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Psychiatry Residency Interview Questions and Answers

Medical Residency Application & Interview Preparation Specialists

Interviews for a Psychiatry Residency can require a breadth of knowledge and attributes. Here, we present 10 questions and answers suitable for candidates to a Psychiatry Residency in the US. Further questions can be found in our Medical Residency Question Bank

The Career

What subspecialty are you interested in?

I’m very interested in Addiction Psychiatry. This is a one year fellowship, after the residency. I’m eager to help those suffering from addiction, having seen first hand how it can impact patients’ lives both in my general Psychiatry rotation and during an Addiction Psychiatry rotation that I took on at the end of last year. Both experiences allowed me to understand the field, and understand the difficulties that patients suffering from substance addictions, or substance abuse issues, face. I’ve undertaken research in the area, including assisting with a publication in The American Journal of Addictions.

What do you know about the path to specialisation in Psychiatry?

I know that after the 4 year Residency, in which one will already have the chance to specialise to some extent, being able to follow one’s interests and work towards understanding the fellowship one is interested in, one can then take on a 1-2 year fellowship. Most fellowships – like Forensic Psychiatry, Addiction Psychiatry, or Geriatric Psychiatry, are one year, whilst a fellowship in Child & Adolescent Psychiatry takes two years to complete. 

What are your career goals in Psychiatry?

In chronological order, my career goals are to complete my residency, and upon completing it to take a fellowship in addiction psychiatry. After completing this, I’d like to work as an attending at a major centre for addiction psychiatry, build up my clinical knowledge and expertise, and take on research as well. Through this I would hope to further build my clinical base, and connections in the field, until such a point as I could open my own rehabilitation centre, in which I’d ideally pursue the interplay between Art and Medicine through extensive use of art therapy and careful design of the facility.

 

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Knowledge: Diagnosis

How would you diagnose mania?

A diagnosis of mania requires a ‘distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently goal-directed behavior or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).’ During this period, three or more of the following symptoms must have persisted and be present to a significant degree, different from usual behaviour:
Inflated self-esteem or grandiosity
– Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
– More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
– Distractibility as reported or observed.
– Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
– Excessive involvement in activities that have a high potential for painful consequences

The mood disturbance must be sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, OR there may be psychotic features.

The episode must not be not attributable to the direct physiological effects of a substance or another medical condition.

How would you diagnose major depressive disorder?

To diagnose major depressive disorder, there must be 5 or more symptoms during the same two week period that are a change from previous functioning. These symptoms are:
– Depressed mood (most of the day, nearly every day)
– Anhedonia or loss of interest (most of the day, nearly every day)
– Weight loss or gain (change of >5% body weight in a month) or decrease in appetitive nearly every day
– Insomnia or hypersomnia
– Psychomotor agitation or retardation
– Fatigue
– Feeling of worthlessness or excessive / inappropriate guilt (may be delusional)
– Decreased concentration (nearly every day)
– Suicidal ideation or thoughts of death

Additional criteria (must have all four, plus 5 or more of the above)

– Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
– Episode is not attributable to physiological effects of a substance or another medical condition
– Episode is not better explained by other specified and unspecified schizophrenia spectrum and other psychotic disorders
– No history of manic or hypomanic episode

What is the DSM-5 definition of OCD?


Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
– The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).

– The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as with thought insertion).

Compulsions are defined as:
1) Repetitive behaviors (e.g., hand washing ) or mental acts (e.g., praying) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly
2) The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

– The obsessions or compulsions are time consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
– The disturbance is not better explained by the symptoms of another mental disorder
– The disturbance is not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication) or a general medical condition.

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Knowledge: Medications

What SSRI would you use for depression in a minor?

Only two SSRIs have been approved by the FDA for use in minors. These are fluoxetine and escitalopram. Fluoxetine can be used for those aged 8 and older, whilst escitalopram can be used for those 12 and older. It is appropriate to prescribe an SSRI for children and adolescents if they are experiencing persistent, moderate-severe depression or anxiety with clear evidence of functional impairment – this must be done in conjunction with a suitable choice of supportive psychotherapy. 

What SSRI has the longest half life? What about the shortest half life? Why is this important?

Fluoxetine has the longest half life, 4-6 days, or 7-15 days for the active metabolite. Paroxetine has the shortest half life, at 21 hours, although fluvoxamine’s half life of 15-26 hours is comparable. Other SSRIs fall between the two, with sertraline, for example, having a half life of 26 hours. This is important when discontinuing a medication – fluoxetine appears to have the least in the way of withdrawal symptoms, whilst those on paroxetine will have much more marked effects if the medication is withdrawn. 

What medication would be first line for a patient with OCD?

SSRIs, and the TCA clomipramine, are recommended as first-line medications in the treatment of OCD. Specifically, the SSRIs recommended for use are escitalopram, fluvoxamine, fluoxetine, paroxetine, and sertraline. I would consult local guidelines to choose between the SSRIs. 

How would you take a patient off an SSRI?

I would review the patient’s case, and discuss options with them before proceeding. Assuming that their condition was well-managed, and there was no history of recurrent depression or risk of relapse, I would reduce the dose slowly over four weeks. For drugs with a shorter half life – like paroxetine – this process would need to be longer still. I would inform the patient of the risk of discontinuation symptoms, notably in paroxetine and venlafaxine. I would provide the patient with information and safety-net appropriately. Generally, discontinuation symptoms will last between 1 and 2 weeks, and are usually relatively mild. They will disappear rapidly if the medication is reinitiated.

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