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Section 9: Psychiatric Disorders

Which resource is helpful in identifying the diagnostic criteria for schizophrenia?

A. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

B. American Psychiatric Association Practice Guidelines for Psychiatric Evaluation

C. Mini-Mental Status Examination (MMSE)

D. Brief Psychiatric Rating Scale (BPRS)

The answer is A. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides a common language for practitioners to describe and diagnose psychiatric disorders.

Which term best describes the ability of a psychiatric rating scale to determine if a symptom or disorder is absent when the patient does not have the related condition?

A. Reliability

B. Validity

C. Sensitivity

D. Specificity

The answer is D. Specificity is the correct answer and refers to a test’s ability to correctly determine that a symptom or illness is absent when the person does not have the illness. For example, a test with 90% specificity correctly reports 90% of patients without the illness, but 10% patients without the illness are incorrectly identified as false positives.

The primary care clinic providers would like to implement a depression screening tool. The scale needs to be completed by the patient in a short amount of time while waiting to see the clinician. Results would then be assessed by the clinician to determine risk of depression. Select the most appropriate rating scale for depression based on this practice setting.

A. Hamilton Depression Rating Scale (HDRS)

B. Montgomery-Asberg Depression Rating Scale (MADRS)

C. Clinical Global Impressions Scale (CGI)

D. Patient Health Questionnaire (PHQ-9)

The answer is D. Patient Health Questionnaire (PHQ-9) is a patient-rated scale that can be completed by the patient in the waiting area. The other scales are clinician-rated scales that are typically completed during or shortly after the patient encounter (see Table e79-5).

A patient is experiencing the following symptoms: inability to sit still, pacing, feelings of inner restlessness. No other unusual muscle movements are observed such as tremors, twitching, or rigidity. Patient does not complain of any anxiety or being worried about anything in particular. The patient was started on an antipsychotic 2 weeks ago. Which rating scale would be the most appropriate to assess these symptoms?

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