MRCPsych Paper A: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Psychopathology and phenomenology — first-rank symptoms, formal thought disorder, specific delusions
• Psychopharmacology — receptor profiles, antidepressant/antipsychotic/mood stabiliser mechanisms
• Neuroanatomy and neurosciences — limbic system, basal ganglia, frontal lobe functions
• Genetics in psychiatry — heritability estimates, gene-environment, copy number variants
• Human development across the life cycle — attachment, cognitive development, identity formation
• Social and cultural psychiatry — sociology of mental illness, cultural formulation
• History and philosophy of psychiatry — Kraepelin, Schneider, Jaspers, anti-psychiatry
• Statistics and research methodology — reliability, validity, effect sizes, kappa
• Classification — ICD-11 / DSM-5-TR shifts from ICD-10
• Psychological treatments — theory and evidence (CBT, dynamic, family, group)

Drawn from the RCPsych Paper A syllabus, Maudsley Prescribing Guidelines (14th edition) and item density in iatroX.

• Phenomenology — Schneider's first-rank symptoms (audible thoughts, voices arguing/commenting, somatic passivity, thought withdrawal/insertion/broadcasting, delusional perception, made-actions/affect), formal thought disorder subtypes (knight's move, derailment, neologisms)
• Antipsychotic receptor profiles — D2 affinity (haloperidol, risperidone), 5-HT2A blockade (atypicals), M1 muscarinic (olanzapine, clozapine), H1 (olanzapine, quetiapine), α1 (clozapine, risperidone). Side-effect profiles follow receptor binding.
• Antidepressant mechanisms — SSRIs (citalopram QT, sertraline GI), SNRIs (venlafaxine BP, duloxetine), mirtazapine (5-HT2A/3 + H1 + α2), agomelatine (MT1/2 + 5-HT2C), vortioxetine (multimodal). Tetracyclic vs tricyclic.
• Mood stabiliser principles — lithium (TDM 0.6–1.0 mmol/L, narrow therapeutic index, nephrogenic DI, thyroid effects), sodium valproate (avoid in childbearing potential), lamotrigine (rash, Stevens-Johnson risk), carbamazepine (autoinduction, HLA-B*1502).
• Neuroanatomy — limbic system (hippocampus, amygdala, cingulate, fornix), basal ganglia direct/indirect/hyperdirect pathways, frontal lobe syndromes (orbitofrontal disinhibition, dorsolateral executive dysfunction, mesial akinetic mutism)
• Genetics — twin/adoption study heritability for schizophrenia (~80%), bipolar (~85%), MDD (~40%), autism (~80%). Copy number variants (22q11.2 deletion → 20-fold psychosis risk). Gene-environment interaction (5-HTTLPR x life events).
• Statistics — reliability (test-retest, inter-rater kappa interpretation), validity types (content, criterion, construct), effect sizes (Cohen's d), RCT methodology, ITT vs per-protocol, NNT for psychiatric interventions.
• Classification — ICD-11 changes from ICD-10 (gaming disorder added, gender incongruence moved out of mental disorders chapter, complex PTSD as separate disorder). Differential criteria for major disorders.

Observations from UK psychiatry trainees and recent Paper A candidates. Verify against current RCPsych syllabus.

Candidate-reported observations — not official guidance.

1. Receptor profile confusion — antipsychotic D2 vs 5-HT2A vs M1 vs H1 vs α1 binding directly determines side effects. Confusing the receptor and side effect costs marks. Practise structured "by receptor" recall.
2. Phenomenology terminology — first-rank symptoms (Schneider), formal thought disorder subtypes, Gedankenlautwerden (audible thoughts), thought block vs flight of ideas. Frequently muddled.
3. Statistical concepts — sensitivity vs specificity for psychiatric screening tools (PHQ-9, GAD-7, AUDIT), kappa interpretation (Landis & Koch). Often under-prepared.
4. Classification changes — ICD-11 introduced changes that newer revision sources cover (gaming disorder, complex PTSD) but many older banks still teach ICD-10. Check publication dates.
5. History and philosophy of psychiatry — small block (5%) but examined directly. Kraepelin's nosology vs Schneider's symptoms vs Jaspers's general psychopathology. Anti-psychiatry movement (Szasz, Laing).
6. Genetics calculations — heritability estimates differ markedly between disorders (and methodologies). Knowing the approximate figures and study basis matters.
7. Lithium toxicity vs hypothyroidism — distinguishing early subtle toxicity (tremor, fatigue, GI upset), recognising NSAID interactions, recognising lithium-induced renal disease vs nephrogenic DI.
8. Stress-diathesis vs biopsychosocial vs neurodevelopmental models — frameworks examined directly. Knowing which evidence supports which model.

A pragmatic phased approach used by recent UK core trainees who passed Paper A.

1. Weeks 1–6

   Foundation pass across all 10 blueprint topics. 30 questions/day with the iatroX adaptive engine. Read Fish's Clinical Psychopathology for phenomenology fluency and the Maudsley Prescribing Guidelines for pharmacology. Build receptor-profile recall by drug class.

2. Weeks 7–10

   Targeted weak-area drilling. Statistical concepts (sensitivity, specificity, kappa, NNT) daily. Genetics recurrence calculations. Map ICD-11 changes from ICD-10 in a single revision document.

3. Weeks 11–13

   One or two timed 150-item mock exams under exam conditions per week. Practise EMI technique (extended option lists need a quick differential before reading options). Review every incorrect answer in detail.

4. Weeks 14–16

   Bookmark review only. Targeted reading on phenomenology and lithium pharmacology. Confirm Pearson VUE booking — test the platform if you've never used it. Sleep, hydrate, do not learn new material.

Dedicated MRCPsych Paper A question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

Paper A is the scientific and theoretical paper — psychopathology, psychopharmacology, neuroscience, genetics, history and philosophy. Paper B is the applied-clinical and critical-review paper — clinical psychiatry across subspecialties, psychotherapy, critical appraisal of psychiatric research. Both are written exams; CASC is the separate clinical OSCE.

Use the RCPsych Applying for your exam page for sitting-specific dates, application periods and results. Submit the complete application by 15:30 UK time on the published closing date; late or incomplete applications are not accepted.

A single paper of 150 questions over 3 hours. Question types are a mix of single-best-answer MCQs and extended-matching items (EMIs). Delivered via Pearson VUE either at a test centre or online with remote proctoring.

No — they are sat in separate diet windows. Many candidates spread them across consecutive diets or sit them on adjacent days within a diet where the schedule permits. Once you pass your first written paper, you have approximately 4.5 years (1,643 days) to pass the remaining parts of MRCPsych.

Paper A: £565 for PMPT (Pre-Membership Psychiatric Trainees) and Affiliates; £627 for non-PMPT trainees and affiliates (2026 rates). Paper B is slightly cheaper. CASC is significantly more expensive. RCPsych reviews fees annually.

The pass mark for each Paper A diet is set by criterion-referenced standard setting (similar approaches to other Royal College exams). Recent pass rates have varied — check the most recent diet performance reports published by RCPsych.

Full MRCPsych Paper A bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.