BH sim

Behavioral Health Simulation History of Present Illness (HPI) Introduction

• Introduction of Examiner

  • Introduce yourself and the presence of 2 observers.

• Patient Verification

  • Verify correct patient by checking:
  • Patient's initials
  • Last four digits of Social Security Number (SSN)
  • Date of Birth (DOB)

• Reliability Assessment

  • Conduct the Mini Mental State Examination (MMSE) for reliability:
  • “[…] I have a few questions to go over with you prior to talking about what brought you in today. Is that okay?”

Orientation Questions (MMSE)

• Date Orientation
  • Ask:
  • “What is the year?”
  • “What season is it?”
  • “What date is it?”
  • “What day of the week is it?”
  • “What month is it?”
• Place Orientation
  • Ask:
  • “Where are we now?”
  • “What state/country/town/city?”
  • “What hospital/building/floor?”

Registration (MMSE)

• Word Repetition Task
  • “I am going to say 3 words and I would like you to repeat them back to me: dog, ball, tree.”
  • Note: Record how many trials it takes for the patient to repeat them back correctly.

Attention/Calculation (MMSE)

• Backwards Counting Task
  • “I would like you to count backward from 100 in intervals of 7.”
  • Sample sequence: 93, 86, 79, 72, 65
• Alternative Task
  • “Can you please spell WORLD backwards?”

Recall (MMSE)

• Memory Recall Task
  • “Earlier I told you the names of 3 things. Can you remember what they were?”
  • “Can you name the last 3 presidents?”

Language (MMSE)

• Object Naming Task
  • Show the patient 2 simple objects and ask them to name them.
• Phrase Repetition Task
  • “Can you please repeat the phrase: No ifs, ands, or buts.”
• Command Following Task
  • “Take the paper in your right hand, fold it in half, and put it on the floor.”
• Sentence Creation Task
  • “Make up and write a sentence about anything”
  • Must contain both a noun and a verb.
• Reading Instruction Task
  • “Please read #2 and do what it says.”
  • Instructions located on a piece of paper.

Visual-Spatial (MMSE)

• Copy Task
  • “Please copy the picture under #3.”
  • All 10 angles must be present, and at least 2 must intersect.

Scoring (MMSE)

• Inform the proctor of the MMSE exam score (x/30).
• If the patient loses any points, must inform the proctor of the specific items lost.

OPPQRST Assessment Framework

• Onset

  • Assess: Why is the patient here today?
  • When did the symptoms start?
  • What were they doing when the symptoms began?
  • Did symptoms start suddenly or gradually?

• Provocation

  • Inquiry: Does anything make the symptoms worse?

• Palliation

  • Inquiry: Does anything improve the symptoms? Have they tried anything else?

• Quality

  • Ask: Can the patient describe how they are feeling?

• Radiation

  • Assess: Have these feelings affected their ability to perform at work or school?
  • Have they affected home activities or personal relationships?

• Severity

  • Ask for a symptom rating on a scale of 1-10.

• Timing

  • Inquiry: Are the symptoms constant, or do they come and go?
  • Since the symptoms started, have they worsened, improved, or remained the same?
  • Have they ever experienced anything like this before?

SIGECAPSS Depression Assessment

• Sadness
  • “Have you had any increased feelings of sadness?”
• Interest
  • “Have you had reduced interest in your normal activities?”
• Guilt
  • “Are you experiencing any feelings of guilt?”
• Energy
  • “Have you had decreased energy?”
• Concentration
  • “Have you noticed a change in your ability to concentrate on tasks?”
• Appetite
  • “Have you had a change in your appetite?”
• Psychomotor
  • “Have you had any restlessness or feeling like you are moving slower than normal?”
• Sleep
  • “Have you had any changes in your sleep patterns or habits?”
• Suicide
  • “Have you had any thoughts or plans of harming yourself?”

DIGFAST Mania Assessment

• Distractibility
  • “Do you feel distracted by unimportant things?”
• Insomnia
  • “Are you having decreased needs for sleep?”
• Grandiosity
  • “Do you feel as though you have an inflated view of yourself?”
• Flight of Ideas
  • “Do you have any racing thoughts?”
• Activity Increase
  • “Are you having an increase in goal-directed activities or agitation?”
• Spending/Sexual Indiscretion
  • “Are you having more spending sprees or sexual indiscretions?”
• Talkativeness
  • “Do you feel like you are talking more than usual?”

Pertinent Questions

• Hopelessness Assessment
  • “I’m going to have you rate the following on a scale of 1-10: Hopelessness, Anxiousness, Sadness, Energy.”
• Inquiries regarding:
  • Panic attacks
  • Hallucinations
  • Delusions
  • Traumatic experiences
  • Thoughts of self-harm or harming others.
  • If positive, further inquire:
  • “Do you have a plan?”
  • “When do you intend to do it?”
  • “Do you have the means to do it?”

Ensure Patient Reflects Time

• Consult Form Request

  • Ask the proctor for a consult form, which includes:
  • Past Medical History (PMH)
  • Medications
  • Allergies
  • Reactions
  • Family History (FH)
  • Social History (SH)
  • Physical exam findings
  • Diagnostic labs/tests

• Questionnaire Selection

  • Based on patient’s history, request one of the following questionnaires:
  • Leahy Anxiety (acute stress, panic, and adjustment disorders)
  • GAD-7 (Generalized Anxiety Disorder)
  • Social Anxiety Questionnaire (social anxiety disorder)
  • PHQ-9 (Major Depressive Disorder, Persistent Depressive Disorder, Bipolar I)
  • PTSD Questionnaire (Post-Traumatic Stress Disorder)

Assessment & Plan

• Diagnosis Development
  • Develop diagnosis and assess severity level.
  • Determine inpatient vs. outpatient status.
  • Discuss the plan with the patient:
  • Pharmacological options
  • Non-pharmacological options
  • Diagnostic studies needed?
  • Follow-up scheduling
  • Referrals as necessary
  • Patient education regarding condition and treatment.