Psychiatry and Addiction Medicine for the MCCQE Part I: Risk, Capacity and Withdrawal

Weight and scope

Eighteen questions is about twenty-five minutes. The psychosocial dimension of care is heavily represented here, and so are communication and professional-behaviour items. Stems often involve an interview: the right answer is the safest and most respectful next move, such as asking directly about suicidal thoughts, assessing capacity or arranging a safe disposition. Substance use appears in many other domains, including emergency, obstetrics and pediatrics.

The MCC publishes no discipline weights. The 8% figure is our editorial estimate from the MCC Examination Objectives and clinical presentations, and the count is rounded because some items in each section are unscored. Questions from this domain are also spread across the four dimensions of care and the four physician activities.

What is tested

• Mood disorders. Major depression assessment, suicide risk and treatment; bipolar disorder and lithium monitoring.
• Psychotic disorders. Schizophrenia and first-episode psychosis, and the work-up for secondary causes.
• Anxiety and trauma. Anxiety, panic disorder, OCD, PTSD and acute stress reaction.
• Other conditions. Personality disorders, eating disorders, somatic symptom and functional neurological disorders, ADHD and neurodevelopmental conditions across the lifespan.
• Substance use. Alcohol use disorder, withdrawal and Wernicke encephalopathy; opioid use disorder and opioid agonist therapy; cannabis and stimulant use.
• Safety. Self-harm and suicide risk assessment, and involuntary assessment and treatment under provincial mental health legislation.
• Drug effects. Adverse effects of antipsychotics, antidepressants and mood stabilizers, neuroleptic malignant syndrome and serotonin syndrome.
• Older adults and perinatal care. Delirium versus dementia versus depression; perinatal mental health and postpartum psychosis.

Canadian points to anchor your answers

• Provincial mental health law. Involuntary assessment and treatment follow provincial legislation. Ontario uses a Form 1 for a 72-hour assessment, and British Columbia has its own Mental Health Act. Stems that depend on a statute name the province. This detail is recalled and should be checked in the statute.
• Capacity and consent. Capacity is decision-specific. A person with a psychiatric diagnosis may still have capacity for a given decision.
• Alcohol guidance. Canada's Guidance on Alcohol and Health (2023) is the Canadian reference for risk levels and counselling, with no known safe amount in pregnancy.
• Opioids. The 2017 Canadian guideline on opioids for chronic non-cancer pain and current Health Canada guidance frame prescribing. Opioid agonist therapy is a standard treatment for opioid use disorder.
• Screening. The task force published guidance on depression in adults (2025) and perinatal depression (2022). Check the direction in the source.
• Reporting. Duty to report applies to child protection and, in some provinces, to unfit drivers.

How the questions are framed

Psychiatry stems often start with a presentation that could be medical or psychiatric. The first question is safety: is there a risk to self or others, is the patient intoxicated or delirious, is there a medical cause? Only then does the stem move to the diagnosis and the treatment. Look for the clue that changes the pathway: psychotic symptoms with confusion, mania with substance use, withdrawal in the hospitalized patient, or depression with a recent medication change.

Communication items are frequent: how to ask about suicide, how to explain a diagnosis, how to deal with an angry or agitated patient, how to include family while respecting confidentiality. Professional-behaviour items cover boundaries, consent and involuntary care.

Three typical traps

1. Avoiding the direct question about suicide. The expected step is to ask clearly and assess plan, intent and means. Asking does not increase risk.
2. Assuming incapacity from a diagnosis. Capacity is specific to the decision and the time. A psychiatric diagnosis alone does not remove it.
3. Missing a medical cause or a drug effect. Serotonin syndrome, neuroleptic malignant syndrome, withdrawal and delirium can look psychiatric. Check vital signs, medications and substance history.

How to revise it

1. Build a risk-assessment script with the questions, the decision about disposition and the documentation.
2. Make a drug table with the class, the key adverse effect and the monitoring for antipsychotics, antidepressants and lithium.
3. Learn the withdrawal syndromes for alcohol and opioids, with timing and treatment.
4. Review the provincial law concept of involuntary assessment: criteria, duration and rights.
5. Practise communication cases aloud, with a partner or a recording.

Pair this domain with the population health, ethics and professionalism, neurology and obstetrics and gynecology pages.

Subtopic checklist

Our blueprint lists these 18 subtopics for this domain. Tick each one only when you can state the presentation, the first investigation and the first management step without notes.

• Major depressive disorder: assessment, suicide risk and treatment
• Bipolar disorder and lithium monitoring
• Schizophrenia and first-episode psychosis
• Anxiety disorders, panic disorder and OCD
• Post-traumatic stress disorder and acute stress reaction
• Personality disorders
• Eating disorders
• Alcohol use disorder, withdrawal and Wernicke encephalopathy
• Opioid use disorder and opioid agonist therapy
• Cannabis, stimulant and other substance use
• Self-harm and suicide risk assessment
• Antipsychotic, antidepressant and mood-stabilizer adverse effects
• Neuroleptic malignant syndrome and serotonin syndrome
• Delirium versus dementia versus depression in older adults
• Involuntary assessment and treatment under provincial mental health legislation
• Perinatal mental health and postpartum psychosis
• Somatic symptom and functional neurological disorders
• ADHD and neurodevelopmental conditions across the lifespan

How the four dimensions of care show up

Every question in this domain is classified under one dimension of care, so revise psychiatry in four ways, not one.

• Health promotion and illness prevention. Prevention: depression and alcohol screening, substance use counselling and suicide prevention.
• Acute care. Acute: suicide risk, agitation, psychosis, intoxication and withdrawal, and serotonin syndrome.
• Chronic care. Chronic: maintenance treatment, lithium monitoring, long-term opioid agonist therapy and metabolic monitoring on antipsychotics.
• Psychosocial aspects. Psychosocial: housing, trauma, stigma, family involvement, cultural beliefs and access to care.

When you review a wrong answer, note which dimension the question belonged to as well as the topic. A pattern, such as repeated errors on the prevention items, tells you more than a topic score.