CMN 548 MODULE 1 STUDY GUIDE
WITH COMPLETE SOLUTIONS
GUIDE SADOCK Chapter 7.1 - 7.2, 7.6 - Correct Answers -Complete the following table
which outlines the elements of the initial psychiatric
interview:
Identifying data Topic - Correct Answers -Name, age, sex, marital status, religion,
education, address, phone number, occupation, source of referral
Identifying data Questions - Correct Answers -Be direct in obtaining identifying data.
Request specific answers.
Identifying data Comments and helpful hints - Correct Answers -If patient cannot
cooperate, get information from family member or friend; if referred by a physician,
obtain medical record.
Chief complaint (CC) topic - Correct Answers -Brief statement in patient's own words of
why patient is in the hospital or is being seen in consultation
Chief complaint (CC) questions - Correct Answers -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 - Correct Answers -Record answers
verbatim; a bizarré complaint points to psychotic process.
History of present illness (HPI): - Correct Answers -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 - Correct Answers -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 - Correct Answers -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: - Correct Answers -Psychiatric disorders;
psychosomatic; medical, neurologic illnesses (e.g., craniocerebral trauma, convulsions).
Previous psychiatric and medical disorders: QUESTIONS - Correct Answers -Did you
ever lose consciousness? Have a seizure?
Previous psychiatric and medical disorders: comments and helpful hints - Correct
Answers -Ascertain extent of illness, treatment, medications, outcomes, hospitals,
doctors. Determine whether illness serves some additional purpose (secondary gain).
substance use/abuse - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -Sleep phase problems (initial, middle,
terminal insomnia), total sleep time, abnormal sleep events
review of systems: mood depression - Correct Answers -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 - Correct Answers -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 - Correct Answers -Anxiety
Experience of panic attacks, somatic symptoms of anxiety, phobic, or social avoidance
review of systems: psychosis - Correct Answers -Experience of hallucinations,
delusions, disorganized behavior, speech or thought, negative symptoms
review of systems: obsessive-compulsive - Correct Answers -Repetitive intrusive and
unwanted thoughts, compulsive behaviors to neutralize anxiety, hoarding behaviors
review of systems: trauma - Correct Answers -Traumatic exposure; intrusive and
avoidance symptoms, negative alterations in cognitions and mood, excessive arousal
and reactivity
review of systems: behavior - Correct Answers -Substance use, gambling, impulse
control problems, disordered eating, repetitive self-harm
mental status exam - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 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 - Correct Answers -ch 14
WITH COMPLETE SOLUTIONS
GUIDE SADOCK Chapter 7.1 - 7.2, 7.6 - Correct Answers -Complete the following table
which outlines the elements of the initial psychiatric
interview:
Identifying data Topic - Correct Answers -Name, age, sex, marital status, religion,
education, address, phone number, occupation, source of referral
Identifying data Questions - Correct Answers -Be direct in obtaining identifying data.
Request specific answers.
Identifying data Comments and helpful hints - Correct Answers -If patient cannot
cooperate, get information from family member or friend; if referred by a physician,
obtain medical record.
Chief complaint (CC) topic - Correct Answers -Brief statement in patient's own words of
why patient is in the hospital or is being seen in consultation
Chief complaint (CC) questions - Correct Answers -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 - Correct Answers -Record answers
verbatim; a bizarré complaint points to psychotic process.
History of present illness (HPI): - Correct Answers -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 - Correct Answers -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 - Correct Answers -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: - Correct Answers -Psychiatric disorders;
psychosomatic; medical, neurologic illnesses (e.g., craniocerebral trauma, convulsions).
Previous psychiatric and medical disorders: QUESTIONS - Correct Answers -Did you
ever lose consciousness? Have a seizure?
Previous psychiatric and medical disorders: comments and helpful hints - Correct
Answers -Ascertain extent of illness, treatment, medications, outcomes, hospitals,
doctors. Determine whether illness serves some additional purpose (secondary gain).
substance use/abuse - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -Sleep phase problems (initial, middle,
terminal insomnia), total sleep time, abnormal sleep events
review of systems: mood depression - Correct Answers -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 - Correct Answers -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 - Correct Answers -Anxiety
Experience of panic attacks, somatic symptoms of anxiety, phobic, or social avoidance
review of systems: psychosis - Correct Answers -Experience of hallucinations,
delusions, disorganized behavior, speech or thought, negative symptoms
review of systems: obsessive-compulsive - Correct Answers -Repetitive intrusive and
unwanted thoughts, compulsive behaviors to neutralize anxiety, hoarding behaviors
review of systems: trauma - Correct Answers -Traumatic exposure; intrusive and
avoidance symptoms, negative alterations in cognitions and mood, excessive arousal
and reactivity
review of systems: behavior - Correct Answers -Substance use, gambling, impulse
control problems, disordered eating, repetitive self-harm
mental status exam - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 - Correct Answers -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 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 - Correct Answers -ch 14
