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Clinical questions
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If the depression score is only slightly out
of range—for example, 11 or 12—should I still treat for
depression? |
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| Any score outside the normal reference range
indicates clinically significant distress, whether or
not the patient meets strict DSM-IV criteria for major
depression or dysthymic disorder. A Depression score of
11 or 12 indicates a relatively mild depressive
disorder. It would be appropriate to discuss the
findings with the patient and review treatment options
(e.g., lifestyle changes, psychotherapy). At the very
least, the patient should be monitored and re-assessed
periodically. |
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What is the best way to talk to a patient
about a mental health diagnosis? |
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Present the QPD Panel findings matter-of-factly,
as you would any other medical finding. For example, you
could simply say “Your test results show that you are
suffering from depression. The symptoms you are having
are part of depression, and they should clear up when
you get treatment.” Here you might review the specific
symptoms listed on the QPD Panel report, emphasizing
that they are components of the same disorder. Many
patients do not know, for example, that symptoms like
fatigue, or appetite loss, or insomnia are related to
depression.
Most patients are relieved and
grateful when their physician addresses mental health
problems, and appreciate the fact that the physician is
concerned enough to do so. Patients who might otherwise
deny emotional problems tend to be more open to
treatment when presented with the objective QPD Panel
report. Many physicians find it helpful to show the
patient the report while reviewing the findings.
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How often should I re-administer the QPD
Panel? |
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| You can re-administer the test as often as
desired. Patients with no known psychiatric history
should be screened at least once per year as part of an
annual check up. You can think of it as checking the
patient’s “emotional vital signs.” For patients with
mental health problems, the test should be administered
more often. For example, the QPD Panel should be
re-administered 4 to 6 weeks after starting a patient on
an antidepressant to assess response to treatment. The
patient should continue to be assessed every few months
until the symptoms have remitted and the depression
score is within the normal range (0 to 10). Depressed
patients may not initiate follow-up appointments, so it
is important to schedule appointment in advance. It is
also common for depressed patients to stop taking
antidepressants before the medication has time to take
effect. Scheduled follow-up appointments encourage
compliance and lead to better outcomes. |
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A lot of my patients get multiple diagnoses on
the QPD Panel. Is this common? |
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Comorbidity of psychiatric disorders is very high,
and it is common for patients to receive more than one
diagnosis. The comorbidity of depression and anxiety is
so high that DSM task forces are considering a single
combined diagnosis. Mood disorders are often comorbid
with substance abuse, and patients with mood disorders
often use alcohol or drugs in a misguided effort to self-medicate.
It is important to
consider the spectrum of disorders when planning
treatment. For example, a depressed patient who is
abusing alcohol is unlikely to derive much benefit from
treatment unless substance abuse is addressed as well.
Patients with depression and panic attacks are likely to
benefit from psychotherapy in addition to medication. As
the number of QPD Panel diagnoses increases, the
likelihood that the patient is suffering from a
long-standing personality disorder (Axis II) increases
as well, and the physician should be alert to this
possibility. Patients with personality disorders should
generally be referred to a mental health professional
for treatment. |
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How do I know when to diagnose Somatization
Disorder? |
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| Somatization Disorder is diagnosed only after the
physician has rule out medical conditions that may be
causing the symptoms. An out-of-range Somatization score
simply means that the patient has reported multiple somatic
symptoms that are unlikely to result from any single medical
condition, which may be somatic equivalents of depression
or anxiety. The score should raise the physician's index
of suspicion regarding Somatization Disorder, but a thorough
medical work up is indicated. |
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I am a primary care physician. Once I identify
a patient as depressed, what treatment should I
offer? |
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The first intervention is to inform the patient
of the QPD Panel findings. Patients are generally
reassured to know that their symptoms have an
explanation and treatment is available. Sometimes this
alone brings about some improvement, because it offers
hope to a person who may otherwise be feeling confused
and hopeless.
Early treatment is advisable.
Untreated depression tends to be cyclical, with
depressive episodes becoming more severe over time.
Psychotherapy and antidepressant medication are both
effective treatments, and the patient’s preference
should be a determining factor. In one study, primary
care patients identified as depressed by the QPD Panel
were offered the option of psychotherapy, a trial on an
antidepressant, or both. The patients made good
decisions and showed significant improvement at 12 week
follow up, with QPD Panel depression scores decreasing
an average of 7.1 points. |
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Are the results valid if a patient lies when
taking the QPD Panel? |
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| The results are not valid if a patient does not
answer honestly. The QPD Panel is designed for use in
healthcare settings where patients voluntarily seek help.
The test is an extension of the patient’s communication
with his doctor, so patients generally respond candidly. |
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