How mental health is examined
Mental health is 12.5% of the AMC MCQ blueprint, about 19 of 150 questions. Settings range from general practice to the emergency department and the ward. Questions often combine a diagnosis with a safety or legal decision, so read the last line carefully: is it asking for the diagnosis, the immediate step, or the long-term plan?
Depression and bipolar disorder
- Diagnose major depression on DSM-5 criteria: at least 2 weeks of low mood or loss of interest plus other symptoms causing impairment.
- Mild depression: psychological therapy first. Moderate to severe: an SSRI plus psychological therapy; review within 2 weeks and watch for increased suicidal thinking in young people.
- Under Medicare, a GP mental health treatment plan gives access to subsidised sessions with a psychologist.
- Bipolar disorder: lithium, valproate or atypical antipsychotics; avoid antidepressant monotherapy, which can trigger mania.
- ECT is indicated for severe depression with psychosis, catatonia, high suicide risk or refusal to eat and drink.
Psychosis and schizophrenia
First-episode psychosis needs organic and drug causes excluded (including methamphetamine and cannabis), then early intervention. Start a low-dose second-generation antipsychotic and monitor metabolic effects.
| Antipsychotic issue | What to know |
|---|---|
| Metabolic effects | Weight, glucose and lipids at baseline and regularly, especially with olanzapine and clozapine |
| Extrapyramidal effects | Acute dystonia (treat with benztropine), akathisia, parkinsonism, tardive dyskinesia |
| Clozapine | For treatment-resistant schizophrenia; mandatory blood monitoring for neutropenia and watch for myocarditis |
| Hyperprolactinaemia | Especially with risperidone; sexual dysfunction and amenorrhoea |
Suicide risk assessment and safety
Ask directly about suicidal thoughts, plans, means and intent; asking does not increase risk. Assess protective factors and supports, and consider risk alongside needs rather than relying on a single score.
- High concern: a specific plan, access to means, recent attempt, hopelessness, psychosis, intoxication, recent loss or discharge from hospital.
- Make the environment safe, remove means where possible, involve family with consent, and arrange urgent mental health review.
- A patient at serious risk who refuses care may need assessment under the state Mental Health Act.
- Develop a written safety plan and give crisis contacts.
Alcohol and other drugs
| Situation | Management |
|---|---|
| Alcohol withdrawal | Monitor with a withdrawal scale; diazepam for withdrawal; thiamine before glucose to prevent Wernicke encephalopathy |
| Wernicke encephalopathy | Confusion, ataxia, ophthalmoplegia; high-dose parenteral thiamine |
| Opioid use disorder | Opioid agonist treatment with methadone or buprenorphine; naloxone for overdose and take-home naloxone |
| Methamphetamine intoxication | Agitation, psychosis, hyperthermia; safe environment, benzodiazepines, treat complications |
| Benzodiazepine dependence | Slow taper using a long-acting agent |
Australian low-risk drinking guidelines advise no more than 10 standard drinks a week and no more than 4 on any one day for healthy adults.
Psychiatric medicines and their dangers
| Problem | Recognise | Act |
|---|---|---|
| Serotonin syndrome | Rapid onset after serotonergic drug change; clonus, hyperreflexia, agitation, hyperthermia | Stop serotonergic drugs, supportive care, benzodiazepines; cyproheptadine in some cases |
| Neuroleptic malignant syndrome | Slower onset on antipsychotics; rigidity, fever, altered mental state, high CK | Stop the antipsychotic, cooling, supportive care, ICU review |
| Lithium toxicity | Tremor, vomiting, ataxia, confusion; precipitated by dehydration, NSAIDs, ACE inhibitors, diuretics | Stop lithium, fluids, check levels; dialysis if severe |
| QT prolongation | Antipsychotics, citalopram, methadone | ECG, correct electrolytes, review interacting drugs |
Anxiety, eating disorders, dementia and delirium
- Anxiety disorders: cognitive behavioural therapy first; SSRIs for moderate to severe or persistent symptoms; avoid long-term benzodiazepines.
- Eating disorders: check observations, ECG and electrolytes; admit for medical instability; watch for refeeding syndrome (low phosphate).
- Delirium vs dementia: delirium is acute, fluctuating, with impaired attention; look for and treat the cause. Dementia is gradual and progressive.
- Perinatal mental health: screen with the EPDS; postpartum psychosis is an emergency.
- Child and adolescent mental health: see the young person alone, use HEADSS, and involve family where safe.
Mental health law, capacity and consent
Each state and territory has its own Mental Health Act, but the principles are similar: involuntary assessment and treatment are allowed only when a person has a mental illness, needs treatment to prevent serious harm to themselves or others, and no less restrictive option is available. Many Acts also consider decision-making capacity.
- Capacity is decision-specific; assess understanding, retention, weighing and communication.
- Treat the least restrictive way, and review involuntary status regularly.
- Confidentiality can be breached when there is a serious threat to the patient or others.
See our guide to Australian medical ethics for consent and confidentiality in detail.
The mental state examination
| Domain | What to describe |
|---|---|
| Appearance and behaviour | Dress, hygiene, eye contact, psychomotor activity, rapport |
| Speech | Rate, volume, tone, quantity |
| Mood and affect | Mood in the patient's words; affect as observed (range, congruence) |
| Thought form | Logical, tangential, flight of ideas, loosening of associations |
| Thought content | Delusions, preoccupations, suicidal or homicidal ideas |
| Perception | Hallucinations and their type |
| Cognition | Orientation, attention, memory |
| Insight and judgement | Understanding of illness and the need for treatment |
Exam questions often describe an MSE finding and ask for the diagnosis: pressured speech and flight of ideas suggest mania; poverty of speech and blunted affect suggest negative symptoms of schizophrenia.
Acute behavioural disturbance
- Ensure safety for the patient, staff and others; use de-escalation first.
- Look for and treat medical causes: hypoglycaemia, hypoxia, head injury, intoxication, withdrawal, infection.
- If sedation is needed, use oral medicines first where possible, then IM or IV agents according to local protocol, with monitoring afterwards.
- Document the legal basis for any restraint or treatment without consent.
Psychological therapies
| Therapy | Best evidence for |
|---|---|
| Cognitive behavioural therapy | Depression, anxiety disorders, OCD, insomnia, bulimia |
| Exposure and response prevention | Obsessive-compulsive disorder |
| Trauma-focused CBT or EMDR | Post-traumatic stress disorder |
| Dialectical behaviour therapy | Borderline personality disorder with self-harm |
| Family-based treatment | Anorexia nervosa in adolescents |
| Interpersonal therapy | Depression, including perinatal depression |
Mental health in older adults
- Depression in older adults often presents with physical symptoms, poor sleep, cognitive complaints or withdrawal; screen and treat, starting medicines at low doses.
- Delirium is common in hospital: look for infection, drugs (especially anticholinergics and opioids), urinary retention, constipation and pain.
- In dementia, use non-drug approaches for behavioural symptoms first; antipsychotics carry a risk of stroke and death.
- Assess capacity for each decision, and use advance care directives and substitute decision-makers when needed.
Worked examples
Worked example 1 · Drug safety
A 45-year-old woman on sertraline for depression is started on tramadol after a fracture. Two days later she is agitated, sweating and tremulous, with a temperature of 38.6 C and inducible clonus in both ankles. What is the most likely diagnosis?
- A Neuroleptic malignant syndrome
- B Serotonin syndrome
- C Opioid withdrawal
- D Thyroid storm
- E Anticholinergic toxicity
Show the reasoning
Answer B. Tramadol has serotonergic effects, and adding it to an SSRI can cause serotonin syndrome: rapid onset with clonus, hyperreflexia, agitation, sweating and fever. NMS occurs with antipsychotics, develops over days and causes rigidity rather than clonus.
Worked example 2 · Alcohol
A 52-year-old man with heavy daily drinking is admitted with confusion, an unsteady gait and nystagmus. His blood glucose is 3.6 mmol/L. What should be given first?
- A IV dextrose 50%
- B Oral diazepam
- C IV thiamine
- D Haloperidol IM
- E Oral naltrexone
Show the reasoning
Answer C. Confusion, ataxia and ophthalmoplegia in a heavy drinker suggest Wernicke encephalopathy. Give parenteral thiamine before glucose, as glucose can precipitate or worsen it; then correct the low glucose.
Common mental health traps
- Starting an antidepressant alone in bipolar depression.
- Giving glucose before thiamine to a malnourished drinker.
- Missing an organic cause of new psychosis or confusion in an older adult.
- Confusing serotonin syndrome with neuroleptic malignant syndrome.
- Detaining a patient involuntarily when a less restrictive option exists.
Free sample mental health questions
Questions from our AMC MCQ bank. Choose your answer, then open the explanation.
A 24-year-old nurse sees her GP because her hands are cracked and bleeding. She has intrusive thoughts that she will pass a deadly infection to her family, and she washes her hands in a set sequence up to 40 times a day, taking about three hours. She knows the fear is excessive and finds the thoughts distressing, but feels unbearable anxiety if she does not wash. What is the most likely diagnosis?
- AObsessive-compulsive personality disorder
- BObsessive-compulsive disorder
- CIllness anxiety disorder
- DDelusional disorder, somatic type
- EGeneralised anxiety disorder
Show answer and explanation
Answer B. OCD is characterised by obsessions (recurrent, intrusive, unwanted thoughts, urges or images causing distress) and/or compulsions (repetitive behaviours or mental acts performed to reduce anxiety or prevent a feared event). Symptoms are time-consuming, typically more than an hour a day, or cause impairment. Contamination fears with washing are among the most common presentations, and insight is usually good or fair.
Learning point: OCD = ego-dystonic obsessions plus compulsions that take more than an hour a day or cause impairment.
A 21-year-old male university student is brought to his GP by his parents. For the past 10 weeks he has believed that neighbours have installed hidden cameras in his room, and he hears voices commenting on his actions. He has withdrawn from friends and stopped attending lectures. There are no symptoms of depression or mania. He denies drug use and a urine drug screen is negative. Physical examination, full blood count, electrolytes, thyroid function and calcium are normal. What is the most likely diagnosis?
- ABrief psychotic disorder
- BSchizophrenia
- CSchizophreniform disorder
- DPersistent delusional disorder
- ESchizoaffective disorder
Show answer and explanation
Answer C. He has two or more characteristic psychotic symptoms (delusions and hallucinations) with functional decline lasting about 10 weeks. DSM-5 schizophreniform disorder requires a duration of at least 1 month but less than 6 months, whereas schizophrenia requires 6 months including prodromal and residual phases. Organic and substance causes have been reasonably excluded. Around two-thirds of people with schizophreniform disorder go on to a diagnosis of schizophrenia.
Learning point: Psychosis lasting 1–6 months without a mood disorder or organic cause is schizophreniform disorder; 6 months or more is schizophrenia.
A 26-year-old man is brought to the emergency department by friends after smoking crystal methamphetamine ('ice') over the past day. He is anxious, restless and pacing, and believes people are following him. He is not aggressive, accepts reassurance from staff and agrees to take oral medication. Heart rate is 118 beats/min, blood pressure 150/90 mmHg and temperature 37.6 °C. He has no chest pain. What is the most appropriate initial pharmacological management?
- AIV metoprolol for heart rate control
- BIM haloperidol and physical restraint
- COral diazepam, repeated as needed
- DIV ketamine for dissociative sedation
- EOral naltrexone 50 mg as a single dose
Show answer and explanation
Answer C. For a cooperative patient with methamphetamine-related agitation, eTG recommends a calm, low-stimulus environment and oral benzodiazepines such as diazepam, titrated to effect. Benzodiazepines reduce agitation, sympathetic overactivity and seizure risk. Parenteral sedation and restraint are reserved for severe agitation when less restrictive options fail.
Learning point: Treat cooperative methamphetamine agitation with a calm environment and titrated oral diazepam.
Practise more mental health questions free
Every mental health subtopic in our bank
The bank holds 385 mental health questions across 45 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Acute behavioural disturbance and sedation8
- Adjustment disorder6
- Alcohol use disorder & withdrawal8
- Antipsychotics & side effects9
- Benzodiazepine dependence8
- Bipolar disorder9
- Brief intervention7
- Cannabis8
- Capacity and consent in mental health8
- Child and adolescent mental health22
- Culturally safe mental health care7
- Delirium vs dementia12
- Dementia12
- Depression in older adults12
- Drug-induced psychosis8
- Eating disorders12
- ECT indications8
- Gambling disorder7
- Generalised anxiety disorder7
- Grief and bereavement6
- Involuntary treatment under Mental Health Acts8
- Lithium toxicity8
- Major depressive disorder10
- Mental state examination8
- Methamphetamine8
- NMS vs serotonin syndrome7
- Obsessive-compulsive disorder7
- Opioid use disorder & opioid agonist treatment8
- Panic disorder7
- Perinatal depression8
- Persistent depressive disorder6
- Personality disorders8
- Psychiatric emergencies in ED8
- Psychological therapies7
- Psychotropic drug interactions8
- PTSD and acute stress disorder8
- Schizoaffective & delusional disorder7
- Schizophrenia & first-episode psychosis8
- Serotonin syndrome7
- Sexual dysfunction11
- Sleep disorders11
- Social anxiety disorder7
- Somatic symptom and functional disorders12
- Specific phobia6
- Suicide risk assessment and management8
Common questions
How many mental health questions are in the AMC MCQ?
Mental health is 12.5% of the blueprint, about 19 of 150 questions.
Do I need to know each state Mental Health Act?
You need the shared principles: mental illness, risk of serious harm, need for treatment and no less restrictive option. Details differ between states.
How do I tell serotonin syndrome from NMS?
Serotonin syndrome starts quickly after a serotonergic drug change with clonus and hyperreflexia. NMS develops over days on antipsychotics with lead-pipe rigidity and a high CK.
Which alcohol guideline does Australia use?
The NHMRC guidelines: for healthy adults, no more than 10 standard drinks a week and no more than 4 on any one day.
How many mental health questions are in the AMC MCQ bank?
There are 385 mental health questions across 45 subtopics, and the bank grows as new questions pass review.
Can I practise only mental health questions?
Yes. Filter by area or by any subtopic to build a custom block, in tutor mode with explanations after each question or in timed mode.
How are mental health questions explained?
Every question explains why the answer is right and why each other option is wrong, with a learning point and the Australian source behind it.
How much of the AMC MCQ mock is mental health?
About 19 questions in each 150-question mock come from mental health, following our mock blueprint.
Which sources is this mental health page based on?
It summarises current Australian guidance, including AMC MCQ Examination Specifications (version 8, 2025); RANZCP clinical practice guidelines; Therapeutic Guidelines: Psychotropic. Guidelines change, so always check the latest edition.
When was this mental health guide last updated?
It was last reviewed on 9 November 2026. We update topic pages when the exam or Australian guidance changes.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.