The time has finally come… you’re locked in, ready to go, and you’re going to ace your retake exam. Why? Because you’ve followed our TOP 5 tips that ensure your success in passing your Psychiatric Board Exam with ease!
1 – Analyze Your Weak Points
If you know where you struggled with most in the last board exam you can hone in on intaking as much information as you can retain. These don’t need to just be areas you did pool on previously, but could also be ones that could be further reinforced. Try out My Psych Board’s customizable tests that zero in on your most missed questions!
2 – Focus On The NOW
The past is the past, there’s no point in going back! The only way to move in a positive direction is forward. Learn from your mistakes and how you can apply what you’ve learned for better-guaranteed results. If you stay focused on past failure it’s only going to bring negativity and additional stress to your study sessions.
3 – Create A Plan
When studying it’s essential to make the most of your time. Create a plan tailored to your needs. Before you can even begin studying you need to make sure you have all the resources you need. Organize items into folders, check you have all the materials you need, and tidy up your study spot.
4 – Utilize Detailed Questions Banks (like ours here)
With detailed Q-Banks, you’ll get the blueprints, questions, detailed information, vignettes, and more! Within the question breaks, you can get real-time feedback on correct answers, and learn where you’ll need to continue to improve.
BONUS TIP: Did you know we offer FREE Trials of all of our Question Banks? Click here to try today (with no credit card required…)
5 – Take Regular Breaks
As with anything don’t overdo it, You need to ensure you aren’t pushing yourself too far! When you’re studying and preparing for the exam you’re taking a mental health break. This will help break up your studying time, keep you from feeling overwhelmed, and ensure you’re retaining all the information you’re taking in.
Still, feeling uneasy? Contact us and we can help YOU pass your boards with ease!
Syndrome Series: What is Depression
/in GeneralWhat is depression?
Everyone experiences a range of emotions that typically vary based on events and circumstances. Normally feelings of disappointment, sadness, and grief ebb and flow. By contrast, depression tends to feel heavy and constant. People who are depressed are less likely to be feel happy, have good days, be cheered, comforted, or consoled. Clinically, a major depressive episode is characterized by at least two weeks of depressed mood or a loss of interest in enjoyable activities. It also includes a number of other symptoms which may include difficulties with sleep, feelings of worthlessness or guilt, fatigue, difficulty concentrating, appetite changes, or recurrent thoughts of death or suicide.
Depression and Suicide
According to the Centers for Disease Control and Prevention (CDC) in 2018, suicide was the 10th leading cause of death overall in the United States, claiming the lives of over 48,000 people. It is the 14th leading cause of death globally. Individuals dealing with depression are at a higher risk of suicide than other individuals. Some studies estimate this risk to be 20-30 times higher than the non-depressed population. Other risk factors for suicide include past history of suicide attempt, history of self-directed violence, family history of suicide, having a psychiatric disorder, lack of social supports, history of childhood abuse, substance use, homelessness, access to firearms, and more.
Depression and Bereavement
Grief or bereavement is the powerful emotional response that occurs following the death of a loved one or other difficult losses in life. Stages of bereavement may include denial and isolation, anger, bargaining, sadness, and acceptance. The majority of survivors heal over time and their symptoms of grief gradually improve as they resume their routines and activities. They are able to function in their life. Complicated grief occurs when grief responses are considered excessive and depression may occur if individuals do not progress through the normal healing process and have continued symptoms and dysfunction and prolonged feelings of sadness and hopelessness.
First Line Treatments
Moderate to severe: Antidepressants are recommended for the treatment of moderate to severe depression and for dysthymia (persistent depressive disorder).
Mild: Active monitoring, individual guided self‐help, exercise, cognitive behavioral therapy (CBT), or other psychotherapy protocols are preferred.2 Antidepressant medications are not recommended as a first‐line treatment in recent‐onset mild depression.
Psychotherapy
Multiple meta-analyses show psychological therapies to be as effective as antidepressant medications for those with mild or moderate severity of depression. Studies also demonstrate the effectiveness of a number of different types of therapy in depression3. Effective therapies include:
•Cognitive behavior therapy (CBT): based on the idea that our thoughts (cognitions), behaviors, and emotions are all interrelated, so that if we change one then we change the rest.
•Interpersonal psychotherapy (IPT): intervention that focuses on relieving symptoms by improving interpersonal functioning. A central idea in IPT is that psychological symptoms can be understood as a response to current difficulties in everyday relationships with other people.
•Psychodynamic psychotherapy: the psychological interpretation of mental and emotional processes. Rooted in traditional psychoanalysis, it draws from object relations, ego psychology, and self psychology. It was developed as a simpler, less-lengthy alternative to psychoanalysis.
•Problem-solving therapy (PST): brief intervention patients experiencing depression and distress related to inefficient problem-solving skills. The PST model instructs patients on problem identification, efficient problem-solving, and managing associated depressive symptoms.
•Non-directive supportive therapy: relies on the therapeutic alliance to alleviate symptoms, improve self-esteem, restore relation to reality, regulate impulses and negative thinking, and reinforce the ability to cope with life stressors and challenges.
•Behavioral activation therapy: behavioral activation is a component of CBT but behavioral strategies can also be used alone. Behavioral activation is based on the theory that, as individuals become depressed, they tend to engage in increasing avoidance and isolation, which serves to maintain or worsen their symptoms
Pharmaceuticals
There are a number of available antidepressant classes that have evidence for the treatment of depression, anxiety, and other disorders. Each class of antidepressants have a unique mechanism but they all act to manipulate the levels of neurotransmitters in the brain that are responsible for modulating mood and emotions. Examples include serotonin, norepinephrine, and dopamine. Classes of antidepressants include: Selective serotonin reuptake inhibitors (SSRIs); Serotonin-norepinephrine reuptake inhibitors (SNRIs); Tricyclic antidepressants (TCAs) and Tetracyclic antidepressants; Monoamine oxidase inhibitors (MAOIs); and novel or atypical antidepressants.
All antidepressant classes have similar treatment response rates in treating major depression but vary in their mechanism of action, safety, and side effect profiles. SSRIs and SNRIs are the most commonly prescribed antidepressants and are considered first-line treatment due to several distinct advantages:
Practice Question:
A 47-year-old patient comes in discussing feelings of tiredness, decreased appetite, intense periods of irritation, lack of enjoyment in activities they once enjoyed, interpersonal relationship issues, and suicidal ideation. Which FDA-approved pharmaceutical treatment is the first-line treatment for a patient experiencing these symptoms?
A Escitalopram
B Risperidone
C Clozapine
D Fluvoxamine
E Imipramine
Answer: A
Explanation: In older adults suffering from depression, the first line of treatment are SSRIs, such as escitalopram (choice A). Fluvoxamine (choice D) is an SSRI that is only approved for OCD. If the patient had come forward with symptoms for schizophrenia, then an antipsychotic medication, such as clozapine (choice C), would be a good medication to consider prescribing. Risperdal (choice B) is an antipsychotic that is more useful in cases of aggression. Other antidepressants, such as monoamine oxidase inhibitors and tricyclic medications (choice E), are very effective in treating depressive disorders, but these medications are not amongst the group of medications that should be used as a first-line treatment option.
Ready to learn more? Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have so we can get you on the right path today!
REFERENCES
1. Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry. 2018;75(4):336–346. doi:10.1001/jamapsychiatry.2017.4602
2. National Institute for Health and Care Excellence. (2009). Depression in adults: recognition and management. Retrieved from https://www.nice.org.uk/guidance/cg90/chapter/Recommendations
3. Cuijpers, P., Andersson, G., Donker, T., & van Straten, A. (2011). Psychological treatment of depression: results of a series of meta-analyses. Nordic journal of psychiatry, 65(6), 354–364. https://doi.org/10.3109/08039488.2011.596570
4. Blumenthal SR, Castro VM, Clements CC, et al. An Electronic Health Records Study of Long-Term Weight Gain Following Antidepressant Use. JAMA Psychiatry. 2014;71(8):889–896. doi:10.1001/jamapsychiatry.2014.414
5. Voican, C. S., Corruble, E., Naveau., and Perlemuter, G. (2014). Antidepressant-Induced Liver Injury: A Review for Clinicians. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2013.13050709
6. Ward, S. W., Reach, W. J., & Thomas, C. (2016). When to adjust the dosing of psychotropics in patients with renal impairment. Current Psychiatry, 15(8), 60–66.
7. Puckett, J. A., Beach, S. R., & Taylor, J. B. (2020). Pocket psychiatry. Wolters Kluwer.
8. Gaynes BN, Asher G, Gartlehner G, Hoffman V, Green J, Boland J, Lux L, Weber RP, Randolph C, Bann C, Coker-Schwimmer E, Viswanathan M, Lohr KN. Definition of Treatment-Resistant Depression in the Medicare Population. Technology Assessment Program. Project ID: PSYT0816. (Prepared by RTI–UNC Evidence-Based Practice Center under Contract No. HHSA290201500011I_HHSA29032006T). Rockville, MD: Agency for Healthcare Research and Quality. February 2018. http://www.ahrq.gov/clinic/epcix.htm.
9. Taylor, D., Barnes, T. R. E., Young, A. H. (2018). Depression. The Maudsley Prescribing Guidelines in Psychiatry (13th ed., pp. 208–212). Wiley Blackwell.
10. Williams, N. R., Taylor, J. J., Kerns, S., Short, E. B., Kantor, E. M., & George, M. S. (2014). Interventional psychiatry: why now?. The Journal of clinical psychiatry, 75(8), 895–897. https://doi.org/10.4088/JCP.13l08745
11. United States Food and Drug Administration approved labelling. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/211243s004lbl.pdf (Accessed on August 10, 2020).
Study Styles for Psychiatric Residents
/in Board Prep, StudyingWith the impending standardized exam, you may be asking “how the heck should I study?” Here are our top tips to help you pass your boards with ease!
As a senior psychiatry resident, recent graduate or even junior resident, this is a question that may cross your mind when the term ABPN initial certification is mentioned. But as someone who has taken my fair share of medically geared standardized tests- i.e. MCAT, USMLE, PRITE, as well as too many medical school exams to count, teaching for the Princeton review, teaching gymnastics, and the occasional residency didactic topic, the best method to study and retain information may not come into focus until one takes a step back to do some self-assessment. Sometimes you (meaning me) even forget what got you over that what once seemingly insurmountable conglomerate of material until a new challenge presents itself. It is only then can one get refreshed insight on how to approach the material before you, by looking at what worked and did not work before.
I’m a firm believer that the more you hear or see something, the more you retain it. I don’t hesitate to review and re-review the basics. This is true whether you are an athlete preparing for a big event or a chief resident reviewing the DSM V for diagnostic criteria for Major depressive disorder with psychotic features vs schizoaffective disorder. The foundations allow us to build and retain our skills and knowledge, and yes they can sometimes be more palatable to review. With that I must remind myself of what my old gymnastics coach used to say every time I wanted to practice balance beam instead of bars, “To be great, one must practice what they hate not what they love.” So I would begrudgingly trade my beam shoes for my hand grips and chalk up. A medical school or USMLE equivalent could be me tucking away neuroanatomy and forcibly pulling out lung volumes. A PRITE example could be me tip toeing to get to biostats once all my other studying is done, But I digress.
I would argue you need to make time for that which comes easier, and that which you might just slightly avoid. One way I like to go about this is what I call mixing it up. I am also a believer in learning via multiple pathways and methods. I have always found, when the brain processes data from multiple sources, the more likely you are to retain this material. Now I realize we all have our personal preferences and we do not all learn the same way. For example, some of us like to read, while others may like to listen. Some of us never showed up to lectures, and some were front and center. However, I’ve found the material I have retained the greatest, or exams I have done the best on, I was using several of my available senses. This included, reading, watching lectures online on core material, listening to recordings at the gym or while traveling throughout the day, and rewriting key material. The more pathways I used, the better I retained and understood the material. I find this to be key in studying for standardized exams, where the amount of material can seem insurmountable. We will get to this, but this can also come in handy when you are having an off day, a too busy to do much day, a I am over this day.
We all get overwhelmed, me included. The vast amount of material for anything before us can seem daunting and overwhelming. This is when I like to take a deep breath, take a step back and write out a plan. Most importantly, this plan must be unique to you and both your long-term and short-term study goals, and how you will accomplish them. Remember to be kind but firm with yourself. Offer motivational tips and rewards while holding yourself accountable to some sort of framework.
Break it up and use your senses.
Try and study in small, consistent blocks of time and take advantage of hands-on learning. Learning while providing patient care (reading up, reviewing their diagnoses, meds) can go a long way when it comes time to study and sit for a big exam. Just like an athlete who keeps the foundation fresh and well maintained, when time to throw the bigger skill those foundations will allow an easier transition.
Break the material/subject down into systems using several sources of information stimulating different ways of learning. Some examples of systems are reading review, videos, questions.
How I approach each topic, no matter if medical school, USMLE, PRITE, or psychiatry board review:
This brings us to the topic of question banks. A question bank serves several different purposes, again taking what I say with a grain of salt in case that is not your style. Here goes, I initially use question banks for learning the raw material. I don’t time myself and I’m not trying to do a full block, and I’m definitely not worried about timing myself. I take my time, use tutor mode and read everything; I mean EVERYTHING thoroughly. Things I got wrong and things I got right. Test bank explanations can be a gold mine of information for the questions I’m both sure and unsure of. This knowledge is important and allows you to brush up on topics you thought you knew once upon a time, and gives you a feel for the level of material and depth you should know for that exam. Once I personally feel “ready” and comfortable, (although full disclosure I have never been one to feel fully ready for any test), then I start to incorporate the questions slowly into timed and simulated experiences.
As a firm believer of understanding the material from the ground up, I don’t ever recommend going into a standardized examination without using a question bank. There are however people that do just fine using question banks purely as simulated examination situations and to get a feel for the test and types of questions you will see. This is of course fine, as that is a vital part of preparation, but for me, question banks can be used in different ways as described above, depending upon your personality and comfort with learning styles.
Good luck as you start your preparation. You got this! Remember, it is easy to get discouraged or feel like the massive mountain of study material before you can be insurmountable, but remind yourself that even small study sessions will take you one step closer to your goal, and things that you are remote and you think you forgot often come back easier the next time you review them. P.S. I speak from experience 😉
– Dr. J
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