Mental Health Disorders and the Screening Tool that Removes Confusion
Mental Health Disorders and Screening Tools:
The Connected Mind screening tool helps Primary Care and Specialty doctors efficiently screen their patients for mental health disorders, allowing them to assess their patients without knowing up-front which screening tool to use.
Connected Mind Mental Health Screening: If a patient is suffering from 1 mental health condition there is a 50% chance they are suffering from 2 or more. Individually screening for depression or anxiety alone is not enough. This mental health screening tool has recently been validated by a team of researchers working as independent contractors out of the University of North Texas. Connected Mind with Fast Check can shorten the window to treatment by expediting the diagnostic process by simultaneously screening for the 6 most common mental health disorders that most impact physical health, including:
- Bipolar Disorder
- Somatic Symptom Disorder
- Substance Use Disorder
- Also includes the PHQ-9 and GAD-7 results if triggered
PHQ-9 screens for depression: The 9 question PHQ-9 screening tool was published in 2001 and is used for assessing depression. It is delivered as a paper screening but has also been incorporated into various online tools. It includes DSM-IV depression criteria and is used for screening and diagnosis, as well as tracking treatment. Major depressive disorder scores higher than 10 have a sensitivity of 88% and a specificity of 88%. With high internal consistency, the tool has sound psychometric properties. A study involving two different patient populations using 580 structured interviews by a mental health professional had the following results: mental health professionals were 7 to 13.6 times more likely to diagnose individuals with depression when they scored high (≥ 10) on the PHQ-9. Individuals who scored low (≤ 4) had less than 1 in 25 chance of having depression.1
GAD-7 screens for anxiety: Published in 2006, the 7 question screener includes DSM-IV criteria and is used for assessing symptoms of anxiety. It is delivered as a paper screening but has also been incorporated into various online tools. It can also be used to track progress of treatment over time. The patient is asked to evaluate their symptoms for the previous 2-week period. Using simple language, it is suitable for those as young as 14. If screening results are higher than 10, further evaluation is recommended.
The GAD-7 has a sensitivity of 89% and a specificity of 82% for generalised anxiety disorder (threshold score of 10). It can be used to screen three other common anxiety disorders: panic disorder (sensitivity 74%, specificity 81%), social anxiety disorder (sensitivity 72%, specificity 80%), and post-traumatic stress disorder (sensitivity 66%, specificity 81%). 2
Alcohol Use Disorders Identification Test (AUDIT): Published in 1993, the AUDIT is a 10 question self-report screening questionnaire designed to measure harmful alcohol use. The questions focus primarily on symptoms occurring during the recent past. It was developed in conjunction with the World Health Organization and is widely used and useful for routine screening in community health settings. The AUDIT was based on data collected from a large multinational sample, with an emphasis on hazardous drinking rather than long-term dependence and adverse drinking consequences. It can assess three factors of problematic alcohol use:
- Hazardous health impacts
- Dependence symptoms
- Behavioral or social problems of use
Subsequent research has evaluated the AUDIT against other measures of alcohol problems including data from comprehensive interviews. A study with 477 participants (Bush, et al, 1998) found that those who completed the AUDIT and were interviewed to determine significant alcohol related problems, a cutoff score of 8 had a sensitivity of 59% and a specificity of 91%, i.e. a score of 8 or more will only be sensitive to 59% of individuals who actually have drinking problems, and one can be 91% sure it is not a false positive.3
Beck’s Depression Inventory (BDI-II): Published in 1996, the BDI-II has 21 questions and can be used for assessing symptoms of depression, allowing patients to self report their symptoms over the last two week period. It is not meant to be used as a primary diagnostic tool for diagnosing mental health disorders. The BDI-II is meant to give the clinician a better picture of the patient’s symptoms and severity. The BDI-II may be used in community health, clinical or hospital settings. There are numerous Beck assessments, which can be taken on paper or online. Commonly used screeners:
- Beck Anxiety Inventory (BAI)
- Beck Cognitive Insight Scale (BCIS)
- Beck Hopelessness Scale (BHS)4
Mental Health Disorders:
Attention Deficit Hyperactivity Disorder (ADHD): This mental health disorder includes a mixture of chronic behavior problems including hyperactivity, impulsivity and difficulty paying attention. For both children and adults, this may cause unstable or troubled relationships, difficulty at school or work as well as self-esteem issues. Although symptoms may lessen with age, onset starts in early childhood and continues into adulthood. Some may never completely outgrow their ADHD symptoms while others may not be diagnosed until adulthood. As adults, hyperactivity symptoms may decrease while struggles with impulsiveness, restlessness and attentiveness continue. ADHD cannot be cured but finding it early and providing treatment can be very helpful and typically includes behavioral interventions and medications.
Anxiety Disorders: People with anxiety disorder often feel strong and excessive worry and fear just going about their daily life. Episodes of Intense anxiety and fear (panic attacks) may be a typical occurrence. Controlling these feelings is difficult and they can last for far too long. The fear and danger perceived is generally way out of proportion to any real existing danger. Symptoms may begin in childhood or adolescents and can continue into adulthood. Medical conditions requiring treatment can also cause anxiety.
Generalized Anxiety Disorder (GAD): Occurs when you feel over-stressed, over-worried and over-anxious for no apparent reason. Anxiety that feels larger than life and intrudes in your daily activities can have a serious impact on your body, causing headaches, fatigue, stomachaches or other physical ailments. Medications, psychotherapy, coping skills and relaxation techniques can bring about change for the better. GAD is often comorbid with other mood disorders. Additional anxiety disorders include:
- Social phobias
- Specific phobias
- Separation disorder
Bipolar Disorder: This mental health disorder causes extreme swings between mania (high mood) or hypomania (low mood and depression). Formerly called manic depression, those faced with this disorder endure episodes that may happen often or rarely throughout the year. When depressed, feelings of sadness or hopelessness may occur. During episodes, those with bipolar disorder face a typical loss of interest or pleasure in daily activities. Mood swings may bring euphoric highs or unusual irritability, affecting sleep, energy levels, activity, judgment, behavior and clear thinking. This lifelong condition requires a treatment plan and ideally early intervention.
Comorbid Mental health disorders: The most common disorders found in chemically dependent people include mood and anxiety disorders. People with severe mental illness also have co-occurring substance use disorders at higher percentages, they include schizophrenia and schizoaffective disorder (and often include symptoms of hallucinations or delusions and may be called Thought Disorders.)6
Comorbid: If a person is diagnosed with two or more co-existing conditions, for instance having both anxiety and depression, they then have comorbid anxiety and depressive disorders. Other mental disorders that have shown a tendency for comorbidity include eating disorders, anxiety disorders, and substance abuse.5
Co-occurring: also sometimes called dual-diagnosis, those with a substance use disorder as well as a mental health disorder(s) are diagnosed as having co-occurring or dual disorders. Substance use disorders include alcohol and drug use or dependence. If substance use interferes with relationships, school or work, then alcohol or drug abuse is diagnosed. A Co-occurring diagnosis is made once substance use creates or worsens a medical condition. Alcohol or drug abuse is less severe than dependence on drugs or alcohol. People with alcohol or drug dependence are unable to abstain from or control their use of substances. Additionally, physiological dependence may be indicated by increased tolerance (need more to get the same effect) and withdrawal when no longer taking the drugs or alcohol (bringing on symptoms such as nausea and tremors ).
Major Depressive Disorder (MDD): Depression causes persistent feelings of sadness and can lead to feeling as though life isn’t worth living. It is more than a bout of the blues you can simply ‘snap out” of. You may have trouble doing normal day-to-day activities, including feeling: low self-esteem and energy, little interest in things you normally enjoy and unexplained pains. Depression may require long-term treatment, but most people with depression feel better with medication, psychotherapy or both.
Persistent Depressive Disorder (PDD): also called dysthymia, is continuous and chronic (long-term) depression. Those with PDD may find it hard to be cheerful or optimistic and may be described as having a somber personality, constantly complaining or unable to have fun. Feelings may last for years and include: feeling inadequate, loss of interest in daily activities, hopelessness, lack of productivity and low self-esteem. Persistent depression can impact daily activities, school, work, and relationships. Coping with the chronic nature of PDD can be challenging, but treating with a combination of medication and psychotherapy can be effective.
Mood Disorders: Mood disorders cause distorted or inconsistent emotional states based on current circumstances and they may increase risk of suicide. Ability to function may be impacted. Feelings of extreme emptiness, sadness or irritability may occur, including periods of depression or mania. Anxiety disorders are often comorbid with depression, further affecting your mood. Some examples of mood disorders include; Major depressive disorder, Persistent depressive disorder, Bipolar disorder, Seasonal affective disorder (SAD) due to fewer hours of daylight, Cyclothymic disorder which causes emotional ups and downs that are less extreme than bipolar disorder and Premenstrual dysphoric disorder which brings on mood changes and irritability during premenstrual phases of a woman’s cycle. Psychotherapy and medication can help most people suffering with a mood disorder.
Post Traumatic Stress Disorder (PTSD) – Experiencing or witnessing a frightening event can trigger PTSD. Worsening symptoms that last for months or years may include uncontrollable thoughts and flashbacks, as well as nightmares and severe anxiety. Adjusting and coping with day to day life may be difficult but improvement can be found by allowing for self-care and enough lapsed time. Receiving early and effective treatment once PTSD symptoms develop is critical for reductions of symptoms and long term improvement.
Schizophrenia: For those with schizophrenia, interpretation of reality is generally non-typical. This serious mental disorder may result in a combination of delusions, hallucinations as well as extremely disordered thinking. Behaviors displayed may lead to impaired daily functioning which can be disabling. People with schizophrenia require lifelong treatment, the earlier the better, so that serious complications are less likely to develop which improves the long-term outlook.
Somatic Symptom Disorder: Temporary life stressors can lead to symptoms such as body pains and headaches. Generally, these acute symptoms resolve once the stress factors resolve. 70% of patients show improvement within 2 weeks. For those who fail to improve beyond the 3-month mark, fear and extreme focus sets in surrounding their physical symptoms. Chronic or recurrent symptoms remain at the 5-year mark for approximately 20% to 25% of patients.
Although people with chronic subtypes of SSD access medical care at high rates, their suffering is scarcely improved. Many receive unnecessary and invasive somatic examinations while psychological factors are generally left unexplored. SSD patients frequently seek medical care, continuing to search for an explanation even when other serious conditions have been excluded.
Substance Use Disorder (SUD): Experimenting with recreational drugs when in social situations may ultimately lead to addiction. Medically prescribed drugs can also cause addiction. SUD affects the brain’s ability to control the desire for, and use of, legal or illegal drugs. After some time, larger doses may be needed to feel high or well, making it difficult to go without the drug. Addiction rates vary depending on the chosen drug; for instance, high rates of addiction are caused by opioid painkillers. Withdrawal symptoms may cause physical illness and intense cravings for the drug.
Suicide: Suicidal thoughts (ideation) occurs when someone has thoughts of engaging in suicidal behavior. If you or someone you know if thinking about suicide, it is important to get help. Use suicide help lines or call 911 in cases of emergency, taking action is always the best choice. It is ok to talk about suicide, do not worry about pushing someone into doing something harmful to themselves, offering an opportunity to talk about feelings may reduce the risk of acting on suicidal feelings. Consider the following if a friend or loved one show these common signs of suicide thought or plans:
- Using statements such as
- I wish I were dead
- I wish I had never been born
- I am going to kill myself
- They have purchased a gun or saved up drugs / medications
- Socially distant and no longer reaching out
- Mood swings
- Excessive thoughts of death, dying or violence
- Say they feel trapped and hopeless
- Using excessive/increased amounts of drugs or alcohol
- Changes in sleeping or eating patterns
- Becoming more reckless and risky with their behaviors
- Giving away their belongings for no apparent reason
- Saying goodbye although no obvious plans to travel or be away
- Severely personality changes such as anxiety or agitation along with signs above