If there is any tool which can be used for initial screening of Mental disorders by non psychiatric department as well (in hospital setting), we can prevent lots of patient (submerged portion of iceberg phenomena) in the light of clinical investigation.
What are you screening for? depression? Anxiety? PTSD?
Dear Kishor Adhikari,
You may be interested in the Symptom Checklist-90-Revised (SCL-90-R). It is a self-report instrument to be used in adults. The instrument contains domains pertaining to (a) somatization, (b) obsessions and compulsions, (c) interpersonal sensitivity, (d) depression, (e) anxiety, (f) hostility, (g) fobias, (h) paranoid ideation, (i) psychoticism, and (j) a global severity index of psychopathology. It is quite comprehensive. The instrument can be used in community or clinical settings.
All the best,
Screening is probably only a small part of the answer. The experience with schemes like this is that unless there is a good liaison psychiatry service to back up the screening, nothing happens.
There will be a mixture of pre-existing psychiatric conditions both detected and undetected which may or may not have been exacerbated by hospital admission, and new-onset problems.
All of which really needs a joined-up co-ordination of psychiatric services with the other departments.
Don't under-rate nursing observation either.
Kishor,
I suppose that a lot must depend on what sort of disorders one is wishing to pick up, what sort of people turn up at your hospital, why one wishes to screen in the first place, how much time can be set aside for explaining what is required, to the patient , time to complete the exercise, and what is to be done with the information revealed. Also, is there any cost involved in using the questionnaire?
For example, there is the PHQ-9, and GAD-7 questionnaires, which are useful , and widely deployed to screen for common disorders, such as anxiety/depression, and general anxiety, respectively. Then there's the AUDIT tool for alcohol problems, and miniCog for cognitive impairment.
Also, who drew up the questionnaire in the first place? For example, I think that PHQ-9 was compiled by Pfizer, the pharmaceutical company, so it may be that their threshold for detecting mental health problems is set low, in order to draw in more people in for (drug) treatment.
I'm sure that others will provide more helpful answers, particularly those who have current experience in your part of the world.
Bw
Chris Ide
My research and that of Stephen Ternyik in QMH , leads us to the examination of the many brain damaged subject's EEG measurements obtained from the Craig Hospital Neuroscience Lab in Englewood Colorado. These measurements currently reside in the WKDB (World Knowledge DataBase) of the QMH forensic simulator. The WKDB that contains these measurements is available free upon request.
I do not accept that psychiatry is a valid, scientific, medical discipline. For insights into how 'psychiatry' (sometimes confusingly referred to as 'psychological medicine') has come to dominate public understanding of any and all human 'perceived abnormal' behaviour read anything by the late Dr Thomas Szasz, and then follow up with 'Psychiatry under the Influence' by Whitaker and Cosgrove (2015). The confusion and contradictions multiply when you have a look at the unbreakable alliance between psychiatry and industrial pharmacology. Link that to theoretical hypotheses that only by subjective investigation of one's 'brain chemistry' can a person's behaviour be understood. Many psychiatrists mean well but splitting 'physical' health and so-called 'mental' health blatantly denied that human health is holistic and that each human's behaviour is unique to her/him/it.
Philip O'Keeffe PhD MSc Reg MBACP (Accred)
May be you can use - Mini International Neuropsychiatric Interview (MINI)
I'm writing to deadlines on suicide these days. Psychiatry has little to contribute to suicidology - I rely for that opinion upon the late and much missed Edwin Shneidman PhD. Some good people - not I - believe suicide is a 'mental disorder' and thus fertile territory for further psychiatric colonisation. I've saved the MINI and plan to check it out after my textbook is published. I wish you well in your work. Slan is Beannacht. Philip O'Keeffe PhD
If you are looking for a general diagnostic tool that covers the more prevalent mental health conditions in detail and screens for some personality disorders, you might look at the CAAPE-5 that is available anywhere there is Internet coverage at evincediagnostics.com. The CAAPE-5 also provides excellent coverage of substance use disorders.
The MINI is a mini SCID - a diagnostic tool for an array of mental disorders - and used in clinical research more than in healthcare. It is well done and created with the intention to plug it into primary and secondary care, but fairly pricey given the licensing model. It needs a dedicated assessment time of 30-45 mins minimum so planning is important. If you dont have that time or you need a quick primary care screener for most common psychiatric presentations, there are multiple “health screeners ranging from 2 min admin time to 20 mins but can be given to patients before their visit.
We have identified some two-item screens for major depression and PTSD that could be explored. The UNCOPE is a six item screen for substance use disorders that has been validated and widely used. You could combine some of these individual screens to produce a no-cost screening strategy.
The time requirement for the CAAPE-5 is about the same as the MINI, but probably covers substance use disorders better.
how can solve the problem of clinical investigation, is there any statistical inferences used
You can check the DSM 5 website for a Level 1 screening instrument but the DSM 5 itself has people questioning its value. The Mini is a pretty good instrument but cultural competence of the person administering is key to success using any of the available instruments. It is important to remember that any screening instrument is just that and their use does not take the place of clinical investigation and skill. Psychiatry, psychology and counseling are arts with soft science research behind them that is often problematic in my view. Until those fields begin to treat patients in the context of their circumstances, culture and experiences rather than diagnoses, results will be limited. I am glad to see another who is aware of Schneidman. But the way, in your use of screeners, I would suggest using ACE questionnaires in that process. If you have not seen the ACE studies, I recommend that.
Testing folic acid, B12, Vitamin D, and zinc levels would be helpful.
There are several different kinds of such screeners. Which you choose depends on amount of time available for review of responses, and the process for administration. The PHQ-GAD is iften used in primary care settings but many cases slip through because of the brevity if these instruments. We maintain a database of over 20,000 measures used across various medical disciplines. Contact me on LinkedIn and I’ll send you samples to look at.
I think screening of mental disorder is not sufficient, Prevention is most important and It is possible with regulation of daily activities and diet with the help of Ayurveda, because prevention is one of the Basic Fundamental of Ayurveda.
Currently Stephen Ternyik and I have been engaged (as well as members of Stephen's Lab) in the application of Ontological Engineering principles as applied to QMH (Quantifying Mental Health). As such we have designed a forensic simulator in which measurement data is feed from which AI (Artificial Intelligence ) algorithms minimize the predicted value of the "mental state" of the individual from the input measurement. The measurement input is obtained from a question answer session from both patient and people affiliated with the patient.
An overview of the forensic simulator is given in the attachment in addition to miscellaneous tools sets as provided for by the WKDB (World Knowledge DataBase) which is constantly updated with new information.
Al Fermelia Would like to add the psycho-medical view of mood (affective) science and the physiology of emotions, especially, body heat mapping of human emotional states.
Mental disorder is not easy to "test". You need a suspicion (e.g. depression) and after that you can use a test (e.g. hamlton depression scale). BUT a diagnosis ALLWAYS needs a clinical experienced phsician. Everything else leads to devastating consequences for patients...
The diagnosis of most mental health conditions does not necessarily require a physician. First, most physicians other than psychiatrists are not necessarily qualified or knowledgable to make a mental health diagnosis if "clinically experienced" in other areas of medicine. Second, there are any number of doctoral level psychologists who are eminently qualified to diagnose mental health conditions.
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I'm hoping this diagnostic will prevent lengthy unsuccessful treatments that will be expensive and cause extra suffering.
MMPI-2 and MMPI-A can be used to assess mental illness depends on the client's age.
The new versions of the MMPI may be helpful in assessing mental illnesses, but they are too long to be considered screens. They are more appropriate as assessments on the nature of conditions rather than just indicating the likelihood that someone is likely or not likely to have a given condition.
A small set of items where each item maps to a different diagnostic criteria is likely to be the most efficient and accurate screen for a given condition. With the broad range of conditions in the area of mental health, global screens for any or all conditions is not a feasible strategy for screening. A screen needs to be targeted to a given condition or related conditions, such as substance use disorders.
General Health Questionnaire (GHQ) long and short versions available.
PHQ 9 --screening for Depression
HADS- Hospital Anxiety and Depression scale.
Hope these help you
An option for a general assessment of common mental health conditions and substance use disorders is the CAAPE-5 structured interview available as either a paper booklet (www.changecompanies.net) or an online version (evincediagnostics.com). The advantage of the online system is that there is no shipping delay and a report of findings is available as a pdf file immediately after the completion of the interview. The online version does not necessarily require a clinician to conduct the interview and it has an option for the respondent to answer the questions directly with a mouse or touch screen.
As with any assessment tool, any final determinations need to be confirmed by an appropriately credentialed clinician.
Diagnostic and Statistical Manual (DSM) Overview. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook widely used by clinicians and psychiatrists in the United States to diagnose psychiatric illnesses.
You may use "The General Health Questionnaire (GHQ)". GHQ is a screening device for identifying minor psychiatric disorders in the general population and within community or non-psychiatric clinical settings such as primary care or general medical out-patients. Many forms are available based on the length of the interview.
It is available in the following versions:
- GHQ-60: the fully detailed 60-item questionnaire
- GHQ-30: a short form without items relating to physical illness
- GHQ-28: a 28 item scaled version – assesses somatic symptoms, anxiety and insomnia, social dysfunction and severe depression
- GHQ-12: a quick, reliable and sensitive short form – ideal for research studies.
The GHQ-30 is primarily concerned with depression, anxiety, and general discomfort. It does not screen for PTSD or other trauma issues nor does it screen for substance use disorders, which may be among the more common conditions in some populations - especially hospitalized medical patients.
The six-item UNCOPE screen for substance use disorders can identify those at risk for substantial problems and is available without seeking permission for use.
Screening would require an idea of the persons premorbid personality and functioning. Then a test such as the Mini Mental State as a general screening tool if you have the history. If suspicious of depressive symptoms then a Hamilton's would be helpful in confirming suspicions. Schizoaffective disorders and symptomology in-keeping with manic behaviours should be evident if the person is in the acute phase of the illness but I do not know of any screening tool for this; again premorbid personality is so important in recognising these as symptoms.
Without an adequate history or collateral from friends/family then the Mini Mental State would be most suited for general screening. Other tests could be used for cases where depressive, suicidal, manic and schizophrenic symptomology is present.
When interviewing and assessing a persons mental health the process is usually lengthy for any level of certainty. This process is fraught with error. I don't think there is any good single tool for all disorders.
Luke Briant is correct in that there is no single screening tool for all disorders. Such a screen would be impractical. The best strategy would be to routinely screen for those conditions that are most prevalent. Those conditions in most medical or clinical settings are likely to be substance use disorders, depression, PTSD, and panic attacks. The six-item UNCOPE screen for substance use disorders is among the best for those conditions. We have identified two-item screens for major depression and PTSD. This would give you a 10 item screen for conditions likely to be the most prevalent. References for the screens can be obtained by contacting me at [email protected].
The UNCOPE can be Googled, but I can send citations for the two-item screens.
Why on earth would you want to routinely screen people entering an A&E/ED for mental illness (other than possibly for research purposes?)
If I were to be taken to and A&E/ED with a crushing chest pain and shortness of breath because my myocardium was being infarcted, or there was a sizeable pulmonary embolus clogging up my lungs, you bet that I'd be anxious++! I'd take a dim view of someone handing me a questionnaire, scoring it, and saying "Would you like to see our psychiatrist?" instead of putting up a drip, giving me some first class analgesia, organising an ECG, troponins, d-dimers, possible stenting, etc!
Bw
Chris Ide
I don't think that anyone suggesting screens has indicated the intent to attempt screening during an acute medical emergency - that would be ridiculous.
That said, some studies have suggested that as many as one out of four beds occupied on med/surge units is occupied by someone with a serious alcohol use disorder. Some studies of emergency room patients also suggest that prevalence rates of SUD and other behavioral health conditions might be high in those settings.
It borders on medical malpractice not to screen hospitalized medical patients at some point for the more prevalent behavioral health conditions that could have an adverse impact on the long-term outcome of medical conditions given the prevalence rates in these populations.
The MINI is far too long to be a practical screen. In general it covers most of the criteria for a given condition. To be practical, screening for mental health would have to rely on a couple of key or predictive items per condition. For example, we have identified such two-item screens for major depression and PTSD. One has to remember screens are only designed to identify those likely to have a problem and always require detailed assessments for verification to address false positive results.
That said, one has to weigh the level of concern in false negative and false positive screen results. These errors are inversely related. To minimize false negatives one has to accept more false positives. If you minimize false positives you have to accept missing more as false negatives.
Here are some of the most used and internationally famous (together with a good and complete anamnesis and a Semi-structured Clinical Interview focused on the problems, signs and symptoms that afflict the patient):
-The "MMPI", especially its latest version: "MMPI-2".
- "The Questionnaire of the 90 symptoms" by Derogatis (THE SYMPTOM INVENTORY SCL-90-R by L. Derogatis)
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