Thomas Sheeran

Screening for Posttraumatic stress disorder in a general psychiatric outpatient setting

Posttraumatic stress disorder (PTSD) may affect survivors of a number of accidents and illnesses, in addition to violence victims and combat veterans. Prior research suggests that PTSD may be underdiagnosed when trauma is not the presenting problem. Thus, a PTSD screening scale might have utility in routine clinical settings. The authors evaluated the screening performance of the Posttraumatic Diagnostic Scale (PDS) in a general psychiatric setting. Results indicated that the PDS performed as well in this setting as it did in the original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting. A simple cutoff score was adequate for case identification. There were no gender effects, and the scale performed equally well among patients with, versus without, a depressive diagnosis.

Screening for Trauma Histories, Posttraumatic Stress Disorder (PTSD), and Subthreshold PTSD in Psychiatric Outpatients

The ability of the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) modules screening question to identify individuals with PTSD or subthreshold PTSD was examined. First, the screens sensitivity for detecting a trauma history was determined. Second, the incremental validity of a more thorough trauma assessment was examined by determining how many individuals responded negatively to the screen but then were diagnosed with PTSD or subthreshold PTSD. Last, the optimal SCID termination point for assessing subthreshold PTSD was determined. Using a trauma list increased the number of participants reporting a trauma; however, the SCID screen captured almost all individuals who had PTSD or subthreshold PTSD. When one screens for subthreshold PTSD, the SCID can be terminated on failure to meet Criterion B.

Depression and risk for adverse falls in older home health care patients.

Because falls are highly prevalent, harmful events for older adults, identification of patients at risk is a high priority for home health care agencies. Using routine administrative data, we demonstrated that patients with depressive symptoms on the Outcome and Assessment Information Set are at risk for falls. A prospective case-control study that matched 54 patients who experienced an adverse fall with 854 controls showed that patients who fell had twice the odds of being depressed (odds ratio = 1.90, 95% confidence interval = 1.01 to 3.59). Bowel incontinence, high medical comorbidity, stair use, injury and poisoning, memory deficit, and antipsychotic medication use were also predictors, but no association was found for antidepressant medications. These data suggest the potential benefit of including depression screening for multifactorial fall prevention interventions.

ATA practice guidelines for video-based online mental health services

Table of Contents PREAMBLE SCOPE INTRODUCTION Internet-Based Telemental Health Models of Care Today CLINICAL GUIDELINES A. Professional and Patient Identity and Location 1. Provider and Patient Identity Verification 2. Provider and Patient Location Documentation 3. Contact Information Verification for Professional and Patient 4. Verification of Expectations Regarding Contact Between Sessions B. Patient Appropriateness for Videoconferencing-Based Telemental Health 1. Appropriateness of Videoconferencing in Settings Where Professional Staff Are Not Immediately Available C. Informed Consent D. Physical Environment E. Communication and Collaboration with the Patients Treatment Team F. Emergency Management 1. Education and Training 2. Jurisdictional Mental Health Involuntary Hospitalization Laws 3. Patient Safety When Providing Services in a Setting with Immediately Available Professionals 4. Patient Safety When Providing Services in a Setting Without Immediately Available Professional Staff 5. Patient Support Person and Uncooperative Patients 6. Transportation 7. Local Emergency Personnel G. Medical Issues H. Referral Resources I .Community and Cultural Competency TECHNICAL GUIDELINES A. Videoconferencing Applications B. Device Characteristics C. Connectivity D. Privacy ADMINISTRATIVE GUIDELINES A. Qualification and Training of Professionals B. Documentation and Record Keeping C. Payment and Billing REFERENCES.

Screening for psychiatric disorders in outpatients with DSM-IV substance use disorders

Psychiatric disorders are frequent in patients with substance use disorders, and have been associated with increased morbidity and poorer treatment outcome. Because of the clinical importance of comorbid mental disorders, concerns have been raised about the detection of psychiatric disorders in patients with substance use disorders. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong, self-report scale designed to screen for the most common DSM-IV Axis I disorders encountered in outpatient mental health settings. Previously we described the diagnostic performance of the PDSQ in a large sample of psychiatric outpatients. For the present report, we examined the performance of the PDSQ in psychiatric outpatients with drug and alcohol abuse and dependence, and determined whether its performance in patients with substance use disorders is as good as it is in patients without substance use disorders. For the patients with a substance use disorder, 92% of the comorbid mental disorders were detected by the PDSQ subscales (i.e., mean sensitivity across subscales equals 92%) and 97% of the patients who screened negative did not have a disorder (i.e., mean negative predictive value equals 97%). For patients without a substance use disorder, the mean sensitivity and negative predictive values were 88% and 95%, respectively. Receiver Operating Characteristic curves were plotted for each PDSQ subscale for both patient groups, and all areas under the curve were significant and similar in the two groups.

Does depression predict falls among home health patients? Using a clinical-research partnership to improve the quality of geriatric care.

This study found that patients with depressed mood or anhedonia identified on the OASIS were nearly three times more likely to fall. The authors describe the ways these findings are being used in a fall prevention program. The clinical-research partnership used in the study was found to help agencies develop clinically driven research, analyze clinical and administrative data for quality improvement, and provide a foundation for research consultation/collaboration in applied settings.

Screening for principal versus comorbid conditions in Psychiatric outpatients with the Psychiatric Diagnostic Screening Questionnaire

In examining the performance of screening scales, a distinction should be made between principal and additional diagnoses. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong self-report scale designed to screen for the most common Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) Axis I disorders encountered in outpatient mental health settings. In the present report, the authors compared the performance of the PDSQ in identifying principal and comorbid disorders. Seven hundred ninety-nine psychiatric outpatients completed the PDSQ and were interviewed with the Structured Clinical Interview for DSM-IV. The sensitivity and negative predictive values of the PDSQ subscales were similar for principal and additional diagnoses.

Training nursing staff to recognize depression in home healthcare.

OBJECTIVES: To describe the implementation and acceptability of the TRaining In the Assessment of Depression (TRIAD) intervention, which has been tested in a randomized trial. The primary aim of TRIAD is to improve the ability of homecare nurses to detect depression in medically ill, older adult homecare patients.

Assessing past treatment history: test-retest reliability of the Treatment Response to Antidepressant Questionnaire.

A reliable and valid instrument has yet to be developed that elicits antidepressant treatment history via patient interview. The goal of the present study was to establish the test-retest reliability of the Treatment Response to Antidepressant Questionnaire (TRAQ). The TRAQ is a semistructured interview that was designed to collect systematically information regarding previous antidepressant treatment, adequacy of trials, and nature of response. Fifty subjects who sought outpatient treatment as part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project participated in the study. Patients were interviewed initially by a psychologist, who administered the TRAQ. An average of 5 to 6 days later, a psychiatrist who was blind to the results of the initial evaluation readministered the TRAQ to each of these patients. Reliability of recall of antidepressant trials, trial adequacy, and nature of response were evaluated using the kappa statistic. The mean duration of the TRAQ interviews was 3.30 minutes (SD = 2.03 minutes). The reliability of recall of antidepressant trials ranged from 0.81 to 0.95, with an overall kappa of 0.91. The kappa for trial adequacy, depending on the definition used, ranged from 0.72 to 0.84. The kappa for determining positive versus negative response was 0.72. Thus, the test-retest reliability of the TRAQ was found to be in the good to excellent range for each of the principal outcome measures. The TRAQ can be administered by non-MDs as a reliable measure for collecting standardized information regarding antidepressant treatment history via patient interview.

Depression Care for Patients at Home (Depression CAREPATH): home care depression care management protocol, part 2.

High levels of depressive symptoms are common and contribute to poorer clinical outcomes even in geriatric patients who are already taking antidepressant medication. The Depression CARE for PATients at Home (Depression CAREPATH) intervention was designed to meet the needs of medical and surgical patients who suffer from depression. The interventions clinical protocols are designed to guide clinicians in managing depression as part of routine home care.