COMAT
PSYCHIATRY
Examination Practice Questions
2026/2027 Edition
Verified Answers Plus Rationales
Q&A; | Instant Download PDF
EXAM SPECIFICATIONS
Time Allocation: 2.5 Hours
Total Questions: 125 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: Passing per NBOME Standards
Core Focus: Psychopathology, Psychopharmacology, Diagnosis, OMT
COMAT Psychiatry Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This COMAT Psychiatry Examination Prep validates knowledge required for osteopathic medical
students on psychiatry rotations. Content covers psychiatric disorders, psychopharmacology,
diagnosis, treatment, and legal/ethical issues per NBOME COMAT Subject Examination standards
with osteopathic integration.
CONTENT DISTRIBUTION
• Mood & Anxiety Disorders (25%) — Depression, bipolar, anxiety disorders, PTSD, OCD, panic
disorder
• Psychotic & Cognitive Disorders (20%) — Schizophrenia, delusional disorder, dementia,
delirium, neurocognitive disorders
• Substance Use & Personality Disorders (20%) — Alcohol, opioids, stimulants, withdrawal,
personality clusters A/B/C
• Child/Adolescent & Other Disorders (20%) — ADHD, autism, eating disorders, somatoform,
dissociative disorders
• Psychopharmacology & Treatment (15%) — Antidepressants, antipsychotics, mood stabilizers,
anxiolytics, ECT, psychotherapy, OMT
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with DSM-5-TR criteria and osteopathic principles. COMAT
uses scaled scoring.
STUDY STRATEGY
Master DSM-5-TR diagnostic criteria and time frames. Know psychopharmacology mechanisms and
side effects. Understand legal issues: involuntary commitment, duty to warn. Use rationales for
clinical reasoning.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 standards: NBOME COMAT Psychiatry blueprint, DSM-5-TR, Kaplan &
Sadock's Psychiatry, Stahl's Psychopharmacology, and osteopathic principles in mental health.
COMAT Psychiatry Exam Prep 2026/2027 Page 2
, SECTION I: Mood & Anxiety Disorders
1. A patient has 2 weeks of depressed mood, anhedonia, insomnia, weight loss, and suicidal
ideation. Most likely diagnosis:
A. Adjustment disorder
✓ B. Major depressive disorder
C. Bipolar disorder
D. Persistent depressive disorder
Rationale: MDD requires ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia. SI present
here. Adjustment disorder is stressor-related <6mo. Bipolar requires mania/hypomania. PDD is ≥2 years.
2. First-line pharmacologic treatment for major depressive disorder is:
A. Tricyclic antidepressants
✓ B. Selective serotonin reuptake inhibitors (SSRIs)
C. MAO inhibitors
D. Lithium
Rationale: SSRIs (fluoxetine, sertraline) are first-line for MDD due to safety and tolerability. TCAs and
MAOIs are second-line due to side effects/interactions. Lithium is for bipolar.
3. A patient presents with elevated mood, decreased need for sleep, grandiosity, and risky
spending for 7 days. Diagnosis:
A. Major depression
✓ B. Manic episode (Bipolar I)
C. Hypomania
D. Schizophrenia
Rationale: Manic episode: ≥7 days of elevated/irritable mood + ≥3 symptoms (DIGFAST: Distractibility,
Irresponsibility, Grandiosity, Flight of ideas, Activity, Sleep decreased, Talkative). Hypomania is <7 days, no
impairment.
4. Panic disorder is characterized by:
A. Persistent worry about multiple domains
✓ B. Recurrent unexpected panic attacks + fear of more attacks
C. Fear of social situations
D. Obsessions and compulsions
Rationale: Panic disorder: recurrent unexpected panic attacks + ≥1 month worry about more attacks or
maladaptive behavior. GAD is persistent worry. Social anxiety is fear of scrutiny. OCD has
obsessions/compulsions.
5. First-line treatment for generalized anxiety disorder:
A. Benzodiazepines long-term
✓ B. SSRIs/SNRIs and CBT
C. Antipsychotics
COMAT Psychiatry Exam Prep 2026/2027 Page 3
PSYCHIATRY
Examination Practice Questions
2026/2027 Edition
Verified Answers Plus Rationales
Q&A; | Instant Download PDF
EXAM SPECIFICATIONS
Time Allocation: 2.5 Hours
Total Questions: 125 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: Passing per NBOME Standards
Core Focus: Psychopathology, Psychopharmacology, Diagnosis, OMT
COMAT Psychiatry Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This COMAT Psychiatry Examination Prep validates knowledge required for osteopathic medical
students on psychiatry rotations. Content covers psychiatric disorders, psychopharmacology,
diagnosis, treatment, and legal/ethical issues per NBOME COMAT Subject Examination standards
with osteopathic integration.
CONTENT DISTRIBUTION
• Mood & Anxiety Disorders (25%) — Depression, bipolar, anxiety disorders, PTSD, OCD, panic
disorder
• Psychotic & Cognitive Disorders (20%) — Schizophrenia, delusional disorder, dementia,
delirium, neurocognitive disorders
• Substance Use & Personality Disorders (20%) — Alcohol, opioids, stimulants, withdrawal,
personality clusters A/B/C
• Child/Adolescent & Other Disorders (20%) — ADHD, autism, eating disorders, somatoform,
dissociative disorders
• Psychopharmacology & Treatment (15%) — Antidepressants, antipsychotics, mood stabilizers,
anxiolytics, ECT, psychotherapy, OMT
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with DSM-5-TR criteria and osteopathic principles. COMAT
uses scaled scoring.
STUDY STRATEGY
Master DSM-5-TR diagnostic criteria and time frames. Know psychopharmacology mechanisms and
side effects. Understand legal issues: involuntary commitment, duty to warn. Use rationales for
clinical reasoning.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 standards: NBOME COMAT Psychiatry blueprint, DSM-5-TR, Kaplan &
Sadock's Psychiatry, Stahl's Psychopharmacology, and osteopathic principles in mental health.
COMAT Psychiatry Exam Prep 2026/2027 Page 2
, SECTION I: Mood & Anxiety Disorders
1. A patient has 2 weeks of depressed mood, anhedonia, insomnia, weight loss, and suicidal
ideation. Most likely diagnosis:
A. Adjustment disorder
✓ B. Major depressive disorder
C. Bipolar disorder
D. Persistent depressive disorder
Rationale: MDD requires ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia. SI present
here. Adjustment disorder is stressor-related <6mo. Bipolar requires mania/hypomania. PDD is ≥2 years.
2. First-line pharmacologic treatment for major depressive disorder is:
A. Tricyclic antidepressants
✓ B. Selective serotonin reuptake inhibitors (SSRIs)
C. MAO inhibitors
D. Lithium
Rationale: SSRIs (fluoxetine, sertraline) are first-line for MDD due to safety and tolerability. TCAs and
MAOIs are second-line due to side effects/interactions. Lithium is for bipolar.
3. A patient presents with elevated mood, decreased need for sleep, grandiosity, and risky
spending for 7 days. Diagnosis:
A. Major depression
✓ B. Manic episode (Bipolar I)
C. Hypomania
D. Schizophrenia
Rationale: Manic episode: ≥7 days of elevated/irritable mood + ≥3 symptoms (DIGFAST: Distractibility,
Irresponsibility, Grandiosity, Flight of ideas, Activity, Sleep decreased, Talkative). Hypomania is <7 days, no
impairment.
4. Panic disorder is characterized by:
A. Persistent worry about multiple domains
✓ B. Recurrent unexpected panic attacks + fear of more attacks
C. Fear of social situations
D. Obsessions and compulsions
Rationale: Panic disorder: recurrent unexpected panic attacks + ≥1 month worry about more attacks or
maladaptive behavior. GAD is persistent worry. Social anxiety is fear of scrutiny. OCD has
obsessions/compulsions.
5. First-line treatment for generalized anxiety disorder:
A. Benzodiazepines long-term
✓ B. SSRIs/SNRIs and CBT
C. Antipsychotics
COMAT Psychiatry Exam Prep 2026/2027 Page 3
