Course Objectives

The spirit of the Evidence-Based Mental Health (EBMH) course is to facilitate the skills and habits that promote lifelong evidence-based clinical practices, while fostering inter-disciplinary communication and collaboration. The course is organized into “lectures,” presented by invited faculty and “presentations” by participating trainees. A gamut of disorders seen both in childhood and adulthood are covered in a lifespan format.

Course Audience & Attendance Policy

The course is attended by Psychology Interns, General Psychiatry Residents at the PGY-III and PGY-IV level, and Year-1 Child & Adolescent Psychiatry Fellows. Timely attendance is mandatory. Trainees may not enter the classroom more than ten minutes late and repeated absences will be reviewed with the respective training director.

Lectures

Invited instructors will cover broad topics, mostly organized by disorder states, but also by core topics (e.g. gender development and identity, cross-cultural competence.)

Instructors will cover each topic mindful of the audience in attendance. Each lecture will last 55 minutes, including a few minutes for discussion. Which will mean, at an advanced level and in an applied format. The instructors will share their thought processes in considering relevant evidence-based treatments applied to the population served by UMDNJ. Etiology and epidemiology will be only briefly covered, while diagnostic and treatment practices will be supported by readings of evidence-based practices. The readings for each lecture are posted at http://childpsychiatryfellowship.info/NJMS-CAP/EBMH.html. Instructors may elect to add further reading. While instructors will be drawn from varying backgrounds, each will offer the best evidence from an interdisciplinary perspective (e.g. somatic and psychotherapies.)

Presentations

To the extent possible, each psychology intern will be matched with a resident or fellow, to prepare a case-based presentation. The recommended format is below. With the help of a mentor, each team of presenters is to identify an “answerable question,” that is a diagnostic or treatment question for which  evidence will be sought with intent to apply to a real-life case. The presentation is strictly to be oral and may not be supported with a PowerPoint presentation, nor read from a piece of paper. It is not the intent of this presentation to review broad diagnosis or treatment of the disorder or topic. The presentation should foster thought and discussion in addressing questions that arise from actual cases in treatment. The presentation should offer the steps taken to gather evidence that supports the choices made. The question format and research tools will be covered in the first few lectures of the course.

Mentoring

At least two weeks before the presentation is due, the presenting team should arrange to meet with their mentor. This is before any research is done and possibly even before patients have been picked. The mentor will help identify an appropriate case and formulate a question. There needs to be at least a second meeting, to which the “evidence” should be brought for discussion with the mentor.

Case Presentation Format

Introduction

The mental health history should include: demographics, chief complaint, history of the present illness, past psychiatric history, past medical history and review of systems, past personal history, and family history. A mental status exam, physical exam, impression and plan are also included in the initial patient evaluation. Further elaboration of each of these is as follows:

Demographics

Age, sex, religion, marital status, means of support, educational level, where and when with whom is the patient living and how the patient was brought to the hospital. Include primary psychiatric diagnosis if known, current care in one line and number of psychiatric admissions (with number of your own hospital’s admissions).

Chief Complaint

A brief statement in the patient’s words or behavior that best illustrates the reason for admission.

History of Present Illness

A chronological development of symptoms portrayed in a syndromal pattern beginning with the patients last period of usual functioning. This should include pertinent positives and negatives to illustrate diagnoses being considered or ruled out, present medications, outpatient therapy and drug and/or alcohol use.

Past Mental Health History

This should begin with the last psychiatric hospitalization and include all past psychiatric hospitalizations, dates of admission, length of stays, chief complaint on each admission, and response to various interventions (be specific). Significant outpatient therapy and intervention should also be included in a chronological fashion as well as past history of alcohol and drug use.

Past Medical History

The should include pertinent positives and negatives to include: hypertension, diabetes, tuberculosis, hepatitis, AIDS, epilepsy, heart disease, liver disease, kidney disease, medical hospitalizations, surgical procedures, present medications, and allergies/drug sensitivities.

Past Personal History

Beginning with the date of birth describe chronological development along three lines: a) intimate relationships to include family and sexual/marital history, b) social relations to include friends, acquaintances and ability to interact with others, and c) sublimatory capacity through a description of school and work. The quality of the above relationships is investigated in this part of the history. In addition, a history of separation, abuse, early trauma and a description of family members is also included.

Family Medical and Mental Health History

An elaboration of any of the following, biological relatives: bipolar disorder, depression, Alzheimer's, schizophrenia, alcohol or drug use and abuse, antisocial, gives of people or borderline personality disorders, suicide (violent or nonviolent), and psychiatric hospitalizations. In addition, response of any of the above two previous interventions should be noted.

Mental Status Exam (MSE)

Please present a coherent overview of the patient's mental status, so as to include pertinent positive and negative findings. This does not necessarily represent a mental status during a single point in time, but rather may include elements over a discrete period. The MSE describes present symptoms, signs and behavior only. It's basic format consists of: general appearance (hygiene, manner, dress, movements, attitude, etc.) speech (rate, rhythm, pressure, etc.) state of consciousness and orientation affect/mood stream of consciousness (loosening of associations, flight of ideas, circumstantiality, tangentiality) content of consciousness (delusions, ideas of reference, paranoid ideation, suicidal ideation, etc.) perceptual disturbances (delusions, hallucinations, etc.) memory (immediate, recent, remote) concentration intelligence (fund of knowledge, calculations, etc.) abstraction (proverbs, similarities) insight (general and specific) judgment (by history and by formal testing)

Impression

The impression should include a DSM-IV five-axis diagnosis as well as a brief dynamic or psychosocial formulation.