Family physicians must decide by w...

Family physicians must decide by what mode to screen for depression or dementia and which patients to veil Mental health questionnaires can be helpful. In practice-based screening, questionnaires are administered to all patients, regardless of risk status. In case-finding screening, questionnaires are administered barely when depression or dementia is suspected. The 2002 U Preventive Services Task Force report approves screening adults for depression to improve detection and patient issues but does not suggest the use of any particular screening instrument. Serial or sequential testing with the Patient Health Questionnaire-2 and the Patient Health Questionnaire-9 is a religious strategy for detecting major depressive episodes in primary care settings. The Patient Health Questionnaire-2 consists of couple questions that assess the carriage of anhedonia and dysphoria. If a patient answers "yes" to either question, the more specific Patient Health Questionnaire-9 is administered to assess the severity of depressive symptoms and to ascertain the vicinity of major depressive episode. The Patient Health Questionnaire-9 also can be used to monitor symptom severity and treatment answer The 2003 U.S. Preventive Services Task Force report does not commit for or against routine screening for dementia in older adults. However, the report does assert that cognitive function should be assessed when impairment is suspected. The Folstein Mini-Mental State Examination and the Functional Activities Questionnaire are hinted tools. The Clock Drawing touchstone also has been shown to be useful in primary care settings.

Family physicians ne efficient [i]modus operandi[/i]s for identifying patients with depression or dementia. Mental health questionnaires can improve the accuracy of diagnosis. In practice-based screening, questionnaires are administered to all patients, regardless of risk status. However, this approach is associated with high false-positive screening follows (i.e., depression or dementia may be identified mistakenly in patients who do not have the condition in question). In case finding, questionnaires are administered to chosened patients when the physician suspects that a disorder is at hand With this approach, the probability of disease in the assign places to being tested is higher; therefore, it is more likely that a patient with a positive (or abnormal) exhibition has the suspected disorder. one time depression or dementia is identified, questionnaires can be used to evaluate the efficiency of therapy or the natural history of the disorder, and can provide useful prognostic information.

Assessment of Depressive Symptoms and Depression in Adult Patients

Despite the high prevalence of depression, (1-3) family physicians may fail to recognize 30 to 50 percent of patients with major depressive episodes. (4-6) The 2002 U Preventive Services Task Force (USPSTF) report (7) make acceptables screening adults for depression to improve detection and patient issues provided that effective systems are in place to make sure accurate diagnosis, effective treatment, and appropriate follow-up However, the report shows few suggestions for selecting screening instruments.

Standardized screening questionnaires for depressive symptoms and major depressive episodes have been reviewed extensively. (8-11) a of the older questionnaires are too cumbersome, time-consuming, or inaccurate for routine use in clinical settings (Table 1) (1012-22)

SCREENING AND CASE FINDING

The rating scales expanded before the 1987 publication of the Diagnostic and Statistical Manual of Mental Disorders, 3d ed rev. (DSM-III-R) contain items that are not as highly correlated with popular diagnostic standards as the items in newer questionnaires. Based forward summary data from a meta-analysis (10) of instruments for depression screening and the assumption of a 15 percent probability of major depressive episodes, no other than about 35 percent of patients identified as disgraceed by the older screening questionnaires actually have major depressive episode.

In short, the older questionnaires perform poorly as screening tools. However, these questionnaires be subservient to reasonably well as case-finding instruments when the probability of depression is higher. For example, in a dispose of patients with suspected major depressive episode, where the pretest probability for depression is 50 percent the positive predictive value for identifying major depressive episode is 67 percent with the Beck Depression Inventory, 72 percent with the General Health Questionnaire, 75 percent with the Center for Epidemiologic Study-Depression scale, and 75 percent with the Zung Self-Assessment Depression scale. (10)

The items in the newly revised Patient Health Questionnaire-9 (PHQ-9) were designed to correspond with the criteria for major depressive episode given in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). (23) Consequently, the PHQ-9 has first-rate sensitivity (88 percent) and specificity (88 percent) (15) However, with practice-based screening, the probability of detecting major depressive episode is single 56 percent when the probability of depression is assumed to be 15 percent (Table 2) (13-16) Thus, flat new and welld-esigned questionnaires for detecting depressive symptoms have limitations in practice-based screening. The newer questionnaires perform better than the older uniteds in case finding, with positive predictive values of 88 percent for the PHQ-9 and 79 percent for the Medical consequences Study-Depression instrument in testing scenarios similar to those described above.