COCAS cheat sheet

DSM-5-TR uses a categorical approach with criteria sets; diagnosis requires clinical significance and rule-out of substance/medical causes.

Differential diagnosis: consider medical conditions, substance use, and other mental disorders before assigning a primary diagnosis.

Cultural Formulation Interview (CFI) is a 16-question tool to assess cultural factors in diagnosis.

Reliability: inter-rater reliability is improved with structured interviews (e.g., SCID-5).

Validity: a diagnosis is valid if it reflects the true condition; DSM focuses on descriptive validity.

Comorbidity is common; DSM-5-TR allows multiple diagnoses when criteria are met.

Specifiers (e.g., with anxious distress, with mixed features) provide additional clinical detail.

Severity specifiers (mild, moderate, severe) are used for some disorders (e.g., major depressive disorder).

Cognitive model: thoughts influence emotions and behaviors; interventions target maladaptive cognitions.

Behavioral activation: increase engagement in rewarding activities to improve mood.

Cognitive restructuring: identify and challenge cognitive distortions (e.g., all-or-nothing thinking).

Exposure therapy: gradual, repeated exposure to feared stimuli to reduce anxiety through habituation.

Homework assignments are a core component; they extend therapy beyond sessions.

Socratic questioning: guide clients to examine evidence for and against their beliefs.

Behavioral experiments: test the validity of beliefs through real-world actions.

Relapse prevention: identify high-risk situations and develop coping strategies.

SSRIs: first-line for depression/anxiety; common side effects include GI upset, sexual dysfunction, and serotonin syndrome risk.

Benzodiazepines: short-term use for anxiety; risk of dependence and withdrawal; avoid in substance use disorders.

Antipsychotics: treat psychosis; monitor for metabolic syndrome and extrapyramidal symptoms.

Mood stabilizers (lithium, valproate): require blood level monitoring; lithium has narrow therapeutic index.

Collaboration: obtain consent, share relevant information, and clarify roles with prescribing providers.

Medication adherence: assess barriers and use motivational interviewing to address ambivalence.

Serotonin syndrome: symptoms include agitation, hyperthermia, tremor; emergency medical attention required.

Neuroleptic malignant syndrome: rare but life-threatening; symptoms include rigidity, fever, autonomic instability.

Informed consent: provide information about nature of therapy, risks, benefits, alternatives, and right to withdraw.

Confidentiality: protect client information; exceptions include danger to self/others, child/elder abuse, and court order.

Tarasoff duty: duty to warn/protect identifiable third parties from serious threats of violence.

Boundaries: avoid dual relationships that could impair objectivity or exploit clients.

Record keeping: maintain accurate records; store securely; retain per state law and ethical guidelines.

Competence: practice within boundaries of training and experience; seek supervision or refer when needed.

Mandated reporting: report suspected child abuse or neglect to designated authorities.

Ethical decision-making: consult ethical codes, laws, colleagues, and supervision when facing dilemmas.

Evidence-based practice: integrate best available research, clinical expertise, and client values.

Randomized controlled trial (RCT): gold standard for establishing causality; random assignment and control group.

Effect size: quantifies strength of treatment effect; Cohen's d (0.2 small, 0.5 medium, 0.8 large).

Internal validity: extent to which changes are due to intervention; threatened by confounding variables.

External validity: generalizability of findings to other populations/settings.

Meta-analysis: statistically combines results from multiple studies to estimate overall effect.

Statistical significance (p < .05) does not imply clinical significance; consider effect size and meaningful change.

Single-case designs: useful for evaluating interventions in practice (e.g., multiple baseline).

Cultural competence: awareness of own biases, knowledge of client's culture, and skills for culturally adapted interventions.

Cultural humility: lifelong commitment to self-reflection and recognizing power imbalances.

Microaggressions: subtle, often unintentional slights that communicate hostility or denigration toward marginalized groups.

Health disparities: racial/ethnic minorities often receive lower quality care and face barriers to access.

Acculturation: process of adapting to a new culture; can affect symptom presentation and help-seeking.

Use of interpreters: trained interpreters, not family members, to ensure accuracy and confidentiality.

Social determinants of health: income, education, neighborhood, and discrimination impact mental health.

Cultural formulation: assess cultural identity, explanations of illness, stressors, and treatment preferences.

Supervision: ensures quality of care, professional development, and gatekeeping for the profession.

Supervisory relationship: build trust, provide feedback, and evaluate progress; avoid dual relationships.

Competency-based supervision: identify specific skills, observe, provide feedback, and assess outcomes.

Consultation: seek expert advice; consultant does not have direct responsibility for client care.

Record supervision: document dates, topics, recommendations, and supervisee progress.

Ethical issues in supervision: informed consent for supervision, confidentiality, and due process for remediation.

Cultural humility in supervision: address power dynamics and cultural differences in the supervisory dyad.

Training: use deliberate practice and feedback to develop clinical skills.

Business plan: outline services, target market, financial projections, and marketing strategy.

Fee setting: consider overhead, insurance reimbursement, and sliding scale options.

Insurance: credentialing with panels, verify benefits, and submit claims accurately.

Documentation: maintain progress notes, treatment plans, and release of information forms.

Risk management: professional liability insurance, informed consent, and emergency protocols.

HIPAA: protect PHI; ensure secure communication and storage; provide Notice of Privacy Practices.

Billing: use CPT codes (e.g., 90837 for 60-minute psychotherapy) and document medical necessity.

Marketing: comply with ethical guidelines; avoid testimonials that could mislead.