Screening for Depression and Anxiety Case Study

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Week 3 Psychiatric ScreeningDepression and anxiety are the most common psychiatric problems affecting patients in primary care. Data from the National Alliance on Mental Illness (NAMI) places the prevalence of depression among American adults at 7.8 percent (representing 19.4 million people), and that of anxiety disorders at 19.1 percent (representing 48 million people) (NAMI, 2021). This week’s assignment focuses on administering relevant screening tools to detect symptoms of depression and anxiety on the presenting client, a 56-year-old Caucasian female. The Beck Depression Inventory (BDI) was selected to screen for symptoms of depression, while the Generalized Anxiety Disorder (GAD-7) scale was selected to screen for anxiety symptoms.The BDI is a 21-item questionnaire that assesses the intensity of symptoms associated with psychoanalytic aspects of depression including social withdrawal, suicidal ideas, guilt, feelings of failure and sadness (Park et al., 2020). It measures the severity and frequency of depression symptoms experienced in the past 2 weeks on a 4-point scale. It is one of the most widely studied measures for assessing depression, with well-established psychometric properties (Garcia-Batista et al., 2018). The 21 items are scored from 1 to 3, yielding a maximum score of 63 and a minimum score of zero. Scores between 1 and 10 indicate normal ups and downs, scores of 21 to 30 indicate moderate depression, 31-40 indicate severe depression, and over 40 indicate extreme depression. The BDI was selected not just for its high validity and reliability, but also because it can be used both as a screening tool and as a measure of severity of depressive symptoms (Park et al. 2020). As such, the clinician does not have to administer a different tool to measure the effect of prescribed medication on symptoms at the time of review. Further, the BDI allows for self-rating, allowing the client to regularly measure the progression of their symptoms.KF’s BDI ScoreQuestion ContentScoreImplicationRationaleSadness2I feel sadThe client reports feeling sad mostly in the morning, but snaps out of it as the day progressesPessimism0Not presentSense of failure2As I look back on my life, I see a lot of failuresClient feels like a failure for losing her son’s custody to her abusive husband and not playing an active role in bringing him upDissatisfaction1I do not enjoy things the way I used toShe no longer enjoys yoga and meditationGuilt2I feel guilty most of the timeReports feeling ‘very’ guilty about divorcing and leaving her son in FranceExpectation of punishment0Not presentSelf-dislike1I am disappointed in myselfClient is disappointed in herself for leaving her son in FranceSelf-accusations1I am critical of myself for my weaknessesSuicidal ideas0I do not have thoughts of killing myselfCrying0Not presentIrritability0Not presentSocial withdrawal2I have lost most of my interest in other peopleThe client tries to engage in at least one social activity weekly, meaning that she has not completely lost her interest in othersIndecisivenessNot presentBody image changeNot presentWork retardation2I have to push myself hard to do anythingShe has difficulty completing work projects and cannot stay focusedInsomnia3I wake up several hours earlier, and cannot go back to sleepThe client has to take pills in order to sleepFatigue2I get tired from doing anythingActivities that were previously enjoyable such as attending social events are now really exhaustingAnorexia3I have no appetite at allClient reports not feeling hungryWeight loss1I have lost more than 5 poundsClient reports losing between 4 and 5 pounds of weight.Somatic preoccupationNot presentLoss of libidoNot presentThe BDI yields a total score of 22, signifying moderate depression (Park et al., 2020). The client was not scored on 8 items including crying, irritability, indecisiveness, body image change, somatic preoccupation, and loss of libido – as there is no specific information that provides answers to these questions.

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As such, if the client were to avail more information, one would expect the depression score to be even higher.The GAD-7 scale is a self-administered questionnaire used to check for the presence and severity of anxiety symptoms over the past two weeks (Johnson et al., 2019). It is scored by assigning scores of 0 to 3 to the response categories of ‘not at all’, ‘several days’ ‘nearly every day’ and ‘more than half the day’, and then summing up the scores to obtain the total anxiety score (Johnson et al., 2019). Scores of 5, 10, and 15 are the cutoff points for mild, moderate, and severe anxiety. The GAD-7 was selected for its proven psychometric properties, including specificity of 82 percent and sensitivity of 89 percent of GAD (Johnson et al., 2019). Further, like the BDI, the GAD-7 can be used both as a screening tool and as a measure of severity for anxiety symptoms (Johnson et al., 2019). As such, it provides an invaluable means for not only identifying whether a patient has anxiety, but also assessing the effectiveness of treatment plans (Johnson et al., 2019).KF’s GAD-7 ScoresFeeling anxious, nervous or on edge – 3Not being able to control or stop worrying – 2Worrying too much about different things – 0Trouble relaxing – 0Being so restless that it is hard to sit still - 0Being easily irritable or annoyed – 0Feeing afraid as if something awful might happen - 0The client is employed as a full-time consultant and mentions that she cannot stay focused anymore and is unable to complete projects for work. The inability to stay focused was interpreted as a sign of anxiety or nervousness and since she works full-time, the effect is felt nearly every day. However, it is not every day that she is unable to control worrying – at least once a week, she takes part in social events, although she finds these activities really exhausting. She has no means to control the worry the rest of the days, which are more than half the days of the week. The client was not scored on the remaining 5 items because there is no information to support such….....

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