Assessment Tools Flashcards
CAGE used for? 4 questions
Quick tool to assess problem drinking
- Have you felt the need to CUT down on your drinking?
- Do you feel ANNOYED by people complaining about your drinking?
- Do you ever feel GUILTY about your drinking?
- Do you ever feel the need to drink an EYE-opener?
= CAGE
Audit C used for? Questions asked?
Audit C used for active alcohol use disorders - short version of full audit assessment
- How often do you have a drink containing alcohol?
a) Never b) monthly or less c) 2-4x/mo d) 4/more/wk - How many standard drinks containing alcohol do you have on a typical day?
a) 1/2 b) 3/4 c) 5/6 d) 7/9 or more - How often do you have six or more drinks on one occasion?
a) never b) less than monthly c) monthly d) weekly e) daily or almost daily
a = 0 points, b = 1 point, c = 2 points d = 3 points, e = 4 points
Men 4+ = drinking problem
Women 3 + = drinking problem
What is PHQ-2? What is it used for?
PHQ-2 = patient health questionnaire-2 - short version of PHQ-9
Used to assess depression - answer each question with: 0 - not at all 1 - several days 2 - more than half the days 3 - nearly every day
Question 1: Little interest or pleasure in doing things
Question 2: Feeling down, depressed or hopeless
Score of 3 is the cutoff. Score >3, do the full PHQ-9
What is the GAD-7?
Brief measure of assessing generalized anxiety disorder.
Answer each question:
0 - not at all, 1 - several days, 2 - more than half days, 3 - nearly every day
Questions:
- Nervous, anxious
- Can’t control worrying
- Worry too much about different things
- Trouble relaxing
- Restless
- Easily annoyed/irritated
- Feeling afraid as if something awful might happen
What is the PHQ-9 used for ? What are the 9 questions asking? Scoring system?
Assesses for depression
Questions:
- Anhedonia?
- Depressed/hopeless?
- Sleep issues
- Low energy
- Feel bad about self?
- Trouble concentrating?
- Moving slowly or restless
- Think you’d be better off dead
- Poor appetite, overeating
Scoring: 1-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderate-severe, 20-27 severe
What is the MoCA? What is it used for?
Montreal cognitive assessment
Picks up early cognitive issues - especially in the elderly. Get baseline, reassess in 1 year etc.
Top score = 30. <26 is concerning. 8th grade edu or earlier can complete.
Tasks: Copy cube, draw clock, name animals drawn on paper, remember 3 words, subtraction, delayed recall
Extra psych-specific questions to ask during evaluation from each section
Psych history - Been hospitalized before? Current or past history suicidal, homicidal, or assaultive thoughts or actions
Social - alcohol/drug use? type of last use? prior urine tox/BAL results? Family structure? Education? Support network?
Current treatment providers?
Mental status exam - orientation (a&ox3), appearance, mood, affect, speech, thought process, thought content, cognitive function, impulse control
Mental status exam parts
Orientation Appearance Build Body movements Behavior Mood Affect Speech
Mental Status Exam: Orientation
Alert and oriented x3 means to place, time and date
Mental Status Exam: Appearance
Well groomed vs... Neat Disheveled Unkempt Malodorous Appropriate
Mental Status Exam: Build
Thin, overweight, short, average, tall
Mental Status Exam: Posture
Slumped, rigid, tense, atypical
Mental Status Exam: Body movments
Restless, vs slow, vs peculiar
Mental Status Exam: Behavior
Cooperative vs agitated, catatonic, compulsive, withdrawn, friendly, guarded, hostile, hyper-sexual, disinhibited
Mental Status Exam: Mood
Angry, anhedonia, anxious, depressed, empty, euphoric, guilty, irritable, lablie, sad, manic, hypomanic
Mental Status Exam: Affect
Congruent with mood, mormal range, appropriate, flat, expansive
Mental Status Exam: Speech
WNL, unintelligible, word salad, stammering, mute, loud
Normal thought process vs abnormal thought process
Linear and goal directed = normal
Abnormal = disorganized, loose, racing, tangental, chaotic
Words to describe insight
Good - fair - poor - impaired - WNL
How well does the pt appreciate their current circumstances or state and can they negotiate the social and physical transactions of life given current mental state?
Words to describe judgement
Good - fair - poor - tenuous
Words to describe impulse control
In control, no issues noted, tenuous