NR 547/ NR547 (NEW 2025/
2026 UPDATE) DIFFERENTIAL
DIAGNOSIS IN PSYCHIATRIC-
MENTAL HEALTH GUIDE|
QUESTIONS & ANSWERS|
GRADE A| 100%
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
,Differential Diagnosis
1. The provider's initial hypothesis
o A working list of potential problems associated with the initial or chief
complaint.
o Uses the Diagnostic and Statistical Manual of Mental Disorders (DSM-
5-TR) for identifying psychiatric diagnoses.
Psychiatric Assessment: History Taking
2. History of Present Illness
o How long have you been feeling this way?
o Did something happen in your life that may have triggered these
emotions?
o How is this current situation impacting your life?
3. The Psychiatric History
o Have you ever been hospitalized for any mental health issues?
o Have you ever had counseling or psychotherapy?
o Have you ever taken medications for your mental health in the past?
o Are you currently on any medications for mental health or sleep?
4. Medical History/Screening for General Medical Conditions
o Do you have a primary care provider?
o Do you have any medical illnesses?
o Are you currently taking any medications or herbal supplements?
o Do you have any allergies to medications?
o Have you ever been hospitalized for any reason?
o Have you ever had surgery?
5. Family Psychiatric History
o Has any relative of yours ever been hospitalized for a mental health issue?
o Has any blood relative of yours ever been diagnosed with a mental health
issue?
, o Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
6. Social and Developmental History
o Tell me a little bit about your childhood and how you grew up.
o How was your experience in school when you were younger? Did you
enjoy school?
o How do you support yourself with your finances?
o Do you have a good support system? Are you currently in a relationship?
Where do you live? Who do you live with?
o What do you do in your free time? What activities do you enjoy?
Screening and Psychiatric Rating Scales
7. Evidence-based screening tools and psychiatric rating scales help identify
symptoms, assess severity, and evaluate treatment response.
Case Scenario: Suicide Risk Assessment
8. A 52-year-old client presents to the emergency department following a car
accident.
o The client describes persistent feelings of sadness and hopelessness.
o She has thoughts of self-harm but denies current suicidal intent.
o Based on the client's ASQ score, what is the most appropriate
response?
▪ Provide a brief suicide safety assessment.
Diagnostic Testing for Mental Health Disorders
9. Used to rule out physical conditions causing psychiatric symptoms and evaluate
treatment effects.
Basic Laboratory Interpretation
10. Complete Blood Count (CBC)
o Measures RBCs, WBCs, hemoglobin, hematocrit, and platelets.
o Used to rule out anemia or infection as causes of psychiatric symptoms.
11. Comprehensive Metabolic Panel (CMP)
, o Assesses fluid/electrolyte balance, metabolism, liver, and kidney
function.
o Monitors medication effects (e.g., antipsychotics on glucose/liver
function).
12. Thyroid Function Tests (TFTs)
o Rules out thyroid disorders as a cause of anxiety, depression, or cognitive
issues.
13. Vitamin B12 Level
o Deficiency can cause depression, mania, psychosis, or cognitive
impairment.
14. Vitamin D Level
o Low levels linked to depression, irritability, and cognitive impairment.
15. Toxicology Screen
o Rules out substance use as a cause of symptoms.
16. Urinalysis (UA)
o Rules out UTIs causing neuropsychiatric symptoms (e.g., confusion).
Treat or Refer Scenarios
17. Toni (TSH 6.3 mIU/L) → Refer (hypothyroidism).
18. Leo (normal hemoglobin/hematocrit) → Begin treatment (fatigue not due to
anemia).
19. Terri (positive urine leukocyte esterase) → Refer (UTI causing confusion).
20. Julio (Vitamin D 11 ng/mL) → Refer (depression linked to deficiency).
21. Beth (T3 260 ng/dL) → Refer (hyperthyroidism causing anxiety).
22. Fred (normal B12, psychosis) → Begin treatment (psychosis not due to
deficiency).
23. Ted (elevated creatinine/BUN) → Refer (kidney dysfunction causing confusion).
Symptom-Directed Treatment
24. Psychiatric medications are prescribed based on symptoms rather than
diagnoses.
Social Determinants of Health (SDOH)
2026 UPDATE) DIFFERENTIAL
DIAGNOSIS IN PSYCHIATRIC-
MENTAL HEALTH GUIDE|
QUESTIONS & ANSWERS|
GRADE A| 100%
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
,Differential Diagnosis
1. The provider's initial hypothesis
o A working list of potential problems associated with the initial or chief
complaint.
o Uses the Diagnostic and Statistical Manual of Mental Disorders (DSM-
5-TR) for identifying psychiatric diagnoses.
Psychiatric Assessment: History Taking
2. History of Present Illness
o How long have you been feeling this way?
o Did something happen in your life that may have triggered these
emotions?
o How is this current situation impacting your life?
3. The Psychiatric History
o Have you ever been hospitalized for any mental health issues?
o Have you ever had counseling or psychotherapy?
o Have you ever taken medications for your mental health in the past?
o Are you currently on any medications for mental health or sleep?
4. Medical History/Screening for General Medical Conditions
o Do you have a primary care provider?
o Do you have any medical illnesses?
o Are you currently taking any medications or herbal supplements?
o Do you have any allergies to medications?
o Have you ever been hospitalized for any reason?
o Have you ever had surgery?
5. Family Psychiatric History
o Has any relative of yours ever been hospitalized for a mental health issue?
o Has any blood relative of yours ever been diagnosed with a mental health
issue?
, o Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
6. Social and Developmental History
o Tell me a little bit about your childhood and how you grew up.
o How was your experience in school when you were younger? Did you
enjoy school?
o How do you support yourself with your finances?
o Do you have a good support system? Are you currently in a relationship?
Where do you live? Who do you live with?
o What do you do in your free time? What activities do you enjoy?
Screening and Psychiatric Rating Scales
7. Evidence-based screening tools and psychiatric rating scales help identify
symptoms, assess severity, and evaluate treatment response.
Case Scenario: Suicide Risk Assessment
8. A 52-year-old client presents to the emergency department following a car
accident.
o The client describes persistent feelings of sadness and hopelessness.
o She has thoughts of self-harm but denies current suicidal intent.
o Based on the client's ASQ score, what is the most appropriate
response?
▪ Provide a brief suicide safety assessment.
Diagnostic Testing for Mental Health Disorders
9. Used to rule out physical conditions causing psychiatric symptoms and evaluate
treatment effects.
Basic Laboratory Interpretation
10. Complete Blood Count (CBC)
o Measures RBCs, WBCs, hemoglobin, hematocrit, and platelets.
o Used to rule out anemia or infection as causes of psychiatric symptoms.
11. Comprehensive Metabolic Panel (CMP)
, o Assesses fluid/electrolyte balance, metabolism, liver, and kidney
function.
o Monitors medication effects (e.g., antipsychotics on glucose/liver
function).
12. Thyroid Function Tests (TFTs)
o Rules out thyroid disorders as a cause of anxiety, depression, or cognitive
issues.
13. Vitamin B12 Level
o Deficiency can cause depression, mania, psychosis, or cognitive
impairment.
14. Vitamin D Level
o Low levels linked to depression, irritability, and cognitive impairment.
15. Toxicology Screen
o Rules out substance use as a cause of symptoms.
16. Urinalysis (UA)
o Rules out UTIs causing neuropsychiatric symptoms (e.g., confusion).
Treat or Refer Scenarios
17. Toni (TSH 6.3 mIU/L) → Refer (hypothyroidism).
18. Leo (normal hemoglobin/hematocrit) → Begin treatment (fatigue not due to
anemia).
19. Terri (positive urine leukocyte esterase) → Refer (UTI causing confusion).
20. Julio (Vitamin D 11 ng/mL) → Refer (depression linked to deficiency).
21. Beth (T3 260 ng/dL) → Refer (hyperthyroidism causing anxiety).
22. Fred (normal B12, psychosis) → Begin treatment (psychosis not due to
deficiency).
23. Ted (elevated creatinine/BUN) → Refer (kidney dysfunction causing confusion).
Symptom-Directed Treatment
24. Psychiatric medications are prescribed based on symptoms rather than
diagnoses.
Social Determinants of Health (SDOH)
