Screening

In today’s busy practice, screening tools are of vital importance. These can often be completed and reviewed in just a few minutes. A two-question screen (“Are you feeling down, depressed, or hopeless?” and “Do you have little interest or pleasure in things?”) can trigger a full depression screening questionnaire.

Although the screening tools were all developed based on DSM-IV, the basic criteria have not changed and the tests are still valid. Several empirically validated tools exist, including the Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI-II), Beck Depression Inventory–Fast Screen, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale, Geriatric Depression Scale, Hamilton Depression Rating Scale, and Zung Self-Rating Depression Scale, among others (fpnotebook.com/Psych/Depress/index.htm).


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For more in-depth assessment, DSM-5 has created an initial screen for 13 different conditions, referred to as a Level-1 screen, with positive results indicating the need for a follow-up Level-2 screening questionnaire. These are available for free at http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures.

Table 1. BATHE Technique

Background: “What is going on in your life?”
Affect: “How do you feel about it?”
Trouble: ““What troubles you most about the situation?”
Handle: “What helps you handle the situation?” (An opportunity to screen for alcohol and drug use)
Empathy:

  • “This is a tough situation to be in”
  • “Anybody would feel as you do”
  • “Your reaction makes sense to me”

fpnotebook.com/Psych/Exam/BthTchnq.htm

As with any screening tool, a positive result for depression is not a guarantee that the condition exists, nor does a negative result completely rule it out. Results should always be in the context of the patient; for example, if the provider knows that the patient is not a “complainer,” a low score on a screening test may still be cause for concern.

A screening tool is valuable for setting a baseline score, as well as to tease out symptoms that the patient may not even realize are related to his or her mood. It is also helpful to use the same screening tools utilized by local crisis intervention programs or community health agencies to improve communication.

For ambiguous or confusing test results, using open-ended questions and the “BATHE” technique can be beneficial to elicit more involvement from the patient (Table 1).3 Moreover, screening can be used to fulfill the requirements under the Patient Protection and Affordable Care Act, a patient-centered medical home, diabetic and cardiovascular care recommendations, and even for performance– or quality improvement–certified medical education (PI– or QI–CME).

Ever-evolving technology concerning pharmacogenetics is emerging as a vital component of psychiatric and medical care. The Clinical Pharmacogenetics Implementation Consortium (CPIC), part of the Pharmacogenomics Knowledgebase (PharmGKB), is one organization attempting to improve the ability of the provider to use pharmacogenetic testing in clinical practice4.