Behavioral and Mental Health
Core concepts
Behavioral health questions test recognition, safety assessment, and first-line treatment. Know screening tools (PHQ-9 for depression, GAD-7 for anxiety, AUDIT-C for alcohol, C-SSRS concepts for suicide risk) and when to escalate. Understand diagnostic criteria for major depressive disorder (five or more symptoms for two weeks, including depressed mood or anhedonia) and the distinction from bipolar disorder-screening for mania before starting antidepressants prevents treatment-emergent mania. Know first-line pharmacotherapy (SSRIs for depression and anxiety), time to response (4–6 weeks), and the black-box warning about suicidality in youth. Recognize substance withdrawal syndromes and their management (e.g., benzodiazepines for alcohol withdrawal).
Traps
- Starting an antidepressant without screening for bipolar disorder.
- Missing medical mimics of psychiatric symptoms: hypothyroidism, anemia, B12 deficiency, substance use, and delirium.
- Underestimating suicide risk-ask directly about ideation, plan, and means; means restriction saves lives.
- Confusing serotonin syndrome (clonus, hyperreflexia, agitation) with neuroleptic malignant syndrome (rigidity, hyperthermia, autonomic instability).
Worked example / rule of thumb
A 24-year-old with two weeks of anhedonia, insomnia, poor concentration, and passive suicidal ideation: screen for mania, assess safety and means, start an SSRI with close follow-up, and refer to therapy. Rule of thumb: ask about suicide directly-it does not increase risk.
Substance use
Brief intervention (motivational interviewing) is effective; know that alcohol withdrawal can be life-threatening and is treated with benzodiazepines and thiamine.