Evaluating Psychiatric Disorders and Screening Response

1. 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 KF.

PHQ-9 -Deppression

GAD-7 -Anxiety

2. Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.

The patient health questionnaire (PHQ) is the most used tool and comes in various forms. The PHQ-9 includes 9 different criteria that is evaluated according to how much they have bothered patient in past 2 weeks According to Levis (2017) the sensitivity of the PHQ-9 was greater than that of previous versions.

According to Jordan et al. (2017) the Generalized Anxiety Disorder scale (GAD-7) is one of the most frequently used screening tools used for the diagnosis and severity of anxiety. The GAD-7 is a questionnaire that consist of 7 questions that a patient has experienced over a 2-week period.

3. Score KF using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.  In your response include what questions could be scored, and your chosen score.  Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.

Using the PHQ-9 questionnaire the following questions could be assessed: little interest or pleasure in doing things-3; trouble falling/staying asleep, sleeping too much-3; feeling tired or having little energy-3; poor appetite or overeating-3; trouble concentrating on things-3(total score is 15 for questions that could be assessed using the above scenario). A score of 15 a diagnosis can be given for moderate depression.

Using the GAD-7 questionnaire the following questions could be assessed: Feeling nervous, anxious, or on edge-unknow; Not being able to stop or control worrying-unknown; Worrying too much about different things-unknown; Trouble relaxing-3; Being so restless that it is hard to sit still-unknown; Becoming easily annoyed or irritable-unknown; Feeling afraid, as if something awful
might happen-unknown

4. Identify your next step for evaluation and treatment for KF. Remember to consider both physical and mental health differential diagnoses when answering this question.   (2-3 sentences).

I would treat KH for depression, this is primarily regarding the screening tools that were used and the outcomes of each questionnaire. The PHQ-9 indicated that she was suffering from moderate depression while the GAD-7 yielded that she was not suffering from anxiety.

5. What medication or treatment is appropriate for KF based on her screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for KF. Include initial prescribing information.

1^st line of treatment for moderate depressions is an antidepressant, commonly used antidepressants include selective serotonin-reuptake inhibitors (SSRIs) (e.g., citalopram, escitalopram, fluoxetine, paroxetine, sertraline), serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g., desvenlafaxine, duloxetine, levomilnacipran, venlafaxine), and other atypical antidepressants (e.g., bupropion, mirtazapine, vilazodone, vortioxetine) (Epocrates web, n.d). I would start this patient on Lexapro 10mg daily and reassess symptoms in one week and increase dose to 20mg daily which is the maximum dose daily. I chose Escitalopram because it treats depression as well as anxiety. According to (Escitalopram (Lexapro), n.d) escitalopram is an SSRI antidepressan that works in the brain and is approved for the treatment of major depressive disorder (MDD) as well as for the treatment for generalized anxiety disorder (GAD).

6. If the medication works as expected, when should KF expect to start feeling better?

KH may show a response 1-2 weeks after starting medication therapy, but it will take 6-8 weeks for her to be in full remission of all symptoms (Epocrates web, n.d). A follow up appointment should be made 1-2 weeks after initiating therapy and continue progressing to monthly evaluations using the PHQ-9 questionnaire to assess severity of symptoms (Epocrates web, n.d).