Thursday, 11 January 2018

Steps of Clinical Assessment of Depression

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 

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