Clin Phys Exam 2: O Neil Behavioral Health Assessment

Potential Solutions to Behavioral Health Workforce Shortage:

1. ____ health to expand reach in underserved areas

2. integrated care models linking mental health with ___ ___

telebehavioral, primary care

Potential Solutions to Behavioral Health Workforce Shortage:

3. leveraging health support workers and expanding ___ ___ ___

scope of practice

Potential Solutions to Behavioral Health Workforce Shortage:

4. accelerated ___ programs

5. ___ reforms to improve reimbursement and retention incentives

training, policy

Components of Behavioral Health Assessment

1. ___ ___ (conducted first, captures full scope of patient's presentation)

intake assessment

Components of Behavioral Health Assessment

2. ___ ___ ____ ( = psychiatric physical exam)

mental status exam

Components of Behavioral Health Assessment

3. ____ ___ tools (provide quantitative symptom data, support early detection/triage in primary care, monitor response to treatment)

standardized screening

Domains of Mental Status Exam (MSE)

1. ___ (grooming, hygiene, clothing, apparent age, physical features)

2. ___/psychomotor activity (eye contact, posture, etc)

3. ___ (rate, volume, tone, etc)

appearance, behavior, speech

Domains of MSE

4. ____ (emotional state)

5. ___ (observable emotional expression)

6. thought ___ (organization and flow of ideas)

mood, affect, process

Domains of MSE

7. thought ___ (delusions, obsessions, etc)

8. ___ (hallucinations, illusions)

content, perceptions

Domains of MSE

9. ____/sensorium (orientation, attention, memory, etc)

10. ____/____

cognition, insight/judgement

Mental Health Screening Tools

-questionnaires designed to detect potential mental health conditions

-key features: ___, standardized, validates, objectively scored, free/widely available

brief

Mental Health Screening Tools-Advantages

1. provide ___ warning systems that identify people who need further evaluation

2. these tools can track symptom ___ over time

early, severity

Mental Health Screening Tools-Advantages

3. these tools provide ways to facilitate ___ about mental health with healthcare providers

4. are instruments to measure treatment ___

conversations, response

Mental Health Screening Tools-Disadvantages

1. these tools are not ____

2. these tools are not substitutes for ___ evaluation

diagnostic, professional

Mental Health Screening Tools-Disadvantages

3. these tools are not 100% ___

4. these tools do not help develop ____ ___

accurate, treatment plans

Components of Screening Tool Design

-___ of symptoms

-___ of symptoms

-__ of symptoms

-functional impairment

frequency, severity, duration

Mental Health Screening Tools

-If minimal/no symptoms → no intervention needed

-If mild symptoms → monitor/lifestyle interventions

-If moderate → recommend ___ ___

-If severe → recommend professional help ____

professional evaluation, immediately

Role of Pharmacist

1. support ____ detection/triage

2. ____/optimize drug therapy

3. monitor ___ of drug therapy

4. monitor __ ___ of drug therapy

early, initiate, effectiveness, adverse effects

____-___ is a screening tool for depression that contains the first 2 questions of the PHQ-9

PHQ-2

PHQ-2

-advantage → takes ___ ___

-limitation → lower ___ than PHQ-9

-cut-off → score ≥__ suggests possible depression and warrants full PHQ-9 administration

30 seconds, specificity, 3

PHQ-2-Preferred Use

-first-line screening for ___ clinical settings

-annual wellness visits with ___ time

-____-scale population screening

busy, limited, large

____-___ is the gold standard screening tool for depression that measures the presence and severity of symptoms over the past 2 weeks based on DSM-5 criteria for MDD

PHQ-9

PHQ-9

-score range from 0-27

-score ≥____ indicated MDD and is the cutoff for clinical action

10

PHQ-9

-question 9 is critical - asks about thoughts of death/self harm - if any positive response to this question, immediate ___ assessment required

safety

PHQ-9-Advantages

-brief

-validated across ___ populations; available in 80+ language

-directly maps to ___ depression diagnostic criteria

diverse, DSM-5

PHQ-9-Disadvantages

-relies on __-___ (so patients may underreport or overreport symptoms)

-doesn't ___ between types of depression

-___ factors may influence responses

self-reporting, differentiate, cultural

PHQ-9-Preferred Use

-___ MDD screening in adults

-patients with ___ medical conditions

-monitoring treatment ___

annual, chronic, response

Geriatric Depression Scale-15

-relies on __-__, requires yes/no answers

self-reporting

Geriatric Depression Scale-15

-cut-off → score ≥__ indicates possible depression

5

Geriatric Depression Scale-15-Preferred Use

-healthy ___

-medically ___ patients

-those with mild-moderate cognitive impairment

seniors, ill

Cornell Scale for Depression in Dementia

-includes both interview with ___ AND interview with ___

patient, caregiver

Cornell Scale for Depression in Dementia

-cut-off → score >__ indicates possible depression

6

Cornell Scale for Depression in Dementia-Preferred Use

-patients with ___

dementia

Beck-Depression Inventory II

-21 item __-___ measure

self-reported

Beck-Depression Inventory II

-advantage → more ___ than PHQ-9, includes __ and __ symptoms

detailed, cognitive, somatic

Beck-Depression Inventory II

-limitation → ___ than PHQ-9, copyright protected

-cut-off → score ≥__ indicates clinically significant depression

longer, 14

Beck-Depression Inventory II-Preferred Use

-___ studies

-____ psychological evaluations

-when there is need for ___ symptom assessment

research, comprehensive, detailed

Hamilton Depression Rating Scale (HAM-D)

-____-administered (not self-administered)

clinician

Hamilton Depression Rating Scale-Preferred Use

-used to measure ___ after depression is already established

-used often in clinical trials and psychiatric evaluations

-not a ___ tool

severity, diagnostic

Edinburgh Postnatal Depression Scale (EPDS)

-asks about depression symptoms over the past 7 days, with emphasis on ___ (inability to feel pleasure) rather than somatic symptoms)

anhedonia

Edinburgh Postnatal Depression Scale (EPDS)-Preferred Use

-during ___ (all 3 trimesters)

-___-___ weeks postpartum (universal screening recommended)

pregnancy, 4-6

Edinburgh Postnatal Depression Scale (EPDS)

-cut-off → score ≥__ indicates depression

-if positive response to question 10 (asks about suicide/self harm) → immediate ___ needed

10, referral

Screening tools for anxiety

1. generalized anxiety disorder 7 (___-__)

2. generalized anxiety disorder 2 (___-__)

GAD-7, GAD-2

GAD-7

-measures frequency of anxiety symptoms over the past 2 weeks

-score ≥__ indicates anxiety

10

GAD-7 Limitations

-doesn't ___ between specific anxiety subtypes

-may miss anxiety disorders with primarily ___ symptoms

distinguish, physical

GAD-7-Preferred Use

-screening for anxiety disorders in ___ ___

-patients with __ physical symptoms

-monitoring anxiety treatment ___

-patients with ___

primary care, unexplained, response, depression

GAD-2

-uses first 2 questions from GAD-7

-score ≥__ indicates possible anxiety and warrants full GAD-7

3

GAD-2-Preferred Use

-first-line screening in ___ clinical settings

-__ wellness exams

-paired with PHQ-2 for combined depression/anxiety screening

busy, annual

Screening tools for cognitive impairment

1. mini mental state examination (___)

2. montreal cognitive assessment (___)

3. brief interview for mental status (___)

MMSE, MOCA, BIMS

mini mental state examination (MMSE)

-performed by trained clinician

-domains: orientation, registration, attention, recall, language, visual construction

-score

24

MMSE-Preferred Use

-general screening

-___ comparison

historical

MMSE-Strengths

-___ used, well-studied

-good for general screening/tracking over time

widely

MMSE-Limitations

-less sensitive to ___ impairment, ___ dysfunction, and some ___-___ patterns

-affected by education, literacy, sensory impairments

early, executive, non-Alzheimer

montreal cognitive assessment (MOCA)

-performed by trained clinician

-domains: 8 cognitive domains (memory, attention, language, visuospatial, executive function)

-score

26

MOCA-Preferred Use

-early detection of ___

MCI

MOCA-Strengths

-designed to detect mild cognitive impairment ___ than MMSE

-____ cognitive coverage, includes executive and visuospatial tasks

earlier, broad

MOCA-Limitation

-requires trained clinical and formal __ in some settings

-____-consuming; may over-identify impairment if cutoffs applied rigidly

certification, time

brief interview for mental status (BIMS)

-structured interview (CMS/MDS 3.0 requirement for all ___ residents)

-domains: orientation and recall only

-cutoff

SNF, 8

BIMS-Preferred Use

-quick compliance check in ___

SNFs

BIMS-Strengths

-required by CMS for SNF cognitive screening

-___, requires minimal training for staff

quick

BIMS-Limitations

-limited ___ (does not assess other cognitive domains, does not assess behavioral/neurological issues)

-lower sensitivity for ___ cognitive impairment than MOCA/MMSE

scope, mild

Screening tools for alcohol use disorders

1. alcohol use disorders identification test (___)

2. ____: quick alcohol screening

AUDIT, CAGE

alcohol use disorders identification test (AUDIT)

-score ≥__ indicates hazardous drinking requiring intervention

8

AUDIT-Preferred Use

-annual screening in ___ ___

-before prescribing meds metabolized by ___

-for patients with liver disease, HTN, MDD, or sleep problems

-evaluating ___ for alcohol treatment

primary care, liver, readiness

There is a brief version of AUDIT called ___-__, which is only 3 questions

AUDIT-C

CAGE

-only 4 question

-score ≥__ suggest alcohol use disorder

2

CAGE- Preferred Use

-very ___ screening (30 seconds)

-when AUDIT is too lengthy

-identifying alcohol ___ specifically

quick, dependence

CAGE- Limitations

-less sensitive than AUDIT for detecting ___ hazardous drinking

early

bottom line

Use ___ for comprehensive screening

Use ___ for rapid screening of established drinkers

AUDIT, CAGE

Screening tools for psychotropic side effects-Patient Completed Scales

1. Glasgow Antipsychotic Side Effect Scale (____ Scale)

2. Systemic Monitoring of Adverse Events Related to Treatments (____)

GASS, SMARTS

Screening tools for psychotropic side effects-Clinician Rating Scales

1. Abnormal Involuntary Movement Scale (___)

2. Barnes Akathisia Rating Scale (___)

3. Simpson Angus Scale (___)

AIMS, ARS, SAS

Use AIMS to screen for ___ ___

tardive dyskinesia

Use ARS to screen for drug-induced ___

akathisia

Use SAS to quanitify drug-related ____, rigidity, and tremor

parkinsonism