Rating Scales, Eponyms, and Syndromes for MRCPsych: High-Yield Recall Guide

Rating scales and eponymous syndromes appear consistently in both Paper A and Paper B. The exam tests knowledge of what each scale measures, the population it is validated for, and the number of items. Eponyms are tested by asking the candidate to identify the syndrome from a brief clinical description. This is one of the most pattern-recognition-heavy sections of the syllabus.

Rating Scales Used in Psychiatry

Mood Disorders

Hamilton Depression Rating Scale (HDRS / Ham-D): 17 items (the original version; 21-item and 24-item versions also exist). Clinician-rated. Covers depressed mood, guilt, suicide, insomnia, work/activities, retardation, agitation, anxiety (psychic and somatic), somatic symptoms (GI, general, genital), hypochondriasis, weight loss, and insight. Does NOT assess atypical symptoms (hypersomnia, hyperphagia) well. Scores: 0-7 normal, 8-13 mild, 14-18 moderate, 19-22 severe. A 50% reduction from baseline defines treatment response.

Montgomery-Asberg Depression Rating Scale (MADRS): 10 items, clinician-rated. More sensitive to change over time than the Hamilton, making it preferred for clinical trials. Items: apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, suicidal thoughts. Each item scored 0-6, total 0-60.

Beck Depression Inventory (BDI-II): 21 items, self-report. Corresponds to DSM criteria for major depression. Each item 0-3, total 0-63. 0-13 minimal, 14-19 mild, 20-28 moderate, 29-63 severe.

Patient Health Questionnaire (PHQ-9): 9 items, self-report. Widely used in primary care and IAPT services in the UK. Each item corresponds to DSM-5 diagnostic criteria. Total 0-27. A score of 10 or above has sensitivity and specificity of approximately 88% for major depression. The PHQ-2 is the two-item ultra-brief version (low mood and anhedonia) used as a screening tool.

Young Mania Rating Scale (YMRS): 11 items, clinician-rated. Used to assess severity of manic symptoms. Items include elevated mood, increased motor activity/energy, sexual interest, sleep, irritability, speech, language/thought disorder, content, disruptive/aggressive behaviour, appearance, and insight.

Psychotic Disorders

PANSS (Positive and Negative Syndrome Scale): 30 items, clinician-rated. 7 positive items, 7 negative items, 16 general psychopathology items. Each item scored 1-7 (absent to extreme). The most widely used scale in schizophrenia clinical trials. The positive scale includes delusions, conceptual disorganisation, hallucinatory behaviour, excitement, grandiosity, suspiciousness/persecution, and hostility. The negative scale includes blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking, lack of spontaneity/flow of conversation, and stereotyped thinking. The SAPS (Scale for Assessment of Positive Symptoms) and SANS (Scale for Assessment of Negative Symptoms) are an alternative with 30 and 25 items respectively.

BPRS (Brief Psychiatric Rating Scale): 18 items (original; expanded version has 24 items), clinician-rated. Shorter than PANSS, used for assessing change in clinical trials. Items rated 1-7. Covers psychotic symptoms, depression, anxiety, hostility, and activation.

Anxiety, OCD, PTSD

Hamilton Anxiety Rating Scale (HAM-A): 14 items, clinician-rated. Covers both psychic anxiety (anxious mood, tension, fears, insomnia, intellectual, depressed mood, behaviour at interview) and somatic anxiety (somatic muscular, sensory, cardiovascular, respiratory, gastrointestinal, genitourinary, autonomic). Each item 0-4.

Yale-Brown Obsessive Compulsive Scale (Y-BOCS): 10 items, clinician-rated. 5 items for obsessions (time, interference, distress, resistance, control) and 5 identical items for compulsions. Total 0-40. Also includes a symptom checklist (not part of the severity score). A score of 0-7 is subclinical, 8-15 mild, 16-23 moderate, 24-31 severe, 32-40 extreme.

Impact of Events Scale (IES-R): 22 items, self-report. Measures subjective distress caused by traumatic events. Three subscales: intrusion, avoidance, and hyperarousal.

Dementia and Cognition

Mini-Mental State Examination (MMSE): 30 items/points. Tests orientation (10), registration (3), attention and calculation (5), recall (3), language (8), and visuospatial function (1). Cut-off commonly used: 24/30 or below suggests dementia. Scores affected by age, education, and language. Copyright restrictions apply (can no longer be freely reproduced).

Montreal Cognitive Assessment (MoCA): 30 points. More sensitive than MMSE for mild cognitive impairment (MCI) and vascular dementia. Includes executive function (trail-making, clock drawing, verbal fluency), visuospatial, language, attention, abstraction, delayed recall, and orientation. Increasingly replacing MMSE in clinical practice. The Addenbrooke’s Cognitive Exam (ACE-III) is another widely used alternative (100 points, includes MMSE items as subset). RUDAS (Rowland Universal Dementia Assessment Scale) is designed for culturally and linguistically diverse populations.

Clinical Dementia Rating (CDR): Global assessment of dementia severity (0 = no dementia, 0.5 = questionable, 1 = mild, 2 = moderate, 3 = severe) based on six domains: memory, orientation, judgement/problem-solving, community affairs, home/hobbies, personal care. Obtained from both patient and informant.

Eponymous Syndromes (High-Yield for EMI Questions)

The exam typically presents a brief clinical description and asks the candidate to identify the syndrome or eponym. The following are the most frequently tested:

Delusional Syndromes

• Capgras syndrome: Belief that familiar people have been replaced by identical-looking imposters. Most common in schizophrenia and dementia. Associated with right hemisphere lesions and face-processing deficits.
• Fregoli syndrome: Belief that different strangers are in fact the same familiar person in disguise. Opposite of Capgras.
• Cotard syndrome: Nihilistic delusions: belief that one is dead, does not exist, has lost organs, or has no blood. Most common in severe depression with psychosis. Can occur in schizophrenia.
• De Clerambault syndrome (erotomania): Belief that someone, usually of higher social status, is in love with the patient. Most often in women; the target is often unobtainable. Can occur in schizophrenia, bipolar disorder.
• Othello syndrome (morbid jealousy): Delusional belief of a partner’s infidelity. Associated with alcohol misuse, organic brain syndromes, and schizophrenia. Can lead to domestic violence and homicide.
• Ekbom syndrome (delusional parasitosis): Belief that the skin is infested with parasites. Associated with cocaine use and organic brain syndromes. Patients often present with skin lesions from picking or samples for the clinician to examine (matchbox sign).

Amnesic and Cognitive Syndromes

• Korsakoff syndrome: Anterograde amnesia with confabulation, caused by thiamine deficiency (usually alcohol-related). Pathology: mammillary body and dorsomedial thalamic atrophy.
• Wernicke encephalopathy: Acute triad: confusion, ataxia, ophthalmoplegia (nystagmus). Also thiamine deficiency. Immediate parenteral thiamine (Pabrinex) prevents progression to Korsakoff.
• Gerstmann syndrome: Dominant parietal lobe lesion (usually angular gyrus). Tetrad: finger agnosia, agraphia, right-left disorientation, acalculia.
• Balint syndrome: Bilateral superior parieto-occipital lesions. Triad: simultanagnosia (cannot perceive the visual field as a whole), optic ataxia (misreaching), and oculomotor apraxia (difficulty shifting gaze).
• Anton syndrome: Denial of blindness with confabulation; bilateral occipital cortex lesions. The patient acts as if they can see despite objective blindness.
• Geschwind syndrome: Interictal behaviour in temporal lobe epilepsy: hyposexuality, hyperreligiosity, hypergraphia, and viscosity (difficulty ending conversations).

Neurological and Personality Syndromes

• Klüver-Bucy syndrome: Bilateral temporal lobe (amygdala) damage. Hyperorality, hypersexuality, visual agnosia (psychic blindness), emotional blunting, bulimia, hypermetamorphosis (excessive exploration of environment).
• Kleine-Levin syndrome: Recurrent episodes of hypersomnia, hyperphagia, and hypersexuality. Classically in adolescent males. Episodes last days to weeks, separated by months of normal functioning.
• Ganser syndrome: Approximate answers to simple questions (“2+2=5”), often accompanied by disorientation, hallucinations, and conversion symptoms. Classically described in prisoners; debated relationship to factitious disorder or dissociative disorder.
• Münchausen syndrome: Factitious disorder with physical symptoms. The patient feigns or induces illness to assume the sick role. Münchausen by proxy (fabricated or induced illness in a dependent). In the ICD-11, this is classified within the category of factitious disorder.
• Briquet syndrome: An older term for somatisation disorder; multiple somatic complaints across organ systems as a manifestation of anxiety.
• Da Costa syndrome: Older term for panic disorder; the experience of anxiety attacks accompanied by attempts to avoid them.
• Heller syndrome: Childhood disintegrative disorder; loss of milestones after age 2 in multiple domains.

Movement and Catatonia Syndromes

• Kahlbaum syndrome: Catatonia; waxy posturing or purposeless excitement, treatable with benzodiazepines and ECT.
• Bell mania: Disorganised hyperactivity (as opposed to waxy flexibility) in lethal catatonia; rare due to antipsychotics.
• Gjessing syndrome: Periodic catatonia; fluctuating withdrawal or agitation.
• Meige syndrome: Dystonic blepharospasm; often antipsychotic-induced (hypodopaminergic state).
• Brueghel syndrome: Trigeminal dystonia affecting the mouth; sometimes provoked by antipsychotics.

High-Yield Fact Summary

• HAM-D vs MADRS: Both 17/10 items, clinician-rated for depression. MADRS more sensitive to change (favoured in trials).
• PANSS: 30 items (7 positive, 7 negative, 16 general). Most common schizophrenia trial scale.
• Y-BOCS: 10 items (5 obsessions, 5 compulsions). Score 0-40.
• MMSE vs MoCA: MMSE 30 points, insensitive to MCI. MoCA 30 points, more sensitive to MCI and vascular dementia.
• PHQ-9: 9 items, self-report, 0-27. Score >=10 = 88% sens/spec for major depression.
• ACE-III: 100 points, includes MMSE items plus more executive and language testing.
• RUDAS: Designed for culturally diverse populations; does not rely on reading/writing.
• CDR: 0-3 dementia staging (0=none, 0.5=questionable, 1=mild, 2=moderate, 3=severe).

PsychStar’s question banks for both Paper A and Paper B include dedicated eponym and rating scale questions. Start with 5 free questions at psychstar.io/try.