differential diagnosis –
Correct Answers - The provider's initial hypothesis
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
Psychiatric assessment: History taking - Correct Answers –
-History of Present Illness
-How long have you been feeling this way?
-Did something happen in your life that may have triggered these emotions?
-How is this current situation impacting your life?
The Psychiatric History
-Have you ever been hospitalized for any mental health issues?
-Have you ever had counseling or psychotherapy?
-Have you ever taken medications for your mental health in the past?
-Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions
-Do you have a primary care provider?
-Do you have any medical illnesses?
-Are you currently taking any medications or herbal supplements?
-Do you have any allergies to medications?
-Have you ever been hospitalized for any reason?
,-Have you ever had surgery?
Family Psychiatric History
-Has any relative of yours ever been hospitalized for a mental health issue?
-Has any blood relative of yours ever been diagnosed with a mental health issue?
-Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
Social and Developmental History
-Tell me a little bit about your childhood and how you grew up.
-How was your experience in school when you were younger? Did you enjoy school?
-How do you support yourself with your finances?
-Do you have a good support system? Are you currently in a relationship? Where do you live? Who do
you live with?
-What do you do in your free time? What activities do you enjoy?
Screening and Psychiatric Rating Scales - Correct Answers - Evidence-based screening tools and
psychiatric rating scales
-can help the provider identify symptoms and assess their severity and can assist with the evaluation of
response to treatment
A 52-year-old client presents to the emergency department following a car accident. The emergency
department (ED) physician is concerned that the client may have intentionally crashed her car and
requests a stat PMHNP consult. In speaking with the PMHNP, the client describes persistent feelings of
sadness and hopelessness. She states that she often wonders if her husband would be happier if she
wasn't around anymore since she's never happy and sometimes thinks about what it would be like to
just take a handful of sleeping pills and go to sleep forever. The client reports a previous suicide attempt
when she was 16 but denies that she is considering killing herself right now.
Based on the client's ASQ score, what is the most appropriate response?
No action is necessary as the client is not currently considering suicide.
Provide a brief suicide safety assessment.
Alert the client's primary care physician.
Provide a ST - Correct Answers - Provide a brief suicide safety assessment.
,Rationale: While the client's responses do not indicate a need for a stat full safety and mental health
evaluation, the client requires a brief suicide safety assessment to determine whether a full mental
health evaluation in necessary. It is also important to notify the client's physician or the clinician
responsible for the client's care.
Diagnostic Testing when diagnosing mental health disorders - Correct Answers - -Diagnostic tests and
labs are most used to rule out physical conditions that may cause psychiatric symptoms and to evaluate
the effects of treatment
Basic Laboratory Interpretation - Correct Answers - Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
Basic Laboratory Interpretation: Complete Blood Count - Correct Answers - -measures RBCs, WBCs,
hemoglobin, hematocrit, and platelets
-includes a differential of the WBCs
-In mental health, the CBC is used to rule out medical conditions that may present with symptoms that
can be attributed to both medical and psychiatric diagnoses
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
, Monocytes: b3%-8%
Platelets: b 150,000-300,000/microliter
Basic bLaboratory bInterpretation: bComprehensive bMetabolic bPanel b(CMP) b- bCorrect bAnswers b- bcommon
bblood btest bused bto bdetermine bgeneral bhealth bstatus
-fluid band belectrolyte bbalance, bstatus bof bthe bbody's bmetabolism, bliver bfunction, band bkidney bfunction
-used bto bmonitor bthe beffects bof bmedications, bsuch bas bantipsychotics, bon bliver bfunction band bglucose blevels
-rule bout bmedical bconditions bthat bcould bcause bsymptoms
• Ex: bchanges bin bmood bor bcognition
Sodium b(Na+): b136-145 bmEq/L
Postassium b(K+): b3.5-5.0 bmEq/L
b
Chloride b(Cl-): b95-105 bmEq/L
b
Bicarbonate b(HCO3-): b22-28 bmEq/L
b
Calcium, bserum b(Ca b2+) b8.4-10.2
b
mg/dl
b
Glucose, bserum bFasting: b70-110 bmg/dl; b2-h bpostprandial: b<120mg/dl
Cholesterol, bserum: bREC<200 bmg/dl
b
Total bProtein b6.0-7.8 bg/dl
Albumin b3.5-5.5 bg/dl
b
-Kidney bTests
• Creatinine, bserum b0.6-1.2mg/dl
• Urea bnitrogen, bserum b(BUN) b7-18mg/dl
-Liver bTests
• Alanine baminotransferase b(ALT), bserum: b8-20 bU/L
• Aspartate baminotransferase b(AST), bserum: b8-20 bU/L
• Bilirubin, bserum b(adult) bTotal//Direct: b0.1-1.0 bmg/dl b// b0.0-0.3 bmg/dl
• Phosphatase b(alkaline), bserum: b20-70 bU/L
Basic bLaboratory bInterpretation: bThyroid bFunction bTests b(TFTs) b- bCorrect bAnswers b- bused bto brule bout
bthyroid bdisorders bas ba bcause bfor bsymptoms
Correct Answers - The provider's initial hypothesis
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
Psychiatric assessment: History taking - Correct Answers –
-History of Present Illness
-How long have you been feeling this way?
-Did something happen in your life that may have triggered these emotions?
-How is this current situation impacting your life?
The Psychiatric History
-Have you ever been hospitalized for any mental health issues?
-Have you ever had counseling or psychotherapy?
-Have you ever taken medications for your mental health in the past?
-Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions
-Do you have a primary care provider?
-Do you have any medical illnesses?
-Are you currently taking any medications or herbal supplements?
-Do you have any allergies to medications?
-Have you ever been hospitalized for any reason?
,-Have you ever had surgery?
Family Psychiatric History
-Has any relative of yours ever been hospitalized for a mental health issue?
-Has any blood relative of yours ever been diagnosed with a mental health issue?
-Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
Social and Developmental History
-Tell me a little bit about your childhood and how you grew up.
-How was your experience in school when you were younger? Did you enjoy school?
-How do you support yourself with your finances?
-Do you have a good support system? Are you currently in a relationship? Where do you live? Who do
you live with?
-What do you do in your free time? What activities do you enjoy?
Screening and Psychiatric Rating Scales - Correct Answers - Evidence-based screening tools and
psychiatric rating scales
-can help the provider identify symptoms and assess their severity and can assist with the evaluation of
response to treatment
A 52-year-old client presents to the emergency department following a car accident. The emergency
department (ED) physician is concerned that the client may have intentionally crashed her car and
requests a stat PMHNP consult. In speaking with the PMHNP, the client describes persistent feelings of
sadness and hopelessness. She states that she often wonders if her husband would be happier if she
wasn't around anymore since she's never happy and sometimes thinks about what it would be like to
just take a handful of sleeping pills and go to sleep forever. The client reports a previous suicide attempt
when she was 16 but denies that she is considering killing herself right now.
Based on the client's ASQ score, what is the most appropriate response?
No action is necessary as the client is not currently considering suicide.
Provide a brief suicide safety assessment.
Alert the client's primary care physician.
Provide a ST - Correct Answers - Provide a brief suicide safety assessment.
,Rationale: While the client's responses do not indicate a need for a stat full safety and mental health
evaluation, the client requires a brief suicide safety assessment to determine whether a full mental
health evaluation in necessary. It is also important to notify the client's physician or the clinician
responsible for the client's care.
Diagnostic Testing when diagnosing mental health disorders - Correct Answers - -Diagnostic tests and
labs are most used to rule out physical conditions that may cause psychiatric symptoms and to evaluate
the effects of treatment
Basic Laboratory Interpretation - Correct Answers - Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
Basic Laboratory Interpretation: Complete Blood Count - Correct Answers - -measures RBCs, WBCs,
hemoglobin, hematocrit, and platelets
-includes a differential of the WBCs
-In mental health, the CBC is used to rule out medical conditions that may present with symptoms that
can be attributed to both medical and psychiatric diagnoses
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
, Monocytes: b3%-8%
Platelets: b 150,000-300,000/microliter
Basic bLaboratory bInterpretation: bComprehensive bMetabolic bPanel b(CMP) b- bCorrect bAnswers b- bcommon
bblood btest bused bto bdetermine bgeneral bhealth bstatus
-fluid band belectrolyte bbalance, bstatus bof bthe bbody's bmetabolism, bliver bfunction, band bkidney bfunction
-used bto bmonitor bthe beffects bof bmedications, bsuch bas bantipsychotics, bon bliver bfunction band bglucose blevels
-rule bout bmedical bconditions bthat bcould bcause bsymptoms
• Ex: bchanges bin bmood bor bcognition
Sodium b(Na+): b136-145 bmEq/L
Postassium b(K+): b3.5-5.0 bmEq/L
b
Chloride b(Cl-): b95-105 bmEq/L
b
Bicarbonate b(HCO3-): b22-28 bmEq/L
b
Calcium, bserum b(Ca b2+) b8.4-10.2
b
mg/dl
b
Glucose, bserum bFasting: b70-110 bmg/dl; b2-h bpostprandial: b<120mg/dl
Cholesterol, bserum: bREC<200 bmg/dl
b
Total bProtein b6.0-7.8 bg/dl
Albumin b3.5-5.5 bg/dl
b
-Kidney bTests
• Creatinine, bserum b0.6-1.2mg/dl
• Urea bnitrogen, bserum b(BUN) b7-18mg/dl
-Liver bTests
• Alanine baminotransferase b(ALT), bserum: b8-20 bU/L
• Aspartate baminotransferase b(AST), bserum: b8-20 bU/L
• Bilirubin, bserum b(adult) bTotal//Direct: b0.1-1.0 bmg/dl b// b0.0-0.3 bmg/dl
• Phosphatase b(alkaline), bserum: b20-70 bU/L
Basic bLaboratory bInterpretation: bThyroid bFunction bTests b(TFTs) b- bCorrect bAnswers b- bused bto brule bout
bthyroid bdisorders bas ba bcause bfor bsymptoms
