- The Exam at a Glance
- Eligibility Checklist
- Fees, Deadlines, and the 2026 Window
- Test-Day Rules and Format
- Reading the Blueprint: Two Dimensions, Overlapping Ranges
- High-Yield Content Areas
- Clinical Pearls for Late-Life Psychiatry
- Scoring and Pass-Rate Facts
- After You Pass: Continuing Certification
- Scheduling Review Around the Blueprint
- Frequently Asked Questions
- The ABPN Geriatric Psychiatry exam has 220 one-best-answer questions in four sections of 55, with 230 minutes of answering time.
- Neurocognitive disorders is the largest Dimension 1 range at 13-17%; Treatment is the largest Dimension 2 range at 31-35%.
- The 2026 initial window is October 5-9, with the next listed initial administration in 2028.
- The initial exam fee is USD 1,900, plus USD 500 if you apply late.
The Exam at a Glance
This is the one-page review for the subspecialty certification examination in Geriatric Psychiatry offered by the American Board of Psychiatry and Neurology (ABPN). It is built for the final stretch: facts you should be able to recite without notes, and the blueprint logic that should drive how you spend your remaining study hours. For a longer planning framework, see our Geriatric Psychiatry study guide.
| Item | Must-Know Fact |
|---|---|
| Certifying body | American Board of Psychiatry and Neurology, Inc. (ABPN) |
| Type | Initial subspecialty certification in Geriatric Psychiatry |
| Delivery | Computer-delivered, proctored at Pearson VUE/Pearson test centers |
| Questions | 220 stand-alone, one-best-answer multiple-choice items |
| Structure | Four sections of 55 questions |
| Answering time | 230 minutes (3 hours 50 minutes) |
| Total session | 240 minutes, including 5 minutes for the NDA/tutorial and 5 minutes for the closing survey |
| Guessing penalty | None |
| Pretest items | If included, excluded from scoring |
Questions are stand-alone, so each item must be answerable on its own without a shared vignette. Expect clinical scenarios that require you to choose the single best diagnosis, next step, treatment, or management decision for an older adult.
Eligibility Checklist
Eligibility problems derail more applications than content gaps. Confirm each of the following well before the deadline. The full walk-through is in our Geriatric Psychiatry requirements guide.
- Medical degree: a qualifying medical degree.
- Licensure: active, full, unrestricted U.S. or Canadian medical licensure.
- Primary certification: ABPN general Psychiatry certification by December 31 of the preceding year.
- Fellowship: one year of ACGME-accredited Geriatric Psychiatry fellowship after completing general Psychiatry residency. General residency exposure does not replace fellowship.
- Deadline for requirements: licensing and training requirements must be met by July 31 of the exam year.
- Training format: a continuous block at no less than half time; exceptions need advance ABPN approval.
- International training: international fellowship training is not accepted under the published specialty policy.
- Time limit: initial certification must be achieved within seven years of the required training unless you complete ABPN's requalification requirements.
Fees, Deadlines, and the 2026 Window
| Item | Detail |
|---|---|
| Initial subspecialty exam fee | USD 1,900 (fee schedule posted January 5, 2026) |
| Late application surcharge | Additional USD 500 |
| 2026 initial exam window | October 5-9 |
| Regular application deadline | April 9 |
| Late application deadline | April 16 |
| Next listed initial administration | 2028 |
That last row matters strategically: the next listed initial administration after 2026 is 2028, so missing this cycle can mean a long wait. For the complete cost picture, including renewal fees, read our Geriatric Psychiatry certification cost breakdown, and for scheduling logistics see Geriatric Psychiatry exam dates, deadlines, and scheduling.
Test-Day Rules and Format
- Identification: bring two valid, signed IDs, including a government-issued photo ID.
- Arrival: arrive 30 minutes early.
- Prohibited items: personal books, papers, and electronic devices are not allowed in the testing room.
- Scratch work: an erasable whiteboard is supplied.
- Breaks: optional breaks consume examination time, so the clock keeps running.
- Navigation: you may flag questions for review or skip them and return later.
Reading the Blueprint: Two Dimensions, Overlapping Ranges
The ABPN content specifications list 32 domain headings, but they are not 32 independent, mutually exclusive topics. Domains 1-23 form Dimension 1 (Psychiatric Disorders and Topics) and Domains 24-32 form Dimension 2 (Physician Competencies and Mechanisms). Every question is classified in both dimensions, so a single item might count toward Neurocognitive disorders in Dimension 1 and Treatment in Dimension 2 at the same time.
Key Takeaway
Do not add percentages across dimensions, normalize them into one 100% pie, or convert ranges into fixed point weights. The published figures are ranges within each dimension, and the blueprint describes exam objectives rather than a preparation curriculum. No single exam tests every detailed outline topic.
For a heading-by-heading tour, see our complete guide to all 32 Geriatric Psychiatry content areas.
High-Yield Content Areas
Dimension 1: Psychiatric Disorders and Topics
| Domain | Published Range |
|---|---|
| Domain 20: Neurocognitive disorders | 13-17% |
| Domain 5: Depressive disorders | 8-12% |
| Domain 19: Other conditions that may be a focus of clinical attention | 8-12% |
| Domain 3: Substance-related and addictive disorders | 7-9% |
| Domain 7: Anxiety disorders | 7-9% |
| Domain 4: Schizophrenia spectrum and other psychotic disorders | 5-7% |
| Domain 6: Bipolar and related disorders | 5-7% |
| Domain 21: Neurologic disorders | 4-6% |
| Domain 23: Dimension 2 topics without a corresponding Dimension 1 topic | 4-6% |
Domain 20: Neurocognitive disorders (13-17%)
The single largest Dimension 1 range, and the heart of the subspecialty.
- Distinguish major from mild neurocognitive disorder and delirium from dementia.
- Know the clinical profiles of Alzheimer disease, vascular, Lewy body, and frontotemporal presentations.
- Link cognitive screening, laboratory workup, and neuroimaging to diagnostic decisions.
- Manage behavioral and psychological symptoms with attention to risks of medication choices.
Domain 5: Depressive disorders (8-12%)
Late-life depression carries features that differ from younger adults.
- Recognize presentations complicated by medical illness, cognitive symptoms, and bereavement.
- Know the role of psychotherapy, pharmacotherapy, and neuromodulation, including safety considerations in older patients.
- Differentiate depression from early neurocognitive disorder.
Domain 19: Other conditions that may be a focus of clinical attention (8-12%)
A large but easy-to-underestimate heading. Expect questions on situations that warrant clinical attention without being a primary psychiatric disorder, including caregiver, relational, and psychosocial circumstances common in late life. Review how these interact with diagnosis and care planning.
Dimension 2: Physician Competencies and Mechanisms
| Domain | Published Range |
|---|---|
| Domain 28: Treatment | 31-35% |
| Domain 26: Clinical aspects of psychiatric and neuropsychiatric disorders | 23-27% |
| Domain 27: Diagnostic procedures | 10-14% |
| Domain 32: Systems-based practice | 8-12% |
| Domain 24: Neuroscience and mechanisms of disease | 7-9% |
| Domain 25: Behavioral/social sciences and psychosocial mechanisms of diseases | 4-6% |
| Domain 30: Professionalism, ethics, and the law | 2-4% |
| Domain 29: Interpersonal and communication skills | 1-3% |
| Domain 31: Practice-based learning and improvement | 1-3% |
Domain 28: Treatment (31-35%)
The largest range on either dimension. Treat it as the organizing frame for all your drug review.
- Age-related pharmacokinetic and pharmacodynamic changes and their effect on dosing.
- Polypharmacy, drug-drug interactions, anticholinergic burden, and falls risk.
- Antidepressant, antipsychotic, mood stabilizer, cognitive-enhancer, hypnotic, and anxiolytic selection in older adults.
- Psychotherapy, neuromodulation, and nonpharmacologic approaches to behavioral symptoms.
Domain 32: Systems-based practice (8-12%)
More weight than many candidates expect. Review care settings and transitions, interdisciplinary teams, caregiver support, long-term care, and community resources. Systems-based practice is also why the question of who hires for this subspecialty matters, which we cover in our overview of Geriatric Psychiatry jobs.
Lower-Weight Headings Worth a Quick Pass
Several headings carry small ranges: Neurodevelopmental disorders (1-2%), Dissociative disorders (1-2%), Feeding and eating disorders (1-2%), Gender dysphoria (1-2%), Disruptive, impulse-control, and conduct disorders (1-2%), and Paraphilic disorders (1-2%). Others sit slightly higher, including Obsessive-compulsive and related disorders (1-3%), Somatic symptom and related disorders (1-3%), Sexual dysfunctions (1-3%), Personality disorders (1-3%), and Forensic psychiatry (1-3%). Trauma- and stressor-related disorders (3-5%), Developmental processes through the life cycle (3-5%), and Sleep-wake disorders (2-4%) round out the list. Give these a focused review of how they present in older adults rather than a deep dive.
Clinical Pearls for Late-Life Psychiatry
The exam rewards judgment about older patients, where multiple conditions and medications interact. Keep these themes at your fingertips:
- Delirium first: acute change in attention and cognition in an older adult demands a search for medical, medication, and environmental causes before a primary psychiatric label.
- Medications as culprits: anticholinergics, sedative-hypnotics, and other agents can produce or worsen confusion, falls, and functional decline.
- Start low, go slow: dosing strategy reflects altered metabolism, comorbidity, and sensitivity to adverse effects.
- Depression versus dementia: overlapping symptoms mean careful longitudinal assessment and attention to cognitive testing patterns.
- Capacity and consent: assessing decision-making capacity, surrogate decision-making, and elder protection issues fall under professionalism, ethics, and the law.
- Substance use is not just a young person's problem: alcohol, benzodiazepines, and opioids are important in the older population and carry a 7-9% Dimension 1 range.
- Safety and suicide risk: older adults, particularly with medical illness and isolation, require careful risk assessment.
Scoring and Pass-Rate Facts
- Standard: passing requires meeting ABPN's criterion-referenced standard on the total percent-correct score.
- No fixed cutoff asserted: no predetermined pass rate exists, and no guessing penalty applies, so answer every question.
- Latest published first-time initial-certification pass rate: 95% in 2024, or 95 of 100 candidates.
- 2021-2025 aggregate: 97% (206 of 212).
These are small cohorts, so interpret them cautiously and do not treat them as a guarantee. Read the Geriatric Psychiatry pass rate analysis and the passing score explainer for context, and see how hard the exam really is for a balanced view of difficulty.
After You Pass: Continuing Certification
Certificates issued from 2012 onward have no fixed expiration date, but they stay valid only through ongoing Continuing Certification (CC), which includes maintaining primary Psychiatry certification and required licensure.
| CC Element | Requirement |
|---|---|
| Block length | Standard three-year blocks |
| CME | 90 Category 1 CME credits |
| Self-assessment | 16 credits (part of, not on top of, the 90) |
| Improvement | One PIP activity for clinically active physicians, subject to applicable waivers |
| Patient safety | One-time activity if your first CC block began in 2017 or later |
| Assessment | Traditional ten-year CC exam or successful ABCC participation |
| ABCC from 2025 | 20 passed article exams per certification per three-year block; successful participation fulfills that block's self-assessment requirement |
| Annual fees | USD 175 for one certification, USD 240 for two, USD 310 for three or more |
To weigh these ongoing obligations against the rewards, see whether the certification is worth it. On compensation, note that Stanford's public Outpatient Geriatric Psychiatrists posting lists assistant-professor psychiatrist base pay of USD 238,000-250,000, excluding incentives. That is one employer's rank-specific range, not a national specialty average or a certification premium. Our salary guide puts figures like this in context.
Scheduling Review Around the Blueprint
This is the one place we recommend a structured plan, and it is driven by the blueprint rather than by generic habits. Because Treatment and Neurocognitive disorders carry the largest ranges, give them the most calendar time and revisit them twice.
Neurocognitive disorders and neurologic disorders
- Delirium versus dementia, subtype features, workup, and imaging.
- Neurologic conditions that overlap with psychiatric presentations.
Treatment, part one
- Geriatric psychopharmacology, interactions, anticholinergic burden, and dosing.
- Neuromodulation and psychotherapy options.
Depressive, anxiety, bipolar, psychotic, and substance-related disorders
- Late-life presentations and treatment selection.
- Sleep-wake disorders and trauma-related conditions.
Systems, ethics, and diagnostics
- Care settings, transitions, capacity, consent, and forensic basics.
- Diagnostic procedures and neuroscience of disease.
Mixed practice and weak spots
- Timed blocks of 55 questions to rehearse the four-section format.
- Rapid pass through the small-range headings.
When you are ready to test yourself under realistic conditions, try the full-length questions on our Geriatric Psychiatry practice test site, and return to the main practice question bank to drill the domains where you miss the most.
Frequently Asked Questions
The computer-delivered ABPN exam has 220 stand-alone, one-best-answer multiple-choice questions in four sections of 55. You have 230 minutes of answering time within a 240-minute session. Any research or pretest items are excluded from scoring.
Neurocognitive disorders is the largest Dimension 1 range at 13-17%, and Treatment is the largest Dimension 2 range at 31-35%. Because every question is classified in both dimensions, the ranges overlap and should not be added together or turned into fixed point weights.
The initial subspecialty exam fee is USD 1,900, with a USD 500 late-application surcharge. The 2026 initial window is October 5-9, with application deadlines of April 9 (regular) and April 16 (late). The next listed initial administration is 2028.
No. You need one year of ACGME-accredited Geriatric Psychiatry fellowship after completing general Psychiatry residency, plus ABPN general Psychiatry certification, full unrestricted licensure, and all requirements met by July 31 of the exam year. General residency exposure does not substitute, and international fellowship training is not accepted under the published policy.
No. Passing is based on a criterion-referenced standard applied to your total percent-correct score, and there is no guessing penalty, so you should answer every question. Flag uncertain items to revisit, but make sure nothing is left blank when time expires.
Use this cheat sheet as a final checklist, then confirm every date and fee against the official ABPN sources before you apply. For broader background on the credential itself, see our overview of Geriatric Psychiatry certification.