NCMHCE cheat sheet

DSM-5 eliminated the five-axis system; psychosocial stressors and disability are recorded through separate notations (V/Z codes and the WHODAS 2.0).

Most DSM-5 diagnoses require clinically significant distress or impairment in social, occupational, or other important areas of functioning as an explicit criterion.

Major depressive episode = 5 or more of 9 symptoms for at least 2 weeks, including at least one of depressed mood or loss of interest/pleasure.

Manic episode = elevated, expansive, or irritable mood plus increased energy for at least 1 week (any duration if hospitalization is required), with 3 or more symptoms (4 if mood is only irritable).

Substance use disorder severity by criteria met in 12 months: 2-3 mild, 4-5 moderate, 6 or more severe.

PTSD requires exposure to actual or threatened death, serious injury, or sexual violence plus symptoms lasting more than 1 month across four clusters: intrusion, avoidance, negative cognitions/mood, arousal-reactivity.

Panic attack = abrupt surge peaking within minutes with 4 or more of 13 symptoms; 'with panic attacks' functions as a specifier across multiple diagnoses.

PHQ-9 total score bands: 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20 or above severe; 10 or above typically triggers full diagnostic evaluation.

Diagnostic hierarchy rule: rule out substance/medication-induced and other-medical-condition etiologies before assigning a primary mental disorder.

Case conceptualization 4 Ps: predisposing, precipitating, perpetuating, and protective factors.

Treatment plan elements: presenting problem with DSM-5 diagnosis, measurable goals, objectives, interventions, timeframe, and evaluation method.

SMART goals = Specific, Measurable, Achievable, Relevant, Time-bound; objectives are the smaller steps that build toward each goal.

Prochaska and DiClemente stages: precontemplation, contemplation, preparation, action, maintenance; relapse recycles the client to an earlier stage.

CBT formulation chain: core beliefs produce intermediate beliefs/rules, which produce automatic thoughts, which drive emotions and behaviors.

ASAM Criteria use six dimensions (withdrawal potential, medical conditions, emotional/behavioral/cognitive conditions, readiness to change, relapse potential, recovery environment) to assign level of care.

ADDRESSING framework (Hays): Age, Developmental disability, Disability acquired, Religion, Ethnicity, Socioeconomic status, Sexual orientation, Indigenous heritage, National origin, Gender.

Measurement-based care: administer standardized measures (PHQ-9, GAD-7, ORS) at intake and intervals, and revise the plan when scores fail to improve.

Lapse versus relapse: a lapse is an initial return to the behavior, relapse is a full return to the prior pattern; relapse-prevention plans target high-risk situations and coping responses.

Core CBT interventions: cognitive restructuring, behavioral activation, exposure with response prevention, and skills training; typical course is 12-20 sessions.

DBT (Linehan) four skill modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.

Motivational interviewing uses OARS (open questions, affirmations, reflections, summaries) and evokes change talk summarized as DARN-CAT.

Rogers' person-centered core conditions: unconditional positive regard, accurate empathic understanding, and congruence/genuineness.

Exposure therapy depends on habituation, achieved through repeated prolonged contact with the feared stimulus without avoidance; response prevention blocks rituals in OCD.

Solution-focused techniques: miracle question, scaling questions, exception finding, and compliments.

Structural family therapy (Minuchin) targets boundaries, hierarchy, and enmeshment; Bowen therapy targets differentiation, triangles, and multigenerational genograms.

Yalom group therapeutic factors include universality, instillation of hope, altruism, corrective recapitulation of the primary family, and interpersonal learning.

Roberts' seven-stage crisis intervention: assess lethality, establish rapport, identify problems, deal with feelings, explore alternatives, develop an action plan, follow up.

ACA Code of Ethics sections A-I: Counseling Relationship; Confidentiality and Privacy; Professional Responsibility; Relationships with Other Professionals; Evaluation, Assessment, and Interpretation; Supervision, Training, and Teaching; Research and Publication; Distance Counseling, Technology, and Social Media; Resolving Ethical Issues.

Tarasoff v. Regents (1976) established the duty to protect or warn identifiable third parties when a client presents a serious threat of violence.

Confidentiality exceptions: imminent danger to self or others, suspected child/elder/dependent adult abuse, valid court order, and client-signed release.

ACA prohibits sexual or romantic relationships with former clients for at least 5 years after professional termination, and such relationships remain ethically risky thereafter.

A boundary crossing is a deviation from standard practice that may be harmless or clinically useful; a boundary violation is exploitative or harmful and is never acceptable.

HIPAA Privacy Rule applies the minimum necessary standard to uses and disclosures of PHI; 18 identifier categories define de-identified data.

42 CFR Part 2 protects substance use disorder records more strictly than HIPAA and generally requires specific written consent naming the recipient.

Privilege belongs to the client, not the counselor; a subpoena alone does not override privilege absent client consent or a court order.

Informed consent covers nature of services, techniques, risks and benefits, alternatives, right to withdraw, fees, confidentiality limits, supervision status, and records access.

SOAP note format: Subjective (client report), Objective (observable/measurable data), Assessment (clinical interpretation and diagnosis), Plan (next steps).

DAP note format: Data, Assessment, Plan; a condensed alternative used when agency policy favors brevity.

A compliant progress note records date, time, duration, modality, diagnosis, intervention delivered, client response, and plan for the next session.

Treatment plans are typically reviewed and updated at least every 90 days, or sooner when goals are met or the clinical picture changes, per common payer and accreditation standards.

A valid release of information identifies client, specific information released, recipient, purpose, expiration date, and signature; it is revocable in writing.

CPT codes: 90791 diagnostic intake, 90834 45-minute psychotherapy, 90837 60-minute psychotherapy, 90853 group psychotherapy.

Discharge summary contents: reason for referral, presenting problem, diagnosis, course of treatment, progress toward goals, medications, referrals, prognosis.

Coordination of care with PCP, psychiatrist, school, or probation requires a signed ROI before any PHI is shared.

Documenting no-shows, cancellations, and the clinical rationale for referrals supports continuity of care and risk management.