MHP cheat sheet

The DSM-5-TR uses a categorical classification system; a diagnosis requires clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Differential diagnosis requires ruling out substance/medication-induced and medical conditions; e.g., panic attacks can be caused by hyperthyroidism or stimulant use.

The mental status exam (MSE) includes appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment.

A standard MSE does not include a formal cognitive screening score; the MMSE or MoCA is a separate instrument.

The PHQ-9 is a 9-item depression severity measure; a score of 10 or more suggests moderate depression and warrants further evaluation.

The GAD-7 is a 7-item anxiety screen; scores of 5, 10, and 15 represent mild, moderate, and severe anxiety, respectively.

The C-SSRS (Columbia Suicide Severity Rating Scale) assesses suicidal ideation and behavior; it is not a diagnostic tool for depression.

The AUDIT-C is a 3-item alcohol screen; a score of 4 or more in men (3 or more in women) is considered positive.

Intellectual disability (intellectual developmental disorder) requires deficits in intellectual functions and adaptive functioning with onset during the developmental period.

SMART goals are Specific, Measurable, Achievable, Relevant, and Time-bound; treatment plans should include measurable objectives.

The stages of change (Prochaska & DiClemente) are precontemplation, contemplation, preparation, action, and maintenance; relapse is common and not a separate stage.

Motivational interviewing (MI) uses open-ended questions, affirmations, reflective listening, and summaries (OARS).

Cognitive behavioral therapy (CBT) targets automatic thoughts and core beliefs; behavioral activation is a component for depression.

Dialectical behavior therapy (DBT) includes individual therapy, skills group, phone coaching, and therapist consultation team; skills modules are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Exposure and response prevention (ERP) is the first-line psychotherapy for obsessive-compulsive disorder.

Prolonged exposure (PE) and cognitive processing therapy (CPT) are evidence-based treatments for PTSD.

Contingency management uses tangible reinforcers for verified abstinence and is effective for stimulant use disorder.

Medication-assisted treatment (MAT) for opioid use disorder includes buprenorphine, methadone, and naltrexone.

A safety plan (Stanley-Brown) includes warning signs, coping strategies, social contacts, professional contacts, and means restriction.

Means restriction (e.g., locking firearms, removing medications) is a key suicide prevention intervention.

Risk factors for suicide include prior attempt, family history, access to lethal means, substance use, and recent loss.

Protective factors include social support, reasons for living, and engagement in treatment.

The crisis intervention model often follows Roberts' seven-stage model: assess, establish rapport, identify problems, explore feelings, generate alternatives, formulate action plan, follow-up.

De-escalation techniques include maintaining calm tone, giving space, offering choices, and avoiding arguing with delusions.

Involuntary commitment criteria generally require imminent danger to self or others or grave disability; specific laws vary by state.

Mandatory reporting of suspected child abuse or neglect overrides confidentiality; report to designated child protective services.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, and voluntariness.

Confidentiality exceptions include imminent danger to self or others (duty to warn/protect), suspected abuse/neglect, and court order.

Tarasoff v. Regents established a duty to protect identifiable third parties from a client's serious threat of violence.

HIPAA permits disclosure for treatment, payment, and operations (TPO) without authorization; psychotherapy notes require specific authorization.

Dual relationships should be avoided when they could impair objectivity or exploit the client.

Boundary crossings are not always unethical; boundary violations are harmful and often unethical.

Minors' confidentiality rights vary by state; generally, parents have access unless the minor can consent to treatment independently.

The principle of least restrictive alternative requires using the least restrictive intervention that meets the client's needs.

SOAP notes stand for Subjective, Objective, Assessment, Plan.

DAP notes stand for Data, Assessment, Plan.

Progress notes should include date, time, duration, modality, interventions, client response, and plan.

Documentation should be completed contemporaneously; late entries should be marked as such.

Corrections to records should be made with a single line, initials, date, and reason; do not erase or use correction fluid.

Records should be retained according to state law and payer requirements; common retention is 7 years after termination, longer for minors.

Release of information (ROI) requires client authorization specifying what information, to whom, for what purpose, and expiration.

Psychotherapy notes are kept separate from the medical record and have additional protections under HIPAA.

Active listening includes paraphrasing, reflecting feelings, clarifying, and summarizing.

Open-ended questions encourage elaboration; closed-ended questions elicit specific facts.

Reflections in motivational interviewing can be simple or complex; complex reflections add meaning.

The communication loop includes sender, message, medium, receiver, and feedback.

Transference is the client's projection of feelings onto the clinician; countertransference is the clinician's emotional reaction to the client.

Cultural humility involves lifelong learning, self-reflection, and addressing power imbalances.

Use of professional interpreters is preferred over family members for accuracy and confidentiality.

Nonverbal communication includes body language, tone, and proximity; it can reinforce or contradict verbal messages.

Major depressive disorder requires 5 or more symptoms for at least 2 weeks, including depressed mood or anhedonia.

A manic episode requires elevated/expansive or irritable mood plus increased energy for at least 1 week (or any duration if hospitalization).

Schizophrenia requires 2 or more symptoms (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms) for at least 6 months.

Panic disorder involves recurrent unexpected panic attacks and at least 1 month of worry about attacks or maladaptive behavior change.

Obsessive-compulsive disorder involves obsessions and/or compulsions that are time-consuming or cause distress/impairment.

Posttraumatic stress disorder (PTSD) requires exposure to trauma and symptoms in four clusters: intrusion, avoidance, negative cognitions/mood, and arousal/reactivity, lasting >1 month.

Generalized anxiety disorder requires excessive anxiety/worry for at least 6 months and 3 or more symptoms (only 1 in children).

Borderline personality disorder is characterized by instability in relationships, self-image, affect, and marked impulsivity.

Neuroleptic malignant syndrome includes fever, muscle rigidity, autonomic instability, and altered mental status; it is a medical emergency.

The 988 Suicide & Crisis Lifeline provides 24/7 crisis support via call, text, or chat.

Assertive Community Treatment (ACT) is a team-based, intensive service for individuals with severe mental illness; it has a low staff-to-client ratio.

Certified Community Behavioral Health Clinics (CCBHCs) provide integrated mental health and substance use services with 24/7 crisis services.

Medicaid is the largest payer for mental health services in the U.S.

The sequential intercept model maps points of interception for individuals with mental illness in the criminal justice system.

Housing First is a model that provides housing without preconditions such as sobriety.

Peer support specialists are individuals with lived experience who are trained to provide support; they are not licensed clinicians.

Telehealth can improve access but requires compliance with HIPAA and state licensure laws.