GC017 Common Mental Health Problems In Primary Care
Common mental health problems in primary care are frequently encountered psychiatric conditions—principally depression, anxiety disorders, and stress-related disorders—that are initially identified and managed by general practitioners in the community setting.
Common Mental Health Problems in Primary Care
Lecture Map
Most mental health problems that exist in the community never reach a psychiatrist. They present first — and often only — to the primary care physician. The family doctor's job is to detect what is frequently hidden behind somatic complaints, use validated screening tools appropriately (but not confuse screening with diagnosis), and know when and how to explore mood, anxiety, and suicidality. This lecture, delivered by Prof. Amy Ng (HKU FMPC), is a high-yield target for GC-related exam questions on depression screening, PHQ-2/PHQ-9, GAD-7, medically unexplained physical symptoms (MUPS), insomnia assessment, and the patient-centred approach to psychological distress in primary care.
1. Understand the primary care approach to diagnosing patients with depression, anxiety, and undifferentiated psychological distress. [1]
2. Recognize the relationship between psychological distress and unexplained physical symptoms. [1]
3. Know some patient-centred strategies for assessing a depressed patient. [1]
Past papers have tested: choosing the correct screening tool (PHQ-2 vs PHQ-9 vs GAD-7 vs MMSE), distinguishing depression from GAD when overlapping symptoms exist, the concept of MUPS, insomnia assessment as a gateway to mood assessment, and suicidal risk assessment in primary care. The lecture also connects to the Family Medicine principle that patients present with problems not diagnoses, and the doctor must bridge the gap.
Psychological symptoms are common in the general population, affecting more than 50% of adults at some time. [1]
The three most common psychological complaints people experience at some point are:
- Worry
- Tiredness
- Sleep disturbance
These are almost universal human experiences. Having them does not mean you have a psychiatric disorder — a vital distinction the lecture emphasizes.
Approximately 1 in 7 may have a diagnosable mental disorder. The two most common are Depression and Anxiety Disorders (including GAD, panic disorder, OCD, PTSD, phobias). [1]
Under-detection is the Norm
There is widespread under-detection of depression and anxiety disorders by doctors — more than 50% are missed. [1] This statistic comes from a Hong Kong primary-care study (Chin et al., 2014). The main reasons are: (a) patients present with somatic symptoms, not psychological ones; (b) doctors don't ask; (c) short consultation times; (d) stigma. This is a favourite exam point — they love testing your awareness that mental health conditions are commonly missed.
Not all patients present with psychological symptoms; many present with somatic symptoms. [1]
Why does this matter from first principles? In many cultures, including Hong Kong Chinese culture, there is significant stigma attached to admitting psychological distress. Patients may not have the vocabulary, or may somatize (convert emotional distress into bodily complaints). The GP who only asks about physical symptoms will miss these diagnoses. The lecture deliberately frames this as the central challenge of mental health in primary care.
2. Screening Tools — PHQ-2, PHQ-9, GAD-7
Critical Concept: Screening ≠ Diagnosis
These are NOT diagnostic tools. They are used to SCREEN ONLY. [1] A positive screen tells you the patient warrants further clinical assessment. You must then apply DSM-V criteria and clinical judgment to make a diagnosis. This distinction is commonly tested.
The PHQ-2 is the simplest entry-level screen for depression. It asks two questions about the past 2 weeks:
| Item | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
| Little interest or pleasure in doing things | Not at all | Several days | More than half the days | Nearly every day |
| Feeling down, depressed, or hopeless | Not at all | Several days | More than half the days | Nearly every day |
Scoring: Total 0–6.
Positive if cut-off ≥ 3 → sensitivity 84%, specificity 90% for major depression. [1]
Why these two questions? Because they capture the two cardinal symptoms of major depression in DSM-V — low mood and anhedonia (loss of interest/pleasure). If a patient scores ≥ 3, proceed to the full PHQ-9.
Clinical use: The PHQ-2 is recommended in the Hong Kong Reference Framework for Preventive Care for Older Adults — i.e., it can be used opportunistically during routine health assessments.
The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in DSM-V. [1]
| # | Item (Over the past 2 weeks…) | What it maps to in DSM-V |
|---|---|---|
| 1 | Little interest or pleasure in doing things | Anhedonia |
| 2 | Feeling down, depressed, or hopeless | Low mood |
| 3 | Trouble falling asleep, staying asleep, or sleeping too much | Sleep disturbance |
| 4 | Feeling tired or having little energy | Fatigue |
| 5 | Poor appetite or overeating | Change in appetite/weight |
| 6 | Feeling bad about yourself, feeling that you are a failure, or that you have let yourself/your family down | Worthlessness/guilt |
| 7 | Trouble concentrating on things such as reading the newspaper or watching television | Lost concentration |
| 8 | Moving or speaking so slowly that other people could have noticed; OR the opposite — being so fidgety or restless | Psychomotor agitation/retardation |
| 9 | Thinking that you would be better off dead or that you want to hurt yourself in some way | Suicidal ideation |
Scoring: Each item 0–3, same scale as PHQ-2. Total 0–27.
PHQ-9 Score Interpretation: [1]
| Total Score | Severity |
|---|---|
| 0–4 | No depression |
| 5–9 | Mild depression |
| 10–14 | Moderate depression |
| 15–19 | Moderately severe depression |
| 20–27 | Severe depression |
PHQ-9 score ≥ 10 for major depression → sensitivity 88%, specificity 88%. [1]
Key Features of PHQ-9 (from lecture):
- Short and quick [1]
- Can be administered in person, by telephone, or self-administered [1]
- Helps with diagnosis of major depression [1]
- Assesses symptom severity and useful for monitoring treatment responses [1]
- Validated [1]
- Can be used in adolescents as young as 12 years of age [1]
Exam Trap: PHQ-2 vs PHQ-9
A common MCQ asks which instrument to use next when a patient presents with low mood and anhedonia. If they have NOT been screened yet, PHQ-2 is a reasonable first step. If PHQ-2 is positive (≥ 3), or if you already have a strong clinical suspicion, go to PHQ-9 for severity assessment. A 2022 past paper (Q80) tested exactly this: a 35-year-old woman with low mood and loss of interest — the answer was PHQ-9 (not PHQ-2), because enough information was already given to warrant the fuller instrument. [3]
7-item scale, based on DSM-V criteria, for identifying likely cases of Generalized Anxiety. Validated. [1]
| # | Item (Over the past 2 weeks…) |
|---|---|
| 1 | Feeling nervous, anxious, or on edge |
| 2 | Being unable to stop or control worrying |
| 3 | Worrying too much about different things |
| 4 | Trouble relaxing |
| 5 | Being so restless that it is hard to sit still |
| 6 | Becoming easily annoyed or irritable |
| 7 | Feeling afraid as if something awful might happen |
Scoring: Same 0–3 scale. Total 0–21.
GAD-7 Score Interpretation: [1]
| Total Score | Level of Anxiety |
|---|---|
| 0–4 | No anxiety |
| 5–9 | Mild anxiety |
| 10–14 | Moderate anxiety |
| 15–21 | Severe anxiety |
GAD-7 > 10 for GAD → sensitivity 89%, specificity 82%. [1]
Can also be used as a quick tool to assess for other anxiety disorders (panic, social anxiety, PTSD). [1]
3. DSM-V Diagnostic Criteria
Clinical depression is diagnosed when there are at least 5 or more symptoms present for > 2 weeks. [1]
The nine symptoms are:
| # | Symptom | Mnemonic aid |
|---|---|---|
| 1 | Low mood | Must have (1) and/or (2) |
| 2 | Loss of interest (anhedonia) | Must have (1) and/or (2) |
| 3 | Sleep disturbance | |
| 4 | Lost concentration | |
| 5 | Fatigue | |
| 6 | Change in appetite or weight | |
| 7 | Agitation/retardation | |
| 8 | Feelings of worthlessness or guilt | |
| 9 | Suicidal thoughts |
A useful mnemonic: SIG E CAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor changes, Suicidality) — plus Mood.
All four additional criteria must also be met: [1]
- Symptoms cause significant impairment in social/occupational/other areas of function
- Not attributable to physiological effects of a substance or other medical condition
- Not explained by other schizophrenia/affective disorders
- No history of manic/hypomanic episodes (which would make it bipolar disorder)
Why 'No manic/hypomanic episodes'?
If a patient has even one manic or hypomanic episode, the diagnosis shifts to bipolar disorder, which has fundamentally different treatment implications (e.g., antidepressant monotherapy can precipitate mania in bipolar). This is why taking a history of past mania is critical before labelling someone as having MDD.
Characterized by excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities. [1]
The person finds it difficult to control the worry and it is associated with 3 or more of: [1]
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or the mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
Additional criteria: [1]
- Must cause significant distress or significantly impair social or occupational functioning
- Cannot be accounted for by substance use or a general medical disorder
Exam Discriminator: Depression vs GAD
A 2023 past paper (Q75) asked which symptom is MOST suggestive of depression over GAD in a patient with overlapping features. The overlapping features were: difficulty falling asleep, loss of concentration, muscle tension, weight gain. The answer was weight gain — because muscle tension is much more characteristic of GAD, and the other two (insomnia, poor concentration) are shared. Weight/appetite changes are listed as a DSM-V criterion for MDD but not for GAD. [4]
In Primary Care, 18.5% of consultations are MUPS. [1]
Other terms used: "somatic", "functional", "unexplained", "dissociative". [1]
Why do patients present this way? From a biopsychosocial perspective:
- Physiological amplification: stress activates the sympathetic nervous system and HPA axis, producing real physical symptoms (palpitations, dry mouth, chest tightness, GI dysmotility).
- Cultural factors: in many Asian cultures, it is more acceptable to present with a physical complaint than an emotional one.
- Cognitive factors: illness-related beliefs, alexithymia (difficulty identifying/expressing emotions). [2]
Actively search for psychosocial stress. Ask about sleep first. If positive, ask about mood/anxiety. [1]
This is a key clinical pearl from the lecture: sleep is the gateway question. Patients will often admit to sleep difficulties more readily than to feeling depressed. Once they open up about poor sleep, you can naturally transition to asking about mood, worries, and functioning.
Common somatic presentations of mental health problems (from lecture illustration): [1]
- Headache
- Tiredness/fatigue
- Body aches ("flu-like")
- Bloating
- Dry mouth
- Shortness of breath
High Yield: MUPS in Primary Care
Approximately 1 in 5 primary care consultations involves MUPS. Always consider underlying depression or anxiety when no physical cause is found. Use sleep as a gateway question. [1]
5. Insomnia Assessment in Primary Care
1/3 of patients experience occasional sleeping problems in primary care (AAFP). 10% of adults experience persistent insomnia. Chronic insomnia refers to sleep difficulty occurring at least three nights per week for one month or more. [1]
- Difficulty falling asleep (sleep-onset insomnia — think anxiety, poor sleep hygiene)
- Difficulty maintaining sleep (sleep-maintenance insomnia — think depression, pain, OSA)
- Waking up too early (early morning awakening — classic for depression)
- Non-refreshing sleep
- Fatigue
- Lack of energy
- Difficulty concentrating
- Irritability
The lecture provides a detailed list of assessment questions. These are important because they cover not just the symptom but the differential diagnosis of insomnia:
| Question | What it helps rule in/out |
|---|---|
| How has the patient been sleeping recently? | Baseline |
| When did the problem begin? | Acute vs chronic insomnia |
| Does the patient have a psychiatric or medical condition? | Secondary insomnia |
| Is the sleep environment conducive to sleep? | Environmental factors |
| "Creeping, crawling or uncomfortable feelings" in the legs relieved by moving? | Restless legs syndrome |
| Legs or arms jerk during sleep (bed partner report)? | Periodic limb movements |
| Loud snoring, gasping, choking, or stops breathing? | Obstructive sleep apnoea |
| Shift worker? Adolescent? | Circadian rhythm disorders |
| Bedtimes/rise times on weekdays vs weekends? | Poor sleep hygiene |
| Caffeine, tobacco, alcohol? Stimulating medications (antidepressants, steroids, decongestants, beta-blockers)? | Substance-induced insomnia |
| Daytime consequences? | Severity/functional impact |
| Dozing off during routine tasks, especially driving? | Dangerous — needs urgent attention |
Exam Tip: Insomnia as a Presenting Complaint
A 2025 past paper (Q19) presented a 36-year-old clerk seeking hypnotics for sleep problems with "unhappy events." The correct answer was that symptoms of psychiatric comorbidity should be explored — not which hypnotic to prescribe. [5] This directly reflects the lecture's teaching: when a patient presents with insomnia, always look for the underlying cause, especially depression and anxiety.
6. Assessing the Depressed Patient — Patient-Centred Strategies
The lecture provides a list of questions that a GP can use to explore depression in a patient-centred way: [1]
Opening / Exploring:
- What do you think is the matter with you?
- Do you think your feelings are possibly caused by nerves, anxiety, or depression?
- Can you think of any reason why you feel this way?
Mood:
- Do you feel down in the dumps?
- Do you feel that you are not coping well? / How are you coping with this?
- Do you have any good times?
Life events:
- Has anything changed in your life?
Sleep:
- How do you sleep? Do you wake early?
Diurnal variation:
- What time of the day do you feel at your worst? (Classic for melancholic depression — worse in the morning)
Severity rating:
- Where would you put yourself between 0% and 100%?
Hopelessness:
- Have you felt hopeless?
Neurovegetative:
- What is your energy like?
- What is your appetite like?
- Are you as interested in sex as before?
Guilt:
- Do you feel guilty about anything?
Hidden distress:
- Do you cry when no one is around?
The lecture highlights a video case showing a young male patient:
Males often will not express sadness, depression, crying, or hopelessness. Instead, they may experience frustration, anxiety, irritability, and anger, and may have somatic concerns. [1]
Why? Social norms around masculinity often discourage men from expressing vulnerability. The clinical consequence is that asking "are you sad?" may get a blank stare, whereas asking "have you been feeling more irritable/angry than usual?" opens the door.
Key clinical pearls from the video analysis: [1]
- Patients are often "sent in" by family — the patient may not think they have a problem.
- Males are much more comfortable talking about the physical aspects and somatic presentation of their distress.
- When asking about sensitive topics (drugs, alcohol), signposting may be helpful — e.g., "I'm going to ask some routine questions that I ask everyone."
- The doctor should look calm when hearing about pain — this makes the conversation feel safe.
- Summarising what the patient has said shows you have been listening and encourages further disclosure.
- A patient who talks about anger may look very sad and may disclose suicidal feelings when they feel connected enough.
High Yield: Always Assess for Suicide
45% of persons who complete suicide had consulted a GP within 1 month of their act. [1]
Persons who survive lethal suicide attempts have similar clinical and psychosocial profiles as suicide completers. [1]
Over 50% of those who complete suicide initially presented with self-harm. [1]
Therefore, you should ASSESS for SUICIDE and SELF-HARM in every patient you suspect depression. [1]
Why is this such a big deal for primary care? Because:
- The GP is often the last medical professional to see the patient alive.
- Self-harm is the strongest predictor of completed suicide.
- Asking about suicide does NOT increase risk — this is a myth. In fact, patients often feel relieved when asked.
How to ask (practical approach):
- Start with hopelessness: "Have you felt hopeless about the future?"
- Escalate: "Have you wished you were dead or that you could go to sleep and not wake up?"
- Be direct: "Have you thought about hurting yourself or ending your life?"
- If yes: explore plan, means, intent, access to lethal means, protective factors.
PHQ-9 Item 9 directly screens for this: "Thinking that you would be better off dead or that you want to hurt yourself in some way." Any score > 0 on this item warrants further exploration regardless of total score.
8. Special Populations
Depression in the elderly is often misdiagnosed as dementia or psychosis. [1]
- May include odd behaviours such as histrionic behaviours, delusions, disordered thinking — these can mimic psychosis or dementia.
- Assess sleep — often the most reliable entry point.
- Helpful screening questions (from Geriatric Depression Scale concept):
- Are you basically satisfied with your life?
- Do you feel that your life is empty?
- Are you afraid that something bad is going to happen to you?
- Do you feel happy most of the time?
Clinical significance: "Pseudodementia" — depression masquerading as cognitive impairment — is a reversible cause of apparent dementia. It is listed in the DEMENTIA mnemonic for reversible causes (the "E" for Emotions). [6] Distinguishing features: depressed patients tend to say "I don't know" (emphasise their inability), while truly demented patients confabulate or try to answer; onset is often more acute; there may be a precipitant (e.g., bereavement).
Do not assume all women want to have children. Even the ones who want to have kids can be sad. Includes health professionals! [1]
Be non-judgmental and remember to ask at every visit! [1]
Specific clues to perinatal depression: [1]
- Poor weight gain in pregnancy
- Excessive anxiety/worries about parenting
- Defaulting medical care
- Low self-esteem
Why does this matter? Perinatal depression affects not just the mother but the child's development (attachment, feeding, cognitive development) and the family unit. The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening tool in this population (mentioned in OG lectures). [7]
1. Emotional symptoms are common but do not necessarily mean that the sufferer has a diagnosable mood disorder. [1]
2. Many mood disorders are short-lived responses to stresses in people's lives such as work stress or bereavement. [1]
3. The cornerstone to the detection of a mood disorder is an understanding of the presenting symptoms and syndromes and exploring sleep, psychosocial history. [1]
4. Depression and anxiety are common in primary care but are missed by doctors in at least 50% of cases. [1]
5. Screening tools such as the PHQ-9 and GAD-7 can be useful to enhance detection rates for depression and anxiety. [1]
6. Patients with depression or anxiety often present with physical symptoms. [1]
10. Integration with Related Material
When a primary care screen is positive, the next step is a proper psychiatric assessment. The psychiatric structured interview includes: [8]
- Presenting complaint (in patient's own words)
- HPI: nature, onset, duration, severity, precipitating/perpetuating factors, functional impact
- Risk assessment (suicide, self-harm, harm to others)
- Mental State Examination (MSE)
- Brief cognitive assessment (if indicated)
MUPS and mental health problems are listed as the top two indications for a family-oriented approach to patient care. [9] Understanding the patient's family context — life-cycle stage, family stressors, social support — is essential for both detection and management.
A 2024 past paper EMQ (Q22-23) tested this directly: a 60-year-old grieving accountant presenting with insomnia — the main reason for consultation was insomnia (not depression), because he needed to function at work (patient's agenda). A 32-year-old mother with insomnia — main reason was limit of anxiety (about dementia). Understanding the patient-centred reason for consultation is key. [10]
While this lecture focuses on detection, the management continuum (from Ryan Ho Psychiatry notes and CFB PSY lectures) is: [2]
| Severity | Management Approach |
|---|---|
| Mild depression (PHQ-9: 5–9) | Watchful waiting, exercise, sleep hygiene, guided self-help, psychoeducation |
| Moderate (PHQ-9: 10–14) | CBT, problem-solving therapy, antidepressant (SSRI first-line) |
| Moderately severe–severe (PHQ-9: 15–27) | Antidepressant + psychotherapy, consider psychiatry referral |
| With suicidality/psychosis | Urgent psychiatry referral, consider admission |
For GAD:
- Mild: psychoeducation, relaxation training, self-help
- Moderate–severe: CBT and/or SSRI/SNRI, consider referral
Likely Exam Questions
1. A 45-year-old man presents with tiredness. History does not suggest any physical cause. Which two screening questions would you ask to screen for depression?
- Answer: PHQ-2 — (1) Little interest or pleasure in doing things? (2) Feeling down, depressed, or hopeless? Over the past 2 weeks. [Based on 2018 SAQ Q10c] [11]
2. A 35-year-old woman has had low mood for 6 weeks with loss of interest in cooking and playing with her children. Which assessment instrument is MOST relevant?
- Answer: PHQ-9 (not PHQ-2, not GAD-7, not MMSE). PHQ-9 because symptoms already suggest depression and the fuller instrument assesses severity. [2022 MCQ Q80] [3]
3. Which symptom best discriminates depression from GAD: difficulty falling asleep, loss of concentration, muscle tension, or weight gain?
- Answer: Weight gain — it is a DSM-V criterion for MDD but not GAD. Muscle tension is characteristic of GAD. [2023 MCQ Q75] [4]
4. A 36-year-old clerk wants hypnotics for sleep problems due to "unhappy events." What is the MOST IMPORTANT area to cover?
- Answer: Symptoms of psychiatric comorbidity should be explored. [2025 MCQ Q19] [5]
5. What proportion of primary care consultations involve medically unexplained physical symptoms?
- Answer: ~18.5%. [1]
6. Name four differential diagnoses for "tiredness" in a primary care setting.
- Markscheme: Depression, anxiety disorder, anaemia, hypothyroidism, diabetes mellitus, chronic fatigue syndrome, malignancy, sleep disorder (any 4). [11]
7. A GP suspects depression in a patient. Why should they assess for suicide?
- Markscheme: 45% of suicide completers saw a GP within 1 month; > 50% of completers initially presented with self-harm; survivors of lethal attempts have similar profiles to completers; asking does not increase risk. [1]
8. List the DSM-V criteria for GAD.
- Markscheme: Excessive anxiety/worry, more days than not, ≥ 6 months, about multiple events/activities, difficulty controlling worry, 3+ of: restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance; causes significant distress/impairment; not due to substance/medical condition. [1]
| Feature | PHQ-2 | PHQ-9 | GAD-7 |
|---|---|---|---|
| Purpose | Quick depression screen | Depression screening + severity + monitoring | GAD screening + severity |
| Items | 2 | 9 | 7 |
| Timeframe | Past 2 weeks | Past 2 weeks | Past 2 weeks |
| Score range | 0–6 | 0–27 | 0–21 |
| Positive cut-off | ≥ 3 | ≥ 10 | > 10 |
| Sensitivity / Specificity | 84% / 90% | 88% / 88% | 89% / 82% |
| Based on | 2 DSM-V criteria | 9 DSM-V criteria | DSM-V GAD criteria |
| Diagnostic? | No — screening only | No — screening only | No — screening only |
| Can monitor treatment? | No | Yes | Yes |
| Age | Adults | ≥ 12 years | Adults |
| Other uses | — | — | Can screen for other anxiety disorders |
| Feature | MDD | GAD |
|---|---|---|
| Duration requirement | ≥ 2 weeks | ≥ 6 months |
| Number of symptoms required | ≥ 5 of 9 | ≥ 3 of 6 (plus excessive worry) |
| Cardinal symptom | Low mood AND/OR anhedonia | Excessive uncontrollable worry |
| Weight/appetite change | Yes (DSM criterion) | Not a criterion |
| Muscle tension | Not a criterion | Yes (DSM criterion) |
| Suicidal ideation | Yes (DSM criterion) | Not a criterion |
| Worthlessness/guilt | Yes (DSM criterion) | Not a criterion |
| Overlapping symptoms | Sleep, concentration, fatigue, irritability | Sleep, concentration, fatigue, irritability |
| Screening tool | PHQ-9 | GAD-7 |
High Yield Summary
1. > 50% of depression and anxiety in primary care are missed by doctors — mainly because patients present with somatic symptoms, not mood complaints.
2. PHQ-2 (≥ 3) is a quick screen; PHQ-9 (≥ 10) assesses severity. GAD-7 ( > 10) screens for GAD. None are diagnostic — they are screening tools only.
3. DSM-V MDD: ≥ 5/9 symptoms for > 2 weeks, must include low mood and/or anhedonia, with functional impairment, not explained by substance/medical condition/other psychiatric disorder, no manic episodes.
4. DSM-V GAD: Excessive worry more days than not for ≥ 6 months, ≥ 3 associated symptoms, with functional impairment.
5. MUPS account for ~18.5% of primary care consultations. Ask about sleep first — it is the gateway to detecting underlying mood/anxiety disorders.
6. Always assess suicide risk in suspected depression. 45% of suicide completers saw a GP within 1 month of their act.
7. Males may present with irritability, anger, and somatic complaints rather than sadness. Elderly may mimic dementia. Perinatal patients may default care or have poor weight gain.
8. Emotional symptoms are common but do not always mean a diagnosable disorder. Many are short-lived stress responses.
Active Recall - Common Mental Health Problems in Primary Care
[1] Lecture slides: GC 017. Common mental health problems in primary care.pdf (all pages) [2] Senior notes: Ryan Ho Psychiatry.pdf (pp. 158, 204, 70) [3] Past papers: 2022 Fourth Summative MCQ.pdf (Q80) [4] Past papers: 2023 Fourth Summative MCQ.pdf (Q75) [5] Past papers: 2025 Fourth Summative MCQ.pdf (Q19) [6] Senior notes: Maksim Medicine Notes.pdf (p. 114 — DEMENTIA mnemonic for reversible causes) [7] Lecture slides: CFB (OG02) Puerperium and Related Problems.pdf [8] Lecture slides: General Clerkship-Psychiatric Assessment Skills Training-Learning Materials 2024_3 Sep.pdf (pp. 2, 28) [9] Lecture slides: GC 019. The Family in Family Medicine [Pre-Lecture Reading 1].pdf (p. 2) [10] Past papers: 2024 Fourth Summative MCQ.pdf (Q22-23) [11] Past papers: 2018 Fourth Summative SAQ.pdf (Q10)
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