Screening Tools and Diagnostic Criteria

Question 1

What is the screening tool(s) for Depression? What should happen if a patient tests postive?

Answer 1

PHQ 2–> PHQ 9
*Patient testing positive on PHQ 9 should be confirmed with DSM-V to diagnose depression and then be offered treatment

Question 2

a score of 1-4 on the PHQ 9 shows signs of

Answer 2

minimal depression

Question 3

a score of 5-9 on the PHQ 9 shows signs of

Answer 3

mild depression

Question 4

a score of 10-14 on the PHQ 9 shows signs of

Answer 4

moderate depression

Question 5

a score of 15-19 on the PHQ 9 shows signs of

Answer 5

moderately severe depression

Question 6

a score of 20-27 on the PHQ 9 shows signs of

Answer 6

severe depression

Question 7

what are some of the purposes of PHQ 9

Answer 7

-measuring severity
-diagnosis (with DSM-V)
-monitoring response to treatment (repeated every 4-6 weeks)

Question 8

what needs to be ruled out to diagnose depression?

Answer 8

-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

Question 9

in the elderly, what is the method of diagnosing depression? what is considered a positive screen?

Answer 9

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

Question 10

what is GAD-7 screening for?

Answer 10

generalized anxiety disorder

Question 11

When is further evaluation recommended for a GAD 7 screening

Answer 11

when the score is 10+

Question 12

What three other common anxiety disorders is GAD 7 moderately good at screening?

Answer 12

-panic disorder
-social anxiety disorder
-post-traumatic stress disorder

Question 13

What is the MDQ screening for?

Answer 13

Bipolar disorder

Question 14

what is a positive screen for the MDQ

Answer 14

-When yes is checked to 7+ items
- yes to question #2 “moderate to severe impairment”

Question 15

which Bipolar disorder is the MDQ better at screening?

Answer 15

Bipolar 1
-not as sensitive to bipolar Ii

Question 16

why screen for bipolar disorder?

Answer 16

-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

Question 17

what are the substance abuse screening tools?

Answer 17

AUDIT- C
DAST- 10
NIAAA- single item screening

Question 18

When is the NIAAA single item screening positive?

Answer 18

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)

Question 19

When is an AUDIT-C (alcohol use disorder identification test) positive?

Answer 19

positive for women = 3+
positive for men = 4+

Question 20

what is CAGE screening for?

Answer 20

alcohol use

Question 21

DAST 10 is screening for?

Answer 21

illicit substance use

Question 22

limitations to psychiatric surveys

Answer 22

-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

Question 23

DSM-5 criteria for major depression disorder

Answer 23

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

Question 24

what does the pneumonic SIGECAPS stand for?

Answer 24

-sleep disturbance
-decrease interest or pleasure
-excessive guilt or feelings or worthlessness
-energy complaints/fatigue
-concentration/attention problems
-appetite changes
-psychomotor changes
-suicidal ideation

Question 25

depressed mood for most of the day, for more days than not, for at least two years: diagnosis?

Answer 25

dysthymia (persistent depressive disorder)

Question 26

when depressed with dysthymia, a patient will have have two or more of the following symptoms?

Answer 26

-poor appetite or overeating -decreased or increased sleep -fatigue or low energy -reduced self-esteem -decreased concentration or problems making decisions -feelings of hopelessness

Question 27

symptoms of dysthymia cannot be absent for how long?

Answer 27

symptoms are never absent longer than two consecutive monts

Question 28

development of emotional or behavioral symptoms in response to identifiable stressor (s) occurring within THREE months of onset of stressor

Answer 28

adjustment disorder

Question 29

what is adjustment disorder?

Answer 29

stressor causes significant functional impairment or causes distress out of proportion to the severity or intensity of the stressor

Question 30

does adjustment disorder meet the criteria for major depression? what does it exclude? when do symptoms stop?

Answer 30

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

Question 31

what are some conditions that cause depression?

Answer 31

thyroid dysfunction parkinson's disease huntington's disease multiple sclerosis HIV other endocrine disorders

Question 32

what are some medications that may worsen depression?

Answer 32

steroids interferon chantix (smoking medication) contraceptives some beta blocker and calcium channel blockers

Question 33

Belief that some group/ wishes to harm, harass, or kill them

Answer 33

persecutory

Question 34

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)

Answer 34

referential

Question 35

belief that individual has specific significance, power, knowledge

Answer 35

grandiose

Question 36

false belief that another person, group, or external force can control one's thoughts, feelings, impulses or behaviors

Answer 36

Control

Question 37

making up words

Answer 37

neologism

Question 38

rhyming all the words without apparent logical connection

Answer 38

clang

Question 39

repetition of words or ideas

Answer 39

Perseveration

Question 40

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

Answer 40

Brief psychotic disorder

Question 41

presents with the same symptoms of schizophrenia but symptoms last between 1 and 6 months

Answer 41

Schizophreniform disorder

Question 42

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

Answer 42

Delusional disorder

Question 43

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)

Answer 43

schizoaffective disorder

Question 44

psychosis due to medical condition

Answer 44

secondary psychotic disorder

Question 45

reduced motivation towards goals or desire, reduced ability to complete everyday tasks (may have poor hygiene)

Answer 45

avolition

Question 46

diminished speech

Answer 46

alogia

Question 47

reduced social drive, lack of sexual interest

Answer 47

a-sociality

Question 48

lack of pleasure in previous hobbies or interest

Answer 48

anhedonia

Question 49

reduced range of of emotions, feeling numb or empty inside

Answer 49

affective blunting

Question 50

monitor for tardive dyskinesia with

Answer 50

AIMS test periodically

Question 51

what is a mixed episode

Answer 51

an episode with simultaneous manic and depressive symptoms -requires full criteria of mania/ hypomania and three depressive symptoms often misdiagnosed as agitated depression

Question 52

insomnia disorder is described as

Answer 52

sleep difficulty occurs at least 3 nights per week and is present for at least 3 months