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QPD
Panel Users Guide (v7.1)
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Background |
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Patients with psychiatric disorders are more likely
to seek help from their physicians than from mental health
professionals.1 They tend to present with somatic
complaints rather than emotional complaints and physicians
often overlook the psychiatric disorders. Studies show
that psychiatric disorders are present in at least 20%
of medical outpatients1-2 and physicians fail
to diagnose 50% to 75% of these cases.3-11
Patients with undiagnosed psychiatric disorders suffer needlessly. Additionally, they are high utilizers
of health care services as they repeatedly seek relief
from symptoms that are not properly diagnosed and treated. They contribute disproportionately to rising healthcare costs.12-15
Until now, tests to screen for psychiatric disorders have
been impractical for routine use in busy medical clinics. They have required too much time from physicians or clinic staff, or have
not provided results in a form helpful to physicians.
The Shedler QPD Panel™ (an acronym for Quick PsychoDiagnostics
Panel) is the product of extensive research into
the needs of primary care physicians. It integrates easily
into busy medical clinics and provides valid diagnostic
information in a user-friendly format.
The QPD Panel is fully automated. Patients self-administer
the test in approximately six minutes using portable,
hand-held computer tablets. The test screens for nine
common psychiatric disorders.
Physicians immediately receive a computer-generated “lab
report.”
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When to Use the QPD Panel |
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The QPD Panel can be used with all new or established
patients or it may be administered when a mental health problem is suspected. Given the
ease of administration and the high prevalence of psychiatric
disorders in primary care, routine administration
is recommended.
The QPD Panel can be re-administered as often as desired
to monitor patient progress or assess treatment outcome.
The QPD Panel "lab report" includes a patient
trending graph showing changes over time. |
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How to Administer the QPD Panel
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The equipment consists of a portable hand-held
computer tablet and a docking station. The docking station
connects to an office PC.
Patients may be given the handheld computer tablet when
they check in and can self-administer the test in the
reception area or waiting room. The handheld tablet displays
diagnostic questions on a video screen and patients answer
by pressing True/False response buttons. The procedure
is self-explanatory and the questions require only a fifth
grade reading level. Patients complete the test in 6.2
minutes, on average. A Spanish version is also available.
Once the patient completes the test, the handheld computer
tablet is placed on the docking station and the “lab
report” prints automatically. |
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The QPD Panel Report |
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The QPD Panel provides a computer-generated lab
report that has a “look and feel” familiar to physicians,
resembling a standard blood chemistries report (please
see the sample
report at bottom of page).
Numeric Scores
Numeric scores indicate the severity of 1) depression,
2) anxiety, 3) panic disorder, 4) posttraumatic stress,
5) bulimia, 6) alcohol/substance abuse, and 7) somatization.
Higher scores indicate more distress. Normal reference
ranges are included on the printout, and scores outside the
reference ranges signify clinically significant disturbance.
The scores are sensitive to change over time. If the test has been administered previously, the provider can compare scores to evaluate change. For the depression and anxiety scores,
changes of five points or more are clinically
meaningful (corresponding to approximately one standard deviation).
Diagnostic Notes
Below the numeric scores, the "notes" section lists applicable DSM-IV diagnoses (e.g., major depressive
episode, dysthymic disorder, generalized anxiety disorder). Special notes identify patients who report
suicidal ideation, who are imminent suicide risks, or
who are victims of domestic abuse. Finally, the report includes lists the specific symptoms the patient has reported
Tracking Change
When a patient completes the QPD Panel more than once, the report includes a trending graph showing changes in anxiety and depression over time. The trending graph providers to track patient progress and
assess treatment outcome.
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Rule Out Organic Factors |
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| The QPD Panel is designed as an aid to qualified healthcare professionals making psychiatric diagnoses. Findings are based solely
on information reported by the patient, and the provider should consider other relevant information before making
a final diagnosis. Additionally, the provider should
rule out other diseases that may cause symptoms resembling
those of a psychiatric condition. Additional tests may
be warranted depending on the patient's history and presentation. |
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Validity |
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| The QPD Panel has been validated against the SCID
(Structured Clinical Interview for DSM-IV) diagnostic interview, widely considered the “gold
standard” for psychiatric diagnosis. The test has high
sensitivity and specificity.17,18 |
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Third-Party Reimbursement |
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There are several options for
submitting health insurance claims. The provider may request
reimbursement for administration of the QPD Panel using
Current Procedural Terminology (CPT) code 96103 for computerized psychological testing.
For physicians who bill using Evaluation and Management
(E/M) codes, the review of psychological systems and the
inclusion of psychological data in making a differential
diagnosis warrant the use of a higher level E/M for the
office visit. The QPD Panel report in the patient
chart provides documentation of the additional data reviewed
and services provided. |
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Diagnostic Notes on the QPD Panel
Report |
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The following diagnostic notes may appear on the
QPD Panel lab report. This section provides further
information about the diagnostic notes and general
treatment guidelines.
| Diagnostic
Note |
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Treatment
Options/Comments |
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“Patient appears to meet criteria for Major Depressive
Episode (296.2)”
......................................
At least five of the following symptoms
have been present for two weeks or longer, and one
of the symptoms is depressed mood or diminished
interest in activities: (1) depressed mood most of
the day, nearly every day, (2) diminished interest
or pleasure in activities, (3) increased or
decreased appetite, (4) insomnia or hypersomnia,
(5) psychomotor retardation or agitation, (6)
fatigue or energy loss, (7) feelings of
worthlessness or guilt, (8) diminished ability to
think or concentrate, (9) recurrent thoughts about
death.
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Psychotherapy and antidepressant
medication have both proven effective.
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“Patient appears to meet criteria for Dysthymic Disorder (300.4)”
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Depressed mood most of the day, more days
than not, for two years or longer, with at least
two of the following symptoms: (1) poor appetite
or overeating, (2) insomnia or hypersomnia, (3)
low energy or fatigue, (4) low self-esteem, (5)
poor concentration or difficulty making decisions,
(6) feelings of
hopelessness.
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Psychotherapy can be
effective. |
“Possible Bipolar Mood Disorder (296.xx)”
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The
patient appears to have experienced past manic
episodes. The present depressive episode may be
occurring in the context of a bipolar
disorder.
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The patient should be referred to a
specialist for diagnosis and treatment. Some
antidepressant medications can precipitate manic
episodes in bipolar patients.
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“Clinically significant anxiety
secondary to depressive disorder.”
.....................................
Anxiety
symptoms developed in conjunction with
depression.
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Clinically significant anxiety often
accompanies depressive disorders. Treat for
depression. |
“Patient appears to meet criteria for Generalized Anxiety Disorder (300.2)”
......................................
Excessive worry and anxiety, more days than
not, for six months or longer, with at least three
of the following symptoms: (1) restlessness or
feeling keyed up, (2) being easily fatigued, (3)
difficulty concentrating, (4) irritability, (5)
muscle tension, (6) sleep
disturbance.
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Psychotherapy is generally
effective. Some antidepressants have been approved
for treatment of generalized anxiety
disorder. |
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“Patient appears to meet criteria for Panic
Disorder (300.01)”
......................................
Recurrent unexpected panic attacks,
followed by a month or more of worry that the
attacks will recur or anxiety about their meaning.
A panic attack is the sudden onset of intense fear
or distress, accompanied by four or more of the
following symptoms: (1) palpitations or racing
heart, (2) sweating, (3) trembling, (4) shortness
of breath, (5) feelings of choking, (6) chest
pain, (7) nausea or abdominal pain, (8) feeling
dizzy or feint, (9) feeling unreal or detached
from one’s body, (10) fear of losing control, (11)
fear of dying, (12) numbness or tingling, (13)
chills or hot flushes.
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Psychotherapy has proven effective
in controlled
studies. |
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“Likely Posttraumatic Stress Disorder (309.81)”
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Exposure to a traumatic life event accompanied
by at least two of the following symptoms associated
with PTSD: intrusive recollections of the event,
dreams of the event, feelings of reliving event,
psychological distress when exposed to reminders
of event, physiological reactivity when exposed
to reminders of event, avoidance of stimuli associated
with event.
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Consider referral to a mental health professional
with expertise in trauma. |
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“Patient appears to meet criteria for Bulimia Nervosa (307.51)”
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Episodes of binge eating followed by
self-induced vomiting, misuse of laxatives,
enemas, etc., occurring at least twice a week for
three months or longer.
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Bulimia is a complex syndrome that
may have a variety of causes. Consider referral to
a mental health professional with expertise in
eating disorders. |
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“Likely Alcohol/Substance
Abuse (305.x)”
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The QPD
Panel does not distinguish between abuse of
alcohol and other substances. The physician may
wish to inquire about the substance(s) being
abused.
The patient appears to suffer from
substance abuse or dependence. Abuse is a
maladaptive pattern of use causing clinically
significant impairment. Dependence is
characterized by the development of tolerance for
the substance, or withdrawal
symptoms.
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Consider referral to AA, NA, or
similar Twelve Step program, or referral to a
chemical dependency treatment program. In cases of
severe dependence, inpatient treatment may be
required. |
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“Patient may be prone to
somatization.”
......................................
The
patient has reported numerous physical symptoms
unlikely to result from any single medical
condition.
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Rule out organic causes. If the
symptoms cannot be attributed to organic factors,
consider possible Somatization Disorder. A mental
health referral may be
warranted. |
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“Patient expresses suicidal
ideation.”
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The
patient answered true to: “I think about killing
myself.”
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The physician should inquire about
the suicidal thoughts in straightforward manner. A
mental health referral may be indicated.
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“Patient may be an imminent
suicide
risk.”
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The
patient answered true to: “I am planning to kill
myself.”
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The patient should be evaluated by a
mental health professional without delay. If the
patient is at immediate risk, he or she should be
accompanied at all times (e.g., by a family member
or friend). Hospitalization may be
necessary. |
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“…score is out of range, but patient does not
appear to meet formal diagnostic criteria…”
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This
note may appear in conjunction with any of the
numeric scores on the QPD Panel lab report. The
note indicates that the patient is experiencing
a clinically significant level of distress, but
does not fall cleanly into an established DSM-IV
diagnostic category.
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A review of the symptoms listed on the lab
report will provide further insight into the patient’s
condition.
Treatment or referral to a mental health
professional may be warranted.
DSM-IV diagnosis codes for “Depressive Disorder NOS” (not otherwise
specified) or “Anxiety Disorder NOS” may be applicable.
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“Patient reports physical or sexual abuse within
past month”
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The patient
answered true to one or both of the following
statements: 1) "In the past month, someone
has hit, shoved, punched, kicked, or otherwise
physically hurt me." 2) "In the past
month, someone has forced me to engage in unwanted
sexual acts or contact." .
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Follow clinic policy and applicable regulatory
guidelines.
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Support |
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| For assistance and additional information, send an
e-mail to support@digitaldiagnostics.com
or call us at 800-559-9885. We provide
training and consultation on clinical and research issues. |
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References |
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1 Regier D.A., Goldberg I.D., &
Taube C.A. The de facto U.S. mental health services
system. Arch Gen Psychiatry. 1978;35:685-693.
2 Kessler LG, Burns BJ, Shapiro S, et
al. Psychiatric diagnoses of medical service users;
evidence from the Epidemiological Catchment Area
program. Am J Public Health, 1987;77:18-24.
3 Borus JF, Howes MJ, Devins NP,
Rosenberg R, Livingston WW. Primary health care
providers’ recognition and diagnosis of mental disorders
in their patients. Gen Hosp Psychiatry.
1988;10;317-321.
4 Katon W.
The epidemiology of depression in medical care. Int J
Psychiatry in Medicine, 1987;17:
5 Katon W, Sullivan, M. Depression
and chronic medical illness. J Clin Psychiatry
1990;51:6 (suppl):3-11.
6 Nielson AC,
Williams T. Depression in ambulatory medical patients.
Arch Gen Psychiatry 1980;37:999-1004.
7 Robins L & Regier D (Eds.)
Psychiatric Disorders in America. Free Press,
1991.
8 Rydon P, Redmon S,
Sanson-Fisher RW, Reid ALA. Detection of Alcohol related
problems in general practice. J Stud Alcohol.
1992;53;197-202.
9 Schulberg HC,
Burns BJ. Mental disorders in primary care:
epidemiologic, diagnostic, and treatment research
directions. Gen Hosp Psychiatry. 1988;79-87.
10 Kessler LG, Cleary PD, Burke JD
Jr. Psychiatric disorders in primary care: results of a
follow-up study. Arch Gen Psychiatry.
1988;10:79-87.
11 Schulberg
HC, Saul M, McClelland M. Assessing depression in
primary medical and psychiatric practices. Arch Gen
Psychiatry. 1985;12:1164-1170
12
Franco K, Tamburino, M, et al. The added cost of
depression to Medical Care. Pharmacoeconomics.
1995;7;284-291.
13 Kammerow DB, Picus
HA, Macdonald DI. Alcohol abuse, other drug abuse, and
mental disorders in medical practice: prevalence, costs,
recognition, and treatment. JAMA. 1986;255:2054-2057.
14 Broadhead WE, Blazer DG, George
LK, Tse CK. Depression, disability days, and days lost
from work in a prospective epidemiological survey.
JAMA. 1990;264:2524-2528.
15 Wells KB, Stewart A, Hays
RD, et al. The functioning and well-being of depressed
patients: results from the medical outcomes study.
JAMA. 1989;262:914-919.
16
American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders, 4th ed.
Washington, DC: American Psychiatric Press; 1994.
17 Shedler J. The Shedler
Quick PsychoDiagnostics Panel (QPD Panel): A psychiatric
“lab test” for primary care. In M. Maruish (Ed.),
Handbook of Psychological Assessment in Primary Care
Settings. NY: Erlbaum; 2000.
18 Shedler J, Beck A, Bensen
S. Practical mental health assessment in primary care:
validity and utility of the Quick PsychoDiagnostics Panel.
J Fam Pract. 2000;49:614-621. |
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