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Vanderbilt Core Clinical Curriculum

Abnormalities of Mood

Required Skills/Procedures:

1. Perform situation-appropriate (problem-focused or complete) history and physical examinations
2. Interpret clinical information to formulate a prioritized differential diagnosis
3. Guide the creation of a patient-specific management plan

Appropriate Setting: Inpatient and Outpatient

Expected level of Responsibility: Direct supervision with real patients

Learning Topics during encounters with a patient with ABNORMALITIES OF MOOD can include:

Medical Knowledge Learning Topics related to ABNORMALITIES OF MOOD

1. Signs and symptoms of mood abnormalities, and identifying when the abnormality of mood is indicative of a mood disorder
2. Clinical features that help distinguish normal grief reaction from a mood disorder
3. Clinical features that help differentiate one form of mood disorder from another (DSM IV TR) including: adjustment disorder with depressed mood, dysthymia, major depressive disorder, bipolar disorders, substance-induced mood disorders, mood disorder secondary to general medical condition, cyclothymia.
4. Risk factors for suicide and their presence or absence in patients with mood disorders. Planning for what should be done if risk factors are present
5. Role of neuropsychological studies in the evaluation of patients with mood disorder; including determination if neuropsychological studies are appropriate for patients that are seen with mood disorders, taking into account indications, limitations, and cost
6. Morbidity and mortality of the various mood disorders, including the impact upon the management of primary medical disorders
7. Epidemiology of mood disorders, including prevalence, incidence, and socio-economic features
8. Biological (including genetic) and environmental bases of the mood disorder of the patient

Diagnostic Evaluation Learning Topics related to ABNORMALITIES OF MOOD

1. Age-appropriate medical history
2. Complete mental status examination, including when appropriate a mini-mental status exam
3. Neurological examination
4. Recommendations regarding when to order the following neuropsychiatric and laboratory tests (both prior to and after initiating treatment), based on the differential diagnosis, including justification for ordering and interpretation of the results (with consultation). Testing includes thyroid function tests, urine drug screen, BMP, CMP, CBC, lipid profile, serum iron, serum B12, EEG, MRI, CT scan, neuropsychological testing, lead level, prolactin level, urinalysis and specific gravity, and EKG.
5. Differential diagnosis, recognizing specific history and testing results that suggest a form of mood disorder

Management Plan Learning Topics related to ABNORMALITIES OF MOOD

1. Determination of appropriate treatment plans for each form of mood disorder, including explanation of indications for the following aspects of a treatment plan:

  • psychopharmacology
  • psychotherapy
  • inpatient vs. outpatient treatment setting
  • coordination with primary care physician or referral to/management by a psychiatrist
  • utilization of community resources
  • advocacy for patients with mood disorders who are lacking the energy and motivation to address the mood disorder and the primary medical disorders

2. Impact of medical co-morbidities on developing a differential diagnosis and determining a patient’s specific problem, as well as provision of appropriate treatment for the medical co-morbidities
3. Communication of information about the disorder to the patient and family, including prognosis for a patient with a mood disorder to the patient and family (as appropriate) in a caring and compassionate manner
4. Preventive measures after stabilization, such as stress management and supportive therapy
5. Professional behavior and appropriate attitudes, including appreciation of:

  • disruption in life when abnormalities of mood occur
  • negative impact that mood abnormalities have on medical illness
  • significant morbidity and mortality that can occur in individuals with mood disorders
  • challenges that patients with mood disorders face in terms of access to resources, cognitive challenges in maneuvering the medical system given the impact of mood disorders on executive functioning, and sense of hopelessness and loss of motivation that may be cardinal symptoms of the mood disorder disease itself
  • disparities in resources available to treat mood disorders and the impact upon the care available to the patients
  • vulnerability of patients struggling with mood disorders

6. Significance of transference and countertransference in the doctor patient relationship, specifically recognizing how your reaction to a patient can affect the care provided to the patient.

Potential Differential Diagnosis Topics Include:

  • adjustment disorder with depressed mood
  • cyclothymia
  • dysthymia
  • major depressive disorder
  • bipolar disorder
  • substance-induced mood disorders
  • mood disorder secondary to general medical condition