Mastering the cognitive knowledge within a field such as psychiatry is a formidable task. It is even more difficult to draw on that knowledge, procure and filter through the clinical data, develop a differential diagnosis, and finally form a rational treatment plan. To gain these skills, the student often learns best by directly interviewing patients, guided and instructed by experienced teachers and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education at the patient’s side. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is to prepare carefully crafted cases designed to simulate the clinical approach and decision making. In an attempt to achieve this goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches relevant to psychiatry. Most important, the explanations for the cases emphasize mechanisms and underlying principles rather than merely rote questions and answers.

This book is organized for versatility: to allow the student “in a rush” to read the scenarios quickly and check the corresponding answers, as well as to provide more detailed information for the student who wants thought-provoking explanations. The answers are arranged from simple to complex: a summary of the pertinent points, the bare answers, an analysis of the case, an approach to the topic, case correlations allowing for easily accessible comparisons among similar cases, a comprehension test at the end for reinforcement and emphasis, and a list of resources for further reading. A listing of cases is included in the front matter to aid students who desire to test their knowledge of a certain area or to review a topic, including the basic definitions. Several multiple-choice questions are included at the end of each scenario to reinforce concepts or introduce related topics.

HOW TO GET THE MOST OUT OF THIS BOOK

Each case is designed to simulate a patient encounter by using open-ended questions. At times, the patient’s complaint differs from the issue of greatest concern, and sometimes extraneous information is given. The answers are organized into four different parts, as follows.

PART I

1. A Summary: The salient aspects of the case are identified, filtering out extraneous information. The student should formulate a summary of the case before looking at the answers. This is in bullet form now. A comparison with the summation appearing in the answer will help improve the student’s ability to focus on the important data while appropriately discarding irrelevant information, a fundamental skill required in clinical problem solving.

2. A Straightforward Answer to each open-ended question.

3. An Analysis of the Case consisting of two parts:

   1. Objectives: A listing of the two or three main principles that are crucial for a practitioner in treating the patient. Again, the student is challenged to make “educated guesses” about the objectives of the case on initial review of the case scenario, which helps sharpen his or her clinical and analytical skills. We have included the entrustable professional activities (EPA) corresponding to the objective for instructors and curriculum overseers (see Table 1).

   2. Considerations: A discussion of the relevant points and a brief approach to the specific patient.

PART II

An Approach to the Disease Process consisting of three distinct parts:

1. Definitions: Terminology pertinent to the disease process.

2. Clinical Approach: A discussion of the approach to the clinical problem in general, including tables and figures.

3. Case Correlation: A handy reference to other relevant cases in the book.

PART III

Comprehension Questions: Each case contains several multiple-choice questions that reinforce the material presented or introduce new and related concepts. Questions about material not found in the text are explained in the answers.

PART IV

Clinical Pearls: A listing of several clinically important points that are reiterated as a summation of the text and allow for easy review, such as before an examination.