CMN 548 Module 1 study guide
GUIDE SADOCK Chapter 7.1 - 7.2, 7.6 - answer Complete the following table which
outlines the elements of the initial psychiatric
interview:
Identifying data Topic - answer Name, age, sex, marital status, religion, education,
address, phone number, occupation, source of referral
Identifying data Questions - answer Be direct in obtaining identifying data. Request
specific answers.
Identifying data Comments and helpful hints - answer If patient cannot cooperate, get
information from family member or friend; if referred by a physician, obtain medical
record.
Chief complaint (CC) topic - answer Brief statement in patient's own words of why
patient is in the hospital or is being seen in consultation
Chief complaint (CC) questions - answer Why are you going to see a psychiatrist? What
brought you to the hospital? What seems to be the problem?
Chief complaint (CC) comments and helpful hints - answerRecord answers verbatim; a
bizarré complaint points to psychotic process.
History of present illness (HPI): - answerDevelopment of symptoms from time of onset
to present; relation of life events, conflicts, stressors: drugs; change from previous level
of functioning
History of present illness (HPI): questions - answerWhen did you first notice something
happening to you? Were you upset about anything when symptoms began? Did they
begin suddenly or gradually?
History of present illness (HPI): comments and helpful hints - answerRecord in patient's
own words as much as possible. Get history of previous hospitalizations and treatment.
Sudden onset of symptoms may indicate drug-induced disorder.
Previous psychiatric and medical disorders: - answerPsychiatric disorders;
psychosomatic; medical, neurologic illnesses (e.g., craniocerebral trauma, convulsions).
Previous psychiatric and medical disorders: QUESTIONS - answerDid you ever lose
consciousness? Have a seizure?
,Previous psychiatric and medical disorders: comments and helpful hints -
answerAscertain extent of illness, treatment, medications, outcomes, hospitals, doctors.
Determine whether illness serves some additional purpose (secondary gain).
substance use/abuse - answerSubstance use disorders can mimic or induce psychiatric
syndromes, elevate risk of suicide and violence, and have important impact on safe
medication prescribing.
Various tools can be used to aid in gathering the substance use history. Examples
include the commonly used CAGE questionnaire which has been modified to include
other drugs (and now called CAGE-AID)
Past medical history - answerThe interviewer is interested in obtaining an accounting of
major medical disorders both to develop a complete history and to identify illness that
could mimic a psychiatric disorder, contribute to the context of the presentation or factor
into treatment planning.
Family History (FH): topic - answerPsychiatric, medical, and genetic illness in mother,
father, siblings; age of parents and occupations; if deceased, date and cause; feelings
about each family member, finances .
Because many psychiatric illnesses have a genetic predisposition, if not cause, a
careful review of family history is important to the assessment and can aid in diagnosis
and establishing expected prognosis .
Family History (FH): question - answerHave any members in your family been
depressed? Alcoholic? In a mental hospital? In jail? Describe your living conditions. Did
you have your own room?
Family History (FH): comments and helpful hints - answerGenetic loading in anxiety,
depression, schizophrenia. Get medication history of family (medications effective in
family members for similar disorders may be effective in patient).
developmental and social history - answerThe developmental and social history reviews
the stages of the patient's life from gestation to the present with an eye toward
understanding the important exposures, relationships, and events that shaped the
person's life story.
It is often helpful to review the social history chronologically; doing so provides a natural
flow to the questions and ensures a complete history.
Review of systems - answerAs in a general medical interview, the review of systems is
intended to capture any current physical signs and symptoms not already identified in
the HPI or past medical history (including Table 7.1-2 and is organized by asking
sentinel questions about the major systems of the body).
,review of systems: sleep - answerSleep phase problems (initial, middle, terminal
insomnia), total sleep time, abnormal sleep events
review of systems: mood depression - answerDepression: persistent sadness, reduced
interest or pleasure in usual activities, tearfulness, reduced or excessive sleep, reduced
or increased appetite, weight loss or gain, low energy, reduced concentration, low libido,
excessive or inappropriate guilt, psychomotor change (slowing or agitation), negative
self-appraisal, helpless and hopeless thinking thoughts of death or suicide. A common
mnemonic used to remember the symptoms of major depression is SIGECAPS (Sleep,
Interest, Guilt, Energy, Concentration, Appetite, Psychomotor agitation or slowing,
Suicidality).
review of systems: mood Hypomania/mania - answerHypomania/Mania: elevated,
expansive or irritable mood, decreased need for or inability to sleep, excessive energy,
marked increase in goal and pleasure directed activity, increase amount and pace of
speech and thought, grandiosity, heightened libido, impulsivity and/or recklessness in
behaviors such as spending and sex
review of systems: anxiety - answerAnxiety
Experience of panic attacks, somatic symptoms of anxiety, phobic, or social avoidance
review of systems: psychosis - answerExperience of hallucinations, delusions,
disorganized behavior, speech or thought, negative symptoms
review of systems: obsessive-compulsive - answerRepetitive intrusive and unwanted
thoughts, compulsive behaviors to neutralize anxiety, hoarding behaviors
review of systems: trauma - answerTraumatic exposure; intrusive and avoidance
symptoms, negative alterations in cognitions and mood, excessive arousal and
reactivity
review of systems: behavior - answerSubstance use, gambling, impulse control
problems, disordered eating, repetitive self-harm
mental status exam - answerThe MSE is the functional equivalent of the physical
examination in other areas of medicine.
It is a systematic collection of the observations (e.g., signs such as blunt affect or rapid
speech) and reported mental experiences (e.g., symptoms such as depressed mood or
hallucinations) that produce a picture of the patient's current mental state. The
interviewer makes these observations throughout an encounter and ultimately
documents the findings together in the MSE section of the evaluation document.
physical exam - answerPsychiatrists do not usually personally conduct comprehensive
physical examinations but may conduct focused examinations such as neurological or
thyroid examinations. In the outpatient setting, the psychiatrist generally relies on the
, PCP to conduct the physical examination and it is useful in the initial evaluation to
record the date of the most recent physical examination and review of recent
laboratories if results are available.
plan formulation - answerThe formulation should include a brief summary of the relevant
findings from the history and examination including the psychosocial contexts in which
the problem has developed and comments on the relevant contributions to the
presentation of personality function, medical problems, social stress, and other social
and cultural factors.
Finally, the formulation should include a summary of the risk assessment with estimates
of acute and long-term risk of suicidal or violent behavior and opinion about the
appropriate level of care that will lead to a safe and successful outcome.
treatment plan - answerWhen evaluation produces treatment recommendations, these
are typically shared with the patient at the conclusion of the encounter in a manner
consistent with the patient's capacity to receive and process the information and with
explicit discussion of matters relevant to informed consent for recommended treatment.
Treatment discussions typically involve a good deal of psychoeducation about
diagnosis, the nature, risks, and benefits of recommended treatments and information
that addresses stigma and adherence.
It is wise to involve significant others in these conversations especially if there are
concerns that the patient may need assistance in processing information and making
decisions to ensure that decisions are consistent with the patient's best interest.
Recommendations may include referral to other professionals or peer supports such as
the National Alliance for Mental Illness (NAMI), the Mental Health Association (MHA), or
Alcoholics Anonymous (AA). Plans for crisis contacts and supports are typically
addressed. All of these counseling and coordination of care efforts should be
documented in the medical record.
Carlat, Chapter 14 - answerch 14
1. How is the history of present illness different from the past psychiatric history? -
answer
Why is it important to have an understanding of the history of present illness if I'm going
to obtain the psychiatric history anyway? - answer
What time period should be covered in the history of present illness? - answerOften,
psychiatric crises occur over a 1- to 4-week period.
GUIDE SADOCK Chapter 7.1 - 7.2, 7.6 - answer Complete the following table which
outlines the elements of the initial psychiatric
interview:
Identifying data Topic - answer Name, age, sex, marital status, religion, education,
address, phone number, occupation, source of referral
Identifying data Questions - answer Be direct in obtaining identifying data. Request
specific answers.
Identifying data Comments and helpful hints - answer If patient cannot cooperate, get
information from family member or friend; if referred by a physician, obtain medical
record.
Chief complaint (CC) topic - answer Brief statement in patient's own words of why
patient is in the hospital or is being seen in consultation
Chief complaint (CC) questions - answer Why are you going to see a psychiatrist? What
brought you to the hospital? What seems to be the problem?
Chief complaint (CC) comments and helpful hints - answerRecord answers verbatim; a
bizarré complaint points to psychotic process.
History of present illness (HPI): - answerDevelopment of symptoms from time of onset
to present; relation of life events, conflicts, stressors: drugs; change from previous level
of functioning
History of present illness (HPI): questions - answerWhen did you first notice something
happening to you? Were you upset about anything when symptoms began? Did they
begin suddenly or gradually?
History of present illness (HPI): comments and helpful hints - answerRecord in patient's
own words as much as possible. Get history of previous hospitalizations and treatment.
Sudden onset of symptoms may indicate drug-induced disorder.
Previous psychiatric and medical disorders: - answerPsychiatric disorders;
psychosomatic; medical, neurologic illnesses (e.g., craniocerebral trauma, convulsions).
Previous psychiatric and medical disorders: QUESTIONS - answerDid you ever lose
consciousness? Have a seizure?
,Previous psychiatric and medical disorders: comments and helpful hints -
answerAscertain extent of illness, treatment, medications, outcomes, hospitals, doctors.
Determine whether illness serves some additional purpose (secondary gain).
substance use/abuse - answerSubstance use disorders can mimic or induce psychiatric
syndromes, elevate risk of suicide and violence, and have important impact on safe
medication prescribing.
Various tools can be used to aid in gathering the substance use history. Examples
include the commonly used CAGE questionnaire which has been modified to include
other drugs (and now called CAGE-AID)
Past medical history - answerThe interviewer is interested in obtaining an accounting of
major medical disorders both to develop a complete history and to identify illness that
could mimic a psychiatric disorder, contribute to the context of the presentation or factor
into treatment planning.
Family History (FH): topic - answerPsychiatric, medical, and genetic illness in mother,
father, siblings; age of parents and occupations; if deceased, date and cause; feelings
about each family member, finances .
Because many psychiatric illnesses have a genetic predisposition, if not cause, a
careful review of family history is important to the assessment and can aid in diagnosis
and establishing expected prognosis .
Family History (FH): question - answerHave any members in your family been
depressed? Alcoholic? In a mental hospital? In jail? Describe your living conditions. Did
you have your own room?
Family History (FH): comments and helpful hints - answerGenetic loading in anxiety,
depression, schizophrenia. Get medication history of family (medications effective in
family members for similar disorders may be effective in patient).
developmental and social history - answerThe developmental and social history reviews
the stages of the patient's life from gestation to the present with an eye toward
understanding the important exposures, relationships, and events that shaped the
person's life story.
It is often helpful to review the social history chronologically; doing so provides a natural
flow to the questions and ensures a complete history.
Review of systems - answerAs in a general medical interview, the review of systems is
intended to capture any current physical signs and symptoms not already identified in
the HPI or past medical history (including Table 7.1-2 and is organized by asking
sentinel questions about the major systems of the body).
,review of systems: sleep - answerSleep phase problems (initial, middle, terminal
insomnia), total sleep time, abnormal sleep events
review of systems: mood depression - answerDepression: persistent sadness, reduced
interest or pleasure in usual activities, tearfulness, reduced or excessive sleep, reduced
or increased appetite, weight loss or gain, low energy, reduced concentration, low libido,
excessive or inappropriate guilt, psychomotor change (slowing or agitation), negative
self-appraisal, helpless and hopeless thinking thoughts of death or suicide. A common
mnemonic used to remember the symptoms of major depression is SIGECAPS (Sleep,
Interest, Guilt, Energy, Concentration, Appetite, Psychomotor agitation or slowing,
Suicidality).
review of systems: mood Hypomania/mania - answerHypomania/Mania: elevated,
expansive or irritable mood, decreased need for or inability to sleep, excessive energy,
marked increase in goal and pleasure directed activity, increase amount and pace of
speech and thought, grandiosity, heightened libido, impulsivity and/or recklessness in
behaviors such as spending and sex
review of systems: anxiety - answerAnxiety
Experience of panic attacks, somatic symptoms of anxiety, phobic, or social avoidance
review of systems: psychosis - answerExperience of hallucinations, delusions,
disorganized behavior, speech or thought, negative symptoms
review of systems: obsessive-compulsive - answerRepetitive intrusive and unwanted
thoughts, compulsive behaviors to neutralize anxiety, hoarding behaviors
review of systems: trauma - answerTraumatic exposure; intrusive and avoidance
symptoms, negative alterations in cognitions and mood, excessive arousal and
reactivity
review of systems: behavior - answerSubstance use, gambling, impulse control
problems, disordered eating, repetitive self-harm
mental status exam - answerThe MSE is the functional equivalent of the physical
examination in other areas of medicine.
It is a systematic collection of the observations (e.g., signs such as blunt affect or rapid
speech) and reported mental experiences (e.g., symptoms such as depressed mood or
hallucinations) that produce a picture of the patient's current mental state. The
interviewer makes these observations throughout an encounter and ultimately
documents the findings together in the MSE section of the evaluation document.
physical exam - answerPsychiatrists do not usually personally conduct comprehensive
physical examinations but may conduct focused examinations such as neurological or
thyroid examinations. In the outpatient setting, the psychiatrist generally relies on the
, PCP to conduct the physical examination and it is useful in the initial evaluation to
record the date of the most recent physical examination and review of recent
laboratories if results are available.
plan formulation - answerThe formulation should include a brief summary of the relevant
findings from the history and examination including the psychosocial contexts in which
the problem has developed and comments on the relevant contributions to the
presentation of personality function, medical problems, social stress, and other social
and cultural factors.
Finally, the formulation should include a summary of the risk assessment with estimates
of acute and long-term risk of suicidal or violent behavior and opinion about the
appropriate level of care that will lead to a safe and successful outcome.
treatment plan - answerWhen evaluation produces treatment recommendations, these
are typically shared with the patient at the conclusion of the encounter in a manner
consistent with the patient's capacity to receive and process the information and with
explicit discussion of matters relevant to informed consent for recommended treatment.
Treatment discussions typically involve a good deal of psychoeducation about
diagnosis, the nature, risks, and benefits of recommended treatments and information
that addresses stigma and adherence.
It is wise to involve significant others in these conversations especially if there are
concerns that the patient may need assistance in processing information and making
decisions to ensure that decisions are consistent with the patient's best interest.
Recommendations may include referral to other professionals or peer supports such as
the National Alliance for Mental Illness (NAMI), the Mental Health Association (MHA), or
Alcoholics Anonymous (AA). Plans for crisis contacts and supports are typically
addressed. All of these counseling and coordination of care efforts should be
documented in the medical record.
Carlat, Chapter 14 - answerch 14
1. How is the history of present illness different from the past psychiatric history? -
answer
Why is it important to have an understanding of the history of present illness if I'm going
to obtain the psychiatric history anyway? - answer
What time period should be covered in the history of present illness? - answerOften,
psychiatric crises occur over a 1- to 4-week period.
