Psychosocial and Behavioral Health
This domain covers the psychological, social, and behavioral factors that shape health: mental health conditions, substance use, cognitive impairment, caregiver stress, social determinants (housing, food, transportation, finances), and health behavior change. Know the biopsychosocial model and screen for depression (PHQ), anxiety, cognitive status, and substance use using validated tools.
Understand motivational interviewing (OARS: open questions, affirmations, reflections, summaries; elicit change talk; avoid the righting reflex). Recognize stages of change (precontemplation, contemplation, preparation, action, maintenance, relapse) and match intervention to stage - a frequent question type. Know harm reduction as a legitimate approach for substance use. Distinguish delirium (acute, fluctuating, inattention) from dementia (chronic, progressive) and depression (mood with cognitive effects).
Traps: confronting or lecturing a patient in precontemplation; labeling behavior as nonadherence without exploring barriers; missing depression or cognitive impairment that mimics nonadherence; ignoring caregiver burden; and treating social needs as outside the care plan. Also watch for safety: screen for suicidal ideation and intimate partner violence and know escalation pathways.
Rule of thumb: Meet the patient at their stage of change - persuasion fails before contemplation; use reflective listening and roll with resistance.
Worked example: A patient with diabetes repeatedly misses appointments. Rather than labeling them nonadherent, the CM screens for depression and transportation barriers, finds both, and addresses them - connecting to behavioral health and arranging transport - before re-approaching self-management.