Psychiatric screening for adolescents

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As is common in many locales, there is a significant wait to see a pediatric psychiatrist in my area. What are the recommendations for starting patients on antidepressants or atypical agents? We conduct basic screening (Patient Health Questionnaire [PHQ] and Mood Disorder Questionnaire), but are there other tools that are more useful for adolescents?
—Deanna Bridge, MPAS, PA-C, Mont Alto, Pa.

The PHQ is a very good screening tool for adults, but you might find the Beck Depression Inventory–II more helpful for younger teens. It is indicated for ages 13 and up, contains 21 items, and takes about five minutes to complete. It is available for purchase at www.psychcorp.com. For older teens, remember that there is good evidence you can screen effectively for depression using only two questions: (1) Have you often been bothered by feeling down, depressed, or hopeless? And (2) have you often been bothered by little interest or pleasure in doing things? A positive response to either question can identify more than 90% of patients with Major Depressive Disorder. But this screening method is only 60% specific and requires subsequent confirmation with a PHQ. For more information, see Psychol Assess. 1998;10:83-89 and J Gen Intern Med. 1997;12:439-445.
—Julee B. Waldrop, MS, PNP (120-9)

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