Psych

Question 1

PHQ-2

Answer 1

For Depression

Universal screen - USPSTF recommends for age 12+ that pts get universal screening. If test positive for this, test on PHQ-9.

2 question survey: “Over the past two weeks, how often have you been bothered by any of the following problems?”
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless

Question 2

PHQ-9

Answer 2

For Depression.

Give if pt is positive on PHQ-2. If test positive, diagnoses should be confirmed with DSM-V. First two Qs are same as PHQ-2. Asks same Qs as DSM-V.

Good for: screening, measuring severity, diagnosis (w DSM-V), monitoring response to tx (often repeated every 4-6wks)

Question 3

Important things before diagnosing Depression

Answer 3

• Need 5/9
• Confirm symptoms not due to another condition (hypothyroid, anemia, sleep disorder, etc)
• Confirm symptoms not due to physiology effects of a substance/drug
• Rule out bereavement
• Rule out manic/hypomanic episode

Question 4

Depression screening for older adults

Answer 4

Can start with PHQ-2, if positive move to:
- Five-Item Geriatric Depression Scale (GDS5)
- Or the 15 item Geriatric Depression Scale (or PHQ-9)

Scoring on GDS5: two positive answers suggests depression

Question 5

GAD-7

Answer 5

For anxiety screening (Generalized Anxiety Disorder 7 item)
Further evaluation recommended when score 10+
Moderately good at screening 3 other common anxiety disorders: panic disorder, social anxiety disorder, PTSD

Question 6

MDQ

Answer 6

For Bipolar (Mood Disorder Questionnaire).
Positive screen needs more comprehensive eval.
Positive screen requires: “yes” to 7+ items, “yes” to Q2, “moderate to severe impairment”
Ensure they aren’t answering Qs based on a period of substance use
Depending on pts insight, may need to ask examples of behavior

Better at screening bipolar 1 (manic), not as sensitive to bipolar 2 (hypomanic)

Question 7

Indications to screen for Bipolar Disorder

Answer 7

• Clear indicators of mood instability
• Difficult to interview in linear fashion
• Hx of failed antidepressant trials
• Severely disrupted sleep cycle
• Significant agitation, irritability, anger on presentation
• Family Hx of bipolar disorder

Question 8

3 Substance Use Screening Tools

Answer 8

Single Item Screening (alcohol use and drug use)
AUDIT-C (alcohol specific)
DAST-10 (drug specific)

Question 9

Single-item screening (NIAAA)

Answer 9

For alcohol abuse.
Do your sometimes drink beer, wine, or other alcoholic beverages?
If yes: How many times in the past year have you had 4(F)/5(M) or more drinks in a day?

Positive if response is >1 ( not diagnostic - just requires further questioning)

Question 10

AUDIT-C

Answer 10

Alcohol Use Disorders Identification Test (all answers have diff score values given to them)
Q1: How often did you have a drink containing alcohol in the past year?
Q2: How many drinks did you have on a typical day when you were drinking in the past year?
Q3: How often did you have six or more drinks on one occasion in the past year?

Positive: 3+ (F), 4+ (M)

Question 11

CAGE

Answer 11

Not first line questionnaire
Have you ever felt you should CUT down on your drinking?
Have people ANNOYED you by criticizing your drinking?
Have you ever felt bad or GUILTY about your drinking?
Have you ever taken a drink first think in the morning (EYE-opener) to steady your nerves or get rid of a hangover?

Question 12

DAST and Single Item

Answer 12

For illicit substances (means requires further questions)
Single Item: “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?” (positive is 1 or more)

DAST-10: substance related questions, scored, gives suggested action for each score range. Drug Abuse Screening Tool. Self-reported for the opioid naïve

Question 13

DSM-V criteria for Depression

Answer 13

S - sleep disturbance (too much/too little/insomnia)
I - decreased interest or pleasure (anhedonia)
G - excessive guilt or feelings of worthlessness
E - energy complaints/fatigue (excessive or lack)
C - concentration/attention problems (distractibility, memory disturbance, indecisiveness)
A - appetite changes (gain/loose weight, increase/decrease appetite)
P - psychomotor changes (retardation/excitation, slowing down, moving through sand)
S - suicidal ideation (thoughts, plans, behaviors)

Question 14

Diagnostic tools for ADHD

Answer 14

DIVA 2.0 (diagnostic interview)
Adult ADHD Self-Report Scale (ASRS), Conners Adult ADHD Rating Scale (CAARS) (both are neurological tests)

Diagnostic interview is most effective and neurological tests are used as supplemental

Question 15

QBTEST

Answer 15

Used in context of ADHD. Tracks how often pt is moving head around - looks at hyperactivity/inattentiveness. Can use to track progress and see if meds are working

Question 16

AIMS Test

Answer 16

Abnormal Involuntary Movement Scale (AIMS) Items. Test for abnormal and unintentional movements. Have them sit still in a chair and follow guidelines in test. Should get a baseline before starting meds. Use to look for and monitor progression.

Use to monitor when giving antipsychotic (for schizophrenia)

Monitors for Tardive Dyskinesia (for example) - EPS symptom

Question 17

Polysomnography

Answer 17

diagnose apnea

Question 18

Patient Safety Screener/Columbia-Suicide Severity Rating Scale

Answer 18

Suicide screening and risk

Question 19

ESP

Answer 19

Eating disorder screen for primary care

Are you satisfied with your eating patterns?
Do you ever eat in secret?
Does your weight affect the way you feel about yourself?
Have any members of your family suffered with an eating disorder?
Do you currently suffer with or have you ever suffered in the past with an eating disorder?

Positive screen: 2+ abnormal responses

Question 20

SASQ

Answer 20

Single alcohol screening questionnaire (2 or higher is positive and requires further evaluation)

Question 21

SAWS

Answer 21

Short alcohol withdrawal scale
12+ means refer for medically managed withdrawal from alcohol.

Question 22

NIDA

Answer 22

Drug use screening tool
To identify pt drug use, including non medical use of prescription drugs
For all pts

Question 23

ORT

Answer 23

Opioid risk tool
To identify those at risk of prescription drug abuse prior to prescribing
For pain pts
Provider reported
For opioid naïve

Question 24

SOAPP

Answer 24

Screener and Opioid Assessment for Patients With Pain
To identify those at risk of prescription drug abuse prior to prescribing
For pain pts
For opioid Naïve
Self-reported

Question 25

COMM

Answer 25

Current Opioid Misuse Measure
To determine if patients on opioid therapy are abusing their prescriptions
For pain patients on opioid therapy
Self reported

Question 26

DIRE

Answer 26

Diagnosis, Intractability, Risk, & Efficacy Score
For opioid naïve
Provider reported

Question 27

PMQ

Answer 27

Pain Medication Questionnaire
Self reported
For the opioid-experienced

Question 28

PDUQ

Answer 28

Prescription Drug Use Questionnaire
Provider reported ( self reported is PDUQp)
For the opioid experienced