MCM Pre-Internship Exam cheat sheet

DSM-5-TR requires symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning for most disorders.

Major depressive episode: 5+ of 9 symptoms for at least 2 weeks, including depressed mood or anhedonia; excludes mania/hypomania.

Generalized anxiety disorder: excessive worry more days than not for at least 6 months, difficult to control, with 3+ of 6 symptoms (1+ in children).

Panic attack specifier: abrupt surge peaking within minutes, with 4+ of 13 symptoms; can be expected or unexpected.

Differential diagnosis requires ruling out substance/medication-induced and medical conditions before assigning a primary psychiatric diagnosis.

Mental status exam components: appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, judgment.

Suicide risk assessment elements: ideation, plan, intent, means, prior attempts, protective factors, and access to lethal means.

Screening instruments: PHQ-9 for depression, GAD-7 for anxiety, AUDIT-C for alcohol use, C-SSRS for suicide risk.

SMART goal format: Specific, Measurable, Achievable, Relevant, Time-bound; each problem statement pairs with a measurable objective.

CBT core model: thoughts influence feelings and behaviors; interventions include cognitive restructuring, behavioral activation, and exposure.

Exposure therapy hierarchy: build fear ladder, start with low-anxiety items, progress as habituation occurs, avoid safety behaviors.

Motivational interviewing: OARS (Open questions, Affirmations, Reflections, Summaries); rolling with resistance rather than confronting.

DBT four modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness; targets reduce self-harm and improve coping.

Behavioral activation: schedule reinforcing activities and monitor mood-activity link to counter avoidance and withdrawal.

Relapse prevention plan: identify high-risk situations, coping skills, support network, and early warning signs with a written plan.

Informed consent for treatment includes nature of therapy, risks/benefits, alternatives, confidentiality limits, fees, and right to withdraw.

SSRIs first-line for depression and most anxiety disorders; onset of therapeutic effect typically 2-4 weeks, full benefit 6-8 weeks.

Serotonin syndrome triad: mental status changes, autonomic instability, neuromuscular abnormalities (clonus, hyperreflexia); risk with serotonergic combinations.

SSRI discontinuation syndrome: dizziness, flu-like symptoms, paresthesias, irritability; taper rather than abrupt stop.

Benzodiazepines: GABA-A positive modulators; risks include sedation, tolerance, dependence, respiratory depression with opioids; short-term use.

Lithium: narrow therapeutic index (roughly 0.6-1.2 mEq/L); monitor levels, renal and thyroid function; toxicity signs include tremor, ataxia, vomiting.

Antipsychotics: monitor for extrapyramidal symptoms, tardive dyskinesia, metabolic syndrome, and QT prolongation.

Bupropion lowers seizure threshold and is contraindicated in seizure disorder or eating disorders.

MAOIs require tyramine-restricted diet to prevent hypertensive crisis; avoid serotonergic drug combinations.

Informed consent requires capacity, voluntariness, disclosure of material information, and comprehension.

Confidentiality limits: imminent danger to self/others, suspected abuse/neglect of children or vulnerable adults, court order, and duty to warn/protect where applicable.

Boundary crossings become boundary violations when they exploit or harm the client or serve the clinician's needs.

Multiple relationships: avoid when they could impair objectivity or risk exploitation; document rationale if unavoidable.

Competence: practice within training and scope; seek supervision or refer when outside competence.

Ethical decision-making: identify problem, consult code and laws, consider stakeholders, consult, implement, document, evaluate.

Fees and billing must be disclosed in advance; avoid fee arrangements that create conflicts of interest.

Research ethics: IRB approval, informed consent, minimal risk, confidentiality, and right to withdraw without penalty.

Mandated reporting: clinicians must report suspected child abuse/neglect to designated agencies per state law; timing varies by jurisdiction.

Duty to protect: Tarasoff-based duties vary by state; common elements include warning identifiable victims, notifying police, and/or protective actions.

HIPAA Privacy Rule permits disclosures without authorization for treatment, payment, operations, and as required by law; minimum necessary standard applies.

42 CFR Part 2 provides stricter protection for substance use disorder records than HIPAA; requires specific consent for most disclosures.

Minor consent: age of majority and minor consent laws vary; many states allow minors to consent to certain services (e.g., substance use, mental health) at specified ages.

Subpoena vs. court order: a subpoena is a request; a court order is a legal directive; consult counsel and assert privilege where appropriate.

Privilege belongs to the client and can be waived; exceptions include client-litigated claims and court-ordered evaluations.

Record retention periods vary by state and client age; keep records for the longer of state law or payer requirement, and never less than required.

Suicide risk factors: prior attempt, access to lethal means, substance use, isolation, hopelessness, recent loss, and history of self-harm.

Protective factors: social support, reasons for living, future orientation, treatment engagement, and restricted access to means.

Safety planning components: warning signs, coping strategies, social contacts, professional resources, and means restriction.

Crisis de-escalation: ensure safety, reduce stimulation, use calm tone, validate emotion, offer choices, avoid confrontation.

Emergency evaluation indications: imminent risk to self/others, acute psychosis, severe intoxication, or inability to care for self.

Documentation of risk assessment includes the questions asked, responses, risk formulation, actions taken, and follow-up plan.

Postvention: support after a suicide or critical incident; monitor close contacts and provide resources and follow-up.

Mandatory hold criteria vary by state but generally require mental illness plus danger to self/others or grave disability.

Cultural formulation interview domains: cultural identity, cultural conceptualizations of distress, psychosocial stressors, cultural features of the clinician-client relationship, and overall cultural assessment.

Idioms of distress are culturally specific ways of expressing suffering (e.g., somatic complaints) that may not map to DSM criteria.

Cultural syndromes: clusters of symptoms recognized within a cultural group; distinguish from delusions or malingering.

Language access: use qualified interpreters, not family members, for clinical communication; document interpreter use.

Implicit bias can affect diagnosis and treatment; use structured assessment and reflect on cultural assumptions.

Acculturation stress and minority stress (e.g., discrimination, stigma) contribute to mental health disparities.

Spiritual and religious beliefs may shape symptom presentation and treatment preferences; assess and integrate respectfully.

Avoid overpathologizing culturally normative behavior; consider context, norms, and functional impairment.

Evidence hierarchy: systematic reviews/meta-analyses > randomized controlled trials > cohort > case-control > case series > expert opinion.

Internal validity threats: selection bias, attrition, confounding, instrumentation, and maturation.

Reliability vs. validity: reliability is consistency; validity is accuracy of measuring the intended construct.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence; a test with high sensitivity can have low PPV in low-prevalence settings.

Effect size (e.g., Cohen's d): small ~0.2, medium ~0.5, large ~0.8.

p-value is the probability of data as extreme or more, assuming the null is true; it is not the probability the null is true.

Evidence-based practice integrates best research evidence, clinical expertise, and client values and preferences.

SOAP note format: Subjective, Objective, Assessment, Plan; each section should be specific and measurable.

Progress notes should link to treatment plan goals and document interventions, client response, and next steps.

Documentation must be timely, accurate, legible, and free of subjective judgments or derogatory language.

Corrections: draw a single line through errors, write 'error' and initials/date; never obliterate or use correction fluid.

Release of information requires client authorization specifying recipient, purpose, information to be disclosed, and expiration.

Minimum necessary standard: disclose only the information needed for the purpose.

Security: store records securely, encrypt electronic records, and follow breach notification requirements.

Record content includes assessment, diagnosis, treatment plan, progress notes, consent forms, and termination summary.

Supervision contract should define goals, roles, expectations, evaluation methods, and due process.

Supervisor responsibilities: ensure client welfare, monitor supervisee competence, and gatekeep the profession.

Supervisee should disclose limits of competence and seek consultation when cases exceed training.

Documentation of supervision includes dates, topics, recommendations, and supervisee progress.

Parallel process: supervisee-client dynamics may mirror supervisor-supervisee dynamics; use as a reflective tool.

Consultation differs from supervision: consultant advises but retains no legal responsibility for the client.

Feedback should be specific, behavioral, timely, and paired with a plan for improvement.

Boundary issues in supervision: avoid dual relationships, romantic relationships, and exploitation; maintain clear role boundaries.