Week 3 Psychiatric Screening

Depression and anxiety are the most common psychiatric problems affecting patients in primary care. Data from the National Alliance on Mental Illness (NAMI) places the prevalence of depression among American adults at 7.8 percent (representing 19.4 million people), and that of anxiety disorders at 19.1 percent (representing 48 million people) (NAMI, 2021). This weeks assignment focuses on administering relevant screening tools to detect symptoms of depression and anxiety on the presenting client, a 56-year-old Caucasian female. The Beck Depression Inventory (BDI) was selected to screen for symptoms of depression, while the Generalized Anxiety Disorder (GAD-7) scale was selected to screen for anxiety symptoms.

The BDI is a 21-item questionnaire that assesses the intensity of symptoms associated with psychoanalytic aspects of depression including social withdrawal, suicidal ideas, guilt, feelings of failure and sadness (Park et al., 2020). It measures the severity and frequency of depression symptoms experienced in the past 2 weeks on a 4-point scale. It is one of the most widely studied measures for assessing depression, with well-established psychometric properties (Garcia-Batista et al., 2018). The 21 items are scored from 1 to 3, yielding a maximum score of 63 and a minimum score of zero. Scores between 1 and 10 indicate normal ups and downs, scores of 21 to 30 indicate moderate depression, 31-40 indicate severe depression, and over 40 indicate extreme depression. The BDI was selected not just for its high validity and reliability, but also because it can be used both as a screening tool and as a measure of severity of depressive symptoms (Park et al. 2020). As such, the clinician does not have to administer a different tool to measure the effect of prescribed medication on symptoms at the time of review. Further, the BDI allows for self-rating, allowing the client to regularly measure the progression of their symptoms.

KFs BDI Score

Question Content

Score

Implication

Rationale

Sadness

2

I feel sad

The client reports feeling sad mostly in the morning, but snaps out of it as the day progresses

Pessimism

0

Not present

Sense of failure

2

As I look back on my life, I see a lot of failures

Client feels like a failure for losing her sons custody to her abusive husband and not playing an active role in bringing him up

Dissatisfaction

1

I do not enjoy things the way I used to

She no longer enjoys yoga and meditation

Guilt

2

I feel guilty most of the time

Reports feeling very guilty about divorcing and leaving her son in France

Expectation of punishment

0

Not present

Self-dislike

1

I am disappointed in myself

Client is disappointed in herself for leaving her son in France

Self-accusations

1

I...

The client was not scored on 8 items including crying, irritability, indecisiveness, body image change, somatic preoccupation, and loss of libido as there is no specific information that provides answers to these questions. As such, if the client were to avail more information, one would expect the depression score to be even higher.

The GAD-7 scale is a self-administered questionnaire used to check for the presence and severity of anxiety symptoms over the past two weeks (Johnson et al., 2019). It is scored by assigning scores of 0 to 3 to the response categories of not at all, several days nearly every day and more than half the day, and then summing up the scores to obtain the total anxiety score (Johnson et al., 2019). Scores of 5, 10, and 15 are the cutoff points for mild, moderate, and severe anxiety. The GAD-7 was selected for its proven psychometric properties, including specificity of 82 percent and sensitivity of 89 percent of GAD (Johnson et al., 2019). Further, like the BDI, the GAD-7 can be used both as a screening tool and as a measure of severity for anxiety symptoms (Johnson et al., 2019). As such, it provides an invaluable means for not only identifying whether a patient has anxiety, but also assessing the effectiveness of treatment plans (Johnson et al., 2019).

KFs GAD-7 Scores

Feeling anxious, nervous or on edge 3

Not being able to control or stop worrying 2

Worrying too much about different things 0

Trouble relaxing 0

Being so restless that it is hard to sit still - 0

Being easily irritable or annoyed 0

Feeing afraid as if something awful might happen - 0

The client is employed as a full-time consultant and mentions that she cannot stay focused anymore and is unable to complete projects for work. The inability to stay focused was interpreted as a sign of anxiety or nervousness and since she works full-time, the effect is felt nearly every day. However, it is not every day that she is unable to control worrying at least once a week, she takes part in social events, although she finds these activities really exhausting. She has no means to control the worry the rest of the days, which are more than half the days of the week. The client was not scored on the remaining 5 items because there is no information to support such…