Analysis of the most frequently tested themes from the May 2025, October 2025 and February 2026 MRCPsych sittings — with targeted revision priorities for candidates sitting in 2026.
Disclosure: Recall information is compiled from candidate feedback after each sitting and does not contain actual exam questions. The RCPsych does not release past papers — all specific question text is our own interpretation of reported themes.
Why Do Recalls Matter?
While the MRCPsych does not repeat questions verbatim, the themes tested are surprisingly consistent across sittings. The RCPsych curriculum is fixed, and question writers draw on the same high-yield clinical topics year after year.
Knowing what appeared in the last 3 sittings tells you three things: which topics the question bank is currently focused on, where to concentrate your final-week revision, and what not to neglect because it "never comes up" (it usually does, eventually).
February 2026 Sitting — Paper B
The February 2026 Paper B sitting showed a notable emphasis on genetic syndromes, forensic concepts, and dementia pharmacotherapy. Critical review questions were particularly stats-heavy, with multiple NNT and sensitivity/specificity calculations.
- Genetic Syndromes in LD
Chromosomal anomalies, phenotypic features of Prader-Willi, Angelman, Fragile X, Down's syndrome — including specific behavioural phenotypes. Multiple questions on gene loci.
- Forensic Psychiatry
MCA and MHA interaction in forensic settings, fitness to plead criteria, diminished responsibility under the Homicide Act 1957, structured risk tools (HCR-20, PCL-R).
- Substance Effects & Intoxication
Specific drug-symptom pairings: GHB withdrawal, cannabis-induced psychosis features, ketamine uropathy, benzodiazepine overdose management.
- Dementia Types
DLB diagnostic criteria (2017 consensus), FTD vs. Alzheimer's differentiation, posterior cortical atrophy, biomarkers (CSF tau/amyloid, DAT scan).
- EPS Management
Algorithm for antipsychotic-induced EPS — which drugs worsen which side effects, when to switch vs. add, clozapine and metabolic monitoring.
- Statistical Measures
NNT, NNH, absolute risk reduction, likelihood ratios from 2×2 tables. Funnel plot interpretation for meta-analysis.
October 2025 Sitting — Paper B
October 2025 was notable for a high density of psychotherapy and ICD-11 questions — many candidates were caught off guard by ICD-11 changes from ICD-10. Health economics appeared as an EMI theme for the first time in several sittings.
- Psychotherapy Techniques
Specific techniques within CBT (Socratic questioning, thought records, behavioural experiments), DBT skills (DEAR MAN, TIPP, radical acceptance), mentalisation-based treatment.
- ICD-11 Psychotic Disorders
ICD-11 removed schizophrenia subtypes. New categories: schizophrenia, schizoaffective disorder, schizotypal disorder, brief psychotic disorder, schizophreniform disorder, delusional disorder. Know the duration criteria.
- Substance Intoxication Presentations
Distinguishing between PCP, dissociative agents, synthetic cannabinoids, and stimulants — using specific clinical features (vital signs, pupil size, clonus, seizure threshold).
- Learning Disability Syndromes
Specific syndromes with associated psychiatric co-morbidities and behavioural phenotypes (self-injurious behaviour in Lesch-Nyhan, sleep disturbance in Smith-Magenis).
- Health Economics
QALYs, DALYs, ICER, willingness-to-pay thresholds (NICE £20,000–£30,000 per QALY). EQ-5D instrument. Direct vs. indirect costs.
- Dementia Types (again)
Posterior cortical atrophy, CJD (MRI findings, 14-3-3 protein), normal pressure hydrocephalus (the triad), CADASIL.
May 2025 Sitting — Paper B
May 2025 featured a strong critical review component and several questions on the medico-legal aspects of psychiatry — Mental Health Act 2007 amendments, Deprivation of Liberty Safeguards, and the statutory instruments governing community treatment orders.
- Validity Types & Study Design
Internal vs. external validity, face, content, construct and criterion validity. Cohort vs. case-control advantages and limitations. Bradford Hill criteria for causation.
- Statistical Tests
Choosing the correct test (t-test vs. Mann-Whitney, Pearson vs. Spearman, chi-squared vs. Fisher's exact). When parametric assumptions are violated. Type I vs. Type II error.
- ECG Changes & Psychiatry
QTc prolongation — which drugs (haloperidol, ziprasidone, quetiapine, amisulpride, tricyclics) and at what doses. Brugada pattern, PR interval lengthening with lithium toxicity.
- Psychotherapy Concepts
The therapeutic relationship, transference and countertransference, the corrective emotional experience, mentalisation. Interpersonal therapy (IPT) phases and focus.
- Inheritance Patterns
Autosomal dominant (Huntington's, CADASIL), autosomal recessive (PKU, Wilson's), X-linked (Fragile X, Rett syndrome), mitochondrial (MELAS).
- Levels of Prevention
Primary, secondary, tertiary prevention in psychiatry context. Universal, selective, indicated prevention. Ottawa Charter principles. Upstream vs. downstream interventions.
Cross-Sitting Patterns: Your Highest-Priority Revision Targets
These topics appeared in two or more of the last three sittings — they are effectively guaranteed to appear again:
✓ Dementia types and their distinguishing features
✓ Learning disability genetic syndromes
✓ Statistical tests and 2×2 table calculations
✓ Psychotherapy techniques and their indications
✓ ICD-11 updates from ICD-10
✓ Substance intoxication and withdrawal presentations
✓ QTc prolongation and antipsychotics
✓ Mental Capacity Act in clinical scenarios
✓ Levels of prevention in psychiatry
✓ ECT — indications, contraindications, consent
How to Use Recalls in Your Revision
Recalls should inform your revision priorities, not replace them. Use them in the last 3–4 weeks before your sitting:
1. Identify your weakest recall themes from the list above
2. Find questions on those themes in your MCQ bank (filter by topic)
3. Review wrong answers — understand why the correct answer is correct, not just what it is
4. For EMI themes like statistics, do worked examples with actual 2×2 tables
5. In your final week, re-read the recall themes once — treat them as a checklist, not a shortcut
► Psychgateway's Paper B Mocks 13–17 are built from candidate recall data — covering May 2025, October 2025, February 2026. Mock 19 and the Critical Appraisal Mock are completely free. Visit psychgateway.com