Learning objectives in psychiatry for WUMS

Revised 6/4/98
 
Notes

By Kevin J. Black, M.D., with substantial input from Devnandini Rastogi-Cruz, M.D., Laura Bierut, M.D., Jim Hudziak, M.D., and others (but I am solely to blame for errors). Click here for 1996 version, history, and names of others who helped. Please direct comments to me by clicking here or by phone, etc.

This version is intended to more realistically delineate expectations for students by prioritizing each learning point (see "priority" column: 1=essential, 2=desirable, 3=elective). A student's mastery of the 3 levels in the required 3rd year clerkship is expected to correspond very roughly to grades of P, HP, and H. In the remaining columns I have marked where in the 4-year curriculum each topic is currently addressed, including independent reading by the student. 

Abbreviations: yr1 = 1st year WUMS curriculum; yr2 = 2nd year; inpt = clerkship experience on inpatient wards at Barnes-Jewish Hospital or Metropolitan Psychiatric Center; OPC = outpatient psychiatry conference in which all students participate as part of the required clerkship; quiz = online open-book quiz required as part of the 3rd-year clerkship; ambulatory = available in the ambulatory psychiatry option in the 3rd year ambulatory medicine course (paper = clinical review required of all students on amb. psy., CL = consult service, MPCER = MPC emergency room, child = child psychiatry, clinic = WU adult psychiatry clinic); electives = learning experiences are available to interested students via certain elective courses; nonpsych = taught in other courses, e.g. neurology, internal medicine; self-study = students should read independently for this information.

 Outline
Brief Summary
Detailed objectives
   Basic science
   The nature of psychiatric illness
   Behavior towards patients
   Interviewing skills
   Psychiatric history
   Physical and mental status examination
   Indications for and evaluation of ancillary testing
   Psychiatric diagnosis
   Psychiatric emergencies
   Delirium, dementia and other cognitive disorders
   Substance-related disorders
   Schizophrenia and other psychotic disorders
   Mood disorders
   Anxiety disorders
   Somatoform and factitious disorders
   Eating disorders
   Personality disorders
   Sleep disorders
   Neuropsychiatric movement disorders
   Child and adolescent psychiatry
   Geriatric psychiatry
   Community and forensic psychiatry, and other societal aspects of mental health care
   Psychopharmacology and ECT
   Psychotherapy
Objectives priority yr1 yr2 inpt OPC quiz ambulatory electives nonpsych self-study

Brief summary

A student who receives the M.D. degree from WUSM should:

Have a broad knowledge of the basic sciences which underlie modern clinical psychiatry, and ... 2-3* x x
...demonstrate skill at finding and interpreting studies relevant to questions in clinical psychiatry
1
      
paper
Recognize that psychiatric illnesses are real, common, reliably diagnosable, (often) serious, and treatable, and understand the medical and societal implications of these observations 1 x x
Know epidemiology, clinical characteristics, pathophysiology, natural history, diagnosis, differential diagnosis, and treatment for the major psychiatric illnesses 1-2* x x x x
Demonstrate skill and sensitivity in interacting with patients in all clinical settings 1 x all
Understand important ethical questions arising in clinical medicine and behave ethically towards patients at all times 1 x x x all
* = priority varies for different subtopics

Detailed objectives

Basic science

Understand the critical conceptual issues in research as they relate to psychiatric illness, including the issues of: cause versus association; retrospective viewpoints versus systematic and controlled studies; selection biases in clinical research; problems of measuring symptoms, signs, traits, and illnesses; and categorical versus quantitative diagnosis as this relates to studies of etiology and pathophysiology 2 x x
Have a good grasp of basic neuroscience including the physiology of the neuron, basic and clinically relevant neuroanatomy, neurochemistry, molecular neurogenetics, and developmental neurobiology 2 x
Understand the basic methods of psychiatric epidemiology, and their advantages and limitations 3 x
Understand the basic methods of both Mendelian genetics and the genetics of common illnesses and quantitative traits, and their advantages and limitations in the study of psychiatric illnesses 3 x x
Understand the basic methods of commonly employed structural and functional imaging techniques, and their advantages and limitations in the study of psychiatric illnesses 3 x
Understand the advantages and limitations of available physiological and biochemical measurements in studying the physiology and etiology of mental illness 3 x
Knowledgeably discuss the advantages and limitations of self- and observer-rated scales for quantifying symptoms, signs and overall illness severity 3 paper x
Understand the fundamental principles of biostatistics and medical decision making, including tests of significance, study design, Bayes' theorem, and interpretation of laboratory tests 3 x x

The nature of psychiatric illness

Demonstrate in interactions with peers and patients the recognition that psychiatric illnesses are real, common, reliably diagnosable, (often) serious, and in general as treatable as other medical illnesses 1 x x x x x x
Have personal experience with the clinical features and short-term (weeks) evolution of a wide variety of psychiatric illnesses in each of several clinical settings, including inpatient wards for the most severely ill patients 1 x x x
Have thoughtfully considered questions such as what constitutes an illness, under what conditions physicians should be responsible for the management of symptoms, etc. 1 x x x
Discuss the question, "what makes an illness psychiatric or non-psychiatric?" Specifically discuss this question in relation to illnesses such as general paresis (tertiary neurosyphilis), Alzheimer's disease, Tourette syndrome, schizophrenia, and migraine 2 x x x
Consistently use objective criteria (such as DSM-IV) in diagnosing psychological symptoms and discuss the advantages of this approach 1 x x x
Use objective criteria (such as DSM-IV) in diagnosing somatic symptoms which do not appear to fit known diseases 2 x x CL
Recognize the problems which arise from basing treatment on theories rather than on empiric studies 2 x x x
Recognize the burden of psychiatric illness in terms of its impact on: human suffering, the practice of general medicine, and the cost of medical care 1 x x x x x x

Behavior towards patients

demonstrate respect, empathy, responsiveness, and concern regardless of the patient's problems or personal characteristics 1 x x x x x x x
use appropriate strategies for dealing with patients who are hostile, disparaging, noncompliant, or seductive; patients who seek frequent clinical attention; patients who are terminally ill 2 x x x
demonstrate behavior consistent with accepted professional ethical guidelines 1 x x x x x
understand the practical, scientific and ethical difficulties involved in the use by physicians of suggestion and placebos 2 x
show appreciation for the moral debates surrounding medical issues at the beginning and end of life 2 x
discuss the ethical issues related to informed consent for treatment and for research in patients with dementia, severe mood disorders, or psychosis 3 x
understand the ethical principle of nonmaleficence in medicine (i.e., "first, do no harm"), and show appreciation for these principles in one's treatment of patients 1 x x x x
discuss the difference between giving a treatment because it fits one's unproven theories of illness, on the one hand, and on the other hand doing the best one can for one's patient in the absence of proven treatments while recognizing that this is what one is doing 1 x x x

Interviewing skills

explain the value of skillful interviewing for patient and doctor satisfaction and for obtaining optimal clinical outcomes 1 x x x
state and use basic strategies for interviewing disorganized, cognitively impaired, hostile / resistant, mistrustful, circumstantial / hyperverbal, unspontaneous / hypoverbal, and potentially assaultive patients 2 x x x
demonstrate the following interviewing skills: appropriate initiation of the interview; establishing rapport; the appropriate use of open-ended and closed questions; techniques for asking "difficult" questions; the appropriate use of facilitation, empathy, clarification, confrontation, reassurance, silence, summary statements; soliciting and acknowledging expression of the patient's ideas, concerns, questions, and feelings about the illness and its treatment; communicating information to patients in a clear fashion; appropriate closure of the interview 2 x x x
show sensitivity to patient needs during the interview 1 x x x
use these skills in all clinical settings (i.e. not just on the psychiatry service) 2 CL x x

Psychiatric history

elicit and clearly record a complete psychiatric history 1 x x x
recognize the importance of, and be able to obtain and evaluate, historical data from multiple sources, and routinely seek such information in the evaluation of psychiatric and medically unexplained symptoms 1 x x x x
correctly define and use important symptom names from the accepted psychiatric nomenclature 1 x x x x x x
appreciate the distinction between symptoms and signs as applied to psychiatric evaluation 1 x x x
pay adequate attention to psychiatric diagnosis in describing psychiatric history in the general medical setting (e.g. chart diagnoses of "history of psychosis" or "treatment for depression," not "psych problems") 1 x CL x x

Physical and mental status examination

perform a competent general physical examination, including recognition of salient abnormalities 1 x x
perform a competent neurological examination, including recognition of salient abnormalities 1 x x x
correctly define and use words describing signs noted in the mental status examination 1 x x x
appreciate the effects of age, culture, education, and comorbid illness (including intoxication and neurobehavioral deficits) on psychiatric symptoms and signs 2 x x x x x
elicit, describe, and precisely record the components of the mental status examination, including: general appearance and behavior; speech; motor signs (agitation, retardation, tremor, akathisia, tics, chorea, rigidity, catalepsy, echopraxia, etc.); flow of thought; content of thought (including hallucinations, delusions, obsessions, compulsions, and suicidal or homicidal thoughts, plans, and intent); mood; affect; alertness, attention, orientation, memory, language, and fund of knowledge; other signs reflecting higher cortical dysfunction such as apraxia, dyscalculia, neglect phenomena, perseveration, etc.; insight; judgment 1 x x x x
show how signs of illness can be elicited and described in patients who are lethargic, mute, or uncooperative 2 x x x x
understand which important psychiatric and general medical illnesses can be overlooked when one omits a given component of the full mental status examination 1 x x x
conduct an adequate screening mental status examination, appropriate to the clinical situation, in every physical examination in every clinical setting 1 x CL x x
examine for suicidal thoughts, plans and intent in every clinical situation in which it is indicated (not just on the psychiatry service) 1 x CL x x
competently perform a thorough mental status examination when indicated 1 x x x
recognize physical signs and symptoms that accompany classic psychiatric disorders, (e.g., motor retardation in melancholic depression, abnormalities of posture and movement in catatonia, tachycardia and shortness of breath in panic disorder) 2 x x x
assess for the presence of general medical illness in psychiatric patients, and determine the extent to which a general medical illness contributes to a patient's psychiatric problem 2 x CL x x
recognize and identify the effects of psychotropic medication on the physical examination 2 x x x x x
present cases clearly and concisely 1 x x x

Indications for and evaluation of ancillary testing

demonstrate reasonable understanding of the benefits, limitations, indications and interpretation of each of the following, as applied to the evaluation of psychological and atypical somatic symptoms: neuroimaging; neuroendocrine challenge tests; neuropsychological testing; tests of personality, and projective tests 3 x x

Psychiatric diagnosis

identify significant psychopathology 1 x x x x x
appreciate the problems that arise when one uses ill-defined, unreliable, or invalid psychiatric diagnoses 2 x x
accurately represent the general conclusions of studies of the reliability and validity of diagnosis in psychiatry compared with diagnoses in the rest of medicine 1 x
discuss the ways in which a diagnosis can be validated, and the ways in which a valid diagnosis can be clinically useful, in the case of psychiatric and other medical illnesses for which there is no currently known pathological abnormality (including "chronic fatigue syndrome," "irritable bowel syndrome," etc.) 3 x
formulate accurate differential and working diagnoses, using DSM-IV, for psychological symptoms 2 x x x x x
formulate accurate differential and working diagnoses, using DSM-IV, for "psychogenic," "hysterical" and atypical somatic symptoms 3 x CL x
use the five axes of the DSM-IV in evaluating patients with a primary psychiatric diagnosis 2 x x x
appreciate that psychiatric symptoms can be caused by specific neurologic or general medical illnesses in the absence of delirium 1 x x x x

Psychiatric emergencies

identify the clinical and demographic factors associated with increased risk of suicide 2 x x x
develop a differential diagnosis, conduct a clinical assessment, and recommend management for a patient exhibiting suicidal thoughts or behavior, in any clinical setting 1 x x x x x
always screen for delirium in evaluating psychiatric symptoms 1 x x x x
discuss the clinical features, differential diagnosis, and evaluations of delirium (a.k.a. "encephalopathy," "mental status changes"), including emergencies 1 x x x
recognize the typical signs and symptoms of common psychopharmacologic emergencies (e.g. lithium toxicity, neuroleptic malignant syndrome, anticholinergic delirium, MAOI-related hypertensive crisis), and discuss treatment strategies 2 x x
recognize signs and symptoms of potential assaultiveness 2 x
take appropriate steps to ensure his/her own safety in evaluating all patients 1 x MPCER 3rd yr
orientation
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 2 x x x
identify the problems associated with the use of the term "medical clearance" 2 x

Delirium, dementia and other cognitive disorders

compare, contrast, and give examples of the following: delirium, dementia, ... 1 x x x x x
  ...cortical and subcortical dementia
3
            
x
  
x
know the approximate mortality associated with a diagnosis of delirium in the general medical setting 2 x x
discuss the clinical features, differential diagnosis, evaluation, and treatment of delirium 1 x x CL
formulate an appropriate differential diagnosis for dementia and discuss the epidemiology, clinical features, and course of the most common forms of dementia 2 x x x
list common treatable causes of dementia, and summarize their clinical manifestations 2 x x x
summarize the medical evaluation and clinical management of a patient with dementia, including treatment of cognition and of non-cognitive symptoms (e.g. delusions, agitation) 2 x x x x
discuss the diagnosis, differential diagnosis, and treatment of amnestic disorders 3 x x x
discuss the common psychiatric manifestations of certain neurologic illnesses (e.g. seizure disorders, stroke, head injury, parkinsonism, Wilson's disease), general medical illnesses (e.g. hypothyroidism, hypercalcemia, lupus), and the postpartum state 3 x x x
discuss the clinical features, differential diagnosis, and general management of common problems in behavioral neurology 3 x x x

Substance-related disorders

screen appropriately for substance abuse in all clinical settings 1 x x x x
obtain a thorough history of a patient's substance use when indicated 1 x clinic x
refer patients with substance abuse (in all clinical settings) to treatment 1 x x
list and compare the characteristic clinical features of substance abuse and substance dependence 3 x
discuss the epidemiology, clinical features, patterns of usage, course of illness, and treatment of substance use disorders 2 x x x x
in particular, discuss the psychiatric, general medical, and social sequelae of alcohol abuse or dependence and of nicotine dependence, and their responsiveness to treatment of abuse/dependence 2 x x x
identify typical presentations of substance abuse in general medical practice 1 x x
discuss the role of the family, support groups, and rehabilitation programs in the recovery of patients with substance use disorders 2 x
know the clinical features of intoxication with, and withdrawal from: cocaine, amphetamines, hallucinogens, cannabis, phencyclidine, barbiturates, opiates, caffeine, nicotine, benzodiazepines, alcohol 2 x x
correctly manage substance intoxication and withdrawal, including referral as appropriate 2 x x x
recognize and manage related emergencies such as Wernicke's encephalopathy 2 x x

Schizophrenia and other psychotic disorders

correctly define the term "psychosis" 1 x x x x x
develop a differential diagnosis for a person presenting with psychosis 2 x x x
summarize the available knowledge concerning the etiology and pathophysiology of schizophrenia 3 x x x
summarize the epidemiology, clinical features, course, and complications of schizophrenia 2 x x
list the features that differentiate delusional disorder, schizophreniform disorder, schizoaffective disorder, and brief psychotic disorder from each other and from schizophrenia 3 x x x x
correctly describe an appropriate course of treatment for a patient with schizophrenia, including discussion of treatment goals, assessment of change, pharmacologic treatment, education, and family therapy 2 x x

Mood disorders

understand the differences between depressive symptoms and major depression, why the distinction is important, and consistently attempt to differentiate between the two in general medical patients 1 x x x x x x x
discuss whether or not treatment of the syndrome of major depression should depend on whether sadness seems "understandable" in a given patient 2 x
discuss the common signs and symptoms, differential diagnosis, course of illness, comorbidity, prognosis, and complications of mood disorders 1 x x
compare and contrast the epidemiologic and clinical features of unipolar depression and bipolar (I) disorder 2 x x
summarize the available knowledge concerning the etiology and pathophysiology of major depression and bipolar disorder 3 x x
know the most common general medical causes of the depressive syndrome 2 x x x
consistently include general medical causes of depression in the differential diagnosis of major depression 2 x x
discuss the impact of major depression on morbidity and mortality in patients with general medical/surgical illness 2 x x
discuss the identification and management of suicide risk in general medical setting, including discussion of the physician's responsibility 1 x x
CL,
MPCER
screen for depression in general medical patients, and evaluate more fully when indicated 1 x x
describe the recommended acute and maintenance treatments for dysthymia, ... 3 x
  ... major depression, and ...
1
    
x
x
x
x
... bipolar disorder (manic and depressive phases)
2
    
x
state the characteristics and techniques of psychological treatments for depression, including cognitive therapy and interpersonal therapy 2 x x

Anxiety disorders

summarize the available knowledge concerning the etiology and pathophysiology of panic disorder, social phobia, and obsessive-compulsive disorder 3 x x x x
discuss the diagnosis and management of panic disorder, agoraphobia, social phobia, specific phobias, and obsessive compulsive disorder 2 x x x
list the common general medical and substance-induced causes of anxiety, and assess for these causes in evaluating a person with an anxiety disorder 3 x clinic
outline psychotherapeutic and pharmacologic treatments (as appropriate) for each of the anxiety disorders 2 x clinic
discuss the difference between pharmacologic benzodiazepine tolerance during treatment of anxiety disorders, and prescription drug abuse, and risk factors for the latter 2 x x
discuss the role of anxiety and anxiety disorders in the presentation of general medical symptoms, the decision to visit a physician, and health care expenditures 2 x x

Somatoform and factitious disorders

discuss the fallacies in the assumption that a patient has a "psychogenic" illness when the patient has bizarre, placebo-responsive, or suggestible physical symptoms, or a presentation which does not appear to fit any known syndrome 2 x
discuss how one can manage patients with the presentations described above without either reinforcing their symptoms or assuming their illness is "psychogenic" 3 x x
give examples of neurologic illnesses which respond to placebo, are worse in the doctor's office than in the waiting room, disappear with sleep, worsen with suggestion, or are associated with psychological symptoms 3 x x x
compare the follow-up stability of a diagnosis of somatization disorder (Briquet's syndrome) with that of a diagnosis of conversion disorder 3 x
state the clinical characteristics of somatization disorder, conversion disorder, pain disorder, body dysmorphic disorder, and hypochondriasis; and know which one of these diagnoses has been validated using follow-up and family studies 3 x
discuss the relative clinical value of documenting the presence or absence of somatization disorder in general medical patients with bizarre, placebo-responsive, "nonphysiological," or suggestible physical symptoms, or a presentation which does not appear to fit any known syndrome 2 x CL
discuss the clinical implications of the high rate of underlying general medical/neurologic illness in follow-up studies of patients diagnosed with pain disorder and conversion disorder 2 x
list the characteristic features of factitious disorder and malingering 3 x
summarize the principles of management of patients with somatoform disorders, including the role of the nonpsychiatric physician 3 x clinic
discuss difficulties physicians may have with patients with these diagnoses 3 x
discuss the impact of somatoform disorders on the cost of medical care 3 x
CL,
MPCER
consistently use the principles outlined above in diagnosing and managing patients with atypical symptoms in the general medical setting 2 x x

Eating disorders

summarize knowledge regarding etiology, clinical features, epidemiology, course, comorbid disorders, complications, and treatment for anorexia nervosa 3 x child
summarize knowledge regarding etiology, clinical features, epidemiology, course, comorbid disorders, complications, and treatment for bulimia nervosa 3 x child
discuss knowledge regarding the prevalence, etiology, and treatment of obesity 3 x
list the nonpsychiatric medical complications and indications for hospitalization in patients with eating disorders 2 child x

Personality disorders

explain how the DSM-IV defines personality traits and disorders, and identify features common to all personality disorders 2 x x
list the three descriptive groupings (clusters) of personality disorders in the DSM-IV 3 x
appreciate that there are numerous theories which have been advanced to explain personality disorders, including neurobiological, genetic, developmental, behavioral, psychodynamic, and sociological theories 3 x
summarize the current state of knowledge (as opposed to theory) regarding the etiology of antisocial personality disorder and other personality disorders 3 x x
discuss the relationships that exist between certain Axis I and Axis II disorders (e.g. schizophrenia and schizotypal PD, OCD and OCPD, social phobia and avoidant PD) 3 x x x
identify difficulties in diagnosing personality disorders in the presence of substance abuse and other disorders 2 x x x x
specifically, discuss the implication for diagnosis of personality disorders of observations that personality disorder features often improve or remit upon successful treatment of a comorbid Axis I disorder (e.g. major depression, panic disorder, schizophrenia) 3 x
list the commonly accepted psychotherapeutic and pharmacologic treatment strategies for patients with personality disorders, and generally appreciate the strength of the evidence for efficacy and safety of these strategies 3 clinic
discuss knowledge regarding the influence of neurologic and general medical illnesses on personality, and the clinical utility of the DSM-IV diagnosis Personality Change due to a General Medical Condition 3 x x x
discuss the questions, "are personality disorders illnesses?" and "do personality disorders constitute an appropriate focus of medical attention?" 3 x x
discuss the probable cost implications of denying insurance coverage of medical treatment of personality disorders 3 CL,ER x
discuss the management of patients with personality disorders in the general medical setting 2 x x

Sleep disorders

describe normal sleep physiology, including sleep architecture, throughout the life cycle 3 x x
obtain a complete sleep history when indicated 3 x
discuss the manifestations, differential diagnosis, evaluation, and treatment of primary sleep disorders, including dyssomnias and parasomnias 3 x
describe the typical sleep disturbances that accompany psychiatric and substance use disorders 3 x x
summarize the effect(s) of psychotropic medications on sleep 3 x
describe sleep hygiene treatment 3 clinic x
demonstrate appropriate knowledge of the indications, efficacy and safety of short- and long-term use of hypnotics, including the relative contraindications for specific hypnotics in patients hospitalized on nonpsychiatric services 3 CL x x

Neuropsychiatric movement disorders

discuss clinical features, recognition, and treatment of neuroleptic-induced parkinsonism, akathisia, and dystonia 2 x x
discuss the clinical features of tardive movement disorders (including prevalence and risk factors), and the medical and legal implications 3 x
name two commonly used drugs which are not antipsychotics but which can cause tardive dyskinesia 2 x x
routinely screen for movement disorders in patients treated with neuroleptics 2 x
discuss the clinical importance of recognizing neuroleptic malignant syndrome or catatonia in patients with or without preexisting psychiatric illness, and discuss accepted treatments 2 x x
discuss clinical features (both motor and psychological), DSM-IV definition, differential diagnosis, epidemiology, genetics, pharmacology, and treatment for Tourette syndrome 3 x x

Child and adolescent psychiatry

discuss the evaluation of children and adolescents at different developmental stages 3 handout child x
obtain data from families, teachers, and other nonphysicians when evaluating psychological symptoms in children 2 child x
state the indications for assessment in children and list common tests in a psychometric evaluation 3 child x
outline the evaluation of academic performance and behavioral problems in children 3 child x
summarize attention deficit hyperactivity disorder and conduct disorder 3 child x
discuss mental retardation 3 child x
name the major clinical features of autism 3 child x
be able to distinguish mental retardation and autism 3 child x
differentiate developmentally normal from pathological anxiety disorders in childhood 3 child x
discuss the clinical features of mood disorders in children 3 child x
discuss suicide risk in adolescents 3 child x
screen for suicide risk in children and adolescents with significant psychological symptoms 1 child x
state when and how a physician must protect the safety of a child who may be the victim of physical or sexual abuse or neglect 1 x
identify signs and symptoms of child sexual and physical abuse, and discuss sequelae 2 x
contact the DFS hotline in suspected cases of abuse or neglect 1 x

Geriatric psychiatry

know the normal physiology and psychology of aging 3 x
routinely obtain historical information from collateral sources 2 x
discuss the clinical presentation of depression in elderly patients 3 x x
summarize the special considerations in prescribing psychotropic medications in the elderly 2 x x x
discuss the physician's role in diagnosing, managing, and reporting elderly victims of physical or sexual abuse 3 x

Community and forensic psychiatry, and other societal aspects of mental health care

define deinstitutionalization, and discuss its effects on patients and on the community 3 x
discuss the process of admission to a psychiatric hospital; specifically a. the implications of voluntary vs. involuntary commitment status; b. the principles of civil commitment; and c. the process for obtaining a voluntary or involuntary commitment, and the physician's role in obtaining it; and d. know how to initiate a 96-hour commitment in Missouri 3 x x
summarize the elements of informed consent, determination of capacity (e.g., to consent to treatment, to manage funds), and the role of judicial or administrative orders for treatment 3 x
discuss the difference between involuntary commitment and guardianship for medical treatment, and discuss appropriate strategies for treating general medical patients who appear unable to give informed consent, both in emergency and non-urgent situations 3 CL x x
discuss the difference between (1) clinical judgment (e.g. by psychiatrists) of a patient's ability to understand health care decisions and (2) the legal question of competence 3 x
discuss the duty to warn 3 x
define the right to treatment and right to refuse treatment 3 x
discuss the legal requirements for reporting child abuse or neglect 1 x x
discuss the economic impact of chronic mental illness on patients and their families, including the effect of discriminatory insurance coverage 1 x x x
discuss the financial and psychosocial burden of chronic mental illness to family members 1 x x x

Psychopharmacology and ECT

Anxiolytics - The student will discuss:

the indications, mechanism of action, pharmacokinetics, common side effects, signs of toxicity of the different benzodiazepines and sedative-hypnotics 2 x x
guidelines for prescribing benzodiazepines 3 x x x
the difference between (1) pharmacological tolerance and withdrawal from benzodiazepines and (2) prescription drug abuse 3 x
indications, efficacy and safety of buspirone 3 x

Antidepressants - The student will summarize:

the indications, mechanisms of action, pharmacokinetics, and common or serious side effects of:
tricyclic antidepressants, 2 x x
monoamine oxidase inhibitors, 3 x x
selective serotonin reuptake inhibitors and clomipramine, 2 x x
other antidepressants such as trazodone, bupropion, venlafaxine and nefazodone. 3 x x
the pretreatment assessment and strategies of antidepressant use, including ensuring adequacy of trial and blood level monitoring 2 x x
the evidence that prescription of small doses of tricyclics for sad outpatients usually confers no proven benefit and carries substantial risk 2 x x x
the effect of tricyclic antidepressants on the cardiac conduction system and EKG 2 x x
dietary and pharmacologic restrictions in prescribing an MAOI 3 x
relative advantages of different classes of antidepressants 3 x x

Antipsychotics - The student will discuss:

the indications, mechanisms of action, pharmacokinetics, common or serious side effects, and signs of toxicity of antipsychotics 2 x x x
differences between high potency and low potency neuroleptics, including the side effects common to each group 2 x x x
diagnosis and management of extrapyramidal side effects including dystonia, Parkinsonism, akathisia, tardive dyskinesia, and neuroleptic malignant syndrome 2 x
the indications and special considerations in using clozapine, including total cost of treatment 3 x clinic
the theoretical and practical differences between classic neuroleptics, depot neuroleptics, risperidone, clozapine, olanzapine, and quetiapine 3 x x clinic

Mood Stabilizers - The student will discuss:

the indications, mechanism of action, pharmacokinetics, side effects, signs of toxicity of lithium 2 x x clinic
the pretreatment assessment and strategies of use of lithium, including blood level monitoring 3 x clinic
the indications, pharmacokinetics, common and serious side effects, toxicity, drug interactions, and plasma level monitoring for carbamazepine and valproic acid in the treatment of bipolar disorder 3 x clinic

Electroconvulsive therapy (ECT) - The student will summarize:

indications, physiologic effects, and side effects of ECT 3 x MPCER
clinical situations in which ECT may be the treatment of choice, including in patients with a nonpsychiatric illness 3 x MPCER
the general perception by the public of ECT, the state of the evidence regarding these perceptions, and answers to commonly asked questions about ECT 2 x MPCER

Other topics - The student will discuss:

the indications for and side effects of stimulants 3
the pharmacology of nootropics 3
the pharmacology and ethics of the prescription of placebos 3 x
accepted indication(s) and the strength of the evidence for use of phototherapy 3

Psychotherapy

understand the principles and techniques of the common psychosocial therapies sufficient to explain them to a patient and make a referral when indicated 2 x clinic x
state the characteristics and techniques of, and common indications (if any) and contraindications (if any) for: psychodynamic psychotherapy; psychoanalysis; supportive psychotherapy; cognitive and behavioral therapies; group therapies; couples and family therapy and psychoeducational interventions 3 x x
discuss the clinical factors which favor the use of one of these over another in specific situations 3 x
describe behavioral medicine interventions (e.g., relaxation training, assertiveness training, contingency management, stimulus control, relapse prevention, biofeedback and hypnosis), and know for which nonpsychiatric medical problems they may be effective (e.g., smoking cessation) and ineffective 3 x
state the major findings of studies of the efficacy of psychosocial interventions in the treatment of psychiatric and general medical disorders and in reducing health care costs 2 x clinic x
discuss the principles of transference and countertransference in relation to physician encounters outside psychiatry 3 x
discuss the difference between giving a treatment because it fits one's unproven theories of illness, on the one hand, and on the other hand doing the best one can for one's patient in the absence of proven treatments while recognizing that this is what one is doing 2 x x
(end)