Depression_Screening_and_Assessment_Flashcards

Question 1

What are the two screening questions for depression?

Answer 1

The two screening questions for depression are: ‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’ and ‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’

Question 2

What should prompt a more in-depth assessment during depression screening?

Answer 2

A ‘yes’ answer to either of the screening questions should prompt a more in-depth assessment.

Question 3

What are some tools used to assess the degree of depression?

Answer 3

Some tools used to assess the degree of depression include the Hospital Anxiety and Depression (HAD) scale and the Patient Health Questionnaire (PHQ-9).

Question 4

What does the Hospital Anxiety and Depression (HAD) scale consist of?

Answer 4

The Hospital Anxiety and Depression (HAD) scale consists of 14 questions, 7 for anxiety and 7 for depression.

Question 5

How is the Hospital Anxiety and Depression (HAD) scale scored?

Answer 5

Each item on the HAD scale is scored from 0-3, producing a score out of 21 for both anxiety and depression.

Question 6

What is the severity range for the Hospital Anxiety and Depression (HAD) scale?

Answer 6

The severity range for the HAD scale is: 0-7 normal, 8-10 borderline, 11+ case.

Question 7

What should patients be encouraged to do when answering the HAD scale questions?

Answer 7

Patients should be encouraged to answer the HAD scale questions quickly.

Question 8

What does the Patient Health Questionnaire (PHQ-9) ask patients?

Answer 8

The PHQ-9 asks patients ‘over the last 2 weeks, how often have you been bothered by any of the following problems?’

Question 9

How are the items on the PHQ-9 scored?

Answer 9

The items on the PHQ-9 are scored from 0-3.

Question 10

What additional item does the PHQ-9 include?

Answer 10

The PHQ-9 includes an item asking about thoughts of self-harm.

Question 11

How has depression severity traditionally been grouped?

Answer 11

Depression severity has traditionally been grouped into four categories: subthreshold, mild, moderate, and severe.

Question 12

What are the two categories of depression severity in the updated NICE guideline?

Answer 12

The updated NICE guideline uses a simpler two-category definition of depression: less severe or more severe depression.

Question 13

What scores on the PHQ-9 correspond to less severe and more severe depression?

Answer 13

A score < 16 on the PHQ-9 corresponds to less severe depression, while a score of ≥ 16 corresponds to more severe depression.

Question 14

What criteria does the DSM-5 provide for diagnosing major depressive disorder (MDD)?

Answer 14

The DSM-5 criteria for diagnosing major depressive disorder (MDD) include five (or more) symptoms present during the same 2-week period, with at least one symptom being either depressed mood or loss of interest or pleasure.

Question 15

What are some symptoms included in the DSM-5 criteria for major depressive disorder (MDD)?

Answer 15

Some symptoms included in the DSM-5 criteria for MDD are: depressed mood most of the day, diminished interest or pleasure in activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicidal ideation.

Question 16

SUMMARISE DEPRESSION SCREENING AND ASSESSMENT

Answer 16

Depression: screening and assessment

Screening

The following two questions can be used to screen for depression
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’

A ‘yes’ answer to either of the above should prompt a more in depth assessment.

Assessment

There are many tools to assess the degree of depression including the Hospital Anxiety and Depression (HAD) scale and the Patient Health Questionnaire (PHQ-9).

Hospital Anxiety and Depression (HAD) scale
consists of 14 questions, 7 for anxiety and 7 for depression
each item is scored from 0-3
produces a score out of 21 for both anxiety and depression
severity: 0-7 normal, 8-10 borderline, 11+ case
patients should be encouraged to answer the questions quickly

Patient Health Questionnaire (PHQ-9)
asks patients ‘over the last 2 weeks, how often have you been bothered by any of the following problems?’
9 items which can then be scored 0-3
includes items asking about thoughts of self-harm

Traditionally, depression severity has been grouped under 4 categories (subthreshold, mild, moderate and severe). The updated NICE guideline uses a simpler 2 category definition of depression: less severe or more severe depression.

Less severe depression encompasses subthreshold and mild depression, and more severe depression encompasses moderate and severe depression. Thresholds on validated scales were used in this guideline as an indicator of severity
a score < 16 on the PHQ-9: less severe depression
a score of ≥ 16 on the PHQ-9: severe depression

The DSM-5 also provides criteria for diagnosing major depressive disorder (MDD), commonly referred to as depression.

Major Depressive Disorder (MDD) DSM-5 Criteria:

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Question 17

A 25-year-old woman sees her psychiatrist for review following management and treatment for an episode of moderate depression disorder. From the patient’s history, her psychiatrist believes that the patient’s early morning waking is the symptom most troubling her at the moment.

What is the best description for this type of symptom?

Atypical depression symptom
Core depression symptom
Psychotic symptom
Personality disorder symptom
Somatic symptom

Answer 17

Somatic symptom

Somatic symptoms can include early morning waking and changes in appetite and weight

Early morning waking is the best example here of a somatic symptom.

Other examples of somatic symptoms (sometimes referred to as biological/melancholic symptoms (DSM-V) or vital symptoms) include:
Loss of emotional reactivity
Diurnal mood variation
Anhedonia
Early morning waking
Psychomotor agitation or retardation
Loss of appetite and weight
Loss of libido

Depression with somatic symptoms is thought to be a more biological/endogenous depressive episode and is typically more severe than an episode with no somatic symptoms.

An atypical symptom is one that is unusual in depressive patients and may include increased appetite and hypersomnia.

A core depressive symptom includes anhedonia, anergia or low mood. These are the 3 core symptoms characteristic of depressive disorders.

A psychotic symptom includes examples such as hallucinations or delusions. These would be features similar to a presentation of psychotic condition such as schizophrenia or schizoaffective disorder.

A personality disorder symptom can be described as a feature that may fit a typical personality disorder (e.g. being socially withdrawn in schizoid personality disorder). These features are rarely taken in isolation to diagnose a patient.