Goal

To provide medical students with a broad clinical exposure and greater understanding of the epidemiology, presentation, evaluation, and treatment of common psychiatric disorders.

Objectives

A.     Psychiatric History, Physical, and Mental Status Examination

1.      Elicit, describe, and clearly record a complete psychiatric history and mental status examination obtained from the patient and other collateral sources.

2.      Demonstrate the ability to orally present a coherent and concise case presentation utilizing appropriate medical terminology.

3.      Recognize physical signs and symptoms that accompany psychiatric disorders and differentiate these from other medical conditions that may present similarly.

4.      Assess for and recognize the high rate of comorbid medical illnesses in patients with psychiatric disorders.

5.      Recognize and identify the effects of psychotropic medications in the physical examination.

B.    Diagnosis, Classification, and Treatment Planning

1.      Utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) to identify the specific signs and symptoms that pertain to the psychiatric disorders.

2.      Utilize the five axes of the DSM in evaluating patients.

3.      Formulate a differential diagnosis for major presenting symptoms and alter hypotheses and management in response to changes in clinical status.

4.      Develop a comprehensive treatment plan that encompasses the medical, psychopharmacologic, psychotherapeutic, and social needs of the patient.

C.    Diagnostic Testing

1.      State the indications for, and limitations of, the tests that are used to evaluate physiologic functioning of persons with psychiatric symptoms (e.g., thyroid function, RPR, toxicologies, HIV)

2.      Discuss the indications for neuroimaging in psychiatry.

3.      Discuss the indications for obtaining psychologic and neuropsychologic testing.

D.    Psychiatric Emergencies

1.      Clinically assess, recognize risk factors, and recommend treatment for a patient exhibiting suicidal or homicidal thoughts or behavior.

2.      Discuss the pharmacologic and nonpharmacologic management of acutely agitated, combative, and potentially violent patients.

3.      Recognize the typical signs and symptoms of common psychopharmacologic emergencies (e.g., drug toxicities, neuroleptic malignant syndrome, extrapyramidal symptoms, MAO related hypertensive crisis, serotonin syndrome) and discuss treatment strategies.

4.      Recognize the clinical findings that suggest a non-psychiatric etiology for symptoms commonly seen with psychiatric illness (e.g., hallucinations, altered consciousness, violent behavior).

5.      Discuss the indications for psychiatric hospitalization, including the presenting problem and its acuity, risk of danger to patient or others, community resources, and family support.

E.     Cognitive Disorders

1.      Discuss the clinical features, differential diagnosis, evaluation, and treatment of delirium.

2.      Discuss the epidemiology, differential diagnosis, clinical features, etiologies, course, and available treatments for the various dementias (e.g., Alzheimer’s, vascular, substance-induced, Parkinson’s, HIV)

3.      Demonstrate the use of cognitive screening instruments to assess and monitor patients with cognitive impairment.

4.      Discuss the diagnostic criteria differentiating amnestic disorders from the other, more commonly seen, cognitive disorders.

F.     Substance Use Disorders

1.      Describe the clinical features of intoxication and withdrawal states of:  alcohol, cocaine, amphetamines, hallucinogens, cannabis, phencyclidine, barbiturates, opiates, caffeine, nicotine, and benzodiazepines and recognize the appropriate treatment of each.

2.      Obtain a thorough history of a patient’s substance abuse and dependence through empathic, nonjudgmental, and systematic interviewing.

3.      Recognize the utility of the CAGE questionnaire and AUDIT (Alcohol Use Disorders Identification Test) test as a screening instrument for alcohol usage.

4.      Discuss the genetic, biologic, and psychosocial explanations of the etiology of substance abuse and dependence.

5.      Discuss the role of medications, family, support groups, and rehabilitation programs in the recovery of patients with substance use disorders.

G.    Psychotic Disorders, Mood Disorders, Anxiety Disorders

1.      Discuss the evidence for biological, genetic, psychological, and environmental etiologies for these disorders.

2.      Discuss the epidemiologic data for these disorders.

3.      Describe the diagnostic criteria for each of the disorders in these categories of psychiatric illness in order to develop differential diagnoses.

4.      Discuss the importance of a comprehensive treatment plan incorporating pharmacologic, psychotherapeutic, and psychosocial interventions.

H.    Somatoform and Factitious Disorders

1.      Describe the diagnostic criteria for the Somatoform Disorders and differentiate these from Factitious Disorder and Malingering.

2.      Discuss the importance of recognizing physical symptoms as manifestations of psychiatric illness.

3.      Discuss difficulties physicians may have with patients with these diagnoses.

4.      Describe a comprehensive treatment plan for these disorders.

I.        Dissociative Disorders

Develop an understanding of the DSM categories for Dissociative Disorders   

and of the hypothesized role of psychological trauma in their development.

J.      Eating Disorders

1.  Summarize the etiologic hypotheses, epidemiology, and diagnostic criteria for      

     Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. 

2.  Discuss the medical complications, indications for hospitalization,

     multidisciplinary treatment approaches, and prognosis for these disorders.

K.    Sexual Disorders

Discuss the DSM categories of sexual disorders and their recommended treatment modalities.

L.     Sleep Disorders

Discuss the DSM categories of sleep disorders and their recommended treatment modalities. 

M.    Personality Disorders

1. Describe the diagnostic criteria for each of the Personality Disorders and list the 3 diagnostic clusters they are grouped in within the DSM.
2. Summarize the biologic and developmental theories of the etiologies of the personality disorders.
3. Discuss the differential diagnosis, course, comorbid psychiatric disorders, and prognosis for these disorders.
4. Discuss a comprehensive treatment plan including the difficulties a clinician encounters in treating these disorders.

N.    Child and Adolescent Psychiatry

1. Discuss the psychiatric evaluation of children at different developmental stages and the importance of obtaining collateral information from other adults involved in the child’s care.
2. Describe the psychiatric disorders that usually present during the childhood years (Mental Retardation, Learning Disabilities, Pervasive Developmental Disorders, Separation Anxiety, Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Tic Disorders) and how to approach a comprehensive evaluation and treatment plan.

O.    Geriatric Psychiatry

1. Discuss the psychiatric evaluation of the elderly with special consideration of the cognitive examination and the importance of collateral information.
2. Discuss the importance of comorbid medical illnesses and medication side effects/interactions in the evaluation and treatment of the elderly.

P.     Forensic Psychiatry

1. Discuss the implications of a voluntary vs. involuntary psychiatric admission.
2. Summarize the elements of informed consent and differentiate the roles of the psychiatrist and judicial system in these determinations.
3. Discuss the duty to warn if a patient alleges homicidal intent toward a specific individual or group.

Q.    Psychopharmacology

1. Discuss the indications, mechanism of action, pharmacokinetics, common side effects, and drug interactions of the commonly prescribed medications to treat psychiatric disorders.
2. Summarize the use of ECT including the indications, physiologic effects, side effects, pretreatment assessment, and medical care of the patient. 

18. Psychotherapies
    1. Describe the theoretical principles for the following types of psychotherapy:  cognitive-behavioral, interpersonal, behavioral, psychodynamic and supportive.
    2. Discuss indications for using each of the types of psychotherapy.
    3. Summarize the defense mechanisms and the terms transference and countertransference.

19. Attitudes, Perspectives, and Personal Development
    1. Demonstrate an empathic, respectful, and nonjudgmental demeanor in interactions with patients and staff members.
    2. Demonstrate an ability to provide patient care in a conscientious and responsible manner.
    3. Demonstrate an enthusiasm for learning by independently researching the literature, asking questions to further one’s education, and obtaining appropriate consultation and/or supervision to optimize patient care.