PLAB 1 Psychiatry 2025 — 50 Q&A Practice Questions UK GMC
Verified Explanations
Series:
CrashCourses Professional Study Series
Author:
Dr Z. Moomba, MBChB, MRCPsych | BethelWellness Ltd
Exam Target:
PLAB 1 Psychiatry
Year:
2025/2026
Format:
50 Questions with Verified Answers and Rationales
>
Author's Note:
This document is an original work produced for the CrashCourses Professional Study Series.
Clinical questions and professional scenarios were composed by Dr Z. Moomba based on current
exam objectives, published guidelines, and evidence-based sources (2024–2025). All patient
names, ages, and case details are fictional. Any resemblance to existing published Q&A banks is
coincidental. For personal study use only — not for reproduction or redistribution.
SECTION A — FOUNDATIONS
Question 1
A 24-year-old man presents to the GP with a 6-month history of social withdrawal, apathy, and
poor self-care. He reports hearing two voices discussing his actions in the third person. According
to ICD-11, which of the following is the most likely diagnosis?
A) Bipolar affective disorder
B) Schizoaffective disorder
C) Schizophrenia
D) Delusional disorder
E) Psychotic depression
,Answer: C
Rationale:
The presence of third-person auditory hallucinations (a first-rank symptom) alongside negative
symptoms (apathy, withdrawal) persisting for months is classically indicative of schizophrenia.
The key discriminating feature is the combination of persistent negative symptoms and
Schneiderian first-rank hallucinations.
Delusional disorder fails as the primary diagnosis here because prominent hallucinations and
negative symptoms are not its core features.
Examiner Pearl: ICD-11 requires at least one core psychotic symptom (e.g., first-rank
delusions/hallucinations) present for at least one month for a schizophrenia diagnosis,
distinguishing it from acute transient psychotic disorders.
Question 2
A 32-year-old woman is brought to A&E by police under Section 136 of the Mental Health Act. She
is highly agitated, speaks rapidly, claims she has discovered a cure for cancer, and has not slept
for 5 days. What is the most appropriate ICD-11 classification for her current episode?
A) Hypomanic episode
B) Manic episode with psychotic symptoms
C) Mixed episode
D) Acute schizophrenia
E) Borderline personality disorder
Answer: B
Rationale:
This patient exhibits elevated mood, reduced need for sleep, pressure of speech, and grandiose
delusions (cure for cancer), satisfying criteria for a manic episode with psychotic features.
The presence of grandiose delusions makes this a psychotic manic episode rather than simple
mania.
Hypomania is incorrect because her symptoms are severe enough to require police intervention
(Section 136) and feature frank delusions.
Examiner Pearl: In bipolar disorder, a single manic episode is sufficient for a diagnosis of Bipolar
Type I, regardless of past depressive episodes [ICD-11].
,Question 3
A 45-year-old man presents to his GP with low mood, anhedonia, and early morning wakening for
4 weeks. His PHQ-9 score is 22. He states he believes his internal organs are rotting as
punishment for past sins. Which of the following is the most accurate diagnosis?
A) Moderate depressive episode
B) Severe depressive episode without psychotic symptoms
C) Severe depressive episode with psychotic symptoms
D) Schizophrenia
E) Illness anxiety disorder
Answer: C
Rationale:
A PHQ-9 score of 22 indicates severe depression, and the belief that his organs are rotting is a
mood-congruent nihilistic delusion (Cotard's syndrome).
The key feature is the combination of severe biological depressive symptoms with a clear
somatic/nihilistic delusion.
Illness anxiety disorder fails as the patient has true delusional beliefs and profound systemic
depressive symptoms rather than just anxiety about health.
Examiner Pearl: Psychotic symptoms in depression are typically mood-congruent (guilt, poverty,
nihilism) and demand urgent psychiatric assessment due to high suicide risk [NICE NG222].
Question 4
A 28-year-old woman has a known diagnosis of bipolar disorder. She presents to the clinic crying
uncontrollably, reporting profound sadness, yet simultaneously exhibits pressured speech, racing
thoughts, and extreme psychomotor agitation. How is this state best classified under ICD-11?
A) Rapid cycling bipolar disorder
B) Mixed episode
C) Psychotic depression
D) Emotionally unstable personality disorder
E) Manic episode
Answer: B
Rationale:
, A mixed episode features the simultaneous presence or rapid alternation of manic symptoms
(pressured speech, racing thoughts, agitation) and depressive symptoms (profound sadness,
crying).
The key discriminating feature is the concurrent mix of both polarities in a single acute
presentation.
Rapid cycling refers to four or more distinct mood episodes in a 12-month period, not
simultaneous symptoms.
Examiner Pearl: Mixed states carry a particularly high risk of suicide due to the combination of
depressive cognitions and manic energy/impulsivity.
Question 5
A 21-year-old university student is assessed for formal thought disorder. During the interview, his
speech repeatedly shifts between entirely unrelated topics without any logical connection, making
him difficult to follow. Which specific sign of formal thought disorder is this?
A) Knight's move thinking (Derailment)
B) Flight of ideas
C) Neologisms
D) Word salad
E) Circumstantiality
Answer: A
Rationale:
Knight's move thinking (derailment) is characterized by a complete lack of logical connection
between sequential ideas.
The key feature is the sudden, illogical shift in topic, typical of schizophrenia.
Flight of ideas (seen in mania) fails because, in flight of ideas, there are still discernible, albeit
tangential, links between thoughts (e.g., rhymes or puns).
Examiner Pearl: Formal thought disorder is a core diagnostic criterion for schizophrenia spectrum
disorders in ICD-11 and indicates disorganized thought processes.
Question 6
A 55-year-old man with known schizophrenia is deteriorating at home and refusing medication. He
lacks insight and is neglecting himself severely. An Approved Mental Health Professional (AMHP)
Verified Explanations
Series:
CrashCourses Professional Study Series
Author:
Dr Z. Moomba, MBChB, MRCPsych | BethelWellness Ltd
Exam Target:
PLAB 1 Psychiatry
Year:
2025/2026
Format:
50 Questions with Verified Answers and Rationales
>
Author's Note:
This document is an original work produced for the CrashCourses Professional Study Series.
Clinical questions and professional scenarios were composed by Dr Z. Moomba based on current
exam objectives, published guidelines, and evidence-based sources (2024–2025). All patient
names, ages, and case details are fictional. Any resemblance to existing published Q&A banks is
coincidental. For personal study use only — not for reproduction or redistribution.
SECTION A — FOUNDATIONS
Question 1
A 24-year-old man presents to the GP with a 6-month history of social withdrawal, apathy, and
poor self-care. He reports hearing two voices discussing his actions in the third person. According
to ICD-11, which of the following is the most likely diagnosis?
A) Bipolar affective disorder
B) Schizoaffective disorder
C) Schizophrenia
D) Delusional disorder
E) Psychotic depression
,Answer: C
Rationale:
The presence of third-person auditory hallucinations (a first-rank symptom) alongside negative
symptoms (apathy, withdrawal) persisting for months is classically indicative of schizophrenia.
The key discriminating feature is the combination of persistent negative symptoms and
Schneiderian first-rank hallucinations.
Delusional disorder fails as the primary diagnosis here because prominent hallucinations and
negative symptoms are not its core features.
Examiner Pearl: ICD-11 requires at least one core psychotic symptom (e.g., first-rank
delusions/hallucinations) present for at least one month for a schizophrenia diagnosis,
distinguishing it from acute transient psychotic disorders.
Question 2
A 32-year-old woman is brought to A&E by police under Section 136 of the Mental Health Act. She
is highly agitated, speaks rapidly, claims she has discovered a cure for cancer, and has not slept
for 5 days. What is the most appropriate ICD-11 classification for her current episode?
A) Hypomanic episode
B) Manic episode with psychotic symptoms
C) Mixed episode
D) Acute schizophrenia
E) Borderline personality disorder
Answer: B
Rationale:
This patient exhibits elevated mood, reduced need for sleep, pressure of speech, and grandiose
delusions (cure for cancer), satisfying criteria for a manic episode with psychotic features.
The presence of grandiose delusions makes this a psychotic manic episode rather than simple
mania.
Hypomania is incorrect because her symptoms are severe enough to require police intervention
(Section 136) and feature frank delusions.
Examiner Pearl: In bipolar disorder, a single manic episode is sufficient for a diagnosis of Bipolar
Type I, regardless of past depressive episodes [ICD-11].
,Question 3
A 45-year-old man presents to his GP with low mood, anhedonia, and early morning wakening for
4 weeks. His PHQ-9 score is 22. He states he believes his internal organs are rotting as
punishment for past sins. Which of the following is the most accurate diagnosis?
A) Moderate depressive episode
B) Severe depressive episode without psychotic symptoms
C) Severe depressive episode with psychotic symptoms
D) Schizophrenia
E) Illness anxiety disorder
Answer: C
Rationale:
A PHQ-9 score of 22 indicates severe depression, and the belief that his organs are rotting is a
mood-congruent nihilistic delusion (Cotard's syndrome).
The key feature is the combination of severe biological depressive symptoms with a clear
somatic/nihilistic delusion.
Illness anxiety disorder fails as the patient has true delusional beliefs and profound systemic
depressive symptoms rather than just anxiety about health.
Examiner Pearl: Psychotic symptoms in depression are typically mood-congruent (guilt, poverty,
nihilism) and demand urgent psychiatric assessment due to high suicide risk [NICE NG222].
Question 4
A 28-year-old woman has a known diagnosis of bipolar disorder. She presents to the clinic crying
uncontrollably, reporting profound sadness, yet simultaneously exhibits pressured speech, racing
thoughts, and extreme psychomotor agitation. How is this state best classified under ICD-11?
A) Rapid cycling bipolar disorder
B) Mixed episode
C) Psychotic depression
D) Emotionally unstable personality disorder
E) Manic episode
Answer: B
Rationale:
, A mixed episode features the simultaneous presence or rapid alternation of manic symptoms
(pressured speech, racing thoughts, agitation) and depressive symptoms (profound sadness,
crying).
The key discriminating feature is the concurrent mix of both polarities in a single acute
presentation.
Rapid cycling refers to four or more distinct mood episodes in a 12-month period, not
simultaneous symptoms.
Examiner Pearl: Mixed states carry a particularly high risk of suicide due to the combination of
depressive cognitions and manic energy/impulsivity.
Question 5
A 21-year-old university student is assessed for formal thought disorder. During the interview, his
speech repeatedly shifts between entirely unrelated topics without any logical connection, making
him difficult to follow. Which specific sign of formal thought disorder is this?
A) Knight's move thinking (Derailment)
B) Flight of ideas
C) Neologisms
D) Word salad
E) Circumstantiality
Answer: A
Rationale:
Knight's move thinking (derailment) is characterized by a complete lack of logical connection
between sequential ideas.
The key feature is the sudden, illogical shift in topic, typical of schizophrenia.
Flight of ideas (seen in mania) fails because, in flight of ideas, there are still discernible, albeit
tangential, links between thoughts (e.g., rhymes or puns).
Examiner Pearl: Formal thought disorder is a core diagnostic criterion for schizophrenia spectrum
disorders in ICD-11 and indicates disorganized thought processes.
Question 6
A 55-year-old man with known schizophrenia is deteriorating at home and refusing medication. He
lacks insight and is neglecting himself severely. An Approved Mental Health Professional (AMHP)
