Overall Goal
By the end of the clerkship, the student will demonstrate the ability to obtain a complete psychiatric history, recognize relevant physical findings, and perform a complete mental status examination.

Specific Objectives
The student will be able to:

1. Elicit and clearly record a complete psychiatric history including the identifying data; chief complaint; history of the present illness; past psychiatric history; medications (psychiatric and nonpsychiatric); general medical history; review of systems; substance abuse; family history; and personal and social history;
2. Explain the importance of, and be able to obtain and evaluate, historical data from multiple sources (family members, community mental health resources, medical records, etc.);
3. Elicit, describe, and precisely record the components of the mental status examination including: general appearance and behavior; motor activity; speech; affect; mood; thought processes; thought content; perception; sensorium and cognition; judgment; and insight;
4. Use appropriate terms associated with the mental status examination;
5. Make a clear and concise case presentation;
6. Assess for the presence of general medical illness in psychiatric patients, and determine the extent to which a medical/surgical illness contributes to a patient’s psychiatric problem.

Overall Goal
By the end of the clerkship, the student will be able to identify psychopathology, formulate accurate differential and working diagnoses, and develop appropriate assessment and treatment plans for psychiatric patients.

Specific Objectives
Using his or her knowledge of psychopathology, diagnostic criteria, and epidemiology, the student will:

1. Explain the advantages and limitations to using a diagnostic system like the DSM-IV;
2. Use the DSM IV in identifying specific signs and symptoms that comprise a syndrome or disorder;
3. Use the five axes of the DSM IV in evaluating patients:
4. State the typical signs and symptoms of the common psychiatric disorders, such as: major depression, anxiety disorders, bipolar disorder, dementia, delirium, schizophrenia, personality disorders, and substance use disorders;
5. Formulate a differential diagnosis for major presenting problems;
6. Formulate a plan for evaluation;
7. Assess changes in clinical status, and alter hypotheses and management in response to changes;
8. Develop an individualized treatment plan for each patient; and
9. Discuss the prevalence and barriers to recognition of psychiatric illness in general medical populations.

Overall Goal
By the end of the clerkship, the student will conduct an interview in a manner that facilitates information-gathering and formation of a therapeutic alliance.

Specific Objectives
The student will:

1. Demonstrate respect, empathy, responsiveness, and concern regardless of the patient’s problems or personal characteristics;
2. Identify his or her emotional responses to patients;
3. State and use basic strategies for interviewing disorganized, cognitively impaired, hostile/resistant, mistrustful, circumstantial/hyperverbal, unspontaneous/hypoverbal, and potentially assaultive patients;
4. Demonstrate the following interview 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;
5. State and avoid the following common mistakes in interviewing techniques: interrupting the patient unnecessarily; asking long, complex questions; using jargon; asking questions in a manner suggesting the desired answer; asking questions in an interrogatory manner; ignoring patient verbal or non-verbal cues; making sudden inappropriate changes in topic; indicating patronizing or judgmental attitudes by verbal or non-verbal cues; (e.g., calling an adult patient by his or her first name, questioning in an oversimplified manner, etc.); incomplete questioning about important topics.

Overall Goal
By the end of the clerkship, the student will assess and begin emergency management and referral of a person with neuropsychiatric symptoms.

Specific Objectives
The student will:

1. Identify the clinical and demographic factors associated with a statistically increased risk of suicide;
2. Develop a differential diagnosis, conduct a clinical assessment, and recommend management for a patient exhibiting suicidal thoughts or behavior;
3. Recognize signs and symptoms of potential assaultiveness;
4. Discuss classes, indications, and associated risks of medications used for management of acutely psychotic, agitated, and combative patients;
5. Discuss the nonpharmacologic components of management of acute psychosis, agitation and combativeness;
6. Identify the indications, precautions, and use of restraints;

Overall Goal
By the end of the clerkship, the student will recognize the psychiatric manifestations of brain disease and will state the evaluation and initial management of these neuropsychiatric disorders.

Specific Objectives
The student will:

1. Define the terms delirium, dementia;
2. Discuss the clinical features and differential diagnosis of delirium;
3. Discuss the behavioral and pharmacologic treatments of delirious patients;
4. List the treatable causes of dementia, and summarize their clinical manifestations;
5. Summarize the medical evaluation and clinical management of a patient with dementia;
6. Employ cognitive screening evaluations to assess and follow patients with cognitive impairment, and state the limitations of these instruments.

Overall Goal
By the end of the clerkship, the student will recognize, evaluate, and state the treatments for patients with mood disorders.

Specific Objectives

1. State the common signs and symptoms, differential diagnosis (including the general medical illnesses that can present with depression), course of illness, comorbidity, prognosis, and complications of mood disorders;
2. Contrast normal mood variations, states of demoralization, and bereavement with the pathological mood changes that constitute depressive illness;
3. Describe some common presentations of depression in nonpsychiatric settings and develop an approach to evaluating and treating affective disorders in a general medical practice;
4. Outline the recommended acute and maintenance treatments for major depression and bipolar disorder (manic and depressive phases);
5. State the characteristics and techniques of nonpharmacological treatments for depression, including psychotherapy.

Overall Goal
By the end of the clerkship, the student will demonstrate proficiency in the recognition, evaluation, and management of persons with psychosis associated with schizophrenic, affective, general medical, and other psychotic disorders.

Specific Objectives
The student will:

1. Define the term psychosis;
2. Develop a differential diagnosis for a person presenting with psychosis, including identifying historical and clinical features which assist in the differentiation of general medical, affective, schizophrenic and other causes;
3. Summarize the clinical features, course, and complications of schizophrenia;
4. Name the clinical features of schizophrenia that are associated with good and poor outcome;

Overall Goal
By the end of the clerkship, the student will recognize, evaluate and state the treatments for patients with anxiety disorders.

Specific Objectives
The student will:

1. Discuss the clinical features, course, and complications of panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and obsessive compulsive disorder;
2. List the general medical causes of anxiety, and assess for these causes in evaluating a person with an anxiety disorder;
3. Outline the behavioral, psychological, and pharmacologic treatments for each of the anxiety disorders.

Overall Goal
By the end of the clerkship, the student will recognize maladaptive traits and interpersonal patterns that typify personality disorders, and discuss strategies for caring for patients with personality disorders.

Specific Objectives
The student will:

1. Identify the traits of character common to all personality disorders;
2. Discuss the epidemiology, differential diagnosis, course of illness, prognosis, and comorbid psychiatric disorders in patients with personality disorders;
3. List the general medical and Axis I psychiatric disorders that may present with personality changes;
4. Discuss the concepts of hierarchical levels of defense and regression under stress, and list typical defense mechanisms used in various personality disorders;
5. Discuss the association of childhood abuse and trauma with personality disorders in adulthood;
6. State the psychotherapeutic and pharmacologic treatment strategies for patients with personality disorders;
7. Discuss how patients with personality disorders commonly present in the medical setting; and
8. Summarize principles of management of patients with personality disorders including: being aware of one’s own response to the patient, soliciting consultations from colleagues when indicated, and using both support and nonpunitive limit setting.

Overall Goal
By the end of the clerkship, the student will identify, clinically evaluate, and treat the neuropsychiatric consequences of substance abuse and dependence.

Specific Objectives
The student will:

1. 0btain a thorough history of a patient’s substance use through empathic, nonjudgmental, and systematic interviewing techniques;
2. Summarize and recognize characteristic clinical features (including denial) of psychoactive substance abuse and dependence;
3. Summarize the presentations of substance abuse in general medical practice;
4. Know the clinical features of intoxication with, and withdrawal from, amphetamines, opiates, nicotine, benzodiazepines, and alcohol;
5. State the treatments of alcohol intoxication and withdrawal;
6. Summarize the epidemiology, clinical features, and course of alcoholism;
7. Summarize the psychiatric complications of alcoholism including depression, suicide, violence, accidents, amnestic syndromes, and psychosis;
8. Discuss the role of support groups and rehabilitation programs in the recovery of patients with substance abuse;
9. State guidelines for prescribing benzodiazepines;
10. List the psychiatric disorders that share significant comorbidity with substance use disorders.

Overall Goal
By the end of the clerkship, the student will diagnose and state the principles of management of patients with somatoform disorders.

Overall Goal
By the end of the clerkship, the student will summarize the unique general factors essential to the evaluation of children and adolescents.

Overall Goal
By the end of the clerkship, the student will summarize the unique general factors essential to the evaluation of geriatric patients.

Specific Objectives
The student will:

1. Employ a cognitive screening evaluation to assess and follow patients with cognitive impairment, and state the limitations of these instruments;
2. Summarize the special considerations in prescribing psychotropic medications in the elderly;
3. Appreciate that multiple medications can cause cognitive, behavioral, and affective problems in the elderly;
4. Summarize the assessment and treatment of a patient with dementia;
5. Summarize the assessment and treatment of a patient with delirium.

Overall Goal
By the end of the clerkship, the student will summarize the indications, basic mechanisms of action, common side effects and drug interactions of each class of psychotropic medications, and demonstrate the ability to select and use these agents to treat mental disorders.

Specific Objectives

Anxiety - The student will discuss:

1. The indications, mechanisms of action, pharmacokinetics, common side effects and signs of toxicity of the different benzodiazepines and sedative-hypnotics;
2. The consequences of abrupt discontinuation;
3. Patient characteristics associated with benzodiazepine abuse;
4. Guidelines for prescribing benzodiazepines.

Antidepressants - The student will summarize:

1. The indications, mechanisms of action, pharmacokinetics, common or serious side effects, and signs of toxicity of tricyclics, and serotonin reuptake inhibitors;
2. The effect of antidepressants on the cardiac conduction system and EKG;
3. Advantages and disadvantages of serotonin reuptake inhibitors.

Antipsychotics (neuroleptics) - The student will discuss:

1. The indications, mechanisms of action, common side effects, and signs of toxicity of neuroleptics;
2. Differences between high potency and low potency neuroleptics, including the side effects common to each group;
3. Diagnosis and management of extrapyramidal side effects including acute dystonia, Parkinsonism, akathisia, tardive dyskinesia, and neuroleptic malignant syndrome; and
4. The indications and special considerations in using clozapine.

Lithium and Valproate - The student will discuss:

1. The indications, side effects and signs of toxicity (neurological, gastrointestinal, renal, endocrine, cardiac) of mood stabilizers.
2. The pretreatment assessment of strategies of use of mood stabilizers and blood level monitoring.

Anticholinergics - The student will discuss:

1. The indications, mechanisms of action, pharmacokinetics, common and serious side effects and signs of toxicity of antiparkinson agents;
2. Which antidepressants and antipsychotics tend to be associated with a higher degree of anticholinergic side effects;
3. Special considerations in prescribing these medications in the elderly; and
4. The high prevalence of anticholinergics in over the counter medications.

Electroconvulsive therapy (ECT) - the student will summarize:

1. Indications, physiologic effects, and side effects of ECT;
2. Clinical situations in which ECT may be the treatment of choice;
3. Pretreatment assessment, including conditions requiring special precautions; and
4. The medical care of the patient before, during and after ECT treatment.

Other topics - the student will discuss:

1. The use of beta blockers in psychiatry; and
2. The indications for and side effects of stimulants.

Overall Goal
By the end of the clerkship, the student will understand the principles and techniques of the psychosocial therapies sufficient to explain options to a patient and make a referral when indicated.

Specific Objectives
The student will:

1. State the characteristics, techniques, and common indications for: psychodynamic psychotherapy; psychoanalysis; supportive psychotherapy; cognitive and behavioral therapy; group therapies; couples and family therapy; and psychoeducational interventions;
2. Describe behavioral medicine interventions (e.g., relaxation training, assertiveness training, contingency management, stimulus control, relapse prevention, biofeedback), and know for which medical problems they are helpful (e.g., smoking cessation);
3. Define and begin to recognize transference, countertransference, and commonly used defense mechanisms; discuss the concepts of hierarchical levels of defense and regression under stress; and list some typical defense mechanisms used in various personality disorders.

Overall Goal
By the end of the clerkship, the student will work effectively with other health professionals.

Specific Objectives
The student will:

1. Participate as a member of a multidisciplinary patient care team;
2. Summarize the special skills of a psychiatric nurse, psychologist, psychiatric social worker, and physician assistant;
3. Participate in discharge planning and referral of a patient to an ambulatory setting or to another inpatient facility;
4. Request a consultation, in writing or by phone, from a practitioner of another specialty.

Overall Goal
By the end of the clerkship, the student will demonstrate maturation in clinical and personal development.

Specific Objectives
The student will:

1. Summarize his or her strengths and weaknesses in interviewing skills, assessment, and management of persons with psychiatric disorders;
2. Accept, utilize, and provide constructive criticism;
3. Demonstrate empathy for patients, colleagues, and supervisors;
4. Request consultation and supervision when knowledge, attitudes, or skills are insufficient for a given patient’s care;
5. Accept that some patients and colleagues are not cooperative and likeable, and that some patients and colleagues will not like the student;
6. Perform clinical tasks (including soliciting assistance) under the pressure of difficult situations;
7. Demonstrate comfort in participating in the care of psychiatrically ill persons;
8. Obtain information from the psychiatric and general medical literature;
9. Refute myths about psychiatric illness, psychiatric patients, psychiatric treatments, and mental health practitioners;
10. Comment on the value of prompt and enthusiastic response to requests for consultation.