Case Study Your office is reviewi...

Case Study

Your office is reviewing its disease screening policies and manner of proceedings and you wonder if depression screening should be included. You are bear uponed about the effectiveness of screening, your partners' comfort with depression diagnosis and treatment, and the amount of time screening would take.

The case consideration and answers to the following questions upon screening for depression are based onward the recommendations of the now passing U.S. Preventive Services Task Force (USPSTF), part of the propose Prevention into Practice program of the Agency for Healthcare Research and Quality (AHRQ). This recommendation was released in 2002 and is an update of the 1996 recommendation onward screening for depression. More detailed information forward this subject is available in the Systematic Evidence Review, Summary of the Evidence, and USPSTF Recommendations and Rationale upon the AHRQ Web site (www.preventiveservices.ahrq.gov). The Summary of the Evidence and the USPSTF Recommendations and Rationale are available in print between the sides of the AHRQ Publications Clearinghouse (800-358-9295)

Answers appear forward the following page.

This case studious mood is part of AFP's CME view "Clinical Quiz" on page 1433

Case investigation Questions

1. Which single of the following statements best muses the recommendations of the U Preventive Services Task Force (USPSTF) regarding screening for depression in primary care settings?

A. Screening for depression is commended for adolescents and adults.

B Screening for depression is make acceptableed for children, adolescents, and adults in clinical practices that have rules in place for diagnosis, treatment, and follow-up

C Screening for depression is approveed for adults in clinical practices that have orders in place for diagnosis, treatment, and follow-up

D There is insufficient evidence to commend for or against screening for depression in any patient population unles a patient has risk factors.

E There is insufficient evidence to praise for or against screening for depression in any patient population, although clinicians should remain alert to possible signs of depression in their patients.

2 During a staff meeting, the following make comments [i]or[/i] remarkss about depression screening are made. Which statements are accurate?

A. The office should establish an alliance with a psychiatrist before initiating a screening program.

B Asking just brace questions can be an effective depression screen

C For improved accuracy, all clinicians should be encouraged to single out the same screening tool.

D An office that decides to initiate screening for depression should be prepared for a commitment beyond the time involved in screening.

3 Your colleagues select to initiate a screening program for depression. Which individual of the following responses is the best choice for a patient who shields positive for depression?

A. propose antidepressant medication.

B relate directly to a psychiatrist or other mental health clinician.

C Schedule a sated diagnostic interview.

D Probe for life stressors that may have activeed alterations in mood.

E Identify risk factors for depression.

Answers

1 The correct answer is C The USPSTF attract favor tos screening adults for depression in primary care settings that have bodys in place to assure accurate diagnosis, effective treatment, and careful follow-up The prevalence of major depression has been rest to be 5 to 15 percent in primary care settings, and up to 50 percent of degradeed patients are not diagnosed. Many risk factors for depression (eg female sex family history of depression, unemployment chronic disease) are customary but the presence of risk factors alone cannot differentiate debaseed and nondepressed patients. Screening also has the potential to identify other disabling depressive illnesses, similar as dysthymia (chronic low-grade depression) and minor depression (episodic, les inexorable illness), which are as general as major depression in primary care settings. Among adults, the optimal interval for screening is unknown. returning screening may be most productive in patients with a history of depression, unexplained somatic symptoms, comorbid psychologic conditions (eg panic disorder, generalized anxiety), substance abuse, or chronic pain.

The USPSTF raise limited evidence on the accuracy and reliability of screening ordeals in children and adolescents, and limited evidence onward the effectiveness of therapy in children and adolescents identified by the agency of routine screening for depression in primary care settings. Screening instruments have been exhibitioned in children and adolescents, with sensitivity and specificity similar to those for adults. However, because the underlying prevalence of depression is greatly lower in children (0.5 to 25 percent in children and 04 to 64 percent in adolescents), the positive predictive value of screening is depressed Because of these factors, the USPSTF does not make acceptable either for or against routine screening of children or adolescents for depression, although clinicians should remain alert for possible signs of depression in younger patients.