MRCPsych Paper B is the clinical psychiatry paper. Unlike Paper A, which tests sciences, Paper B tests your ability to assess, diagnose, and manage psychiatric conditions across all subspecialties — general adult, old age, child and adolescent, forensic, liaison, perinatal, intellectual disability, and substance misuse. The exam contains 150 questions (SBA and EMQ) in three hours, with three diets per year.
What Paper B tests
Paper B assumes you can apply psychiatric knowledge to clinical decision-making. Questions present clinical vignettes — a patient with specific symptoms, history, and risk factors — and ask you to identify the most appropriate management, the most likely diagnosis, or the correct legal framework. The distinction from Paper A is that Paper B does not test why a drug works (mechanism) but rather which drug to use, when to switch, and how to manage side effects in a specific clinical context.
Topic weighting
Schizophrenia and psychosis account for roughly 16 per cent — first-episode management, antipsychotic selection, treatment-resistant schizophrenia and the clozapine pathway (initiation criteria, monitoring protocol, rechallenge after neutropenia, management of clozapine-induced side effects), long-acting injectable antipsychotics, and concordance strategies.
Mood disorders account for 14 per cent — depression (NICE stepped care, treatment-resistant depression, augmentation strategies, ECT indications), bipolar disorder (acute mania management, maintenance therapy, lithium monitoring, valproate in women of childbearing potential, perinatal considerations), and bereavement-related presentations.
Anxiety and stress-related disorders account for 8 per cent. Substance misuse accounts for 8 per cent — alcohol detoxification (chlordiazepoxide regimen, Wernicke's prophylaxis), opioid substitution therapy (methadone and buprenorphine), and novel psychoactive substances. Old age psychiatry accounts for 8 per cent — dementia subtypes, BPSD management, depression in the elderly, capacity assessment, and DOLS.
Child and adolescent psychiatry accounts for 8 per cent — ADHD (NICE pathway, stimulant versus non-stimulant), autism spectrum disorder, self-harm in young people, and eating disorders. Forensic psychiatry accounts for 6 per cent — risk assessment frameworks (HCR-20), MAPPA, fitness to plead, and the interface between criminal justice and mental health services. Liaison psychiatry accounts for 6 per cent — delirium, capacity assessment in the general hospital, deliberate self-harm assessment in ED, and medically unexplained symptoms.
Mental Health Act sections account for 8 per cent — Sections 2, 3, 4, 5(2), 5(4), 135, 136, Community Treatment Orders, and the nearest relative framework. Mental Capacity Act 2005 is also tested. Personality disorders, eating disorders, psychotherapy approaches, and rehabilitation account for the remainder.
Clozapine
Clozapine questions appear in virtually every Paper B sitting. You must know the indications (treatment-resistant schizophrenia — failure to respond to two adequate antipsychotic trials), the registration and monitoring requirements (CPMS, mandatory blood monitoring schedule), the side effect profile (neutropenia, agranulocytosis, metabolic syndrome, myocarditis, constipation), and the rechallenge protocol after drug-induced neutropenia. These are high-yield, precise questions.
Mental Health Act
MHA questions test specific sections and their clinical application. Know the duration, grounds for detention, the role of the approved mental health professional, the nearest relative, and the appeal mechanisms for Sections 2, 3, 4, 5(2), 5(4), 135, and 136. Know the CTO framework. Know the differences between the MHA and the MCA — they serve different purposes and the exam tests the distinction.
Revision strategy
Three months. Start with schizophrenia and mood disorders — together they account for 30 per cent of the exam. Ensure your clozapine knowledge is comprehensive and your NICE depression pathway is solid. Month two should cover substance misuse, old age, C&A, and forensic psychiatry. Month three should cover MHA/MCA, liaison, personality disorders, and mock exams.
iatroX's MRCPsych Paper B bank contains over 1,500 questions covering all subspecialties. EMQ sets replicate the real exam format. Clozapine, MHA, and MCA questions are tagged for focused practice. The adaptive algorithm ensures subspecialties you have less clinical exposure to — forensic, perinatal, intellectual disability — receive proportionate revision time. All included at £29 per month or £99 per year.