MRCPsych Paper B: question practice and revision.

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

• Adult general psychiatry — affective, psychotic, anxiety, OCD, eating disorders, perinatal
• Old age psychiatry — dementia, late-onset psychosis, depression in old age
• Child and adolescent psychiatry — neurodevelopmental, mood, attachment, eating disorders
• Learning disability psychiatry — challenging behaviour, comorbid mental illness, ethics
• Forensic psychiatry — risk assessment, fitness to plead, hospital orders
• Substance misuse psychiatry — alcohol, opioids, cannabis, prescription drugs, BBV
• Liaison psychiatry — perinatal mental health, medically unexplained symptoms, delirium
• Psychotherapy — CBT, dynamic, family, group, IPT, EMDR, evidence base
• Critical appraisal of psychiatric research — RCT methodology, meta-analysis, observational study design
• Mental Health Act and Mental Capacity Act — sections, holding powers, advance decisions
• Suicide, self-harm and risk assessment — assessment frameworks, dynamic vs static factors

Mapped to the published RCPsych Paper B syllabus and prioritised using item-density signals across the iatroX bank.

• Mental Health Act sections — Section 2 (assessment, up to 28 days), Section 3 (treatment, up to 6 months renewable), Section 5(2) (doctor's holding power, 72 hours), Section 5(4) (nurse's holding power, 6 hours), Section 136 (police, 24 hours)
• Antidepressant sequencing — SSRI first-line, switching strategies (washout for fluoxetine, cross-taper for others), augmentation (mirtazapine + SSRI, lithium, atypical antipsychotic), serotonin syndrome recognition
• Antipsychotic management — clozapine eligibility (treatment-resistant after 2 antipsychotic failures), monitoring (FBC weekly × 18 weeks then less frequent, metabolic screen), recognising agranulocytosis vs myocarditis, LAI antipsychotics
• Suicide risk assessment — frameworks (DSH-2 etc.), dynamic vs static risk factors, recognising imminent risk patterns, no contracts for safety, IMPACT on outcomes
• Critical appraisal of psychiatric trials — STAR*D depression sequencing, CATIE schizophrenia, BALANCE bipolar, RAID liaison, GENDEP for SSRI choice. Interpret HRs, NNTs, CIs, funnel plots
• Capacity — MCA in psychiatric practice, functional test (understand, retain, weigh, communicate), IMCA referrals, advance decisions to refuse treatment (ADRTs), LPA-health-and-welfare
• Substance misuse — alcohol detox regimens (chlordiazepoxide tapered), Wernicke's prevention (parenteral thiamine before glucose), opioid substitution (methadone vs buprenorphine), benzodiazepine tapers
• Psychotherapy evidence base — CBT for moderate depression, IPT for postnatal depression, family therapy for adolescent eating disorders, EMDR for PTSD per NICE NG116, DBT for emotionally unstable PD

Observations from UK psychiatry trainees and recent Paper B candidates. Verify against current RCPsych syllabus and Mental Health Act Code of Practice.

Candidate-reported observations — not official guidance.

1. Mental Health Act vs Mental Capacity Act — when each applies, overlapping situations, treatment of physical health under MHA limitations (cannot be detained under MHA for purely physical illness). Edge cases tested directly.
2. Clozapine monitoring — ANC thresholds for stopping (<0.5 × 10⁹/L), metabolic monitoring frequency, recognising myocarditis (highest risk in first 2 months), constipation prevention. Routinely tested.
3. Drug interactions — lithium and NSAIDs/ACEi/thiazides (raised levels), MAOI dietary restrictions (tyramine), SSRI and tramadol (serotonin syndrome), warfarin and SSRIs (bleeding risk).
4. Statistical concepts — funnel plot interpretation, heterogeneity in meta-analyses, publication bias, intention-to-treat vs per-protocol, ITT in trials with high dropouts. Critical appraisal block is high-yield and under-prepared.
5. Forensic psychiatry — fitness to plead (Pritchard criteria), diminished responsibility, hospital orders (Section 37 with or without Section 41), recognition of insanity defence. Tested but variably prepared.
6. Child and adolescent disorders — distinguishing ADHD, ASD, conduct disorder presentations, recognising attachment disorder, Fraser/Gillick competence in CAMHS context.
7. Eating disorders — recognising anorexia nervosa (BMI, electrolyte abnormalities, ECG changes), refeeding syndrome (Mg/PO4/K shifts), MARSIPAN guidelines, when to compulsorily treat under MHA.
8. Perinatal mental health — recognising postpartum psychosis (urgent admission), bipolar postpartum recurrence risk, antidepressants in pregnancy and breastfeeding, mother and baby units.

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

1. Weeks 1–6

   Foundation pass across all 11 blueprint topics. 30 questions/day with the iatroX adaptive engine. Read the Maudsley Prescribing Guidelines 14th edition for psychopharmacology and the Mental Health Act Code of Practice for legal frameworks.

2. Weeks 7–10

   Targeted weak-area drilling. Daily critical appraisal practice (interpret RCT abstracts, meta-analysis forest plots). Map NICE guidelines for depression (NG222), anxiety (CG113), bipolar (CG185), schizophrenia (CG178). Practice with real-world psychiatric trial abstracts.

3. Weeks 11–13

   One or two timed 150-item mock exams under exam conditions per week. Practise EMI technique for the larger option lists. Review every incorrect answer in detail, mapping back to NICE/Maudsley sources.

4. Weeks 14–16

   Bookmark review only. Targeted reading on Mental Health Act sections, MHRA prescribing updates (e.g. valproate in childbearing potential), recent practice-changing trials. Confirm Pearson VUE booking. Sleep, hydrate, do not learn new material.

Dedicated MRCPsych Paper B 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, Mental Health Act framework and critical appraisal of psychiatric research. Both are written exams; CASC is the separate clinical OSCE.

RCPsych typically runs three diets per year — typically February, May/June and October. Exact 2026 dates and application windows are published on the RCPsych examinations page. Confirm directly before planning. Once you pass your first written paper, you have approximately 4.5 years (1,643 days) to pass the remaining parts of MRCPsych.

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. Approximately 60-65% of items are MCQ-style and 35-40% are EMI-style.

About 13% (19 questions). This is one of the highest-yield blocks in Paper B and is consistently under-prepared. Items test interpretation of RCT abstracts, forest plots in meta-analyses, hazard ratios, NNTs and study design strengths/weaknesses. Practise with real psychiatric trial papers.

Paper B: £508 for PMPT (Pre-Membership Psychiatric Trainees) and Affiliates; £564 for non-PMPT trainees and affiliates (2026 rates). Slightly cheaper than Paper A and significantly cheaper than CASC. RCPsych reviews fees annually.

Yes — there is no required order. The papers can be taken in either order or even on adjacent days within a diet where the schedule permits. Many candidates sit Paper A first for the scientific foundation, but some prefer Paper B first to capitalise on clinical exposure.

Full MRCPsych Paper B 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.