| 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) |