CMN 548 MODULE 1 STUDY GUIDE PRACTICE
QUESTIONS WITH VERIFIED ANSWERS
GUIDE SADOCK Chapter 7.1 - 7.2, 7.6
Complete the following table which outlines the elements of the initial psychiatric
interview:
Identifying data Topic
Name, age, sex, marital status, religion, education, address, phone number, occupation, source of
referral
Identifying data Questions
Be direct in obtaining identifying data. Request specific answers.
Identifying data Comments and helpful hints
If patient cannot cooperate, get information from family member or friend; if referred by a
physician, obtain medical record.
Chief complaint (CC) topic
Brief statement in patient's own words of why patient is in the hospital or is being seen in
consultation
Chief complaint (CC) questions
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
Record answers verbatim; a bizarré complaint points to psychotic process.
History of present illness (HPI):
Development 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
When 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
Record 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:
Psychiatric disorders; psychosomatic; medical, neurologic illnesses (e.g., craniocerebral trauma,
convulsions).
Previous psychiatric and medical disorders: QUESTIONS
Did you ever lose consciousness? Have a seizure?
Previous psychiatric and medical disorders: comments and helpful hints
Ascertain extent of illness, treatment, medications, outcomes, hospitals, doctors. Determine
whether illness serves some additional purpose (secondary gain).
substance use/abuse
Substance 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
The 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
Psychiatric, 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
Have 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
Genetic 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
The 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
As 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
Sleep phase problems (initial, middle, terminal insomnia), total sleep time, abnormal sleep events
review of systems: mood depression
Depression: 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
Hypomania/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
Anxiety
Experience of panic attacks, somatic symptoms of anxiety, phobic, or social avoidance
review of systems: psychosis
Experience of hallucinations, delusions, disorganized behavior, speech or thought, negative
symptoms
review of systems: obsessive-compulsive
Repetitive intrusive and unwanted thoughts, compulsive behaviors to neutralize anxiety,
hoarding behaviors
review of systems: trauma
, Traumatic exposure; intrusive and avoidance symptoms, negative alterations in cognitions and
mood, excessive arousal and reactivity
review of systems: behavior
Substance use, gambling, impulse control problems, disordered eating, repetitive self-harm
mental status exam
The 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
Psychiatrists 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
The 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
When 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
QUESTIONS WITH VERIFIED ANSWERS
GUIDE SADOCK Chapter 7.1 - 7.2, 7.6
Complete the following table which outlines the elements of the initial psychiatric
interview:
Identifying data Topic
Name, age, sex, marital status, religion, education, address, phone number, occupation, source of
referral
Identifying data Questions
Be direct in obtaining identifying data. Request specific answers.
Identifying data Comments and helpful hints
If patient cannot cooperate, get information from family member or friend; if referred by a
physician, obtain medical record.
Chief complaint (CC) topic
Brief statement in patient's own words of why patient is in the hospital or is being seen in
consultation
Chief complaint (CC) questions
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
Record answers verbatim; a bizarré complaint points to psychotic process.
History of present illness (HPI):
Development 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
When 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
Record 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:
Psychiatric disorders; psychosomatic; medical, neurologic illnesses (e.g., craniocerebral trauma,
convulsions).
Previous psychiatric and medical disorders: QUESTIONS
Did you ever lose consciousness? Have a seizure?
Previous psychiatric and medical disorders: comments and helpful hints
Ascertain extent of illness, treatment, medications, outcomes, hospitals, doctors. Determine
whether illness serves some additional purpose (secondary gain).
substance use/abuse
Substance 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
The 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
Psychiatric, 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
Have 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
Genetic 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
The 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
As 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
Sleep phase problems (initial, middle, terminal insomnia), total sleep time, abnormal sleep events
review of systems: mood depression
Depression: 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
Hypomania/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
Anxiety
Experience of panic attacks, somatic symptoms of anxiety, phobic, or social avoidance
review of systems: psychosis
Experience of hallucinations, delusions, disorganized behavior, speech or thought, negative
symptoms
review of systems: obsessive-compulsive
Repetitive intrusive and unwanted thoughts, compulsive behaviors to neutralize anxiety,
hoarding behaviors
review of systems: trauma
, Traumatic exposure; intrusive and avoidance symptoms, negative alterations in cognitions and
mood, excessive arousal and reactivity
review of systems: behavior
Substance use, gambling, impulse control problems, disordered eating, repetitive self-harm
mental status exam
The 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
Psychiatrists 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
The 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
When 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
