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Clinical Atlas Prestige · Evidence-first

Psychiatry Fellowship Vivas

Psych · Vivas

Vivas

254 units across 176 domains — Structured oral cross-examination scripts mapped to examiner dimensions.

Back to PsychJump to first domain
Units
254
Domains
176
Consultation-liaison psychiatry — abnormal illness behaviourEmergency psychiatry — absconding and missing patientsPsychotherapyEmergency psychiatryAddiction psychiatryChild and adolescent psychiatry — neurodevelopmentalGeneral adult psychiatry — trauma and stressor-relatedChild and adolescent psychiatry — eating disordersfoundations — advanced EBM and evidence synthesisOld age psychiatry — Alzheimer diseaseSpecialty psychiatry — eating disordersPsychopharmacology — antidepressantsPsychopharmacology — antipsychoticsGeneral adult psychiatry — personality disordersPsychopharmacology — anxiolytics and hypnoticsGeneral adult psychiatry — feeding and eating disordersForensic psychiatry — arson and fire-settingChild and adolescent psychiatry — attachment disordersFoundations — attachmentIntellectual disability psychiatry — neurodevelopmental dual diagnosisConsultation-liaison psychiatryFoundations — basic neuroscience for psychiatryIntellectual disability psychiatry — genetic syndromesPsychopharmacology — benzodiazepine prescribing and taperingOld age psychiatry — grief and lossFoundations — biostatistics for psychiatry examsGeneral adult psychiatry — bipolar and related disordersGeneral adult psychiatry — OCRDProfessional — boundary violations and sexual misconductOld age psychiatry — dementia neuropsychiatryAddiction psychiatry — cannabis and psychosisConsultation-liaison — capacity and consentIntellectual disability — capacity and supported decision-makingOld age psychiatry — capacity, guardianship and end of lifeGeneral adult psychiatryProfessional — psychological therapiesChild and adolescent psychiatry — depressionChild and adolescent psychiatry — child protectionChild and adolescent psychiatry — childhood trauma and maltreatmentChild and adolescent psychiatry — COPMIForensic psychiatry — civilGeneral adult psychiatry — clinical high risk / attenuated psychosisPsychopharmacology — clozapinePsychopharmacology — cognitive enhancersFoundations — cognitive psychologyPublic and community psychiatry — collaborative care and primary careGeneral adult psychiatry — trauma and stressor-related disordersChild and adolescent psychiatry — disruptive behaviourProfessional practice — critical appraisal and EBMProfessional — cultural formulation and Indigenous mental healthOld age psychiatry — delirium and acute cognitive syndromesGeneral adult psychiatry — psychotic disordersfoundations — descriptive psychopathologyChild and adolescent psychiatry — developmental assessmentGeneral adult psychiatry — DID and dissociative amnesiaPublic-community — disaster and mass casualty psychiatryChild and adolescent psychiatry — DMDDGeneral adult psychiatry — dissociative disordersOld age psychiatry — Lewy body dementiasProfessional — doctor health, burnout and impairmentIntellectual disability psychiatry — Down syndromePsychopharmacology — drug interactions and QTcAddiction psychiatry — dual diagnosis and integrated careForensic psychiatry — duty to warn and third-party riskChild and adolescent psychiatry — early-onset psychosisPsychopharmacology — ECT and neurostimulationFoundations — EEG and clinical neurophysiologyOld age psychiatry — elder abuse and vulnerabilityChild and adolescent psychiatry — elimination disordersFoundations — epidemiologic methods for psychiatrySpecialty psychiatry — sexual medicine interfaceForensic psychiatry — expert evidencePsychotherapy — behavioural therapiesPsychopharmacologyForensic psychiatry — FII / medical child abuseGeneral adult psychiatry — factitious disorder and malingeringOld age psychiatry — falls polypharmacy frailtyProfessional — psychosocial interventionsGeneral adult psychiatry — early psychosis pathwayForensic psychiatry — fitness and criminal responsibilityIntellectual disability — neurodevelopmentalProfessional — formulationOld age psychiatry — neurocognitive disordersAddiction psychiatry — behavioural addictionsSpecialty psychiatry — gender and sexualityGeneral adult psychiatry — anxiety disordersAddiction psychiatry — hallucinogen-related disordersAddiction psychiatry — public health and systemsConsultation-liaison — hepatic encephalopathy and advanced transplant psychiatryFoundations — historiographyForensic psychiatry — homicide and mental disorderGeneral adult psychiatry — somatic symptom and relatedAddiction psychiatry — inhalant-related disordersSpecialty psychiatry — sleep medicine interfaceintellectual disability psychiatryGeneral adult psychiatry — impulse controlPsychopharmacology — ketamine and esketaminePsychopharmacology — lamotrigineOld age psychiatry — anxiety disordersOld age psychiatry — mood disordersOld age psychiatry — psychosisFoundations — behavioural sciencePsychopharmacology — lithiumPsychopharmacology — long-acting injectable antipsychoticsGeneral adult psychiatry — mood disordersForensic psychiatry — mental health lawProfessional skills — mental state examinationPsychopharmacology — metabolic syndrome and psychotropic monitoringPublic-community — military and veteran psychiatryPsychopharmacology — atypical and multimodal antidepressantsPsychopharmacology — monoamine oxidase inhibitorsPsychopharmacology — mood stabilisersProfessional — psychological therapies and communicationAddiction psychiatry — psychosocial interventionsGeneral adult psychiatry — psychosisAddiction psychiatry — neonatal abstinencefoundations — neuroscience for fellowship psychiatryIntellectual disability — forensic dual disabilityAddiction psychiatry — substance use disordersgeneral-adultSpecialty psychiatry — clinical paraphilic disordersGeneral adult psychiatry — perinatalPsychopharmacology — pregnancy and lactationFoundations — personality scienceAddiction psychiatry — pharmaceutical and OTC misusePsychopharmacology — pharmacogenomicsfoundations — philosophy of mindPsychopharmacology — phototherapy and chronotherapyGeneral adult psychiatry — mood disorders / women's mental healthOld age psychiatry — psychopharmacologyFoundations — prevention and early interventionForensic psychiatry — prison mental healthFoundations — nosologyIntellectual disability psychiatryFoundations — psychiatric genetics and epigeneticsPsychotherapy — psychoeducation and family interventionsFoundations — psychoneuroendocrinology and psychoimmunologyGeneral adult psychiatry — psychosis rehabilitationGeneral adult psychiatry — secondary / organic psychosisPsychopharmacology — organ impairmentPsychopharmacology — fitness to drivePublic-community — quality improvement and patient safetyFoundations — rating scales and measurement-based careGeneral adult psychiatry — reactive attachment and disinhibited social engagementFoundations — research methods and study designForensic psychiatry — risk assessmentPsychopharmacology — rTMS, VNS and DBSPublic and community psychiatry — rural and remotePublic and community psychiatry — school and workplace mental healthChild and adolescent psychiatry — school refusal and school anxietyPublic-community psychiatry — restrictive practicesPsychopharmacology — SSRIsEmergency psychiatry — self-harm and crisisSpecialty psychiatry — sexual dysfunction and paraphiliasForensic psychiatry — sexual offendingPsychopharmacology — SNRIs and NRIsFoundations — social determinants of mental healthFoundations — social psychologyProfessional — spirituality and religion in psychiatryForensic psychiatry — stalking and harassmentProfessional — stigma, recovery and rights-based careAddiction psychiatry — stimulant and methamphetamine useAddiction psychiatry — acute stimulant syndromesPsychopharmacology — stimulants and ADHD medicationsAddiction psychiatry — substance-induced mood and anxiety disordersGeneral adult psychiatry — substance/medication-induced psychosisEmergency psychiatry — suicide riskProfessional — teaching and supervision skillsPublic and community psychiatry — telepsychiatryForensic psychiatry — therapeutic securityChild and adolescent psychiatry — service interfaceConsultation-liaison — transplant and ICU psychiatryGeneral adult psychiatry — OCRD / BFRBEmergency psychiatry — violence riskForensic psychiatry — young offendersChild and adolescent psychiatry — youth self-harm and suicide
AtlasPsychVivas

Domain

Consultation-liaison psychiatry — abnormal illness behaviour

1

clinical

Abnormal illness behaviour and the sick role — structured clinical viva

You are the C-L registrar. A medical team says a 52-year-old with multi-system symptoms and normal work-ups has ‘abnormal illness behaviour — please section them or take them to psych.’ Defend definitions (Parsons, Mechanic, Pilowsky), classification axes, DSM mapping, assessment including IBQ concept and risk, differential from FND/factitious/malingering, and a non-dualistic management plan including when detention is and is not appropriate.

Open

Domain

Emergency psychiatry — absconding and missing patients

1

clinical

Absconding and missing patients — structured clinical viva

You are the psychiatry registrar. A 41-year-old woman on an acute ward fails to return from two hours of unescorted leave granted this morning. Leave purpose was to collect clothes from home with her sister. She has bipolar disorder, recent mixed depression, and passive death wishes but denied active intent at this morning's review. Lithium level was therapeutic two days ago. At 16:00 she is 90 minutes overdue; phone goes to voicemail; sister says she left the house alone after an argument. Discuss definitions, immediate management, risk stratification and police thresholds, prevention evidence, leave decision-making, and documentation.

Open

Domain

Psychotherapy

9

clinical

Acceptance and commitment therapy — structured clinical viva

You are the psychiatry registrar. A 36-year-old teacher with recurrent major depression and high experiential avoidance says they will rejoin their sports club and rebuild friendships 'when the emptiness and self-critical thoughts are gone.' They ask whether ACT is 'just mindfulness' and whether they must stop sertraline 100 mg to start therapy. Discuss ACT principles, hexaflex processes, experiential avoidance, evidence landmarks (including metas and key trials), comparison with CBT, and combined care.

Open

clinical

Behavioural activation — structured clinical viva

You are the psychiatry registrar in a mood clinic. A 38-year-old with major depression spends evenings in bed waiting for motivation and has declined a long CBT waitlist. The consultant asks you to: define BA and its model; demonstrate TRAP/TRAC with this case; outline session structure and early homework; contrast BA with CT and BATD; summarise Dimidjian, Dobson, COBRA, and synthesis evidence; and state when BA is not enough alone.

Open

clinical

Cognitive analytic therapy — structured clinical viva

You are the psychiatry registrar. A 28-year-old with chaotic relationships and self-harm after criticism is referred for CAT. Define CAT and reciprocal roles; name traps, dilemmas, snags; outline reformulation letter, SDR map, recognition, revision exits, and goodbye letter; summarise Chanen 2008 and Clarke 2013 plus meta-analytic acceptability; contrast CAT with CBT and MBT; describe safety override and ending risks.

Open

clinical

Couples therapy — structured clinical viva

You are the psychiatry registrar. A 38-year-old teacher with major depression and their partner of 8 years present together. They describe a pursue–withdraw cycle: one criticises about ‘emotional distance,’ the other shuts down. PHQ-9 is 15 on sertraline 100 mg with partial benefit. No current physical violence; private screens negative for IPV. They ask whether ‘EFT is better than behavioural couple therapy’ and whether medication must stop for therapy to work. Discuss definition, mechanisms, major models, landmark evidence (distress, depression, SUD, PTSD), safety rules, and combined care.

Open

clinical

Group psychotherapy — structured clinical viva

You are the psychiatry registrar. A consultant asks you to justify starting an outpatient group programme and to answer basic process and evidence questions. A 32-year-old with recurrent depression and interpersonal sensitivity is referred; they fear groups will 'humiliate them.' Discuss definition and formats, therapeutic factors and cohesion, selection and contraindications, leadership of process problems, landmark evidence (format equivalence, depression/anxiety/PTSD/schizophrenia groups, DBT/MBT multiperson packages), and how you would explain limited confidentiality.

Open

clinical

Interpersonal psychotherapy — structured clinical viva

You are the psychiatry registrar. A 41-year-old teacher with recurrent major depression has remitted twice on escitalopram but relapsed 4 months after each discontinuation. Current episode followed their mother’s death 9 months ago; they ‘kept busy and never really cried,’ then became anhedonic and socially withdrawn. They ask whether IPT is ‘better than CBT’ and whether they must stop medication to start therapy. Discuss IPT principles, problem-area selection, phase structure, landmark evidence (including maintenance and meta-analysis), comparison with CBT, and combined care for recurrent depression.

Open

clinical

Mentalisation-based treatment — structured clinical viva

You are the psychiatry registrar. A 25-year-old with recurrent self-harm after relationship ruptures is referred for 'MBT'. Define mentalising and pre-mentalising modes, outline the attachment-arousal model, describe dual-format MBT structure and not-knowing stance, summarise landmark Bateman/Fonagy evidence including MBT vs SCM, contrast MBT with DBT, and describe what you would do if only structured case management is available.

Open

clinical

Schema therapy — structured clinical viva

You are the psychiatry registrar. A 28-year-old with recurrent self-harm after relationship ruptures and a lifelong defectiveness belief is referred for 'schema therapy'. Define EMS, coping styles and modes; outline limited reparenting and core techniques; summarise landmark evidence (Giesen-Bloo; Bamelis or group ST; Nadort pearl); contrast with DBT and TFP; and describe stepped care if specialist ST is unavailable.

Open

clinical

Supportive psychotherapy techniques — structured clinical viva

You are the psychiatry registrar in a community clinic. A 46-year-old with recurrent depression after job loss is demoralised, on sertraline, and faces a long CBT wait. The consultant asks you to: define supportive psychotherapy and the expressive–supportive continuum; demonstrate six techniques with this case; structure a 20-minute medication visit; summarise Winston/Pinsker, Hellerstein, Misch, Markowitz BSP, and alliance/rupture evidence; and state when support-first care replaces exploratory work.

Open

Domain

Emergency psychiatry

7

clinical

Acute agitation and rapid tranquillisation — structured clinical viva

You are the on-call psychiatry registrar. ED calls about a 26-year-old man with known schizophrenia who is extremely agitated after de-escalation failed. He refuses oral medication. Staff ask whether to give IM olanzapine 10 mg with IM midazolam 5 mg now. Discuss your approach including assessment, pharmacology with doses, monitoring, legal/capacity issues, and what you would do if standard RT fails.

Open

clinical

Acute behavioural disturbance and excited delirium — structured clinical viva

You are the psychiatry registrar called to ED. A 26-year-old man with possible methamphetamine use is in continuous extreme agitation after a police struggle. Temperature 39 C. Security are holding him prone. Notes say 'excited delirium'. Staff ask for IM olanzapine 10 mg with IM midazolam 5 mg now. Discuss terminology, medical priorities, pharmacology with doses, monitoring, restraint risks, capacity/law, and disposition.

Open

clinical

Lithium toxicity — structured clinical viva

You are the psychiatry registrar. ED calls about a 70-year-old woman on lithium for bipolar disorder with coarse tremor, ataxia and drowsiness. New medications: naproxen and indapamide. Lithium 3.1 mmol/L, creatinine doubled from baseline. Junior doctor asks whether to give activated charcoal, start forced diuresis with frusemide, and wait until the level exceeds 5 before calling nephrology. Cross-examine the candidate on pattern, mechanisms, EXTRIP, SILENT, and prevention.

Open

clinical

Neuroleptic malignant syndrome — structured clinical viva

You are the psychiatry registrar. A ward doctor calls about a 29-year-old woman with first-episode psychosis who is rigid, febrile (39.0 C), sweating, and confused 48 hours after risperidone was increased and she received IM zuclopenthixol acetate. CK is 3,200 U/L. Staff want more IM olanzapine for 'agitation'. Discuss diagnosis, differentials, immediate management, specific treatments including evidence limits, and later rechallenge principles.

Open

clinical

Overdose and toxicology — structured clinical viva

You are the psychiatry registrar. ED asks you to review a 27-year-old after a large venlafaxine and possible paracetamol overdose. She had two brief seizures. HR 118, BP 100/62, GCS 13. ECG QTc borderline prolonged, QRS 98 ms. A junior doctor says 'SSRIs are safe in OD so she can go to the psych ward now.' Defend relative toxicity, immediate medical priorities, antidote decisions, observation needs, and aftercare.

Open

clinical

Psychiatric emergencies — structured clinical viva

You are the on-call psychiatry registrar. ED calls about a 26-year-old woman with mutism, posturing and refusal of food for 36 hours. Temperature has risen to 38.6 C with tachycardia. Family says she had a puerperal psychosis 2 years ago and recently restarted an antipsychotic. Discuss your differential, examination, immediate management including drug doses, and legal/ethical approach if she cannot consent.

Open

clinical

Serotonin toxicity — structured clinical viva

You are the psychiatry registrar. ED asks you to review a 29-year-old on venlafaxine and recently started linezolid for MRSA soft-tissue infection. He has agitation, temperature 38.9 C, diaphoresis, ocular clonus, and inducible ankle clonus. A medical registrar wonders if this is NMS from an antipsychotic given two months ago. Defend your diagnosis, criteria, differential, management with doses, and prevention counselling.

Open

Domain

Addiction psychiatry

6

clinical

Addiction in older adults — structured clinical viva

You are the psychiatry registrar. A medical team admits a 76-year-old man with confusion two days after hip-fracture surgery. His alcohol history was not taken pre-op. The drug chart shows no benzodiazepines. He is tremulous, hypertensive, and picking at the sheets. Junior staff suggest 'UTI delirium only', 'haloperidol 5 mg IM now', or 'he is too old for detox — just fluids'. Cross-examine on withdrawal vs other delirium, thiamine, geriatric dosing, screening tools for future admissions, naltrexone candidacy later, and late-life suicide risk if depression emerges.

Open

clinical

Alcohol use disorder — structured clinical viva

You are the psychiatry registrar. A 47-year-old with severe alcohol dependence is day two after emergency admission. Last drink about 50 hours ago. He is sweaty, tachycardic, fluctuating orientation, describing insects on the bed. Nursing staff ask whether this is 'just behavioural' and whether antipsychotics first are enough. His partner wants naltrexone started tonight while he is still on PRN oxycodone for rib fractures. Defend diagnosis, differentials, emergency management with doses, Wernicke prevention, and longer-term pharmacotherapy/psychosocial plan.

Open

clinical

Alcohol withdrawal and delirium tremens — structured clinical viva

You are the psychiatry registrar on call. A 49-year-old with alcohol dependence is day two on the medical ward (last drink ~55 hours ago). He is sweaty, HR 128, BP 170/100, fluctuating orientation, pulling at lines, describing animals in the room. The medical team gave 2.5 mg oral diazepam once and now wants regular olanzapine for 'psychosis'. They ask whether CIWA of 8 measured when he was obtunded after the seizure earlier means he is fine. Defend diagnosis, differentials, emergency pharmacology with doses, thiamine strategy, and why the current plan is unsafe.

Open

clinical

Alcohol-related brain injury and Korsakoff — structured clinical viva

You are the psychiatry registrar called to the medical ward. A 49-year-old with severe alcohol dependence day two of admission has nystagmus, ataxia, fluctuating orientation, and confabulates about working in the hospital kitchen. Junior staff gave oral thiamine 100 mg once and want MRI before 'stronger vitamins'. His partner asks whether he has early Alzheimer disease and whether he can sign a tenancy agreement tomorrow. Defend diagnosis, emergency thiamine strategy with doses, imaging role, Korsakoff versus ARBI language, capacity, and long-term care.

Open

clinical

Anti-craving pharmacotherapy — structured clinical viva

You are the psychiatry registrar in the addiction clinic. A 55-year-old with alcohol dependence finished detox four days ago. His GP started naltrexone 50 mg yesterday. Today he reveals he still takes PRN codeine for chronic back pain and drank mouthwash last night 'to test myself'. LFTs: ALT 95, GGT 180. eGFR 42 mL/min. He asks whether to add acamprosate and disulfiram 'for maximum cover' like antibiotics. Defend immediate safety actions, agent-by-agent gates (opioids, liver, renal), COMBINE literacy, and a revised plan.

Open

clinical

Benzodiazepine dependence — structured clinical viva

You are the psychiatry registrar. A GP rings about a 70-year-old woman on nitrazepam 10 mg nightly for 12 years plus recent zopiclone 7.5 mg. Two falls, Mini-Cog decline, daughter wants everything stopped tomorrow. Junior doctor suggests flumazenil 'detox', lifelong zolpidem only, or abrupt stop with 'supportive vitamins'. Cross-examine on elderly harm, Z-drugs, taper, EMPOWER/deprescribing evidence, withdrawal seizures, and alcohol/opioid interaction counselling.

Open

Domain

Child and adolescent psychiatry — neurodevelopmental

2

clinical

ADHD across the lifespan — structured clinical viva

You are the psychiatry registrar in a transition clinic. A 17-year-old with childhood combined ADHD has incomplete adherence to long-acting methylphenidate, new weekend cannabis use, two near-miss driving incidents, and residual organisational failure threatening final-year school completion. Parents want 'something stronger'. Discuss re-assessment, medication options including non-stimulants, diversion and SUD management, driving counselling, and adult-service transition.

Open

clinical

Autism spectrum disorder — structured clinical viva

You are the CAMHS psychiatry registrar. Parents of an 8-year-old with confirmed ASD ask: (1) Is there a tablet that treats autism? (2) His aggression is dangerous — what medicine is evidence-based? (3) Could this be ADHD or just anxiety? (4) What happens when he turns 18? Discuss criteria, differentials, behavioural care, risperidone/aripiprazole evidence with monitoring, suicide/mortality awareness, and transition planning.

Open

Domain

General adult psychiatry — trauma and stressor-related

2

clinical

Adjustment disorders — structured clinical viva

You are the psychiatry registrar. A GP refers a 29-year-old man 10 weeks after a relationship breakdown. He has anxiety, tearfulness and poor sleep tied to the breakup, works but is underperforming, and last week took five of his flatmate's diazepam tablets after drinking, then told a friend he 'didn't care if he woke up'. He asks for 'something stronger to sleep forever if needed' and declines psychology because 'it's just a breakup'. Discuss diagnosis, differentials, risk, legal/setting decisions, stepped care including brief interventions, and the limits of medication.

Open

clinical

Grief and prolonged grief disorder — structured clinical viva

You are the psychiatry registrar. A GP refers a 72-year-old woman 14 months after her husband's death from cancer. She still sets his breakfast place, avoids their bedroom, says life has no meaning without him, and has lost contact with her card group. She scores high on a prolonged grief measure. She has passive wishes to 'join him' when she sees his empty chair, no plan. She asks for 'tablets to stop the pain of missing him' and declines 'talking therapy' because 'you cannot bring him back'. She is on amlodipine and atorvastatin. Discuss diagnosis (DSM-5-TR and ICD-11), differentials including MDD, risk, engagement with grief-focused therapy, evidence (including older-adult CGT trials), and the limited role of medication.

Open

Domain

Child and adolescent psychiatry — eating disorders

1

clinical

Adolescent eating disorders — structured clinical viva

You are the CAP registrar. A 16-year-old with bulimia nervosa (daily binge–vomit, BMI 23) has failed 'supportive counselling.' Parents ask for fluoxetine and whether FBT 'works for bulimia.' A second case on the board is a weight-restored AN patient whose GP wants fluoxetine to 'prevent relapse.' Discuss evidence, doses, differentials from ARFID, medical risks of purging, and capacity if a 15-year-old AN patient refuses NG feeding when bradycardic.

Open

Domain

foundations — advanced EBM and evidence synthesis

1

clinical

Advanced critical appraisal — structured clinical viva

You are in a FRANZCP/MRCPsych advanced EBM viva. The examiner places two figures on the table: (1) a forest plot of a random-effects meta-analysis of second-generation antipsychotics versus placebo for acute schizophrenia (I-squared 58%, prediction interval wide and touching the null for some outcomes); (2) a network plot ranking 21 antidepressants by efficacy and acceptability (Cipriani-style). Follow-ups will cover RoB 2 domains, funnel plots, GRADE certainty versus recommendation strength, non-inferiority margins, ROBINS-I for observational safety, and subgroup credibility. Defend whether you would change local first-line formulary choices.

Open

Domain

Old age psychiatry — Alzheimer disease

1

clinical

Alzheimer disease — structured clinical viva

You are the old-age psychiatry registrar. A 74-year-old man with progressive amnestic cognitive decline over three years now needs help with finances and cooking. MRI (educational report) shows medial temporal atrophy without large cortical infarcts. Family ask whether a 'blood test for Alzheimer' will confirm the diagnosis and whether donepezil should be stopped because he is 'getting worse'. He has new suspiciousness about neighbours. Discuss NIA-AA clinical diagnosis, biomarker framing, AChEI/memantine evidence including DOMINO-AD, BPSD approach, antipsychotic risks, and capacity for financial decisions.

Open

Domain

Specialty psychiatry — eating disorders

1

clinical

Anorexia nervosa — structured clinical viva

You are the psychiatry registrar on call. A 24-year-old woman with a 6-year history of anorexia nervosa (current BMI 15.2 kg/m², binge-purge subtype) refuses admission. ECG shows sinus bradycardia 46 bpm and borderline QTc. She wants 'just olanzapine at home' and says therapy 'never works.' Her partner asks about compulsory feeding. Discuss medical risk, limits of olanzapine, adult psychotherapy options, refeeding if admitted, and capacity/compulsory care.

Open

Domain

Psychopharmacology — antidepressants

1

clinical

Antidepressants — cross-table viva

Examiner draws three columns: Class / Target / Killer side-effect. Then places cards: STAR*D, Cipriani 2018, Hunter criteria, Montejo, Movig, Geddes, lithium aug, T3, atypical AP aug.

Open

Domain

Psychopharmacology — antipsychotics

1

clinical

Antipsychotics — cross-table viva

Examiner places a blank table: pathways vs adverse effects, then asks you to place CATIE, CUtLASS, EUFEST, Leucht NMA, TRRIP and InterSePT in one minute each.

Open

Domain

General adult psychiatry — personality disorders

9

clinical

Antisocial personality disorder — structured clinical viva

You are the psychiatry registrar. A 34-year-old man with multiple assault charges, childhood conduct problems, and alcohol dependence is referred from probation. The consultant asks: 'Is he a psychopath? Is ASPD untreatable? Should we start an antipsychotic for personality?' Discuss diagnosis, the ASPD–psychopathy distinction, risk formulation, evidence-based management limits, and a rational plan.

Open

clinical

Avoidant personality disorder — structured clinical viva

You are the psychiatry registrar. A 31-year-old woman with lifelong social inhibition, self-view as 'unlikeable,' and avoidance of intimacy is referred after she declined a promotion. Her GP asks whether this is 'just social anxiety,' whether antidepressants will fix her personality, and whether group therapy should be forced. Discuss diagnosis, differentials, evidence-based psychological care, rational medication, and risk.

Open

clinical

Borderline personality disorder — structured clinical viva

You are the psychiatry registrar. A 29-year-old man with recurrent self-harm, unstable relationships, and affective instability is referred after a third ED presentation in a month. The ED consultant asks whether he 'just needs a mood stabiliser' and whether personality disorder is 'untreatable.' Discuss diagnosis, differentials, risk formulation, psychotherapy evidence, and a rational approach to medication.

Open

clinical

Cluster A and C personality disorders — structured clinical viva

You are the psychiatry registrar. A GP refers a 26-year-old woman with lifelong odd beliefs about telepathy, eccentric dress, few friends, and social anxiety that feels 'people are watching me,' without clear voices or fixed delusions. Separately, the same clinic day includes a 40-year-old accountant with disabling perfectionism and possible OCD rituals, and a 35-year-old man who will not leave a coercive relationship because he 'cannot cope alone.' Discuss diagnosis, differentials, risk, and management principles across Cluster A and C.

Open

clinical

Dependent personality disorder — structured clinical viva

You are the psychiatry registrar. A 32-year-old man with lifelong difficulty making decisions without others, fear of being alone, and urgent re-partnering after breakups is referred after an impulsive overdose of 20 paracetamol tablets when his partner threatened to leave. His GP asks whether this is 'just borderline,' whether antidepressants will fix his personality, and whether you should take over managing his finances. Discuss diagnosis, differentials, risk, evidence-based psychological care, rational medication, and boundaries.

Open

clinical

Histrionic personality disorder — structured clinical viva

You are the psychiatry registrar. A 33-year-old man with a longstanding pattern of theatrical affect, rapid provisional intimacy, and distress when not the centre of attention is referred after a public argument and an impulsive self-harm episode. His GP asks whether this is 'just drama,' whether the label is sexist, whether antidepressants will fix his personality, and how staff should handle flirtatious behaviour. Discuss diagnosis, validity controversies, differentials, evidence-informed psychological care, rational medication, risk, and boundaries.

Open

clinical

ICD-11 personality disorder dimensional model — structured clinical viva

You are the psychiatry registrar. A consultant asks you to explain how you would diagnose and manage personality pathology using the ICD-11 dimensional model rather than ICD-10 categorical types. A 31-year-old woman with recurrent crises has been labelled 'cluster B ×3' in old notes. Discuss nosology, assessment order, differentials, severity-guided care, and why the model may be more useful clinically.

Open

clinical

Paranoid personality disorder — structured clinical viva

You are the psychiatry registrar. A 39-year-old woman is referred after repeatedly accusing her partner of affairs without evidence and quitting jobs because she believes colleagues mock her in coded language. She has been like this since her early twenties, bears grudges for years, and will not confide in friends. No hallucinations. The consultant asks: 'Is this delusional disorder? Is Cluster A untreatable? Should we start an antipsychotic for the personality?' Discuss diagnosis, differentials, mechanisms, risk, and a rational plan.

Open

clinical

Schizotypal personality disorder — structured clinical viva

You are the psychiatry registrar. A 31-year-old woman with longstanding eccentric beliefs, sparse friendships, and ideas of reference is referred after her partner worries she is 'becoming schizophrenic.' She still works part-time and questions some of her referential ideas. The GP asks whether she needs an antipsychotic 'for personality' and whether her children are at risk from her oddness. Discuss diagnosis, differentials, risk formulation, treatment evidence, and communication with the GP.

Open

Domain

Psychopharmacology — anxiolytics and hypnotics

1

clinical

Anxiolytics and hypnotics — cross-table viva

Examiner draws columns: Class / Mechanism / Dependence risk / Elderly risk / One exam dose pattern. Cards: alprazolam, zolpidem, buspirone, pregabalin, hydroxyzine, melatonin, LOT, EMPOWER, Sun opioid+BZD, Beers, flumazenil.

Open

Domain

General adult psychiatry — feeding and eating disorders

2

clinical

ARFID — structured clinical viva

You are the psychiatry registrar. A 22-year-old university student has lived on five foods since childhood (specific cereal brand, plain rice, chicken nuggets of one brand, apples, milk). BMI is 18.2 kg/m². Ferritin is low; vitamin D is low. He avoids all social meals and failed a placement that required client lunches. He has no fear of weight gain and no body checking. He asks for 'a tablet to make me less picky.' His mother still prepares all meals. Discuss diagnosis, assessment tools, medical risk despite near-normal BMI, CBT-AR principles for adults, family accommodation, autism interface, and limits of medication.

Open

clinical

Pica and rumination disorder — structured clinical viva

You are the psychiatry registrar. A 34-year-old software engineer has had effortless post-meal regurgitation for 18 months. He rechews and reswallows most of the time to avoid embarrassment at work. He has no fear of weight gain, no binge eating, and no body checking. Multiple PPIs and a normal endoscopy have not helped. BMI 21.1 kg/m². He asks whether this is 'just anxiety' and whether a tablet can fix it. Discuss diagnosis versus GORD and BN, mechanism, first-line behavioural treatment, role of biofeedback and baclofen, and when to re-involve gastroenterology.

Open

Domain

Forensic psychiatry — arson and fire-setting

1

clinical

Arson and fire-setting — structured clinical viva

Discuss deliberate firesetting, arson, and pyromania for fellowship standard. Cover the terminology triad; DSM-style pyromania exclusions; NESARC-order community prevalence; Lindberg rarity finding; Anwar psychosis–arson association; multi-trajectory pathways; fire-specific assessment and specialist treatment evidence; youth firesetting; temporal triad of responsibility/fitness/risk; and classic traps. Do not invent statute section numbers.

Open

Domain

Child and adolescent psychiatry — attachment disorders

1

clinical

Attachment disorders in children — structured clinical viva

You are the CAMHS registrar. A 4-year-old looked-after child with prior severe neglect is described by carers as either shut down when hurt or, with other adults, alarmingly overfamiliar. A private therapist has offered a paid 'attachment holding programme.' Discuss diagnosis (RAD vs DSED vs style), differential including ASD, multiagency plan, and why coercive therapies are refused.

Open

Domain

Foundations — attachment

1

clinical

Attachment theory — structured clinical viva

You are the psychiatry registrar. Discuss attachment theory for fellowship examiners using a 22-year-old woman with borderline personality features, recurrent self-harm after perceived abandonment, childhood emotional neglect, and a mother who still becomes dissociative when discussing the death of a sibling. Cover Bowlby constructs, Strange Situation patterns, AAI states of mind, mentalization, the difference between attachment style and RAD/DSED, clinical implications for personality/trauma care and parenting risk, and what interventions you would and would not recommend.

Open

Domain

Intellectual disability psychiatry — neurodevelopmental dual diagnosis

1

clinical

Autism and intellectual disability dual diagnosis — structured clinical viva

You are the dual-diagnosis / ID psychiatry registrar. A multidisciplinary meeting discusses a 12-year-old with moderate ID, suspected ASD, limited speech, weekly self-injury, and possible absence seizures. The paediatrician asks: (1) Can he have both ASD and ID? (2) How do you assess dual diagnosis and communication? (3) How does epilepsy change risk and workup? (4) What is the stepped plan for challenging behaviour, including when medicines are justified? Cover relative developmental rule, AAC, epilepsy gradient, PBS, RUPP/Owen dosing-monitoring, and Tyrer 2008.

Open

Domain

Consultation-liaison psychiatry

16

clinical

Autoimmune encephalitis and organic psychosis — structured clinical viva

You are the psychiatry registrar on call. A 25-year-old woman with first presentation of psychosis over 9 days now has mutism, orofacial dyskinesias, and fluctuating alertness. MRI is normal. The medical team asks whether this is 'just schizophrenia' and whether LP is worth the risk. Discuss red flags, differential, investigation hierarchy including antibodies, immunotherapy principles, tumour search, symptomatic care, and how you answer the team.

Open

clinical

Cardiac psychiatry — structured clinical viva

You are the CL psychiatry registrar. Cardiology refers a 67-year-old woman 3 weeks after STEMI (EF 40%, dual antiplatelets, beta-blocker, ACE inhibitor, statin). Issues: suspected post-ACS depression with passive suicidal ideation and rehab refusal; staff asking whether antidepressants prevent reinfarction; request for amitriptyline for sleep; family asking to stop the beta-blocker 'because it causes depression'; nightmares and hypervigilance suggesting ACS-PTSD symptoms; questions about Takotsubo versus her confirmed coronary disease. Discuss epidemiology/prognosis framing, mechanisms, assessment, trial literacy (SADHART, ENRICHD, CREATE, SADHART-CHF contrast), psychotropic safety, PTSD, and disposition.

Open

clinical

Delirium — structured clinical viva

You are the psychiatry registrar on call. Medical team asks for review of a 74-year-old man on the respiratory ward: fluctuating confusion for 36 hours, pulls oxygen tubing at night, sleeps most of the day. They want 'haloperidol QID until clear' and ask whether he can consent to a CT-guided procedure this afternoon. Discuss diagnosis tools, differentials, causes, non-drug care, antipsychotic evidence, ICU differences if he deteriorates, and capacity.

Open

clinical

Dementia and major NCD — structured clinical viva

You are the psychiatry registrar on CL. A 72-year-old man with progressive cognitive decline over 18 months is admitted with agitation. Nursing staff want risperidone charted 'regularly for dementia behaviours'. Family report stepwise decline after TIAs, poor planning, and dragging gait. He remains independent in dressing but no longer manages finances or medications. Discuss diagnosis framework, differentials including delirium, assessment tools, BPSD approach, cognitive enhancers, antipsychotic risks with named evidence, and capacity for financial decisions.

Open

clinical

Demoralisation and adjustment to medical illness — structured clinical viva

You are the C-L psychiatry registrar. Oncology requests review of a 55-year-old man with advanced pancreatic cancer: 'He is not coping — wants to die and refuses to engage in rehab.' He says life is pointless and he is a burden, still smiles briefly at jokes, and scores high on a demoralisation measure. Team want an antidepressant started today and a capacity statement for refusing further chemotherapy. Structure your approach across definitions, differential, measurement, DHD, named therapies, pharmacology decisions, and capacity.

Open

clinical

Endocrine psychiatry — structured clinical viva

You are the CL psychiatry registrar. Three consultations today: (1) a woman with newly confirmed Cushing disease and severe depression with passive death wishes; (2) a man day 3 after high-dose prednisolone for vasculitis who is sleepless, irritable, and grandiose; (3) a lithium-treated bipolar patient with no thyroid labs for 4 years who now has weight gain and low mood. Structure your approach across syndrome map, investigations, crisis rules (including Addison/AI), steroid algorithm, lithium–thyroid, and residual prognosis after endocrine correction.

Open

clinical

Epilepsy and psychiatry — structured clinical viva

You are the CL psychiatry registrar. Neurology asks you to review a 36-year-old woman with temporal lobe epilepsy who, 48 hours after a seizure cluster and a period of normal conversation, has developed persecutory delusions and is pacing the corridor. Her NDDI-E last month was 17. She was recently up-titrated on levetiracetam. Discuss classification, differential including forced normalisation and NCSE, acute management, depression treatment, AED psychiatric effects, psychotropics and seizure threshold, and how you negotiate the joint plan.

Open

clinical

FND in the medical setting — C-L structured viva

You are the C-L registrar. A 45-year-old man is on the medical ward after recurrent prolonged shaking events. Video-EEG of typical events shows no epileptiform activity. He remains on levetiracetam 1500 mg twice daily and newly started clobazam after each ward event. Nursing handovers describe him as 'putting it on'. Medicine wants same-day discharge with 'anxiety' as the primary code and no follow-up. Discuss C-L role, language repair, acute event management, AED strategy with neurology, explanation as treatment, psychological evidence (LaFrance/CODES), disposition, and prognosis counselling.

Open

clinical

Huntington disease psychiatry — structured clinical viva

You are the CL psychiatry registrar. Neurology asks you to review a 50-year-old man with manifest Huntington disease who has partner-directed irritability, major depressive symptoms with passive suicidal ideation, and recent tetrabenazine titration for chorea. Discuss classification of HD neuropsychiatric syndromes (including apathy versus depression), suicide risk, differentials, stepped psychopharmacology for depression and irritability, VMAT2 cautions, psychosis management principles, predictive testing ethics if family members request testing of a minor, and multidisciplinary disposition.

Open

clinical

Mild cognitive impairment — structured clinical viva

You are the psychiatry registrar in a memory clinic. A 69-year-old woman reports two years of progressive forgetfulness. She still lives alone, manages medications with a dosette box, shops online, and drives short daytime trips. Her son worries she is 'getting dementia'. MoCA is 24/30. She is on amitriptyline 50 mg nocte for sleep and has untreated hearing loss. Discuss definition and subtypes, differentials including depression and major NCD, assessment tools, conversion risk, management including lifestyle evidence, and why cholinesterase inhibitors are not routine.

Open

clinical

Multiple sclerosis psychiatry — structured clinical viva

You are the CL psychiatry registrar. Neurology asks you to review a 38-year-old man with MS who has major depression with passive suicidal ideation, episodes of brief involuntary crying without sadness, cognitive complaints threatening his job, and a request to stop interferon because of mood. Discuss classification of MS psychiatric syndromes, differentials including PBA versus depression, suicide risk, stepwise psychological and pharmacological management including DM/Q where available, steroid-related risks, and shared-care disposition with neurology.

Open

clinical

Pain psychiatry and somatic symptom disorders — structured clinical viva

You are the C-L psychiatry registrar. A pain clinic asks for review of a 52-year-old man with chronic widespread pain, high health anxiety, PHQ-15 high, depression, and escalating oxycodone plus night diazepam. Physicians want 'a somatisation label so we can stop investigating' and pharmacy wants opioid weaning. Discuss nosology (SSD vs IAD vs ICD-11), assessment, differentials, CBT evidence, medication options with doses, and dual diagnosis.

Open

clinical

Perinatal psychiatry in the general hospital — structured clinical viva

You are the CL psychiatry registrar on call. Maternity HDU requests review of a day-4 postpartum woman with rapid mood elevation, almost no sleep, and persecutory ideas about staff 'taking the baby.' She has a bipolar history; lithium was stopped at conception. Midwives ask whether this is blues, whether EPDS is enough, whether she can breastfeed on medicines, and whether the infant can room-in overnight. Structure your approach across syndrome map, medical mimics, dual risk, lithium evidence, acute PPP treatment, ECT threshold, and disposition.

Open

clinical

SLE and autoimmune neuropsychiatry — structured clinical viva

You are the CL psychiatry registrar. A 30-year-old woman with SLE is admitted with new psychosis and low complements. The medical team asks whether to 'just start antipsychotics' or 'give cyclophosphamide tonight'. Discuss ACR nomenclature, attribution, differentials including steroid effects and infection, key investigations, mechanism-based treatment, and your answer to the team.

Open

clinical

Stroke and post-stroke psychiatry — structured clinical viva

You are the CL psychiatry registrar. The stroke rehab team refers a 71-year-old man 5 weeks after ischaemic stroke (left MCA, residual aphasia and hemiparesis). Issues: suspected post-stroke depression with passive suicidal ideation; staff citing 'left frontal so he must be depressed'; request for fluoxetine to improve motor recovery; family asking whether he can consent to moving into residential care next week; intermittent crying spells that may be emotionalism. Discuss epidemiology, mechanisms/location myth, assessment with aphasia, treatment and trial evidence, capacity, and prognosis.

Open

clinical

Traumatic brain injury psychiatry — structured clinical viva

You are the CL psychiatry registrar. Rehab medicine asks you to review a 38-year-old man 4 months after severe TBI (GCS nadir 7, prolonged PTA, right orbitofrontal contusion). Issues: major depression with suicidal ideation; intermittent aggression; family report of personality change; staff requesting regular risperidone; occupational therapy asking whether he can consent to a supported independent living trial and whether he can resume driving. Discuss definition/severity, differentials, assessment, aggression ladder, depression evidence, capacity, and prognosis.

Open

Domain

Foundations — basic neuroscience for psychiatry

1

clinical

Basic neuroscience for psychiatry — structured clinical viva

You are examining a psychiatry registrar. A 22-year-old presents with first-episode psychosis after years of heavy high-THC cannabis use. Family ask 'is it a chemical imbalance we can see on a brain scan?' Walk the panel through multilevel neuroscience relevant to psychosis, dopamine version III and the four pathways, what imaging and EEG would and would not tell you, how ketamine literature both supports glutamate models and (in other contexts) antidepressant use, and how you would explain biology without oversimplifying. Then contrast a depressed patient formulation using circuit and neurotrophic language.

Open

Domain

Intellectual disability psychiatry — genetic syndromes

1

clinical

Behavioural phenotypes and genetic syndromes — structured clinical viva

Examiner: 'Define behavioural phenotype. Compare psychiatric patterns in Down syndrome, fragile X, Prader-Willi, Angelman and 22q11.2DS. A 17-year-old with PWS maternal UPD develops psychosis — what is the evidence link? How do you investigate unexplained ID? How do you prescribe in ID?' Defend mechanisms (imprinting, FMR1, trisomy 21, 22q11), risk numbers teaching points, and pitfalls of diagnostic overshadowing.

Open

Domain

Psychopharmacology — benzodiazepine prescribing and tapering

1

clinical

Benzodiazepine prescribing and tapering — consultant viva

Examiner cards: alprazolam 2 mg TDS script; LOT list blank; equipotency table; opioid co-prescription stem; elderly falls on temazepam; EMPOWER one-liner; flumazenil in chronic user OD; 10–25% taper scaffold; withdrawal seizure after 50% cut.

Open

Domain

Old age psychiatry — grief and loss

1

clinical

Bereavement in later life — structured clinical viva

You are the old-age psychiatry registrar. A GP refers an 82-year-old woman 13 months after her husband's death. She still talks to his empty chair, cannot re-engage with bowls club, and says life has no meaning. Family want 'something to settle her nerves' and ask for diazepam. Discuss normal grief versus PGD (DSM and ICD clocks), differential from MDD and psychosis, dual-process model, suicide/self-neglect risk, CGT evidence including the elderly RCT, role of antidepressants, and why long-term benzodiazepines are a poor plan.

Open

Domain

Foundations — biostatistics for psychiatry exams

1

clinical

Biostatistics — structured clinical viva

You are in a FRANZCP/MRCPsych-style viva. The examiner shows a one-page abstract of a multi-centre double-blind RCT of a new antidepressant versus placebo (N=320). Response at 12 weeks: 50% drug vs 35% placebo, p=0.008. Press release claims a '43% relative risk reduction in non-response'. Secondary time-to-relapse in responders over 24 weeks: HR 0.72 (95% CI 0.48 to 1.08). A companion paper reports a new blood biomarker for depression with Sn 0.88, Sp 0.85 in a tertiary mood clinic. Be prepared to calculate NNT, critique relative framing, define p and power, interpret the HR CI, and recompute predictive values conceptually for community prevalence.

Open

Domain

General adult psychiatry — bipolar and related disorders

4

clinical

Bipolar depression and polarity-safe treatment — structured clinical viva

You are the psychiatry registrar in clinic. A 35-year-old woman with previously diagnosed bipolar II disorder presents with a 6-week major depressive episode, MADRS 32, passive death wishes without plan, sleeping 12 hours/day, and marked anhedonia. She has been taking sertraline 150 mg monotherapy for 3 months started in primary care. She asks for 'a stronger antidepressant.' Discuss your assessment, risks of current treatment, evidence-based options for bipolar depression, and a monitoring plan.

Open

clinical

Bipolar I disorder — structured clinical viva

You are the psychiatry registrar. A 34-year-old woman with known bipolar I, previously stable on lithium, presents in mixed manic-depressive features with racing thoughts, 3 hours of sleep, tearfulness, and active suicidal ideation without a completed plan. Her GP recently started sertraline 50 mg for 'breakthrough depression' without adjusting lithium. Serum lithium 3 weeks ago was 0.55 mmol/L. She is 8 weeks pregnant (unplanned). Discuss diagnosis of the current pole, immediate risk management, medication errors, lithium in pregnancy using Patorno-level framing, and why valproate is not the rescue agent here.

Open

clinical

Bipolar II vs unipolar, hypomania thresholds, lamotrigine and antidepressant risk — structured clinical viva

You are the psychiatry registrar. A GP refers a 41-year-old man with 'treatment-resistant depression' after four antidepressants. Partner describes yearly 1-week stretches of high energy, little sleep need, and overspending without psychosis. He is currently on sertraline 200 mg alone and reports new racing thoughts and 3-hour sleep with high energy for 6 days. Discuss nosology, discriminators from mania and borderline PD, acute management with doses, evidence on antidepressants, lamotrigine role, monitoring, and prognosis counselling.

Open

clinical

Mixed features, rapid cycling, and polarity-safe treatment — structured clinical viva

You are the psychiatry registrar. A 41-year-old man with bipolar I disorder presents with 2 weeks of dysphoric irritability, racing thoughts, decreased sleep need, tearfulness, and active suicidal ideation with a plan to jump from a multi-storey car park. He has had five full mood episodes in the past 11 months. He takes escitalopram 20 mg alone after self-ceasing lithium a year ago. Discuss assessment, nosology, acute management with doses, evidence against antidepressant monotherapy, maintenance options, and monitoring.

Open

Domain

General adult psychiatry — OCRD

3

clinical

Body dysmorphic disorder — structured clinical viva

You are the psychiatry registrar. A 31-year-old man with severe BDD (facial and hair concerns; BDD-YBOCS in the severe range) has delusional-level conviction that strangers photograph his 'deformity.' He has failed what was labelled as 'CBT' (supportive talk without exposures) and two brief low-dose SSRI trials. He demands olanzapine 'for psychosis' and a referral letter for facial surgery. Discuss diagnosis including insight, differential from schizophrenia, adequacy of prior treatment, next pharmacological and psychological steps, suicide risk, and cosmetic pathway advice.

Open

clinical

Hoarding disorder — structured clinical viva

You are the psychiatry registrar. Community fire officers and housing refer a 61-year-old man whose unit has floor-to-ceiling clutter, one blocked exit, and 12 poorly cared-for cats. He has fair-to-poor insight, scores high on SI-R, and refuses any discarding but will discuss 'helping the cats.' Family demand a forced cleanout this week. Discuss diagnosis (HD vs OCD vs squalor/animal hoarding), risk hierarchy, capacity principles, specialised CBT components, limits of medication, and how you respond to the forced-cleanout demand.

Open

clinical

Obsessive-compulsive disorder — structured clinical viva

You are the psychiatry registrar. A 34-year-old man with severe checking OCD (Y-BOCS in the severe range) has failed two adequate SSRI trials (sertraline 200 mg; fluoxetine 80 mg) and a partial trial of clomipramine stopped for anticholinergic intolerance. He has never completed ERP because 'the psychologist only talked.' His partner asks about 'brain stimulation' and whether an antipsychotic will 'cure' him. Discuss assessment of refractoriness, next steps, augmentation evidence, deep TMS, and when DBS might be considered.

Open

Domain

Professional — boundary violations and sexual misconduct

1

clinical

Boundary violations and sexual misconduct — structured clinical viva

You are the psychiatry registrar. A long-term psychotherapy patient tells you they are in love with you and asks to meet for coffee after sessions. You notice you have been extending sessions and answering personal texts after hours. Separately, the patient reports that a previous psychiatrist made sexual advances years ago. Discuss boundary theory, the slippery-slope pathway, your self-management, handling of the historical sexual misconduct disclosure, professional consequences of SBV, and RANZCP-style professional principles — without inventing statute section numbers.

Open

Domain

Old age psychiatry — dementia neuropsychiatry

1

clinical

BPSD — structured clinical viva

You are the psychiatry registrar. A GP and residential-care manager call about a 79-year-old man with Alzheimer disease on risperidone 1 mg twice daily for 9 months for 'aggression'. He is now sleepy, unsteady, and still occasionally resists showers. Family ask whether the tablet is 'keeping him alive calmly' or harming him. Discuss assessment of ongoing need, risks of continued antipsychotics, deprescribing strategy, non-drug alternatives, and how trial evidence (Schneider, CATIE-AD, DART-AD, Devanand) shapes your plan.

Open

Domain

Addiction psychiatry — cannabis and psychosis

1

clinical

Cannabis use and psychosis — structured clinical viva

You are the psychiatry registrar in the early intervention clinic. A 20-year-old man presents with first-episode psychosis and daily high-THC cannabis use since mid-teens. His father asks: (1) Did cannabis cause this? (2) If he stops, will it all go away? (3) Why treat with tablets if it is just drugs? (4) Is CBD better than antipsychotics? Discuss epidemiology, causality limits, SIP vs primary psychosis, conversion risk, dual formulation, CUD treatment, and medication rationale.

Open

Domain

Consultation-liaison — capacity and consent

1

clinical

Capacity and informed consent — structured clinical viva

You are the psychiatry registrar on C-L. A 69-year-old woman with known Alzheimer disease and fluctuating evening confusion is admitted with sepsis from a perforated viscus. Surgeons want urgent laparotomy. Her son says she would never want surgery. She is intermittently able to say she is 'in hospital with a tummy bug' but cannot retain the explanation of perforation or weigh risks. There is no valid advance directive on the chart. Discuss your capacity assessment, the four abilities, fluctuating capacity, best-interests/substitute principles, the role of family, emergency treatment, and how you would document and communicate with the surgical team — without inventing statute section numbers.

Open

Domain

Intellectual disability — capacity and supported decision-making

1

clinical

Capacity and supported decision-making in ID — structured clinical viva

You are the psychiatry registrar. A 22-year-old woman with mild intellectual disability and autism is offered start of a second-generation antipsychotic for a first episode of psychosis with distressing auditory hallucinations. Her father says she cannot make any medical decisions and demands you 'put her under guardianship today'. She communicates verbally with short sentences, becomes anxious with long monologues, and says she wants the voices to stop but is worried the tablets will 'control my brain'. There is no guardianship order. Discuss decision-specific capacity, supports, four abilities, UNCRPD Article 12 principles, when substitute pathways are considered, the interface with mental health law for psychiatric treatment, and how you would respond to the father's request — without inventing statute section numbers.

Open

Domain

Old age psychiatry — capacity, guardianship and end of life

1

clinical

Capacity, guardianship and end-of-life decisions — structured clinical viva

An 81-year-old man with mild-to-moderate vascular cognitive impairment and late-life depression refuses second-line chemotherapy for metastatic solid tumour. His wife wants treatment to continue 'at all costs.' He has an old living will preferring comfort-focused care if he could not live independently. He asks you whether you can 'help me end this.' Discuss capacity assessment (Appelbaum abilities), interface with depression, advance directives and surrogate standards, guardianship thresholds in principle, goals-of-care communication, and assessment of desire for hastened death — without inventing statute numbers.

Open

Domain

General adult psychiatry

2

clinical

Catatonia — structured clinical viva

You are the psychiatry registrar. ED refers a 27-year-old with first-episode psychosis who is mute, postures, and grimaces. Temperature 38.4 C, diaphoretic, BP labile, CK 1,200 U/L (ULN 200). He received IM zuclopenthixol acetate and oral risperidone over the last 72 hours. Staff ask for more IM olanzapine. Discuss diagnosis, differential, immediate management, lorazepam/ECT pathway, and NMS overlap.

Open

clinical

Functional neurological disorder — structured clinical viva

You are the psychiatry registrar in a joint neuropsychiatry clinic. A 41-year-old man has had weekly prolonged shaking attacks for 8 months. Video-EEG captured typical events without epileptiform activity. He is on levetiracetam 1500 mg twice daily and lamotrigine 200 mg twice daily started after a single ED presentation. He is off work, depressed, and his partner was told by a doctor that the attacks are 'pseudoseizures and attention-seeking'. Discuss diagnosis, language, acute attack management, AED plan, psychological evidence (including CODES/LaFrance), risk, and prognosis counselling.

Open

Domain

Professional — psychological therapies

2

clinical

CBT fundamentals — structured clinical viva

You are the psychiatry registrar. A 41-year-old man with recurrent major depression has partial response to sertraline 150 mg daily. He lies in bed until noon, ruminates that he is a failure, and has stopped running and seeing friends. He asks for 'CBT instead of tablets'. Discuss the cognitive-behavioural model of depression, how you would formulate and structure CBT, when behavioural activation comes first, evidence comparing cognitive therapy and antidepressants, homework, therapist drift, and how you integrate medication rather than offering a false dichotomy.

Open

clinical

DBT and third-wave therapies — structured clinical viva

You are the psychiatry registrar. A 24-year-old with recurrent self-harm, affective storms lasting hours, and fear of abandonment is referred for 'third-wave therapy'. Discuss what third-wave means, deliver the full DBT skeleton (modes, modules, stages, hierarchy), explain biosocial theory, summarise landmark evidence including McMain, contrast ACT and MBCT indications, and describe phone coaching and consultation-team functions. Address what you would do if only a skills group is available.

Open

Domain

Child and adolescent psychiatry — depression

1

clinical

Child and adolescent depression — structured clinical viva

You are the CAMHS registrar. A 16-year-old with first-episode major depression has partial response to 8 weeks of CBT alone. PHQ-A remains 16. There is intermittent suicidal ideation without plan, weekly NSSI, and parental conflict about 'putting her on drugs'. Discuss indication for fluoxetine, how you consent for the black-box warning, monitoring schedule, school interface, and what you would do if she fails fluoxetine.

Open

Domain

Child and adolescent psychiatry — child protection

1

clinical

Child protection for psychiatrists — structured clinical viva

A 14-year-old discloses that her stepfather has been sexually abusing her for a year. She does not want police involved and fears her younger sister will be taken into care. Mother has mild intellectual disability and is your outpatient. Discuss thresholds for report, confidentiality, documentation, sibling risk, multi-agency response without invented statutes, parental capacity principles, and psychiatric care for the adolescent.

Open

Domain

Child and adolescent psychiatry — childhood trauma and maltreatment

1

clinical

Childhood trauma and maltreatment — structured clinical viva

You are the CAMHS registrar. A school refers a 12-year-old with declining grades, nightmares, aggression, and a disclosure of chronic physical and emotional abuse by a parent. Discuss typology and ACE science, assessment and private interview, mandatory reporting principles, differential diagnosis, TF-CBT PRACTICE, trauma-informed care, and the role of medication.

Open

Domain

Child and adolescent psychiatry — COPMI

1

clinical

Children of parents with mental illness — structured clinical viva

A mother with recurrent severe depression is your long-term outpatient. Her 12-year-old has started self-harming and says 'I have to look after Mum.' Father is absent. Discuss epidemiology, risk transmission, assessment of parenting capacity, dual loyalty, STAR*D-child and preventive intervention evidence, and when child protection thresholds apply — without inventing statute numbers.

Open

Domain

Forensic psychiatry — civil

1

clinical

Civil forensic psychiatry — structured clinical viva

A solicitor asks you to assess a 74-year-old woman with vascular cognitive impairment who wants to change her will and also manage a large investment portfolio. Separately, her son has filed for a financial management order. Discuss: (1) how you structure civil capacity assessment using decision-specific functional principles; (2) Banks v Goodfellow principles for the will; (3) financial capacity domains; (4) how guardianship/substitute decision-making opinions differ from a global 'incompetent' label; (5) Appelbaum–Grisso abilities and when MacCAT-T is relevant; (6) ethics of dual roles if you are also her treating psychiatrist; (7) report structure and what you will not invent.

Open

Domain

General adult psychiatry — clinical high risk / attenuated psychosis

1

clinical

Clinical high risk and attenuated psychosis — structured clinical viva

You are the psychiatry registrar in a youth early-psychosis assessment clinic. A 17-year-old has attenuated referential ideas with residual insight, intermittent name-calling perceptions, cannabis use, and a parent with schizophrenia. Parents ask: (1) Does she already have schizophrenia? (2) What are the chances she will get it? (3) Should she start an antipsychotic now? (4) Will fish oil stop it? Discuss definition, instruments, conversion evidence, stepped care, monitoring and stigma.

Open

Domain

Psychopharmacology — clozapine

1

clinical

Clozapine — consultant viva

Examiner places cards: TRRIP, InterSePT, myocarditis week 3, smoking cessation, constipation, missed doses 5 days, rechallenge after neutropenia.

Open

Domain

Psychopharmacology — cognitive enhancers

1

clinical

Cognitive enhancers — consultant viva

Examiner places cards: Rogers donepezil, Reisberg memantine, Tariot combination, DOMINO-AD, AD2000, McKeith DLB, EXPRESS PDD, Petersen MCI, donepezil 5→10 mg, renal memantine, oxybutynin interaction.

Open

Domain

Foundations — cognitive psychology

1

clinical

Cognitive psychology for psychiatry — structured clinical viva

You are the psychiatry registrar. Teach cognitive psychology for fellowship using: (1) a depressed patient who cannot hold multi-step advice and speaks only in overgeneral failures; (2) a panic patient with safety behaviours; (3) a schizophrenia patient with remitted positive symptoms but job loss and hostile face misreads. Cover: Baddeley WM, Miller vs Cowan, Miyake EF, Posner attention, heuristics, Beck, Clark, ACT, MATRICS/social cognition, assessment, and exam traps.

Open

Domain

Public and community psychiatry — collaborative care and primary care

1

clinical

Collaborative care and primary care psychiatry — structured clinical viva

You are the consultant psychiatrist advising a large general practice. They employ a part-time psychologist two half-days per week (co-located) but have no registry, no routine PHQ-9 follow-up, and no caseload review. Depression outcomes are poor. Discuss definition of collaborative care, Wagner CCM roots, five principles, three roles, measurement tools, landmark trials (IMPACT, TEAMcare, CADET, Cochrane), multimorbidity, telehealth, pitfalls, and escalation.

Open

Domain

General adult psychiatry — trauma and stressor-related disorders

2

clinical

Complex PTSD and trauma-informed care — structured clinical viva

You are the psychiatry registrar. A 36-year-old refugee with prolonged captivity and torture history presents with PTSD symptoms, chronic shame, affect dysregulation and difficulty trusting anyone. She asks whether she has complex PTSD, whether 'stabilisation forever' is required before any trauma therapy, and whether medication will fix her. Discuss nosology, differential from BPD, phase-based evidence and critique, trauma-informed engagement, risk, and shared decision-making.

Open

clinical

PTSD and acute stress disorder — structured clinical viva

You are the psychiatry registrar. A 41-year-old woman with childhood sexual abuse and adult IPV presents with chronic PTSD symptoms, affect dysregulation, deep shame, and unstable relationships. She asks whether she has 'complex PTSD', whether exposure therapy will 'destroy her', and whether an SSRI or prazosin should be started today. Discuss nosology, formulation, phased treatment evidence, risk, and shared decision-making.

Open

Domain

Child and adolescent psychiatry — disruptive behaviour

1

clinical

Conduct and oppositional disorders — structured clinical viva

You are the CAMHS registrar. A 14-year-old with childhood-onset conduct problems, possible limited prosocial emotions, ADHD on incomplete stimulant adherence, and escalating peer-assisted burglaries is brought by parents who demand 'a tablet to fix his attitude'. Discuss formulation, multiagency plan including MST concepts, medication limits, safeguarding, and adult trajectory counselling.

Open

Domain

Professional practice — critical appraisal and EBM

1

clinical

Critical appraisal — structured clinical viva

You are in a FRANZCP/MRCPsych-style viva. The examiner hands you a one-page abstract of a multi-centre double-blind RCT of a new second-generation antipsychotic versus haloperidol for acute schizophrenia (N=420). Primary outcome: change in PANSS total at 6 weeks. Secondary: extrapyramidal side-effect scales and all-cause discontinuation. Results: mean PANSS difference −4.1 (95% CI −7.0 to −1.2), p=0.006; EPS less with the new drug; discontinuation similar. Industry funded; analysis ITT; allocation concealment via central interactive voice system; outcome assessors blinded. The examiner asks you to appraise validity, results, and whether you would change practice for a first-episode patient. Be prepared for follow-ups on NNT, forest plots, GRADE, and absence of evidence.

Open

Domain

Professional — cultural formulation and Indigenous mental health

1

clinical

Cultural formulation and Indigenous mental health — structured clinical viva

You are the psychiatry registrar. A 28-year-old Māori woman presents after an overdose. She is medically cleared. She wants her whānau involved and says mainstream services never understand wairua. Discuss cultural formulation (OCF/CFI), Te Whare Tapa Whā, culturally informed self-harm care principles, cultural safety vs competence, interpreter/language issues if relevant, risk management, and how you avoid stereotyping — without inventing statute section numbers.

Open

Domain

Old age psychiatry — delirium and acute cognitive syndromes

1

clinical

Delirium in older adults — structured clinical viva

You are the old-age psychiatry registrar. A 79-year-old man with mild cognitive impairment develops fluctuating confusion and inattention on day three after hip fracture surgery. Nursing staff request 'something to settle him' and suggest midazolam. Discuss diagnosis (including CAM), motor subtypes, cause map, multicomponent prevention and treatment, why benzodiazepines are usually avoided, when low-dose antipsychotics might be used carefully, capacity, and prognosis.

Open

Domain

General adult psychiatry — psychotic disorders

4

clinical

Delusional disorder — structured clinical viva

You are the psychiatry registrar. A GP has labelled a 51-year-old woman ‘paranoid schizophrenia’ because she has a fixed 2-year belief that her body is infested with parasites. She brings bags of ‘specimens.’ No voices, no thought disorder, continues part-time work, and has had three unnecessary dermatology procedures. Discuss diagnosis, engagement, liaison, and treatment.

Open

clinical

Schizoaffective disorder — structured clinical viva

You are the psychiatry registrar. A 34-year-old man carries a community label of 'schizophrenia' but his mother insists 'he gets proper manias.' Records show years of mixed treatment with risperidone and intermittent sertraline. He is currently elevated, sleeping 3 hours, grandiose, and still hears commentary voices. Two years ago, for a full month after mania resolved, he remained delusional while euthymic. Discuss diagnosis, re-labelling, and a safe treatment plan.

Open

clinical

Schizophrenia spectrum — structured clinical viva

You are the psychiatry registrar on call. A 26-year-old man with a 3-year history of schizophrenia is brought after stopping his oral olanzapine 2 months ago. He is paranoid, responding to internal stimuli, and expresses passive death wishes without a plan. His mother asks why 'the strong tablet' (clozapine) was never started. Discuss your assessment, acute plan, evidence for clozapine in treatment resistance and suicidality, and physical health priorities.

Open

clinical

Schizophreniform and brief psychotic disorder — structured clinical viva

You are the psychiatry registrar. A GP has labelled a 19-year-old ‘paranoid schizophrenia’ after 12 days of sudden psychosis following a robbery. Premorbid function was excellent. He is perplexed, not blunted, and already improving on low-dose risperidone. Discuss diagnosis, ICD/DSM framing, acute care, and what you will tell the family about prognosis and the ‘schizophrenia’ word.

Open

Domain

foundations — descriptive psychopathology

1

clinical

Descriptive psychopathology and phenomenology — structured clinical viva

You are examining a psychiatry registrar. Define descriptive psychopathology versus diagnosis. Walk through disorders of perception, thought form and content, mood versus affect, and passivity/self-disorders with examples. Explain Schneider first-rank symptoms historically and their modern non-pathognomonic status with named evidence. Contrast flight of ideas with derailment. Outline how you teach elicitation without leading, when phenomenology forces organic work-up, and how cultural formulation prevents mislabelling. Close with multi-board exam pearls.

Open

Domain

Child and adolescent psychiatry — developmental assessment

1

clinical

Developmental assessment in CAP — structured clinical viva

You are the CAMHS registrar. A 5-year-old with language delay, adaptive self-care lag and peer difficulties is referred after years of 'wait and see.' Discuss how you structure developmental assessment (history, milestones, adaptive function, psychometrics hierarchy), what you say about screens versus diagnosis, and how you formulate and plan multiagency care.

Open

Domain

General adult psychiatry — DID and dissociative amnesia

1

clinical

DID and dissociative amnesia — structured clinical viva

You are the psychiatry registrar. A consultant asks you to discuss a 34-year-old patient found after a fugue-like episode who later describes 'alters', intermittent everyday amnesia, childhood abuse, and weekly cutting. She wants hypnosis to 'find all memories' and an MRI to 'prove DID'. Defend nosology of DID vs dissociative amnesia, organic exclusion, trauma vs sociocognitive models, DES/SCID-D, phase treatment, risk, and what you will not do.

Open

Domain

Public-community — disaster and mass casualty psychiatry

1

clinical

Disaster and mass casualty psychiatry — structured clinical viva

You are the psychiatry registrar. After a mass casualty bushfire, you join the emergency operations briefing. Discuss definitions and phases, exposure gradients, epidemiology anchors (Norris, Neria, Galea, Bonanno, Beaglehole, Bryant), Hobfoll five elements, PFA versus mandatory CISD (Rose Cochrane), stepped treatment including TF-CBT/EMDR and sertraline dosing, first-responder care, suicide risk nuance (Kõlves), and disposition — without inventing emergency statute section numbers.

Open

Domain

Child and adolescent psychiatry — DMDD

1

clinical

Disruptive mood dysregulation disorder — structured clinical viva

You are the CAMHS registrar. A paediatrician refers a 9-year-old previously labelled 'bipolar' who is on lithium and risperidone. History shows 2 years of nearly continuous irritable mood and daily explosive outbursts at home and school, with no discrete manic periods. ADHD is untreated. Parents fear stopping 'mood stabilisers' will cause mania. Discuss reformulation, diagnostic hierarchy, what you would stop/start, psychosocial plan, and how you counsel prognosis.

Open

Domain

General adult psychiatry — dissociative disorders

1

clinical

Dissociative disorders — structured clinical viva

You are the psychiatry registrar. A consultant asks you to discuss a 34-year-old patient who self-identifies as having DID after online videos, reports 'alters', intermittent amnesia, chronic depersonalisation, and past sexual abuse. She wants hypnosis to 'find all memories', is cutting weekly, and asks whether an MRI will prove DID. Defend nosology, assessment, trauma vs sociocognitive models, phase treatment, risk, and what you will not do.

Open

Domain

Old age psychiatry — Lewy body dementias

1

clinical

DLB and PDD — structured clinical viva

You are the old-age psychiatry registrar. A 76-year-old man with fluctuating cognition, recurrent visual hallucinations, RBD, and mild spontaneous parkinsonism is labelled 'late-onset schizophrenia' and prescribed high-dose risperidone in ED. Discuss diagnosis (McKeith core features, 1-year rule, PDD distinction), differentials, work-up including biomarkers, neuroleptic sensitivity, ChEI choice with dosing/monitoring, psychosis pathway, RBD management, and prognosis/disposition.

Open

Domain

Professional — doctor health, burnout and impairment

1

clinical

Doctor health, burnout and impairment — structured clinical viva

You supervise a psychiatry registrar who is emotionally exhausted, increasingly cynical about patients, and made a near-miss medication error after consecutive night shifts. They deny low mood at home but admit passive suicidal thoughts after a complaint letter. Discuss definitions, differential diagnosis, assessment, organisation- versus individual-level interventions, physician suicide risk, and how you would handle a separate concern about a consultant smelling of alcohol — without inventing statute section numbers.

Open

Domain

Intellectual disability psychiatry — Down syndrome

1

clinical

Down syndrome and mental health — structured clinical viva

Examiner: 'A 50-year-old with Down syndrome is brought for 'possible dementia'. How do you assess? What is the APP link? How do depression and dementia differ? Which tools do you use? How do you treat depression? What medical mimics must you exclude?' Defend epidemiology (Holland, Mantry), tools (DSQIID, CAMDEX), and least-restrictive care.

Open

Domain

Psychopharmacology — drug interactions and QTc

1

clinical

Drug interactions and QTc — consultant viva

Examiner cards: PK vs PD; CYP1A2 smoking/clozapine; fluvoxamine; Bazett vs Fridericia; QTc 510 ms; TdP magnesium; Ray 2009; methadone + antipsychotic; citalopram dose cap; Tisdale factors.

Open

Domain

Addiction psychiatry — dual diagnosis and integrated care

1

clinical

Dual diagnosis and integrated care — structured clinical viva

You are the psychiatry registrar. A community team refuses to accept a 32-year-old woman with bipolar disorder and alcohol dependence until she completes residential detox and 4 weeks abstinence. She is ambivalent about alcohol, depressed, and at elevated suicide risk. Discuss definition, care models, stages of change, MI, etiological models, integrated management, systems barriers, NICE/RANZCP-style principles, recovery, and evidence limits.

Open

Domain

Forensic psychiatry — duty to warn and third-party risk

1

clinical

Duty to warn and third-party risk — structured clinical viva

You are the psychiatry registrar. A 35-year-old outpatient with bipolar disorder, currently manic with psychotic features, says he will 'deal with' his boss tomorrow with a baseball bat kept in his car. The boss is named. He insists you keep this secret. Discuss Tarasoff warn vs protect principles, Appelbaum's model, how you assess, what protective steps you take tonight, how jurisdiction variation affects your answer for FRANZCP vs ABPN framing, minimum disclosure, documentation, alliance repair, and why diagnosis alone is not the duty trigger. How do you answer if the examiner asks for the exact Mental Health Act section?

Open

Domain

Child and adolescent psychiatry — early-onset psychosis

1

clinical

Early-onset psychosis — structured clinical viva

You are the CAP registrar. A 13-year-old girl presents with 6 months of progressive social withdrawal and 3 months of persecutory delusions and auditory commentary. Premorbid mild language delay. Mother asks: (1) Is this childhood schizophrenia? (2) Could it be autism or trauma instead? (3) Why not the strongest tablet now? (4) Will she ever go back to school? Discuss assessment priorities, organic exclusion, dosing, multi-element care, family/school work and clozapine threshold.

Open

Domain

Psychopharmacology — ECT and neurostimulation

1

clinical

ECT and neurostimulation — consultant viva

Examiner places cards: UK ECT Review Group, CORE continuation, RUL vs BT, ultrabrief, cuff technique, catatonia, Petrides clozapine-ECT, THREE-D iTBS, BROADEN DBS, RANZCP ECT PPG.

Open

Domain

Foundations — EEG and clinical neurophysiology

1

clinical

EEG and clinical neurophysiology in psychiatry — structured clinical viva

You are examining a psychiatry registrar. A 31-year-old inpatient with treatment-resistant schizophrenia on clozapine 500 mg develops a witnessed generalised seizure. Staff also report earlier episodes of blank staring and fluctuating confusion. Family ask whether a brain wave test can prove schizophrenia or whether the medicine has damaged the brain permanently. Walk the panel through EEG indications and limits, band interpretation basics, NCSE concern, clozapine EEG/seizure facts, research biomarker humility (MMN/P300), and how you would communicate and manage next steps with neurology.

Open

Domain

Old age psychiatry — elder abuse and vulnerability

1

clinical

Elder abuse and vulnerability — structured clinical viva

A 76-year-old man with late-life depression and mild cognitive impairment discloses that his partner takes his bank card, restricts visitors, and has slapped him twice. He does not want police involved and wants to go home. Discuss subtypes, risk formulation, capacity for the decision to return home and manage finances, safety planning, multi-agency response, reporting principles without invented statutes, and psychiatric follow-up.

Open

Domain

Child and adolescent psychiatry — elimination disorders

1

clinical

Elimination disorders — structured clinical viva

You are the CAMHS registrar. A GP refers a 7-year-old with lifelong night wetting and school soiling. Parents want 'the bedwetting tablet' and have been punishing wet nights. Discuss classification (DSM/ICCS), the enuresis triad, alarm versus desmopressin, retentive encopresis management, medication safety, and non-punitive care.

Open

Domain

Foundations — epidemiologic methods for psychiatry

1

clinical

Epidemiologic methods for psychiatry — structured clinical viva

You are in a FRANZCP/MRCPsych-style viva. The examiner says: 'A newspaper reports that schizophrenia is rare because few people are admitted each year. A trainee shows you a case-control study where cannabis use was more common among people with first-episode psychosis (OR 2.2) and concludes cannabis causes 50% of psychosis. A GP wants to use a psychosis risk questionnaire with sensitivity 85% and specificity 85% to screen all 18-year-olds in schools where true prevalence of the target state is under 1%. Defend the correct frequency measure for community burden, dismantle the causal overclaim, explain confounding versus effect modification, and walk through predictive values at low prevalence. Be ready for follow-ups on person-time, PAF assumptions, Hill criteria, and STROBE.'

Open

Domain

Specialty psychiatry — sexual medicine interface

2

clinical

Erectile and ejaculatory disorders — structured clinical viva

You are the psychiatry registrar. A urology colleague asks you to co-manage a 41-year-old man referred after two failed sildenafil trials. History reveals: (1) sildenafil taken without sexual stimulation while intoxicated with alcohol; (2) lifelong PE with IELT under 1 minute and severe shame; (3) recent escitalopram 20 mg for panic with new delayed orgasm on masturbation but partner intercourse still early because of PE anxiety; (4) partner threatening separation. Discuss mechanisms, assessment, and an integrated management plan including when PDE5i 'failure' is not pharmacological failure.

Open

clinical

Female sexual interest, arousal and pain disorders — structured clinical viva

You are the psychiatry registrar in clinic. A 42-year-old woman on long-term escitalopram reports 1 year of low desire, poor arousal, and new dyspareunia after perimenopausal symptoms. Her partner wants 'the female Viagra.' Discuss DSM-5-TR vs ICD-11 nosology, Basson/dual-control framing, SSRI contribution, assessment including FSFI, stepped care, flibanserin vs bremelanotide safety, GSM/pain pathways, and how you respond to the partner demand.

Open

Domain

Forensic psychiatry — expert evidence

1

clinical

Expert evidence and forensic report writing — structured clinical viva

You have been instructed as an independent psychiatric expert in a contested civil disability matter, and you also supervise registrars who are often subpoenaed as treating doctors. Discuss: (1) expert versus fact/treating roles; (2) dual-role ethics and when to decline; (3) AAPL-informed forensic assessment steps; (4) essential report structure and opinion quality standards; (5) ultimate-issue and admissibility (Frye/Daubert-type) principles without inventing statutes; (6) bias and inter-expert disagreement; (7) oral testimony and cross-examination method.

Open

Domain

Psychotherapy — behavioural therapies

1

clinical

Exposure and response prevention — structured clinical viva

You are the psychiatry registrar in an anxiety disorders clinic. A 34-year-old woman with longstanding OCD (harm thoughts with mental rituals and checking) remains moderately ill on fluoxetine 60 mg oral daily. The consultant asks you to: define ERP; contrast habituation vs inhibitory learning; design an imaginal and in-vivo plan with response prevention; cite Foa 2005, Simpson SRI-augmentation trials, and POTS briefly; list pitfalls and family accommodation issues; and outline risk management if exposure transiently increases distress.

Open

Domain

Psychopharmacology

1

clinical

Extrapyramidal side effects and tardive dyskinesia — structured clinical viva

You are the psychiatry registrar. A 29-year-old man with first-episode psychosis develops acute torticollis after IM haloperidol, later akathisia on aripiprazole, and after eight months of risperidone shows new orofacial dyskinesia. Discuss classification, acute rescue including doses, akathisia management, TD epidemiology (SGA era), AIMS monitoring, and VMAT2 evidence (name trials).

Open

Domain

Forensic psychiatry — FII / medical child abuse

1

clinical

Fabricated or induced illness — structured clinical viva

You are the psychiatry registrar on the paediatric ward. A 2-year-old has recurrent unexplained apnoeas. Mother is highly medically fluent. Staff note events only when she is alone with the child. Discuss: (1) modern terminology map and why MSBP is imperfect; (2) immediate safety and reporting principles; (3) multi-source assessment structure; (4) perpetrator psychopathology themes from series data; (5) differential including genuine disease and malingering by proxy; (6) covert surveillance ethics; (7) what you will put in a child-protection / family-court opinion and what you will not invent.

Open

Domain

General adult psychiatry — factitious disorder and malingering

1

clinical

Factitious disorder and malingering — structured clinical viva

You are the psychiatry registrar on C-L. A 41-year-old is admitted with non-epileptic events and claimed complete memory loss after a minor workplace incident with an open compensation claim. Ward staff observe normal conversation and smartphone use when unobserved. The medical team wants you to 'get them sectioned as Munchausen'. Defend nosology, differential including FND, assessment with collateral and validity testing, ethics of documentation and non-collusion, and a management plan.

Open

Domain

Old age psychiatry — falls polypharmacy frailty

1

clinical

Falls, polypharmacy and frailty — structured clinical viva

You are the old-age psychiatry registrar. A GP refers an 80-year-old man with mild cognitive impairment, recurrent falls, and low mood. Medications: temazepam 10–20 mg PRN, amitriptyline 50 mg at night for 'sleep and pain,' and the GP proposes quetiapine 50 mg for 'evening restlessness' plus citalopram 40 mg. Discuss frailty framing, FRID review, multifactorial falls prevention, safer psychotropic choices and monitoring, and how you avoid both sedative stacking and under-treatment of depression.

Open

Domain

Professional — psychosocial interventions

1

clinical

Family intervention and expressed emotion — clinical viva

Examiner shows a genogram of a young man with psychosis living with high-EE parents and asks you to structure a family intervention plan.

Open

Domain

General adult psychiatry — early psychosis pathway

1

clinical

First-episode psychosis — structured clinical viva

You are the psychiatry registrar in the early intervention clinic. A 21-year-old man presents with a first episode of psychosis after 4 months of untreated persecutory delusions and auditory commentary. His mother asks: (1) Is this schizophrenia forever? (2) Why not the strongest tablet now? (3) How long must he stay on medication if he gets better? (4) Should he quit university? Discuss assessment priorities, organic exclusion, EIS evidence, dosing, maintenance duration, family work and vocational recovery.

Open

Domain

Forensic psychiatry — fitness and criminal responsibility

1

clinical

Fitness to stand trial and criminal responsibility — structured clinical viva

You are asked by the court to assess a 41-year-old defendant charged with assault. He has mild intellectual disability and recent methamphetamine use. He answers that the judge 'gives out the tablets' and that pleading guilty means 'going home for lunch'. Counsel says he smiles and nods but cannot explain the evidence against him. Discuss how you assess fitness using Presser/Pritchard/Dusky principles, the role of IQ, structured tools, differential of unfitness versus educational/cultural barrier, restorability if unfit, and how this differs from a mental impairment (criminal responsibility) evaluation for the night of the assault. Address intoxication doctrines at principle level and report structure.

Open

Domain

Intellectual disability — neurodevelopmental

2

clinical

Foetal alcohol spectrum disorder — structured clinical viva

You are the dual-diagnosis psychiatry registrar. Kinship carers of a 9-year-old with possible FASD ask: (1) What is FASD and how is it diagnosed? (2) Does he need the facial features for the diagnosis? (3) Is there a medicine that fixes the brain injury? (4) Why is he so impulsive and forgetful if his IQ is average? (5) What will help at school and reduce later trouble with the law? (6) His teenage sister drinks at parties — what should we say about pregnancy? Discuss diagnostic systems, neurobehavioural profile, management, secondary disabilities and prevention.

Open

clinical

Fragile X syndrome — structured clinical viva

You are the dual-diagnosis psychiatry registrar. Parents of a boy with probable fragile X syndrome ask: (1) What is fragile X and how is it inherited? (2) What do the CGG numbers mean? (3) Why does mum's early menopause matter? (4) Is there a medicine that cures the gene problem? (5) What psychiatric problems should we watch for? (6) Who else in the family needs testing? Discuss genetics, phenotype, premutation risks, management and counselling.

Open

Domain

Professional — formulation

1

clinical

Formulation skills — structured clinical viva

You are the psychiatry registrar. A 34-year-old woman presents with 4 months of major depression after redundancy. She drinks a bottle of wine most nights 'to sleep', lies in bed until midday, and has passive death wishes without a plan. She describes childhood emotional neglect, a critical mother, and a partner who wants to help but 'keeps saying snap out of it'. She is proud of being a good parent to a 8-year-old. Discuss your formulation framework, a 4P biopsychosocial formulation, cultural/identity issues you would explore, how formulation differs from diagnosis and from risk assessment, critiques of the BPS model, and how you would present this in under 90 seconds in a CASC.

Open

Domain

Old age psychiatry — neurocognitive disorders

2

clinical

Frontotemporal dementia — structured clinical viva

You are the old-age psychiatry registrar. A 61-year-old woman with progressive social disinhibition, apathy, and hyperorality over two years is referred as 'treatment-resistant bipolar disorder.' MRI report (provided) notes preferential frontal and anterior temporal atrophy. Her father died of motor neuron disease. Discuss diagnostic criteria, differentials from primary psychiatric disease, genetics, investigation plan, pharmacologic limits including antipsychotics, and capacity/driving advice.

Open

clinical

Young-onset dementia — structured clinical viva

You are the psychiatry registrar in a cognitive disorders clinic. A 53-year-old woman with 18 months of progressive memory and executive failure is still working part-time and driving. Her mother and maternal uncle both developed dementia in their 50s. Discuss definition of young-onset dementia, differential, investigation plan including genetics, symptomatic treatment if EOAD is confirmed, antipsychotic cautions, and capacity/driving/employment advice.

Open

Domain

Addiction psychiatry — behavioural addictions

2

clinical

Gambling disorder — structured clinical viva

You are the addiction psychiatry registrar. A 51-year-old woman with restless legs syndrome on pramipexole presents with 6 months of escalating electronic gaming machine use, maxed credit cards, marital crisis, and G-SAS scores in the severe range. She also meets criteria for major depression and smokes 20 cigarettes daily. She wants 'naltrexone like for alcohol' and refuses to involve her neurologist. Discuss diagnosis, iatrogenic contributors, risk, stepped care, and how you would counsel on medication.

Open

clinical

Gaming and internet addiction — structured clinical viva

You are the child and adolescent / addiction psychiatry registrar. A 14-year-old with autism spectrum disorder and ADHD plays an MMORPG 10 hours nightly, has school refusal for 3 months, and parents have tried router locks that trigger meltdowns and threats of self-harm. They ask whether this is 'just his special interest' or 'addiction,' demand naltrexone 'like for alcohol,' and refuse any family sessions. Discuss nosology, formulation, risk, and stepped care.

Open

Domain

Specialty psychiatry — gender and sexuality

1

clinical

Gender dysphoria and affirming care — structured clinical viva

You are the psychiatry registrar. A 28-year-old transgender woman (hormones for 3 years via a community clinic) presents after a near-lethal overdose. She reports ongoing discrimination at work, depression, and fear that 'hormones failed because I still want to die.' She asks you to stop all mental health treatment and 'just approve bottom surgery tomorrow,' and becomes angry when you mention suicide risk. Discuss formulation (including minority stress), differential, acute risk management, evidence-aware discussion of surgery expectations, residual post-transition risk, and collaborative plan.

Open

Domain

General adult psychiatry — anxiety disorders

6

clinical

Generalised anxiety disorder — structured clinical viva

You are the psychiatry registrar. A 40-year-old woman with 8 years of free-floating multi-domain worry, muscle tension and insomnia has been taking diazepam 5 mg three times daily for 3 years from various GPs. Two SSRI trials were stopped within 10 days for 'feeling worse'. She asks for 'something stronger' and declines 'talking therapy' because 'worrying keeps my family safe'. Discuss formulation, criteria, medication sequencing (including why prior SSRIs may have failed), benzodiazepine stewardship, CBT rationale for positive beliefs about worry, and pregabalin/buspirone roles.

Open

clinical

Panic disorder and agoraphobia — structured clinical viva

You are the psychiatry registrar. A 41-year-old man with 3 years of panic disorder and progressive agoraphobia is housebound most days. He takes diazepam 5 mg three times daily from his GP for 18 months, tried sertraline 50 mg for 10 days two years ago 'but felt worse,' and declined psychology. His partner asks whether 'stronger tranquilisers' or 'shock treatment' are next. Discuss formulation, why prior SSRI trial was inadequate, your pharmacological and CBT plan, benzodiazepine taper strategy, and what you would say about ECT.

Open

clinical

Selective mutism — structured clinical viva

You are the psychiatry registrar in CAMHS. A 7-year-old boy has not spoken at school for 8 months. At home he is talkative. The deputy principal wants him held back a year unless he 'chooses to speak.' Parents request diazepam before school forever and refuse any school-based sessions. A speech pathologist notes normal language structure on a home video. Discuss criteria (including duration and language exclusions), why elective mutism is outdated, differentials (SAD, ASD, hearing), first-line behavioural ingredients with school involvement, limits of benzodiazepines, and when fluoxetine would be considered with a concrete dosing and monitoring example.

Open

clinical

Separation anxiety disorder — structured clinical viva

You are the psychiatry registrar. A 29-year-old woman is referred for 'panic disorder' after ED visits when her husband is on night shift. History shows 3 years of inability to sleep alone, repeated nightmares about him dying, refusal to let him take interstate work, and dozens of checking calls. She denies unexpected panic when he is home. She asks for 'something strong like diazepam every night forever' and declines therapy because exposure 'sounds cruel'. Discuss criteria and adult-onset validity, differentials from panic/agoraphobia and dependent personality, formulation including accommodation, first-line CBT/exposure ingredients, limits of benzodiazepines, and when an SSRI would be added with a concrete dosing example.

Open

clinical

Social anxiety disorder — structured clinical viva

You are the psychiatry registrar. A 26-year-old software engineer has avoided team meetings and client calls for 3 years, fearing colleagues will see him blush and judge him as incompetent. He drinks before any social gathering. Two SSRI trials were stopped within 10 days for 'feeling worse'. He asks for 'something stronger than talking' and declines exposure work because 'I already know I am awkward'. Discuss formulation, criteria (including performance-only), CBT rationale targeting safety behaviours and self-focused attention, medication sequencing, alcohol, and refractory options including phenelzine specialist role.

Open

clinical

Specific phobia — structured clinical viva

You are the psychiatry registrar. A 24-year-old veterinary nurse has disabling spider phobia that now prevents her from entering half the clinic rooms. She requests 'a tablet to take the edge off forever' and declines therapy because a friend said exposure is cruel. Separately she nearly faints when assisting with blood draws on animals. Discuss criteria and types, formulation, why exposure/OST is first-line, applied tension for BII features, limits of benzodiazepines, and how you would engage her collaboratively.

Open

Domain

Addiction psychiatry — hallucinogen-related disorders

1

clinical

Hallucinogen-related disorders — structured clinical viva

You are the psychiatry registrar. A 26-year-old woman ingested mushrooms 4 hours ago, is panicking with geometric visual changes, BP 132/80, temperature 36.9°C, clear consciousness. Partner asks whether she has schizophrenia and whether she needs lifelong antipsychotic. She later asks for a microdosing prescription because she read that psilocybin beats antidepressants. Discuss acute management, class pharmacology, HPPD risk, dual formulation, and the research evidence interface.

Open

Domain

Addiction psychiatry — public health and systems

1

clinical

Harm reduction — structured clinical viva

You are the psychiatry registrar on call. A 45-year-old woman is brought to ED after her partner used intranasal naloxone when she was found unresponsive with pinpoint pupils and respiratory rate 4/min. She is now irritable and in moderate opioid withdrawal. She injects heroin and sometimes methamphetamine, uses the needle exchange irregularly, has hepatitis C antibody positive status without RNA follow-up, and was removed from a methadone programme 6 weeks ago after missing three doses and then using. The ED consultant asks whether giving her clean needles and another naloxone kit is 'enabling' and whether you should insist on detox only. Discuss your formulation, acute plan, public-health rationale, and how you would speak with staff about stigma.

Open

Domain

Consultation-liaison — hepatic encephalopathy and advanced transplant psychiatry

1

clinical

Hepatic encephalopathy and advanced transplant psychiatry — structured clinical viva

Station A: Ward referral for a cirrhotic patient with fluctuating confusion, asterixis, and 'new bipolar' query after a benzodiazepine was given for agitation. Station B: Pre-listing psychosocial report for alcohol-associated cirrhosis with depression and DNA pattern; defend your recommendations to the transplant MDT. Cover HE classification and mechanisms at principle level, precipitants, lactulose/rifaximin evidence, benzo risk, capacity reassessment, SIPAT/ISHLT-style domains, Dew outcome data, and psychotropic cautions including valproate hyperammonaemia — without inventing statute section numbers or a universal six-month abstinence law.

Open

Domain

Foundations — historiography

1

clinical

History of psychiatry — structured clinical viva

Examiner: 'Psychiatry’s past is only chains and asylums — modern manuals prove we are scientific now, so history is irrelevant.' Using a 45-year-old man with bipolar mania referred for lithium education, and a family terrified of 'shock treatment' and lifelong hospitalisation, defend a sophisticated historical account: moral treatment, landmarks (ECT, lithium, chlorpromazine), deinstitutionalisation, Rosenhan/DSM-III, validity vs utility, recovery, and ethical dark history — linking each to contemporary practice.

Open

Domain

Forensic psychiatry — homicide and mental disorder

1

clinical

Homicide and mental disorder — structured clinical viva

Discuss homicide associated with mental disorder for fellowship standard. Cover absolute versus relative risk and national survey orders of magnitude; why first-episode untreated psychosis is high-yield; substances and personality pathways; filicide and homicide-suicide pointers; patients with mental illness as victims; how you structure a criminal-responsibility opinion; the fitness/responsibility/risk temporal triad; and common media myths. Do not invent statute section numbers.

Open

Domain

General adult psychiatry — somatic symptom and related

1

clinical

Illness anxiety disorder — structured clinical viva

You are the psychiatry registrar on the CL service. A 45-year-old man on the cardiology ward has had three normal angiograms over 2 years for recurrent chest tightness. Troponins and ECGs are repeatedly normal. He is convinced he has 'missed coronary disease' (poor insight), checks his pulse every 15 minutes, and demands another angiogram tonight. He meets criteria for illness anxiety disorder with care-seeking behaviour and comorbid depression. Nursing staff call him a 'heartsink' patient. Discuss diagnosis vs SSD and delusional disorder, the CBT model, CHAMP relevance, SSRI options with doses, collaborative care, and suicide/mortality risk framing.

Open

Domain

Addiction psychiatry — inhalant-related disorders

1

clinical

Inhalant-related disorders — structured clinical viva

You are the psychiatry registrar. A 17-year-old Aboriginal youth from a remote community is transferred after recurrent petrol sniffing and a brief collapse while being chased. ECG in ED was sinus tachycardia; he is now irritable, craving, and minimising risk. Family want him 'locked up forever.' Separately, a 21-year-old city student on the ward for depression admits daily nitrous oxide balloons and new foot numbness. Discuss acute medical risk (including sudden sniffing death), dual-diagnosis and culturally safe care, the evidence position on pharmacotherapy for volatile misuse, N2O myeloneuropathy work-up and B12 treatment principles, and disposition.

Open

Domain

Specialty psychiatry — sleep medicine interface

5

clinical

Insomnia disorder — structured clinical viva

You are the psychiatry registrar in clinic. A 58-year-old man with residual GAD and depression has taken temazepam nightly for 5 years. He wants a stronger tablet. ISI is high, he extends time in bed to 10 hours, clock-watches, and drinks wine most nights. BMI 34, snoring present, one fall last year. Discuss diagnostic hierarchy, Spielman 3P/hyperarousal framing, why long-term benzodiazepines are problematic, CBT-I components and cautions, OSA work-up, and a safe deprescribing plan.

Open

clinical

Narcolepsy and hypersomnolence — structured clinical viva

You are the psychiatry registrar. A 28-year-old with residual MDD is referred for 'conversion collapses' and 'psychotic visual experiences at night.' History reveals laughter-triggered bilateral atonia with preserved awareness, irresistible daytime sleep attacks, hypnagogic images with insight, and two occupational near-misses. Discuss diagnostic hierarchy, orexin pathophysiology, MSLT rules, first-line EDS and cataplexy treatment with doses/monitoring, driving advice, and traps that lead to antipsychotic over-treatment.

Open

clinical

Obstructive sleep apnoea and psychiatry — structured clinical viva

You are the psychiatry registrar in a clozapine clinic. A 41-year-old man with schizophrenia has gained 18 kg on olanzapine then clozapine. He falls asleep in group programmes, scores high on sleepiness measures, partners report snoring and apnoeas, and nursing staff request 'stronger night sedation' because he is restless at 02:00. BMI 39, BP 150/95. Discuss OSA probability, why more benzodiazepines are the wrong answer, investigation pathway, PAP role, metabolic monitoring, adherence barriers in psychosis, and driving advice.

Open

clinical

Restless legs syndrome — structured clinical viva

You are the psychiatry registrar. A 55-year-old man with residual GAD has taken ropinirole for 'restless legs' for 4 years. He now needs afternoon doses, symptoms spread to his arms, and he recently lost money gambling online. Ferritin 3 years ago was 40 ng/mL and never repeated. He wants a higher dopamine-agonist dose tonight. Discuss diagnostic hierarchy, augmentation, iron, pharmacologic switch strategy, and impulse-control risk.

Open

clinical

Sleep disorders in psychiatry — structured clinical viva

You are the psychiatry registrar in clinic. A 62-year-old man with late-life depression and anxiety has taken temazepam nightly for 6 years. He falls twice in 3 months, scores high on an insomnia severity measure, and his daughter wants 'a stronger sleeping tablet.' BMI 36, loud snoring, ESS elevated. Discuss diagnosis hierarchy, why long-term benzodiazepines are problematic, CBT-I components, OSA work-up, and a safe deprescribing and safety plan.

Open

Domain

intellectual disability psychiatry

1

clinical

Intellectual disability assessment and classification — structured clinical viva

You are the psychiatry registrar in a neurodevelopmental clinic. Parents of a 10-year-old with IQ 58 and major adaptive skill gaps ask: (1) Does a low IQ alone mean intellectual disability? (2) How severe is it and who decides? (3) What blood or gene tests should be done? (4) Is there a tablet that improves intelligence? (5) What supports exist and what happens at 18? Discuss DSM/ICD structure, adaptive domains, aetiological workup, services and capacity.

Open

Domain

General adult psychiatry — impulse control

2

clinical

Intermittent explosive disorder — structured clinical viva

You are the psychiatry registrar. A 31-year-old man is referred from probation after a public assault following a queue argument. He describes lifelong 'short fuse,' weekly explosive outbursts, property damage, and remorse. The consultant asks: 'Is this just ASPD? Does medication work? What is your risk formulation?' Discuss diagnosis, discriminators, evidence-based management, and safety planning.

Open

clinical

Kleptomania and pyromania — structured clinical viva

You are the psychiatry registrar. A 29-year-old woman with repeated unneeded shoplifting and post-arrest despair is referred. The consultant also asks you to teach a junior how to separate pyromania from arson. Discuss criteria, differentials, evidence-based management including naltrexone, and risk formulation.

Open

Domain

Psychopharmacology — ketamine and esketamine

1

clinical

Ketamine and esketamine — consultant viva

Examiner places cards: 0.5 mg/kg, TRANSFORM-2, SUSTAIN-1, ASPIRE, ELEKT-D, aneurysm history, unsupervised take-home spray, dissociation in recovery.

Open

Domain

Psychopharmacology — lamotrigine

1

clinical

Lamotrigine — consultant viva

Examiner places cards: Goodwin pooled, 25→50 titration, valproate, combined OCP, day-12 mucosal rash, missed doses 10 days, pregnancy EURAP.

Open

Domain

Old age psychiatry — anxiety disorders

1

clinical

Late-life anxiety disorders — structured clinical viva

You are the old-age psychiatry registrar. A 74-year-old man has disabling worry, housebound avoidance after a fall, and four years of nightly temazepam. Discuss formulation (late-life GAD vs fear of falling vs depression), work-up, CBT and SSRI evidence (Stanley, Lenze), hyponatraemia risk, Beers criteria benzodiazepine deprescribing, and suicide assessment when depression coexists.

Open

Domain

Old age psychiatry — mood disorders

2

clinical

Late-life bipolar disorder — structured clinical viva

You are the old-age psychiatry registrar. A 69-year-old man with no prior psychiatric contact presents with a first manic episode. Vascular risk factors are present; he started high-dose prednisolone three weeks ago for COPD exacerbation. Discuss formulation (late-onset vs secondary mania), work-up, acute management including whether lithium is reasonable (GERI-BD), suicide risk in older adults, and how you would counsel about long-term lithium if primary bipolar is later confirmed.

Open

clinical

Late-life depression — structured clinical viva

You are the old-age psychiatry registrar. An 81-year-old woman with hypertension and prior lacunar stroke presents with six months of apathy, slowed thinking, low mood, and executive dysfunction on bedside testing. Family say she is 'not herself' since her husband died last year. She has failed an inadequate six-week trial of sertraline 25 mg daily. Discuss formulation (including vascular depression), further assessment, next treatment steps including dosing philosophy, ECT indications, suicide risk in older adults, and maintenance after recovery.

Open

Domain

Old age psychiatry — psychosis

1

clinical

Late-onset psychosis — structured clinical viva

You are the old-age psychiatry registrar. A 79-year-old woman with progressive hearing loss presents with six months of partition delusions, third-person voices, and neighbour conflict. Family worry she has 'Alzheimer's'. Discuss definition of LOS/VLOSLP, formulation including sensory factors, organic work-up, differentials (especially dementia and DLB), antipsychotic choice with dosing and dementia mortality caution, risk, capacity, and follow-up.

Open

Domain

Foundations — behavioural science

1

clinical

Learning theory and behavioural science — structured clinical viva

You are the psychiatry registrar. The consultant asks you to teach behavioural science using a 34-year-old with contamination OCD (handwashing 4 hours/day) and a 41-year-old with major depression who stays in bed to avoid failure. Cover: classical vs operant definitions; schedules; extinction/Bouton; inhibitory learning vs habituation; ERP and BA mechanisms; self-efficacy; exam traps.

Open

Domain

Psychopharmacology — lithium

1

clinical

Lithium — consultant viva

Examiner places cards: BALANCE, Cipriani suicide meta, 12-hour trough, NSAID start, McKnight organs, pregnancy first trimester, EXTRIP, older adult lower target.

Open

Domain

Psychopharmacology — long-acting injectable antipsychotics

1

clinical

Long-acting injectable antipsychotics — consultant viva

Examiner places cards: oral overlap, PP1M day 1+8, PDSS, PRELAPSE, Tiihonen HR 0.36, Rosenheck negative RCT, TRRIP vs LAI, CTO injection.

Open

Domain

General adult psychiatry — mood disorders

5

clinical

Major depressive disorder — structured clinical viva

You are the psychiatry registrar. A 45-year-old man with three prior depressive episodes presents with severe melancholic depression, passive death wishes, and partial response to two adequate antidepressant trials (sertraline 150 mg; venlafaxine XR 225 mg). His partner asks about 'shock treatment' and whether lithium 'is only for bipolar'. Discuss assessment, next pharmacological steps, ECT evidence and consent outline, and maintenance after recovery.

Open

clinical

Melancholic and atypical specifiers — structured clinical viva

You are the psychiatry registrar. Compare and contrast melancholic features and atypical features as DSM-5-TR specifiers. Cover operational criteria, epidemiology signals, HPA versus reverse-vegetative teaching, differentials including bipolarity, first-line treatments, ECT thresholds for severe melancholia, historical MAOI evidence for atypical depression with safety rules, and two common examiner pitfalls.

Open

clinical

Psychotic depression — structured clinical viva

You are the psychiatry registrar. A 61-year-old man has severe major depression with mood-congruent nihilistic and guilt delusions and intermittent accusatory voices. He is medically stable, not catatonic, but has passive death wishes and poor oral intake improving with ward support. Bipolar screen negative. Discuss diagnosis, suicide risk, first-line treatment with evidence (STOP-PD), monitoring, when you would escalate to ECT, and continuation after remission (STOP-PD II).

Open

clinical

Seasonal and atypical depression — structured clinical viva

You are the psychiatry registrar. A 41-year-old woman has winter major depressive episodes for five years with hypersomnia, weight gain, leaden limb heaviness and lifelong rejection sensitivity. She asks whether she needs 'the old MAOI tablets', whether a light box is 'scientific', and whether starting bupropion now in April (southern hemisphere autumn) makes sense while she is still well. Discuss diagnosis, mechanisms, light therapy evidence, atypical-feature pharmacology, and a preventive plan.

Open

clinical

Treatment-resistant depression — structured clinical viva

You are the psychiatry registrar in a mood disorders clinic. A 48-year-old man with recurrent MDD has failed two documented adequate antidepressant trials (sertraline 150 mg for 8 weeks; venlafaxine XR 225 mg for 8 weeks) with verified adherence and PHQ-9 still 19. Bipolar screen is negative; alcohol is minimal; TSH and B12 are normal. He asks about lithium 'only for bipolar people', shock treatment, and 'the ketamine nasal spray he saw online'. Discuss definition of TRD, next-step options with monitoring, ECT indications/consent outline, and place of rTMS/esketamine.

Open

Domain

Forensic psychiatry — mental health law

1

clinical

Mental health law and involuntary treatment — structured clinical viva

You are the psychiatry registrar. A 34-year-old woman with bipolar disorder, currently manic, demands to leave the ward. She spent $40,000 in three days, has not slept, and sexually disinhibited behaviour places her at risk of exploitation. She understands she is in hospital but insists she is 'fine and chosen by God to invest'. Nursing staff ask which section to use. Discuss capacity vs compulsory criteria, least restrictive options, documentation, rights, seclusion thresholds, and what you would say about a CTO later. Do not invent section numbers.

Open

Domain

Professional skills — mental state examination

1

clinical

Mental state examination — structured clinical viva

You are examining a psychiatry registrar. Present a 45-year-old with two weeks of reduced sleep, overspending, irritable mood, pressured speech, and flight of ideas. Family says they are 'not themselves.' Walk the panel through your MSE domain by domain, contrast this with a melancholic depression MSE, explain how you would document insight, when you would add YMRS/PHQ-9/MoCA, how cultural factors could mislead, and how CASC technique differs from a written note. Address first-rank symptoms if the panel asks about 'voices commenting.'

Open

Domain

Psychopharmacology — metabolic syndrome and psychotropic monitoring

1

clinical

Metabolic syndrome and psychotropic monitoring — consultant viva

Examiner cards: ATP III/IDF components; clozapine/olanzapine vs aripiprazole ranking; ADA/APA 4/8/12-week weight; Correll 2009 youth; CATIE metabolic trade-off; H1/5-HT2C; Wu and Jarskog metformin; switch to aripiprazole; keep clozapine in TRS; who owns the bloods.

Open

Domain

Public-community — military and veteran psychiatry

1

clinical

Military and veteran psychiatry — structured clinical viva

You are the psychiatry registrar. A 29-year-old recently discharged combat veteran presents with nightmares, hypervigilance, heavy drinking, and passive death wishes. A licensed firearm is kept at home. Discuss service-context formulation, moral injury versus PTSD, epidemiology anchors (Hoge/Fear/Seal), assessment including weapons and MST principles, PE/CPT evidence (Monson, Steenkamp), SSRI dosing, prazosin equipoise (Raskind 2013 vs 2018), dual loyalty if still serving, and disposition — without inventing compensation statutes.

Open

Domain

Psychopharmacology — atypical and multimodal antidepressants

1

clinical

Mirtazapine, bupropion and multimodal antidepressants — consultant viva

Examiner cards: NaSSA vs NDRI labels; mirtazapine 15 mg script; bupropion XL 300 mg; bulimia history; STAR*D L2 switch trio; CO-MED headline; rocket fuel L4; vortioxetine cognition claim; smoking cessation; low-dose sedation pearl.

Open

Domain

Psychopharmacology — monoamine oxidase inhibitors

1

clinical

Monoamine oxidase inhibitors — consultant viva

Examiner places cards: phenelzine, cheese reaction, fluoxetine washout, pethidine, selegiline 6 vs 12 mg patch, STAR*D level 4, atypical depression, moclobemide RIMA.

Open

Domain

Psychopharmacology — mood stabilisers

1

clinical

Mood stabilisers — levels, toxicity, teratogens and trials viva

Examiner places four drug cards (lithium, valproate, lamotrigine, carbamazepine) and a blank monitoring table. You must fill targets, key toxicities, pregnancy rank, and name BALANCE, Cipriani suicide, EURAP, HLA-B*1502 and EXTRIP in under a minute each.

Open

Domain

Professional — psychological therapies and communication

1

clinical

Motivational interviewing — structured clinical viva

You are the psychiatry registrar in a dual-diagnosis clinic. A 41-year-old woman with bipolar disorder, currently euthymic on lithium, drinks daily and has two recent ED attendances after falls. She says she is 'not ready to stop' but might cut down. The consultant asks you to: define MI and its spirit; demonstrate OARS with example lines; explain change talk (DARN-CAT) and the righting reflex; relate stages of change to MI; summarise MATCH, UKATT, COMBINE, and Cochrane evidence; and outline when MI is insufficient alone.

Open

Domain

Addiction psychiatry — psychosocial interventions

1

clinical

Mutual-help and contingency management — structured clinical viva

You are the psychiatry registrar. A 41-year-old woman with alcohol use disorder has finished inpatient detox. She is ambivalent about AA ('too religious'), has relapsed twice after detox-only, and her GP asks whether 'those voucher programmes for drugs' have any science or are just bribery. She also asks if her husband should attend Al-Anon. Discuss your formulation, mutual-help plan, whether CM applies, landmark evidence, and how you answer the bribery concern.

Open

Domain

General adult psychiatry — psychosis

2

clinical

Negative and cognitive symptoms of schizophrenia — structured clinical viva

You are the psychiatry registrar in a community psychosis clinic. A 34-year-old woman with schizophrenia has controlled positive symptoms on aripiprazole 15 mg orally daily. Family report three years of blunted affect, sparse speech, social withdrawal, and inability to return to work. She scores poorly on working memory and processing speed tasks. There is no rigidity, no major depression, urine drug screen is negative, and thyroid/B12 are normal. Discuss primary negatives, deficit concept, scales, cognition–function link, limited drug evidence including cariprazine nuance, and cognitive remediation.

Open

clinical

Treatment-resistant schizophrenia — structured clinical viva

You are the psychiatry registrar in a community psychosis clinic. A 32-year-old man with schizophrenia has completed two documented adequate antipsychotic trials (risperidone 6 mg for 8 weeks with plasma level in range; olanzapine 20 mg for 8 weeks with verified supervised dosing) with persistent positive symptoms. Bipolar screen is negative; urine drug screen is negative; TSH and B12 are normal. He asks why you are 'pushing the dangerous blood drug', whether shock treatment is next, and whether a 'monthly injection will fix resistance'. Discuss TRRIP definition, clozapine offer with monitoring, InterSePT, LAI role, and ultra-TRS/ECT logic.

Open

Domain

Addiction psychiatry — neonatal abstinence

1

clinical

Neonatal abstinence syndrome — structured clinical viva

You are the addiction psychiatry registrar on perinatal liaison. Neonatology asks you to join a family meeting. A day-4 term infant exposed to maternal buprenorphine–naloxone (16 mg/day) plus third-trimester sertraline has escalating irritability. The unit historically starts morphine when Finnegan scores exceed threshold twice; nursing staff are interested in Eat, Sleep, Console. Mother is tearful, fears the baby will be ‘taken,’ and asks whether switching her to methadone would have been kinder. Father wants the infant moved to NICU away from mother ‘so scoring is objective.’ Discuss assessment models, management ladder, evidence (MOTHER, Suarez, ESC, Kraft), breastfeeding, and ethics of separation and safeguarding.

Open

Domain

foundations — neuroscience for fellowship psychiatry

1

clinical

Neuroanatomy and circuits — structured clinical viva

You are in a FRANZCP/MRCPsych-style viva. The examiner shows a schematic of the brain and asks you to teach the neural circuits a psychiatrist must know. Be prepared to cover prefrontal syndromes, Papez versus modern limbic anatomy, Alexander–DeLong loops, four dopamine pathways, Menon triple network, and a first-episode psychosis localisation work-up. Expect follow-ups on Howes–Kapur, Grace phasic/tonic DA, and why fMRI is not a diagnostic blood test.

Open

Domain

Intellectual disability — forensic dual disability

1

clinical

Offending and intellectual disability — structured clinical viva

You are the dual-disability psychiatry registrar. A 22-year-old man with mild intellectual disability is on remand for arson of a bin store at his supported accommodation. Staff report he lights fires when bored and when staff set demands. Police obtained a detailed confession after a two-hour interview without an Appropriate Adult. He says 'I just said yes so they would stop.' IQ testing years ago was 62; adaptive functioning was never formally updated. Father wants him declared 'unfit forever'. Discuss epidemiology teaching points, interview reliability, fitness versus responsibility, offence formulation including function of fire-setting, risk assessment humility, and management under RNR principles — without inventing statute section numbers.

Open

Domain

Addiction psychiatry — substance use disorders

2

clinical

Opioid substitution therapy and withdrawal — structured clinical viva

You are the addiction psychiatry registrar. A 38-year-old man on methadone 100 mg wants transfer to buprenorphine 'because methadone is heart poison' after reading online. Last ECG QTc 465 ms. He missed one dose yesterday, last heroin use 4 days ago (denies today), and asks whether he can start naltrexone implant this week instead. Discuss assessment, COWS role, transfer risks, cardiac framing, and evidence-based options.

Open

clinical

Opioid use disorder — structured clinical viva

You are the addiction psychiatry registrar. A 41-year-old woman on methadone 90 mg daily presents after two missed clinic doses, wanting to 'come off everything this week' following a relationship crisis. She has chronic back pain, QTc 470 ms on a recent ECG, and smokes cannabis nightly. She asks whether buprenorphine is 'safer' and whether naltrexone implants will 'cure' her. Discuss risk, transfer/taper decisions, cardiac monitoring, pain dual diagnosis, and evidence-based alternatives.

Open

Domain

general-adult

1

clinical

OSFED — purging disorder vs BN and night eating (structured viva)

You are the psychiatry registrar. A 26-year-old woman with BMI 23.5 reports self-induced vomiting 5 nights weekly after normal-sized meals (she denies loss of control or objectively large binges). She also wakes twice weekly to eat cereal with full awareness, then returns to sleep. She says she is 'not sick enough for an eating disorder clinic' because she does not binge and is not underweight. Potassium is 3.2 mmol/L. Discuss diagnostic formulation (OSFED examples), medical risk, differentials including BN and SRED, and a treatment plan including CBT-E targets and when fluoxetine might be considered.

Open

Domain

Specialty psychiatry — clinical paraphilic disorders

1

clinical

Paraphilic disorders (clinical) — structured clinical viva

You are the psychiatry registrar in outpatient clinic. A 41-year-old man reports 2 years of exhibitionistic urges on public transport, two episodes of exposing himself while intoxicated, intense shame, and a request for 'medication to kill my sex drive.' He has no known child-related interests. Partner is distressed. Discuss classification, differential, risk, assessment, WFSBP-aligned management including when SSRIs versus antiandrogens/GnRH are considered, monitoring, and communication about goals of care.

Open

Domain

General adult psychiatry — perinatal

2

clinical

Perinatal mood and anxiety disorders — structured clinical viva

You are the psychiatry registrar on call. A midwife refers a day-4 postpartum mother who is tearful, not sleeping even when the baby sleeps, and has scored 18 on the EPDS with a positive self-harm item. Separately, the consultant asks you to explain how you distinguish perinatal OCD infant-harm thoughts from postpartum psychosis, and how you counsel about sertraline while breastfeeding. Structure your assessment, risk approach, differential, and management including when you would escalate to mother-baby unit care or ECT.

Open

clinical

Postpartum psychosis — structured clinical viva

You are the psychiatry registrar on call. Midwifery refers a day-4 postpartum primipara who has not slept for 48 hours even when the baby is settled, is talking rapidly, and told staff the baby is 'a test from God' and may need to be 'sent back.' Her mother has bipolar disorder. The consultant asks you to structure your assessment, dual risk approach, organic screen, acute treatment algorithm including lithium and ECT thresholds, mother-baby unit decision, and what you will tell the family about recurrence and prevention next pregnancy.

Open

Domain

Psychopharmacology — pregnancy and lactation

1

clinical

Perinatal psychopharmacology viva — hierarchy, signals, shared decision

Examiner places cards: valproate, lithium, lamotrigine, sertraline, olanzapine, diazepam. A blank counselling grid asks untreated illness risk, first-trimester MCM, third-trimester neonate, lactation. Name Grote, Viguera, Huybrechts, Patorno, EURAP/NEAD, Grigoriadis, Bergink within the station.

Open

Domain

Foundations — personality science

1

clinical

Personality theory for psychiatrists — structured clinical viva

You are the psychiatry registrar. The consultant asks you to teach personality theory using: (1) a 24-year-old with high neuroticism and recurrent depression; (2) a 33-year-old with identity diffusion, splitting, and team splits; (3) a 61-year-old with 18 months of new disinhibition. Cover FFM, Cloninger outline, AMPD A/B, ICD-11 severity, internalising–externalising/HiTOP links, assessment, and pitfalls.

Open

Domain

Addiction psychiatry — pharmaceutical and OTC misuse

1

clinical

Pharmaceutical and OTC drug misuse — structured clinical viva

You are the psychiatry registrar. ED presents a 45-year-old man with two syncopal episodes and a wide-complex rhythm that self-terminated. Empty multipacks of loperamide are in his bag. He has a history of prescription opioid dependence, lost his OAT place 8 weeks ago after missing doses, and has been taking ‘boxes of anti-diarrhoea tablets’ to feel normal. Staff ask whether this is ‘just an OTC issue’ and whether psychiatry needs to be involved. Discuss your assessment priorities, toxicology concerns, and addiction plan.

Open

Domain

Psychopharmacology — pharmacogenomics

1

clinical

Pharmacogenomics in psychiatry — consultant viva

Examiner cards: PK vs PD genes; PM/IM/NM/UM; CPIC SSRIs 2015 vs 2023; HLA-B*15:02; HLA-A*31:01; Chen Taiwan; phenoconversion; atomoxetine CYP2D6; GUIDED; PRIME Care; SLC6A4 ban; AGNP TDM.

Open

Domain

foundations — philosophy of mind

1

clinical

Philosophy of mind and psychiatry — structured clinical viva

You are examining a psychiatry registrar. Define philosophy of mind versus philosophy of psychiatry. Map dualism, physicalism, and functionalism. Explain Kendler's multilevel explanatory pluralism and dappled causes. Defend and critique the biopsychosocial model (Engel vs Ghaemi). Outline phenomenological form-first practice (Andreasen; Sass/Parnas self). Discuss free will neuroscience claims in forensic talk (Pierre) and Appelbaum capacity abilities. Close with multi-board exam pearls.

Open

Domain

Psychopharmacology — phototherapy and chronotherapy

1

clinical

Phototherapy and chronotherapy — consultant viva

Examiner places cards: 10,000 lux, Can-SAD, Lam 2016, phase advance, Sit midday light, wake therapy, Eastman 3 weeks, hypomania on day 5.

Open

Domain

General adult psychiatry — mood disorders / women's mental health

1

clinical

Premenstrual dysphoric disorder — structured clinical viva

You are the psychiatry registrar. A 34-year-old woman with prospectively charted PMDD asks why her hormone blood tests were 'all normal', whether sertraline only in the two weeks before her period is 'real medicine', how drospirenone contraception differs from 'any pill', and when doctors ever use 'chemical menopause'. Discuss diagnosis, mechanisms, SSRI dosing strategies, COC evidence, and refractory pathways.

Open

Domain

Old age psychiatry — psychopharmacology

1

clinical

Prescribing psychotropics in older adults — structured clinical viva

You are the old-age psychiatry registrar. A GP sends a 79-year-old man with mild cognitive impairment, depression, AF on apixaban, and two recent falls. Medications include temazepam 10–20 mg PRN, amitriptyline 50 mg at night for 'sleep and pain', and the GP asks whether to start quetiapine 50 mg for 'evening agitation' and citalopram 40 mg for mood. Discuss your approach to Beers/STOPP review, PK/PD, specific drug choices and doses, antipsychotic black-box issues if dementia evolves, QTc and bleeding/falls risks, and a monitoring plan.

Open

Domain

Foundations — prevention and early intervention

1

clinical

Prevention and early intervention — structured clinical viva

FRANZCP/MRCPsych-style viva. Slide 1: table comparing universal school programme, selective perinatal pathway, UHR clinic, and early intervention psychosis team. Slide 2: median DUP 12 months. Slide 3: question — 'Should all UHR patients receive prophylactic antipsychotics?' Follow-ups cover Rose vs Gordon, Cuijpers depression prevention IRR, Correll EIS meta-analysis, clinical staging, and implementation failure.

Open

Domain

Forensic psychiatry — prison mental health

1

clinical

Prison mental health — structured clinical viva

You take over as consultant psychiatrist to a medium-security prison health service. The governor reports rising self-harm on one wing, frequent use of segregation for 'psychiatric prisoners', incomplete reception screens at night, and several near-misses after release last year. Outline your framework for prison mental health: epidemiology anchors, reception standards, suicide and self-harm systems, dual diagnosis, segregation policy from a clinical view, equivalence of care, hospital transfer principles, special populations, and release transition. Be prepared to defend evidence without inventing statute section numbers.

Open

Domain

Foundations — nosology

1

clinical

Psychiatric classification — structured clinical viva

Examiner: 'Psychiatric diagnoses are unreliable and invalid — we should abandon manuals for RDoC and HiTOP only.' Using a 32-year-old man with first-episode psychosis and daily cannabis as a running example, defend a sophisticated position on ICD-11 vs DSM-5-TR, reliability vs validity vs utility, categorical vs dimensional models, ICD-11 psychosis/personality reforms, and how classification links to formulation and risk without reification.

Open

Domain

Intellectual disability psychiatry

1

clinical

Psychiatric disorders in intellectual disability — structured clinical viva

You are the psychiatry registrar in the intellectual disability clinic. Carers of a 28-year-old with moderate ID say new self-injury is 'just the disability'. He has been on risperidone for years for behaviour. Discuss diagnostic overshadowing, modified presentation, DC-LD, hierarchical assessment, and evidence against routine antipsychotics for aggression (Tyrer, Sheehan, Deb). Outline treatment adaptations.

Open

Domain

Foundations — psychiatric genetics and epigenetics

1

clinical

Psychiatric genetics and epigenetics — structured clinical viva

FRANZCP/MRCPsych-style viva. Slide 1: table of approximate twin heritabilities (schizophrenia high ~80%, MDD ~30–40%, bipolar high). Slide 2: schematic Manhattan plot labelled PGC schizophrenia. Slide 3: chromosome 22 with 22q11.2 deletion highlight. Follow-ups cover missing heritability, PRS clinical limits, epigenetics (Meaney/Weaver paradigm), and ethics of commercial genetic testing.

Open

Domain

Psychotherapy — psychoeducation and family interventions

1

clinical

Psychoeducation and family psychoeducation — structured clinical viva

You are the psychiatry registrar in a community early-psychosis team. A 24-year-old woman with schizophrenia is stable on aripiprazole 15 mg orally daily. She lives with her mother and younger brother. Mother is critical about 'laziness' and threatens to stop supporting housing if she misses appointments. The patient asks you to 'just educate Mum so she stops yelling.' The consultant asks you to: define PE and FPE; list EE components and mechanisms; outline session structure and NICE-style dose; name landmark packages and Cochrane findings for psychosis and bipolar PE; handle confidentiality and blame; and state when joint PE is deferred.

Open

Domain

Foundations — psychoneuroendocrinology and psychoimmunology

1

clinical

Psychoneuroendocrinology and psychoimmunology — structured clinical viva

You are examining a psychiatry registrar. A 34-year-old with treatment-resistant depression, early childhood trauma, mild CRP elevation during a respiratory infection, and a relative asking whether 'cortisol and inflammation tests can diagnose depression' is discussed. Separately, a patient on risperidone has amenorrhoea and galactorrhoea. Walk the panel through HPA biology and allostatic load, GR models, sickness behaviour and cytokine pathways, investigation limits (DST, CRP/IL-6), trauma programming, hyperprolactinaemia management, and how you formulate and treat without biomarker overclaim. Name landmark anchors.

Open

Domain

General adult psychiatry — psychosis rehabilitation

1

clinical

Psychosocial rehabilitation in psychosis — structured clinical viva

You are the community psychiatry registrar. A 24-year-old with first-episode schizophrenia is remitting on low-dose antipsychotic therapy. Parents ask: (1) Why is he still not working if the voices are better? (2) Should we keep him at home until he is 100% cured? (3) What is this IPS thing? (4) Do we need family meetings? (5) Is 'recovery' just code for discharging him early? Discuss disability mechanisms, recovery constructs, multi-element packages, IPS principles, family psychoeducation, FEP evidence and recovery abuses.

Open

Domain

General adult psychiatry — secondary / organic psychosis

1

clinical

Psychotic disorder due to another medical condition — structured clinical viva

You are the psychiatry registrar. A 46-year-old woman has a first presentation of psychosis over 3 weeks. Her partner reports new word-finding difficulty and brief facial–arm jerks. She is on no psychotropics. Discuss differential, red-flag organic work-up (including when to image/LP), relationship to autoimmune encephalitis, symptomatic antipsychotic use, capacity, and communication with the medical team.

Open

Domain

Psychopharmacology — organ impairment

1

clinical

Psychotropics in renal and hepatic disease — consultant viva

Examiner places cards: CAST, ASCEND, eGFR 35, paliperidone, Child–Pugh C, LOT benzodiazepines, lithium + NSAID, EXTRIP, valproate ammonia, free fraction.

Open

Domain

Psychopharmacology — fitness to drive

1

clinical

Psychotropics, sedation and driving — consultant viva

Examiner places cards: SDLP, zopiclone 7.5 mg, long-half-life BZD elderly, Thomas ~2×, Fournier concurrent, methylphenidate ADHD highway, commercial licence, alcohol co-use, document advice.

Open

Domain

Public-community — quality improvement and patient safety

1

clinical

Quality improvement and patient safety in psychiatry — structured clinical viva

Discuss quality improvement and patient safety in psychiatry for a fellowship viva: define quality vs safety; Donabedian structure–process–outcome with mental health examples; systems thinking and Swiss-cheese (Reason); just culture; Model for Improvement/PDSA with outcome, process, and balancing measures; psychiatry-specific harm domains; Safewards evidence; suicide-prevention service design (Appleby/While); medication and environmental safety (Grasso/Hunt); regional governance frames. Do not invent Never Event lists or local statute section numbers.

Open

Domain

Foundations — rating scales and measurement-based care

1

clinical

Rating scales and measurement-based care — structured clinical viva

You are examining a psychiatry registrar. Defend how you use PHQ-9, GAD-7, HAM-D or MADRS, PANSS, YMRS, CGI, and MoCA/MMSE in routine care. Define reliability and validity. Explain MBC with named evidence (Guo, STAR*D, Fortney/Lewis). Walk through PANSS percent-change correction and careful cut-offs. Challenge: a consultant says 'I can tell if they are better without forms.'

Open

Domain

General adult psychiatry — reactive attachment and disinhibited social engagement

1

clinical

Reactive attachment and DSED — structured clinical viva

You are the psychiatry registrar in a transition clinic. A 17-year-old leaving foster care has a childhood diagnosis of disinhibited social engagement disorder after institutional care. Residual indiscriminate friendliness continues. He has recent low mood, and carers report he nearly left a train station with a stranger last month. They ask for holding therapy. A youth justice worker asks whether 'RAD' will be his lifelong adult diagnosis. Discuss diagnosis, differentials, risk, management including rejection of coercive therapies, adult residual formulation, and evidence (AACAP, APSAC, BEIP, ERA).

Open

Domain

Foundations — research methods and study design

1

clinical

Research methods and study design — structured clinical viva

You are in a FRANZCP/MRCPsych-style viva. The examiner says: 'A pharmaceutical company proposes an open-label, non-randomised comparison of Drug X versus Drug Y for first-episode psychosis, with PANSS change at 8 weeks as the primary outcome, analysed among completers only. Separately, your department wants to know the 12-month prevalence of depression in the local catchment and whether depression is associated with unemployment on a single household survey. Finally, a trainee asks whether a meta-analysis is always required after a systematic search.' Defend how you would design or redesign each programme, name bias threats, and name reporting standards. Be ready for follow-ups on concealment versus blinding, confounding by indication, STROBE versus CONSORT, and Hill criteria.

Open

Domain

Forensic psychiatry — risk assessment

1

clinical

Risk assessment in forensic settings — structured clinical viva

You are the forensic psychiatry registrar. A 41-year-old man with schizophrenia and antisocial personality traits is reviewed for possible move from high to medium security after 18 months. Index offence: arson of a flat after command hallucinations. He has partial insight, intermittent cannabis use on leave last year (none for 6 months), HCR-style Clinical items improved, protective factors strengthened (work programme, family contact), but VRAG-class static ranking remains high. The tribunal asks whether he is 'safe'. Discuss SPJ vs actuarial approaches, protective factors, institutional vs community horizons, risk scenarios for step-down, multi-agency principles, report communication, and anti-stigma framing. How do you answer 'is he safe?' without false precision?

Open

Domain

Psychopharmacology — rTMS, VNS and DBS

1

clinical

rTMS, VNS and DBS — consultant viva

Examiner places cards: 10 Hz / 120% MT / 3000 pulses, THREE-D, SAINT/SNT, Rush VNS acute, Aaronson 5-year, Mayberg open-label, Holtzheimer SCC, Dougherty VC/VS, malignant catatonia, ferromagnetic implant.

Open

Domain

Public and community psychiatry — rural and remote

1

clinical

Rural and remote psychiatry — structured clinical viva

FRANZCP/MRCPsych-style viva. Slide 1: map of MMM2 regional centre and MMM7 very remote community 600 km away, both without a resident psychiatrist. Slide 2: two recent farmer suicides; local media demands a permanent inpatient unit. Slide 3: proposed telepsychiatry roster from the capital three half-days per week. Follow-ups cover Shore emergency protocols, Fortney collaborative care, workforce maldistribution (Hayter), farmer suicide factors, cultural safety with ACCHO, and retrieval decision-making for acute mania.

Open

Domain

Public and community psychiatry — school and workplace mental health

1

clinical

School and workplace mental health — structured clinical viva

You advise a secondary school principal and an HR director from a manufacturing firm. School: two students hospitalised after overdoses; teachers request 'suicide screening for everyone'. Workplace: rising depression sick leave; managers want compulsory disclosure of diagnoses. Discuss MTSS, SEYLE evidence, whole-school principles, workplace psychosocial risks, organisational vs individual interventions, RTW, disclosure/stigma, burnout vs depression, and crisis red flags.

Open

Domain

Child and adolescent psychiatry — school refusal and school anxiety

1

clinical

School refusal and school anxiety — structured clinical viva

You are the CAP registrar. Discuss school refusal as behaviour versus diagnosis, Kearney’s four functions, Egger’s anxious refusal versus truancy distinction, how you build a graded return-to-school plan with caregivers, landmark CBT evidence (King, Heyne), Melvin fluoxetine augmentation findings, when CAMS-level SSRI evidence applies to the underlying anxiety disorder, and iatrogenic pitfalls of open-ended medical certificates.

Open

Domain

Public-community psychiatry — restrictive practices

1

clinical

Seclusion, restraint and least-restrictive care — structured clinical viva

You are the on-call psychiatry registrar. Nursing staff call you to an acute ward where a 41-year-old woman with bipolar mania has slapped a nurse after two hours of escalating agitation. Oral lorazepam was offered and spat out. A junior doctor suggests immediate mechanical restraint and seclusion 'under section' and asks what maximum seclusion time the Act allows. Discuss definitions, least-restrictive options, thresholds for force, monitoring, harms evidence, reduction frameworks (Six Core Strategies, Safewards, Project BETA), documentation, debrief, and how you handle the section-time question without inventing law.

Open

Domain

Psychopharmacology — SSRIs

1

clinical

Selective serotonin reuptake inhibitors — consultant viva

Examiner cards: six SSRI names, black-box age bands, citalopram 60 mg script, paroxetine stop day 3 symptoms, fluoxetine-to-phenelzine day 7 plan, Hunter clonus stem, Montejo sexual rates, elderly Na 124.

Open

Domain

Emergency psychiatry — self-harm and crisis

1

clinical

Self-harm and crisis intervention — structured clinical viva

You are the psychiatry registrar on call. A 17-year-old is medically cleared after a first hospital presentation with self-harm (superficial cutting and impulsive overdose of a parent’s sertraline, low tablet count). Parents are angry and call it 'attention-seeking'. The young person is ashamed, describes cutting for months to 'feel calm', denies current intent to die, but has ongoing access to medications at home and is refusing to involve school. Discuss your assessment framework, language with family, NSSI functions, safety planning, disposition options, adolescent evidence, and how this differs from a pure suicide-risk-assessment viva.

Open

Domain

Specialty psychiatry — sexual dysfunction and paraphilias

1

clinical

Sexual dysfunction and paraphilias — structured clinical viva

You are the psychiatry registrar. A GP asks advice on three linked problems in one clinic letter: (1) a 52-year-old man with diabetes and erectile dysfunction who takes isosorbide mononitrate and wants sildenafil; (2) his partner, a 48-year-old woman on paroxetine with new anorgasmia; (3) their adult son who emailed the GP describing ego-dystonic sexual interest in prepubescent children, denying any offence, requesting 'chemical castration' online. Discuss classification thresholds, medical safety, medication-induced sexual dysfunction, and risk/ethics for the son's disclosure.

Open

Domain

Forensic psychiatry — sexual offending

1

clinical

Sexual offending — structured clinical viva

You are the forensic psychiatry registrar. A 42-year-old man with prior convictions for non-contact sexual offences and one contact offence against a child is reviewed for possible move from medium security to community forensic follow-up. Static-99R-class ranking is well above average. He has completed offence-focused group CBT, has negative drug screens for 9 months, shows improved self-management plans, and protective factors include stable supported accommodation and no child contact. The tribunal asks: 'Is he safe to release?' Discuss legal vs clinical constructs, key predictors of sexual recidivism, static vs dynamic vs protective assessment, motivation–facilitation formulation, RNR treatment principles, role of WFSBP pharmacotherapy, multi-agency protection principles, and how you answer 'is he safe?' without false precision or sensational language.

Open

Domain

Psychopharmacology — SNRIs and NRIs

1

clinical

SNRIs and NRIs — cross-table viva

Examiner draws columns: Agent / Transporters / Start dose / Killer monitoring. Cards: Blier/Debonnel dose map, Thase BP meta, Thase remission meta, STAR*D switch, Cipriani 2018, Detke duloxetine 60 mg, Gelenberg venlafaxine GAD, Eyding reboxetine, Hunter criteria, Schatzberg discontinuation, Movig hyponatraemia, Montejo sexual SE.

Open

Domain

Foundations — social determinants of mental health

1

clinical

Social determinants of mental health — structured clinical viva

FRANZCP/MRCPsych-style viva. Slide 1: diagram of structural → intermediate → individual determinants. Slide 2: table showing higher CMD prevalence in lowest income quintile. Follow-ups cover ACE dose–response, Rose vs high-risk prevention, migration–psychosis meta-analysis, stigma as fundamental cause, Indigenous equity in ANZ, and a clinical case of homeless discharge planning.

Open

Domain

Foundations — social psychology

1

clinical

Social psychology and group dynamics — structured clinical viva

You are the psychiatry registrar. The consultant asks you to teach social psychology for MRCPsych/FRANZCP using: (1) a family high-EE vignette after psychosis discharge; (2) a junior who publicly agrees with an unsafe senior plan; (3) a patient who delayed care due to stigma. Cover definitions (attribution, dissonance, conformity, obedience, bystander, social identity, groupthink/polarisation, stigma types), EE evidence, anti-stigma evidence, and ethics of classic experiments.

Open

Domain

Professional — spirituality and religion in psychiatry

1

clinical

Spirituality and religion in psychiatry — structured clinical viva

You are the community psychiatry registrar. A 45-year-old woman with recurrent depression says her pastor told her antidepressants are a lack of faith. She has passive death wishes, no active plan, and asks whether you will pray with her in clinic. Discuss definitions of spirituality vs religion, WPA position, HOPE/FICA assessment, positive vs negative religious coping, when religious content becomes psychopathology, professional boundaries, and disposition including spiritual care — without inventing statute numbers.

Open

Domain

Forensic psychiatry — stalking and harassment

1

clinical

Stalking and harassment — structured clinical viva

You are the forensic psychiatry registrar. A 41-year-old man with a history of delusional disorder (erotomanic type) has been sending gifts and letters for 18 months to a GP he saw once for a minor complaint. He believes they are engaged. He has no prior intimate relationship with her. He has not assaulted her but has waited outside the clinic twice. Antipsychotic adherence is intermittent. The clinic asks whether he is 'dangerous' and whether they should 'just ignore him'. Discuss definition vs diagnosis, typology, multi-domain risk (including persistence), assessment method, management of stalker and victim/clinic safety, role of antipsychotic treatment, and how you answer 'is he dangerous?' without false precision.

Open

Domain

Professional — stigma, recovery and rights-based care

1

clinical

Stigma, recovery and rights-based care — structured clinical viva

Discuss mental health stigma types and mechanisms, personal versus clinical recovery (including CHIME), recovery-oriented practice and its abuses, shared decision-making, peer support, anti-stigma intervention evidence, and CRPD/rights-based care tensions with local mental health law — without inventing statute section numbers.

Open

Domain

Addiction psychiatry — stimulant and methamphetamine use

1

clinical

Stimulant and methamphetamine use — structured clinical viva

You are the psychiatry registrar in ED. A 28-year-old woman has used crystal methamphetamine for five days. She is agitated but orientated, tachycardic, BP 168/98, afebrile. She believes police microphones are in the walls. Her partner asks: (1) Is this schizophrenia forever? (2) Can she have a tablet that replaces ice like methadone replaces heroin? (3) Will she have dangerous fits when she stops? (4) What actually works? Discuss assessment, MAP, CV risk, withdrawal, evidence-based treatment and dual diagnosis.

Open

Domain

Addiction psychiatry — acute stimulant syndromes

1

clinical

Stimulant intoxication and withdrawal — structured clinical viva

You are the psychiatry registrar on call. A 27-year-old woman smoked crystal methamphetamine for three days, presents with persecutory delusions and formication, BP 168/98, temperature 37.9°C, clear consciousness. ECG sinus tachycardia. She asks for 'something to stop the craving like methadone for heroin.' Partner wants her sectioned for schizophrenia forever. Discuss acute management, MAP versus primary psychosis, medical toxicity surveillance, withdrawal/crash risk, and the evidence position on anti-craving pharmacotherapy.

Open

Domain

Psychopharmacology — stimulants and ADHD medications

1

clinical

Stimulants and ADHD medications — cross-table viva

Examiner draws columns: Class / Target / Onset / Killer monitoring. Cards: MTA, Cortese NMA, Newcorn, Volkow PET, Cooper, Habel, Hennissen, Wilens SUD meta, Sallee GXR, Michelson ATX, lisdexamfetamine prodrug.

Open

Domain

Addiction psychiatry — substance-induced mood and anxiety disorders

1

clinical

Substance-induced mood and anxiety — structured clinical viva

You are the psychiatry registrar. A 32-year-old woman presents day 2 after a methamphetamine binge with severe dysphoria and suicidal ideation. Partner asks: (1) Is this clinical depression forever? (2) Why not start an antidepressant tonight? (3) Is the panic she had while high a lifelong anxiety disorder? (4) Should addiction services treat her first and psychiatry wait? Discuss timing diagnosis, alcohol/stimulant/cannabis patterns, acute safety, watchful waiting versus treatment, and dual care.

Open

Domain

General adult psychiatry — substance/medication-induced psychosis

1

clinical

Substance-induced psychosis — structured clinical viva

You are the psychiatry registrar. A 24-year-old presents with methamphetamine-associated paranoia and auditory hallucinations 2 days after last use. Mother asks: (1) Is this schizophrenia forever? (2) Why give an antipsychotic if it is just drugs? (3) What is the risk it comes back as a long-term illness? (4) Should addiction services treat him first and psychiatry wait? Discuss timeline diagnosis, discriminators, acute care with named doses, conversion evidence, dual diagnosis, and communication.

Open

Domain

Emergency psychiatry — suicide risk

1

clinical

Suicide risk assessment — structured clinical viva

You are the psychiatry registrar. A 52-year-old man with bipolar disorder is reviewed 48 hours after discharge from a 3-week admission for mixed depression. He has passive death wishes, keeps a hunting rifle at a rural property, and his partner is worried he has been giving away tools. Lithium was restarted in hospital (level in therapeutic range on discharge). Discuss your assessment, means restriction, safety planning, the evidence for post-discharge risk, lithium’s anti-suicide evidence, and how you would document and arrange follow-up.

Open

Domain

Professional — teaching and supervision skills

1

clinical

Teaching and supervision skills — structured clinical viva

You supervise a psychiatry registrar whose MSE is disorganised and whose risk documentation after self-harm assessments is incomplete. Prior supervisors left no written concerns. Discuss definitions of teaching vs supervision, Miller's pyramid, how you give feedback, how you would structure a one-minute preceptor encounter, your approach to underperformance and failure-to-fail, and faculty development — without inventing college form codes.

Open

Domain

Public and community psychiatry — telepsychiatry

1

clinical

Telepsychiatry — structured clinical viva

FRANZCP/MRCPsych-style viva. Slide 1: service map showing capital hub psychiatrists offering home video three half-days per week to a rural catchment without local emergency MOUs. Slide 2: rising ED crisis presentations and one mid-call suicide attempt last month where the patient's address was unknown. Slide 3: proposal to add asynchronous primary-care store-and-forward and a collaborative care manager. Follow-ups cover Shore/Mishkind emergency standards, Hilty effectiveness, Fortney/SPIRIT models, Yellowlees async RCT, Sabin ethics, COVID scale-up lessons, and paediatric ED tele pathways.

Open

Domain

Forensic psychiatry — therapeutic security

1

clinical

Therapeutic security and secure care levels — structured clinical viva

You are appointed consultant to a regional forensic mental health service that provides medium and low secure beds and forensic community outreach, without a separate high secure hospital on site. The clinical director asks you to present a teaching framework on therapeutic security for registrars: define the three security domains, explain high/medium/low principles, describe structured placement assessment (including DUNDRUM-style tools), relational security practice, step-up/step-down and long-stay, restrictive-practice proportionality, discharge outcomes, and ANZ-relevant caveats. Be prepared to defend evidence without inventing statute section numbers.

Open

Domain

Child and adolescent psychiatry — service interface

1

clinical

Transition from CAMHS to adult services — structured clinical viva

You are the CAP registrar. A 17-year-old with emerging emotion dysregulation, recurrent self-harm, and possible ADHD is approaching the CAMHS upper age limit in three months. Adult CMHT has already indicated she 'does not meet severe and enduring criteria'. Parents are angry. Discuss formulation of the service gap, risk management, pathway options, managed transition components, capacity/family issues, and evidence you would cite.

Open

Domain

Consultation-liaison — transplant and ICU psychiatry

1

clinical

Transplant and ICU psychiatry — structured clinical viva

Station A: You are asked to defend your pre-transplant psychosocial report on a heart transplant candidate with treated bipolar disorder and intermittent nonadherence to clinic visits. Station B: The same week you are called to ICU regarding a ventilated patient with fluctuating CAM-ICU positivity and a family asking about capacity and long-term 'brain damage' and PTSD risk. Discuss evaluation frameworks (ISHLT-style/SIPAT), adherence, capacity principles, CAM-ICU/RASS/PADIS-informed delirium care, PICS/PTSD including family, and communication with non-psychiatrist colleagues — without inventing statute section numbers.

Open

Domain

General adult psychiatry — OCRD / BFRB

1

clinical

Trichotillomania and excoriation disorder — structured clinical viva

You are the psychiatry registrar. A 31-year-old woman with longstanding scalp and eyelash trichotillomania plus facial skin-picking has failed 'CBT' that was supportive talk without habit reversal. She takes fluoxetine 20 mg. She wants olanzapine 'like for tics' after reading online, and declines therapy 'because meds should fix it.' She admits swallowing hair. Discuss diagnosis within OCRD, differentials, adequacy of prior treatment, first-line psychological care, NAC evidence including paediatric caveat if relevant to family questions, olanzapine metabolic trade-offs, and trichobezoar risk.

Open

Domain

Emergency psychiatry — violence risk

1

clinical

Violence risk assessment — structured clinical viva

You are the psychiatry registrar. A 35-year-old man with schizophrenia, known methamphetamine use, and two prior assaults on staff is reviewed on the ward day 3. DASA scores have risen overnight. He states a voice is commanding him to 'punish' a junior nurse who he believes poisoned his medication. He has partial insight. Discuss your assessment of imminent vs longer-term risk, command hallucinations, substance factors, risk management plan, least-restrictive options, and documentation. How do you avoid stigmatising language while remaining safety-focused?

Open

Domain

Forensic psychiatry — young offenders

1

clinical

Young offenders — structured clinical viva

You are appointed consultant to a youth justice mental health service covering community youth justice and a detention centre. The director reports rising self-harm, frequent use of isolation for 'psychiatric kids', poor reception screens after midnight, untreated ADHD and trauma, and chaotic handovers when youth turn 18. Outline your framework: epidemiology anchors, developmental pathways, assessment including youth violence risk tools, suicide/self-harm systems, evidence-based psychosocial interventions, pharmacotherapy principles, special populations, and throughcare. Do not invent statute section numbers.

Open

Domain

Child and adolescent psychiatry — youth self-harm and suicide

1

clinical

Youth self-harm and suicide — structured clinical viva

You are the CAMHS/on-call psychiatry registrar. A 16-year-old is medically cleared after first hospital presentation with self-harm (chronic NSSI pattern plus impulsive overdose). Parents are angry and use pejorative labels. The young person is ashamed, denies current intent to die, refuses school contact, and medications remain at home. Discuss assessment framework, language with family, confidentiality limits, safety planning, school interface, therapy evidence, disposition, and how this differs from adult suicide-risk and adult self-harm vivas.

Open