Skip to main content

Steps of Clinical Assessment of Depression

Image
By

Steps of Clinical Assessment  

Step 1: Listen to the patient carefully, establish rapport, and develop a therapeutic alliance.

Step 2: Confirm the diagnosis by identifying the full spectrum of signs and symptoms of depression and anxiety, and confirm a lack of a history of mania. Also exclude organicity especially hyper/hypothyroidism, Cushing disease, brain tumors, and any other physical conditions that can induce or mimic the symptoms of depression. A detailed medical history, physical examination, and relevant laboratory investigations (TFTs,  Cortisol, DST, brain imaging, ECG, etc.) Should be obtained for this purpose. Exclude (depression/anxiety as) the impact of medications (e.g. propranolol), substances of abuse, and alcohol.  

Step 3: Assess the severity clinically and to monitor, with a standard scale, (HAMD/HAM-A, BDI/BAI, etc). Severity also influences the choice of treatment.

Step 4: Assess the impact of the condition on the patient and family, including personal distress, work difficulties, social life, financial matters, etc. A needs assessment scale and global functioning scale may also help. 

Step 5: Assess the risk of suicide, deliberate self-harm, self-neglect, and harm to others. 

Step 6: Assess for etiological factors, confirm the absence of genetic predisposition, and identify any long-term difficulties, recent stressful circumstances, cognitive distortions and dysfunctional beliefs, socioeconomic status, social support, substance abuse, personality factors e.g. sociotropy and neuroticism, borderline personality disorder, dysthymic personality, etc. 

Step 7: For long-term management and patient education, a prognostic assessment is also mandatory. Apart from the short course, and lack of bipolarity, other prognostic factors will be revealed as the assessments above are carried out, e.g. comorbid substance use and personality disorder, social support, etc.  

Step 8: Finally Assess for medical comorbidities, especially atrial fibrillation, other cardiac conditions, hypo/hyperthyroidism, hypertension,  metabolic syndrome (influences drug choice and management) in liaison with a physician.  

Step 9: Determine whether the patient needs admission, based on severity, social support, risks, and patient preference 

Comments

Post a Comment

Your Thoughts?

Popular posts from this blog

ADVOKATE: A Mnemonic Tool for the Assessment of Eyewitness Evidence

By
ADVOKATE: A Mnemonic Tool for Assessment of Eyewitness Evidence A tool for assessing eyewitness  ADVOKATE is a tool designed to assess eyewitness evidence and how much it is reliable. It requires the user to respond to several statements/questions. Forensic psychologists, police or investigative officer can do it. The mnemonic ADVOKATE stands for: A = amount of time under observation (event and act) D = distance from suspect V = visibility (night-day, lighting) O = obstruction to the view of the witness K = known or seen before when and where (suspect) A = any special reason for remembering the subject T = time-lapse (how long has it been since witness saw suspect) E = error or material discrepancy between the description given first or any subsequent accounts by a witness.  Working with suspects (college.police.uk)
Post a Comment
Read more

ICD-11 Criteria for Anorexia Nervosa (6B80)

By
ICD-11 Criteria for Anorexia Nervosa (6B80) Anorexia Nervosa is characterised by significantly low body weight for the individual’s height, age and developmental stage that is not due to another health condition or to the unavailability of food. A commonly used threshold is body mass index (BMI) less than 18.5 kg/m2 in adults and BMI-for-age under 5th percentile in children and adolescents. Rapid weight loss (e.g. more than 20% of total body weight within 6 months) may replace the low body weight guideline as long as other diagnostic requirements are met. Children and adolescents may exhibit failure to gain weight as expected based on the individual developmental trajectory rather than weight loss. Low body weight is accompanied by a persistent pattern of behaviours to prevent restoration of normal weight, which may include behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g. self-induced vomiting, misuse of laxatives), and behaviours aimed at incr
Post a Comment
Read more

ICD-11 Criteria for Depression (Recurrent Depressive Disorder) 6A71

By
ICD-11 Criteria for Depression (Recurrent Depressive Disorder) 6A71 Recurrent depressive disorder is characterised by a history or at least two depressive episodes separated by at least several months without significant mood disturbance. A depressive episode is characterised by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a Bipolar disorder. Inclusions:                Seasonal depressive disorder Exclusions:               Adjustment disorder (6B43) Bipolar or related disorders (BlockL2‑6A6) Sing
Post a Comment
Read more