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Ask the Mental Health Expert Archives 2001-2004

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Mental Health Tool Test

Q. I am seeking a formalized mental health exam tool/test to follow, when interviewing an individual with a severe/persistent mental illness. Can you suggest any that I can obtain?

A. The kind of test or tool you would use would very much depend on the condition or disorder you were tracking over time, and how you wanted to track it. To give you some background: Two main types of scales or tests may be used as adjunctive tools in the evaluation of mood disorders: screening/severity scales, and diagnostic scales. Screening/severity scales are used to detect likely mental disorders, and to gauge their severity.

Diagnostic scales are used to establish the presence of one type of disorder and rule out others. These instruments also glean detailed information as to the course and symptomatic subtype of a disorder. Screening/severity scales may be subdivided into self-rating and observer-rated scales. Self-rating scales require only the patient's input. Observer-rated scales require judgments on the part of a clinician, often in response to interview questions and behavioral observations.

Diagnostic scales are, by nature, observer-based. They focus on differential diagnosis; for example, distinguishing between major depression and schizoaffective disorder. Mood disorder instruments differ in their sensitivity and specificity. Sensitivity refers to how effective the test is at finding true cases of a given disorder. Specificity is the test's ability to screen out other disorders; i.e., to avoid false positives. Most self-report scales are not very specific, but they are very sensitive to depressive symptoms. Thus, they often yield a high rate of false positives.

Clinician-completed rating scales may be more sensitive to improvement in the course of treatment, and may have greater specificity than do self-reports. The Beck Depression Inventory (BDI) and the Zung Self-rating Depression Scale (ZSRDS) are first-generation self-report screening tests that are still widely used for mood disorders. The Hamilton Depression Scale (HAM-D) and the Montgomery-Asberg Depression Scale (MADRS) are commonly-used observer-based instruments. The HAM-D is by far the most frequently used observer-based depression screening scale.

Another observer-rated instrument sometimes used to assess the severity of patients with mood disorders, as well as schizophrenia, is the Clinical Global Impression (CGI) scale. This is also used in modified form for bipolar disorder (CGI-BP). The CGI is a two-item scale that rates patients from 1 to 7 for severity of illness, then rates their improvement after treatment on a 1 to 7 scale from "very much improved" to "very much worse". If you want a simple way of following nearly any patient over time, you can always use the GAF scale provided in the DSM-IV. I personally find this very useful in tracking a patient's progress.

Otherwise, you may need to find the individual tests in the journal articles that first described them. You can also obtain many useful test instruments from the MHS catalog (1-800-456-3003 or www.mhs.com).

March 2002

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