Week 3 – Psychiatric Disorders and Screening Discussions (INITIAL RESPONSE)
Research screening tools for depression and anxiety.
• Choose one screening tool for depression and one screening tool for anxiety that
you feel are appropriate to screen KB.
• Explain why you chose that particular tool for KB.
• Score KB based on the information provided (not all data may be provided).
Include what questions could be scored, and your chosen score. Assume that any
question topics not mentioned are not a concern at this time.
The screening tool chosen for depression is the Patient Health Questionnaire-9 (PHQ-9). It is
estimated that 14% of patients in the primary care setting have depression; and it is frequently
not diagnosed because of the lack of utilization of standardized screening tools (Hirschtritt &
Kroenke, 2017). According to Hirschtritt and Kroenke (2017), when standardized screening
tools are not utilized, primary care providers only recognize depression in an estimated 47% of
patients. The PHQ-9 is a self-report questionnaire based on symptoms experienced over the past
2 weeks that comprises of 9 items, which are then added together to result a score ranging from 0
through 27 (Hirschtritt & Kroenke, 2017). According to Hirschtritt & Kroenke (2017), a total
score ≥10 has an estimated specificity of 85.3% for major depressive disorder. There are several
benefits to the PHQ-9 screening tool which include: self-report format, quick scoring and
interpretation, available in multiple languages, and can be administered remotely such as in cases
where telehealth is utilized (Hirschtritt & Kroenke, 2017). I chose the PHQ-9 screening tool for
depression because it is geared towards the general adult population, and is frequently utilized in
the primary care setting. I find this screening tool very effective and have used it many times
thus far in my clinical rotations, as well as in the emergency department where I currently work.
PHQ-9:
Over the last 2 weeks, how often have you been bothered by any of the following problems? (0 =
not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day)
1. Little interest or pleasure in doing things = 3
2. Feeling down, depressed, or hopeless = 3
3. Trouble falling or staying asleep, or sleeping too much = 1
4. Feeling tired or having little energy = 3
5. Poor appetite or overeating = 3
6. Feeling bad about yourself or you are a failure or have let yourself or your family down = 2
7. Trouble concentrating on things, such as reading the newspaper or watching television = 2
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being
so fidgety or restless that you have been moving around a lot more than usual = Not
Known
9. Thoughts that you would be better off dead or of hurting yourself in some way = Not
Known Total score = 17 (Hirschtritt & Kroenke, 2017).
This study source was downloaded by 100000852681095 from CourseHero.com on 03-07-2023 00:04:54 GMT -06:00
https://www.coursehero.com/file/40804995/Week-3-Psychiatric-Disorders-and-Screeningdocx/
, The scoring ranges for symptoms are as followed: mild depressive symptoms (5-9), moderate
(10-14), moderately severe (15-19), and severe depressive symptoms (≥20). Two items were
excluded from the questionnaire because they were not of concern at this time. Based on the total
score of 17, it can be determined that KB has moderately severe depressive symptoms
(Hirschtritt & Kroenke, 2017). Patients who score a 10 or higher on the PHQ-9 screening tool
should have a more thorough examination by either a primary care provider and/or a
psychologist or psychiatrist before starting treatment (Hirschtritt & Kroenke, 2017).
The screening tool selected for anxiety is the Primary Care PTSD Screen (PC-PTSD). The PC-
PTSD is a commonly used, 4-item self-report questionnaire that uses a score of three as the
screening threshold (Kearney & Simpson, 2015). A positive screening result does not mean that
a patient has post-traumatic stress disorder (PTSD), but it does indicate that they are at risk
(Kearney & Simpson, 2015; Friedman, 2018). This screening tool is reliable and practical for use
in the primary care setting because it can assist primary care providers in identifying anxiety
related to traumatic events (Kearney & Simpson, 2015; Friedman, 2018). The PC-PTSD Screen
was chosen based on the subjective information provided by the patient. My initial interpretation
and assessment of this patient was generalized anxiety disorder (GAD), therefore I was going to
use the GAD-7. However, the more I examined the SOAP note, I came to the conclusion that the
patient appears to be experiencing symptoms more related to PTSD.
PC-PTSD Screen:
Instructions:
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that,
in the past month, you:
1. Have had nightmares about it or thought about it when you did not want to? Not Known
2. Tried hard not to think about it or went out of your way to avoid situations that
reminded you of it? YES
3. Were constantly on guard, watchful, or easily startled? Not Known
4. Felt numb or detached from others, activities, or your surroundings? YES (Friedman,
2018).
Due to limited information provided in the SOAP note, two of the questions were excluded from
the survey. However, KB’s screen was positive due to answering yes to the questions that were
applicable. If a patient answers yes to any of the three out of four questions from the PC-PTSD
Screen tool, then it is considered a positive screen. At this point, a positive screen should be
further evaluated by a mental health professional (Friedman, 2018).
Identify your next step for evaluation and treatment for KB. Include any necessary physical
medicine evaluation.
When screening is positive for possible depression, the diagnosis should be established by
utilizing the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), which
provides diagnostic measures for major depressive disorder (MDD) (Maurer, Raymond, &
Davis, 2018). All patients must be carefully assessed for underlying medical conditions by
This study source was downloaded by 100000852681095 from CourseHero.com on 03-07-2023 00:04:54 GMT -06:00
https://www.coursehero.com/file/40804995/Week-3-Psychiatric-Disorders-and-Screeningdocx/
Research screening tools for depression and anxiety.
• Choose one screening tool for depression and one screening tool for anxiety that
you feel are appropriate to screen KB.
• Explain why you chose that particular tool for KB.
• Score KB based on the information provided (not all data may be provided).
Include what questions could be scored, and your chosen score. Assume that any
question topics not mentioned are not a concern at this time.
The screening tool chosen for depression is the Patient Health Questionnaire-9 (PHQ-9). It is
estimated that 14% of patients in the primary care setting have depression; and it is frequently
not diagnosed because of the lack of utilization of standardized screening tools (Hirschtritt &
Kroenke, 2017). According to Hirschtritt and Kroenke (2017), when standardized screening
tools are not utilized, primary care providers only recognize depression in an estimated 47% of
patients. The PHQ-9 is a self-report questionnaire based on symptoms experienced over the past
2 weeks that comprises of 9 items, which are then added together to result a score ranging from 0
through 27 (Hirschtritt & Kroenke, 2017). According to Hirschtritt & Kroenke (2017), a total
score ≥10 has an estimated specificity of 85.3% for major depressive disorder. There are several
benefits to the PHQ-9 screening tool which include: self-report format, quick scoring and
interpretation, available in multiple languages, and can be administered remotely such as in cases
where telehealth is utilized (Hirschtritt & Kroenke, 2017). I chose the PHQ-9 screening tool for
depression because it is geared towards the general adult population, and is frequently utilized in
the primary care setting. I find this screening tool very effective and have used it many times
thus far in my clinical rotations, as well as in the emergency department where I currently work.
PHQ-9:
Over the last 2 weeks, how often have you been bothered by any of the following problems? (0 =
not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day)
1. Little interest or pleasure in doing things = 3
2. Feeling down, depressed, or hopeless = 3
3. Trouble falling or staying asleep, or sleeping too much = 1
4. Feeling tired or having little energy = 3
5. Poor appetite or overeating = 3
6. Feeling bad about yourself or you are a failure or have let yourself or your family down = 2
7. Trouble concentrating on things, such as reading the newspaper or watching television = 2
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being
so fidgety or restless that you have been moving around a lot more than usual = Not
Known
9. Thoughts that you would be better off dead or of hurting yourself in some way = Not
Known Total score = 17 (Hirschtritt & Kroenke, 2017).
This study source was downloaded by 100000852681095 from CourseHero.com on 03-07-2023 00:04:54 GMT -06:00
https://www.coursehero.com/file/40804995/Week-3-Psychiatric-Disorders-and-Screeningdocx/
, The scoring ranges for symptoms are as followed: mild depressive symptoms (5-9), moderate
(10-14), moderately severe (15-19), and severe depressive symptoms (≥20). Two items were
excluded from the questionnaire because they were not of concern at this time. Based on the total
score of 17, it can be determined that KB has moderately severe depressive symptoms
(Hirschtritt & Kroenke, 2017). Patients who score a 10 or higher on the PHQ-9 screening tool
should have a more thorough examination by either a primary care provider and/or a
psychologist or psychiatrist before starting treatment (Hirschtritt & Kroenke, 2017).
The screening tool selected for anxiety is the Primary Care PTSD Screen (PC-PTSD). The PC-
PTSD is a commonly used, 4-item self-report questionnaire that uses a score of three as the
screening threshold (Kearney & Simpson, 2015). A positive screening result does not mean that
a patient has post-traumatic stress disorder (PTSD), but it does indicate that they are at risk
(Kearney & Simpson, 2015; Friedman, 2018). This screening tool is reliable and practical for use
in the primary care setting because it can assist primary care providers in identifying anxiety
related to traumatic events (Kearney & Simpson, 2015; Friedman, 2018). The PC-PTSD Screen
was chosen based on the subjective information provided by the patient. My initial interpretation
and assessment of this patient was generalized anxiety disorder (GAD), therefore I was going to
use the GAD-7. However, the more I examined the SOAP note, I came to the conclusion that the
patient appears to be experiencing symptoms more related to PTSD.
PC-PTSD Screen:
Instructions:
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that,
in the past month, you:
1. Have had nightmares about it or thought about it when you did not want to? Not Known
2. Tried hard not to think about it or went out of your way to avoid situations that
reminded you of it? YES
3. Were constantly on guard, watchful, or easily startled? Not Known
4. Felt numb or detached from others, activities, or your surroundings? YES (Friedman,
2018).
Due to limited information provided in the SOAP note, two of the questions were excluded from
the survey. However, KB’s screen was positive due to answering yes to the questions that were
applicable. If a patient answers yes to any of the three out of four questions from the PC-PTSD
Screen tool, then it is considered a positive screen. At this point, a positive screen should be
further evaluated by a mental health professional (Friedman, 2018).
Identify your next step for evaluation and treatment for KB. Include any necessary physical
medicine evaluation.
When screening is positive for possible depression, the diagnosis should be established by
utilizing the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), which
provides diagnostic measures for major depressive disorder (MDD) (Maurer, Raymond, &
Davis, 2018). All patients must be carefully assessed for underlying medical conditions by
This study source was downloaded by 100000852681095 from CourseHero.com on 03-07-2023 00:04:54 GMT -06:00
https://www.coursehero.com/file/40804995/Week-3-Psychiatric-Disorders-and-Screeningdocx/
