signs
- Incorrectly believes a psychological stressor must be identified to diagnose conversion disorder
Factitious Disorder (Munchausen)
Intentional symptom production for the sick role, not external gain — by-proxy variant involves a caregiver harming a dependent.
- Confuses the intentional symptom production of factitious disorder with the unconscious process of somatic symptom disorder
- Confuses factitious disorder vs malingering by focusing on intentionality rather than the internal vs external incentive axis
Malingering
External incentive drives intentional symptom fabrication — not a DSM disorder, but specific contextual red flags appear on vignettes.
- Incorrectly classifies malingering as a DSM-5 psychiatric disorder rather than a non-disorder condition
- Confuses the external-incentive motivation of malingering with the sick-role motivation of factitious disorder
Dissociative Disorders (DID, Amnesia, Depersonalization)
DID features amnesia between identities, not shared memory — psychotherapy is first-line over pharmacotherapy.
- Assumes mutual memory access between DID identities, when the primary identity characteristically has amnesia for alter actions
- Conflates depersonalization (detachment from self) with derealization (detachment from external world)
Insomnia Disorder
Three or more nights per week for three or more months — CBT-I is first-line before any pharmacotherapy.
- Selects pharmacotherapy as first-line for chronic insomnia when CBT-I is the correct first-line treatment
- Unaware of the specific frequency (≥3 nights/week) and duration (≥3 months) criteria required to diagnose insomnia disorder
Narcolepsy
Type 1 has cataplexy and orexin loss; daytime sleepiness and cataplexy require different drug classes.
- Confuses type 1 and type 2 narcolepsy by not recognizing cataplexy as exclusive to type 1
- Misattributes narcolepsy type 1 to a brainstem lesion rather than autoimmune loss of hypothalamic orexin neurons
Parasomnias — Sleepwalking, Night Terrors, REM Behavior Disorder
Sleepwalking and night terrors are NREM phenomena with no recall; REM behavior disorder predicts alpha-synucleinopathy.
- Incorrectly assigns sleepwalking and night terrors to REM sleep when they are NREM slow-wave sleep phenomena
- Misunderstands REM behavior disorder as a sleepiness disorder rather than a loss-of-REM-atonia syndrome linked to alpha-synucleinopathies
Selective Serotonin Reuptake Inhibitors (SSRIs)
Reuptake blockade is immediate but therapeutic response takes two to four weeks — citalopram prolongs QT, paroxetine has the highest discontinuation risk.
- Confuses the immediate pharmacologic action of SSRIs with their delayed 2–4 week therapeutic onset
- Confuses serotonin syndrome (clonus, hyperreflexia) with NMS (lead-pipe rigidity, bradyreflexia) in presentation and management
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Norepinephrine reuptake adds pain efficacy and hypertension risk — venlafaxine's NE activity is dose-dependent.
- Overlooks the norepinephrine-mediated side effects of SNRIs (especially hypertension) by treating them as equivalent to SSRIs
- Unaware that the norepinephrine component of SNRIs underlies their efficacy in neuropathic pain and fibromyalgia
Tricyclic Antidepressants (TCAs)
Receptor antagonism drives anticholinergic and antihistaminergic side effects — overdose causes the three Cs, reversed by sodium bicarbonate.
- Confuses reuptake blockade with receptor antagonism as the source of TCA side effects
- Confuses urinary alkalinization with serum alkalinization as the mechanism of bicarbonate in TCA overdose
Monoamine Oxidase Inhibitors (MAOIs)
Tyramine in food triggers hypertensive crisis, not serotonin syndrome — washout periods are asymmetric when switching to or from SSRIs.
- Confuses MAO-A and MAO-B selectivity and fails to distinguish selegiline from nonselective MAOIs
- Confuses tyramine-induced hypertensive crisis with serotonin syndrome
Atypical Antidepressants (Bupropion, Mirtazapine, Trazodone)
Bupropion lowers seizure threshold and is contraindicated in eating disorders; mirtazapine blocks alpha-2; trazodone causes priapism.
- Confuses bupropion's dopamine/norepinephrine mechanism with serotonergic antidepressant mechanisms
- Confuses mirtazapine's presynaptic alpha-2 blockade mechanism with reuptake inhibition
Lithium
Narrow therapeutic window — NSAIDs and thiazides raise levels; chronic use damages kidneys and thyroid and causes Ebstein's anomaly.
- Underestimates how close toxic levels are to therapeutic levels for lithium
- Confuses lithium's renal handling by failing to recognize NSAIDs and thiazides as major toxicity-precipitating interactions
Valproate as Mood Stabilizer
Neural tube defects and hepatotoxicity are the major risks — preferred niche is mixed episodes and rapid cycling.
- Confuses valproate's neural tube teratogenicity with lithium's cardiac teratogenicity
- Confuses valproate's specific niche (mixed/rapid cycling) with lithium's indications in bipolar disorder
Carbamazepine and Lamotrigine (Mood Stabilizers)
Carbamazepine induces CYP and causes SIADH and aplastic anemia; lamotrigine's SJS risk depends on titration speed and valproate co-use.
- Confuses carbamazepine as a CYP inducer with a CYP inhibitor
- Confuses lamotrigine's SJS risk as fixed rather than titration-rate and valproate-interaction dependent
Typical (First-Generation) Antipsychotics
High-potency agents cause more EPS, low-potency agents cause more autonomic effects — NMS requires stopping the drug, not adding one.
- Inverts the side-effect profiles of high-potency versus low-potency typical antipsychotics
- Confuses the timeline of EPS categories, particularly placing tardive dyskinesia early and acute dystonia late
Atypical (Second-Generation) Antipsychotics
5-HT2A blockade reduces EPS — clozapine is reserved for treatment resistance because of agranulocytosis risk requiring ANC monitoring.
- Confuses clozapine's risk profile — it is avoided for agranulocytosis, not EPS
- Fails to rank atypical antipsychotics by metabolic risk, treating them as equivalent
Benzodiazepines
GABA-A frequency increase distinguishes these from barbiturates — LOT agents preferred in liver disease; flumazenil risks seizures in chronic users.
- Confuses benzodiazepine (frequency) with barbiturate (duration) effects on GABA-A chloride channel
- Fails to identify LOT benzodiazepines as preferred agents in liver disease due to glucuronidation-only metabolism
Z-Drugs (Zolpidem, Eszopiclone, Zaleplon)
BZ1-selective GABA-A binding targets sleep without anxiolysis — complex sleep behaviors carry a black-box warning.
- Confuses Z-drug receptor selectivity (BZ1/omega-1) with the non-selective GABA-A binding of benzodiazepines
- Missing knowledge of the black-box warning for complex sleep behaviors with Z-drugs
Buspirone
5-HT1A partial agonism takes weeks to work and cannot substitute for benzodiazepines during withdrawal.
- Confuses buspirone's delayed onset with the immediate relief provided by benzodiazepines
- Confuses buspirone's serotonergic mechanism with the GABAergic mechanism of benzodiazepines
Stimulants for ADHD (Methylphenidate, Amphetamines)
Methylphenidate blocks reuptake; amphetamines also release monoamines — cardiac screening is required only when disease is suspected.
- Confuses methylphenidate's reuptake-blocking mechanism with amphetamine's additional monoamine-releasing mechanism
- Overstates stimulant-induced growth suppression as permanent rather than modest and reversible
Defense Mechanisms
Projection attributes feelings outward; displacement redirects them; reaction formation sustains the opposite attitude across time.
- Confuses projection (attributing feelings to others) with displacement (redirecting feelings to a different target)
- Confuses rationalization (post-hoc justification) with intellectualization (using abstract thought to avoid emotion)
Psychotherapy Modalities
CBT targets present cognitions; DBT is first-line for borderline PD; ERP is the specific psychotherapy for OCD.
- Confuses CBT's present-focused cognitive restructuring with psychodynamic therapy's exploration of unconscious past conflicts
- Misidentifies DBT as a treatment for MDD rather than its primary indication in borderline personality disorder
Electroconvulsive Therapy (ECT)
Indicated for severe, refractory, or psychotic depression and in pregnancy — memory loss is transient, and no absolute contraindications exist.
- Incorrectly believes ECT has absolute contraindications when in fact it has only relative ones
- Overstates ECT-induced memory loss as permanent rather than transient and reversible
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