Screening Tools and Diagnostic Criteria Flashcards
What is the screening tool(s) for Depression? What should happen if a patient tests postive?
PHQ 2–> PHQ 9
*Patient testing positive on PHQ 9 should be confirmed with DSM-V to diagnose depression and then be offered treatment
a score of 1-4 on the PHQ 9 shows signs of
minimal depression
a score of 5-9 on the PHQ 9 shows signs of
mild depression
a score of 10-14 on the PHQ 9 shows signs of
moderate depression
a score of 15-19 on the PHQ 9 shows signs of
moderately severe depression
a score of 20-27 on the PHQ 9 shows signs of
severe depression
what are some of the purposes of PHQ 9
-measuring severity
-diagnosis (with DSM-V)
-monitoring response to treatment (repeated every 4-6 weeks)
what needs to be ruled out to diagnose depression?
-symptoms are not due to another medical condition:
hypothyroid, anemia, sleep disorder
-symptoms are not due to the physiology effects of a substance/drug
-rule out bereavement
-rule out manic/hypomanic episode
in the elderly, what is the method of diagnosing depression? what is considered a positive screen?
start with PHQ-2, if positive move to:
-five item geriatric depression scale (GDS5)
-15 item geriatric depression scale (or PHQ 9)
2 positive answers suggest depression
what is GAD-7 screening for?
generalized anxiety disorder
When is further evaluation recommended for a GAD 7 screening
when the score is 10+
What three other common anxiety disorders is GAD 7 moderately good at screening?
-panic disorder
-social anxiety disorder
-post-traumatic stress disorder
What is the MDQ screening for?
Bipolar disorder
what is a positive screen for the MDQ
-When yes is checked to 7+ items
- yes to question #2 “moderate to severe impairment”
which Bipolar disorder is the MDQ better at screening?
Bipolar 1
-not as sensitive to bipolar Ii
why screen for bipolar disorder?
-getting clear indicators of mood instability
-patients are difficult to interview in a linear fashion
- hx of failed antidepressant trials
-significant agitation, irritability, anger on presentation
family history of bipolar disorder
what are the substance abuse screening tools?
AUDIT- C
DAST- 10
NIAAA- single item screening
When is the NIAAA single item screening positive?
test is positive if response is >1
* when women have had more than one day (having 4 or more drinks in a day)
*when men have had more than one day having 5 or more drinks in a day)
When is an AUDIT-C (alcohol use disorder identification test) positive?
positive for women = 3+
positive for men = 4+
what is CAGE screening for?
alcohol use
DAST 10 is screening for?
illicit substance use
limitations to psychiatric surveys
-self report- under or over-reporting
-concern for stigma
-health literacy- reading, understanding, answering accurately
-PHQ9 and GAD7 are available in 50 languages, but there may be variation in interpretation
-tests have high sensitivity/ specificity overall, but none are perfect
DSM-5 criteria for major depression disorder
Five or more symptoms have been present during the same TWO WEEK period and represent a change from previous functioning; at least one of the symptoms is
-depressed mood,
-lost of interest or pleasure
what does the pneumonic SIGECAPS stand for?
-sleep disturbance
-decrease interest or pleasure
-excessive guilt or feelings or worthlessness
-energy complaints/fatigue
-concentration/attention problems
-appetite changes
-psychomotor changes
-suicidal ideation
depressed mood for most of the day, for more days than not, for at least two years: diagnosis?
dysthymia (persistent depressive disorder)
when depressed with dysthymia, a patient will have have two or more of the following symptoms?
-poor appetite or overeating
-decreased or increased sleep
-fatigue or low energy
-reduced self-esteem
-decreased concentration or problems making decisions
-feelings of hopelessness
symptoms of dysthymia cannot be absent for how long?
symptoms are never absent longer than two consecutive monts
development of emotional or behavioral symptoms in response to identifiable stressor (s) occurring within THREE months of onset of stressor
adjustment disorder
what is adjustment disorder?
stressor causes significant functional impairment or causes distress out of proportion to the severity or intensity of the stressor
does adjustment disorder meet the criteria for major depression? what does it exclude? when do symptoms stop?
1.No it does not meet the criteria
2. it excludes bereavement
3. once the stressor is terminated, symptoms do not persist more than additional 6 months
what are some conditions that cause depression?
thyroid dysfunction
parkinson’s disease
huntington’s disease
multiple sclerosis
HIV
other endocrine disorders
what are some medications that may worsen depression?
steroids
interferon
chantix (smoking medication)
contraceptives
some beta blocker and
calcium channel blockers
Belief that some group/ wishes to harm, harass, or kill them
persecutory
belief that a random or neutral gesture, event, or cue holds special meaning to self
*i.e, commonly believes that certain words or songs on TV are meant to deliver a special message to the individual)
referential
belief that individual has specific significance, power, knowledge
grandiose
false belief that another person, group, or external force can control one’s thoughts, feelings, impulses or behaviors
Control
making up words
neologism
rhyming all the words without apparent logical connection
clang
repetition of words or ideas
Perseveration
presents for at least 1 day but less than 1 month
- has to have one of the following: delusions, hallucinations, disorganized speech, grossly disorganized catatonic behavior
but returns to full remission of symptoms and premorbid level of functioning within 1 month of onset
Brief psychotic disorder
presents with the same symptoms of schizophrenia but symptoms last between 1 and 6 months
Schizophreniform disorder
presense of one or more non-bizarre delusions for at least 1 month (i.e, situations that could happen in real life, being stalked, poisoned, etc.)
Criteria A for schizophrenia never met
only has delusions without any hallucinations, disorganized speech, catatonic behavior or negative symptoms
Delusional disorder
meets criteria for major depressive disorder episode, mania or mixed episode, DURING which criteria for schizophrenia is ALSO met. (Mixture of psychotic AND mood symptoms)
schizoaffective disorder
psychosis due to medical condition
secondary psychotic disorder
reduced motivation towards goals or desire, reduced ability to complete everyday tasks (may have poor hygiene)
avolition
diminished speech
alogia
reduced social drive, lack of sexual interest
a-sociality
lack of pleasure in previous hobbies or interest
anhedonia
reduced range of of emotions, feeling numb or empty inside
affective blunting
monitor for tardive dyskinesia with
AIMS test periodically
what is a mixed episode
an episode with simultaneous manic and depressive symptoms
-requires full criteria of mania/ hypomania and three depressive symptoms
often misdiagnosed as agitated depression
insomnia disorder is described as
sleep difficulty occurs at least 3 nights per week and is present for at least 3 months
