Online Assessment Measures

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Introduction

Maria has been experiencing domestic violence in  her relationship. Her attempts to get out of the relationship became more difficult upon discovering that she was pregnant. Her family background further complicates the issue. Her parents objected the relationship with the boyfriend and accused Maria of setting a bad example to her younger siblings. The stalemate between Maria and her parents has created a rift with her family. She misses her family and cries a lot over it. Her pregnancy makes her anxious of her job security and she is fearful that if her boss discovers about it, she will be sacked. Her friends had long disappeared from her life after she started dating her boyfriend. The above described case represent the complications facing people thus creating a need for therapeutic sessions. While one problem  may be the most visible, it is normally fueled by other underlying issues making the therapeutic  process more complicated. This paper will address Maria’s problem using  the Level 1 Cross-cutting symptom measures and the disorder-specific  severity measures that weighs the severity measure for depression. The two assessment measures will be useful in the diagnosis process and will help understand the client’s behavior, character, and the treatment options.

Level 1 Cross-Cutting Symptom Measures- DSM-5Self Rated  Level 1

According to the American Psychiatric Association (APA), the DSM level 1 Cross-Cutting Symptom Measure refers to a personally rated measure used to evaluate the mental aspect that is deemed important for the psychiatric diagnoses (2016). It helps clinicians know other additional areas of inquiry that are material on the client’s treatment and prognosis. The measure further makes it possible to see the trend in the changes of the client’s symptom presentation over a period of time. Its use makes the treatment process more comprehensive and focused on the real issues affecting the client.

The measure is comprised of a set of 23 questions dealing with thirteen psychiatric domains. These domains include; depression, anger, mania, anxiety, somatic symptoms, suicidal thoughts, sleep disorder, repetitive thoughts, dissociation, personality functioning, and substance abuse (APA, 2016). Clarke and Kuhl (2014) identify that these measures do not serve a pure screening measures for any disorder but rather aim to give the clinicians the ratings to characterize patients in a manner that is simple, useful, and clinically sensible. The measure will facilitate the development of individualized treatment plans and result to an improvement in the treatment outcomes.

The DSM 5 level 1 Cross-Cutting Symptom Measure will be applicable and helpful in analysis and diagnosis of Maria’s case. Sessions with her, showed that she describes herself as sad, anxious and depressed. This measure is relevant in addressing these predispositions and determining other issues that the therapy treatment needs to address. Maria’s case is a complex and the physical manifestations are results on other underlying and unresolved issues that the assessment measure will help unearth. Maria’s troubled relationship will be well analyzed if all underlying issues are determined. 

Severity Measure for Depression

The severity Measure for depression is a self-rated nine item measure used to assess how severe the depressive symptoms are in individuals. The measure can only be used for patients who had had prior sessions with the clinician. The patient is required to provide a rating for their depressive moods experienced during the last seven days (APA, 2016). Kroeke and Spitzer noted that depression was one of the most prevalent but treatable disorder in the medical settings (2001). The PHQ-9 is a unique depression measure and stands out from the rest due to its shortened size. It is made up of the nine criteria on which the diagnosis of DSM-5 depressive disorders is based.

Each item on this measure has a rating of a 4-point scale. These are 0, 1, 2, 3 which represents; Not at all, several days, More than half the days, and nearly every day respectively. The total score ranges from 0-27. The higher the score, the greater the severity of depression. Subsequent running of the test with the same client portrays a trend of either rising or falling score which tells where the disorder is either worsening or improving (Kroeke & Spitzer, 2001). The depression severity include: None with a score of 1-4, Mild (5-9), moderate (10-14), moderately severe (15-19) and severe with a score of 20-27. These rating help the clinicians determine the treatment action to recommend to the client.

The measure will be of great importance during the therapeutic process of Maria. Maria acknowledges having drifted from her family but misses them to a point of crying uncontrollably. With this measure, the depression associated with the family ties will be assessed. Maria’s current situation where her friends forsaken her must have had a toll in making her feel down, depressed and hopeless. She has been left all alone, with no one to turn when troubles such as domestic violence befalls her. Her parents’ reaction to her situation is likely to have made her think negatively about herself. The measure allows for the rating of this situation such as Maria’s where she was considered a bad example to her siblings.

Formal and Functional Diagnosis

In a psychiatric evaluation, two sections are involved. These include; the formal diagnosis and the functional evaluation. The formal diagnosis entails acquisition of history relating to psychiatric, medical, and family. This form of diagnosis includes the description of how the current symptoms may have evolved over time. It entails a review of the past occurrences and treatments, a description of the current and past medical conditions and a patient’s personal history (Manley, 2004). This form of diagnosis is relevant in revealing the interpersonal and adaptive functioning over time. In the scenario of Maria, the formal diagnosis involves a closer check in her interpersonal relationship. This will made possible by the review of the last visit’s notes and the current session in an attempt to full comprehend the situation at hand. The formal diagnosis distinguishes the formal complain that the patient initial rose.

The functional diagnoses checks at the relationships between couple, stress-related problems, anxiety, depression and other chronic disorders. In requires the application of an appropriate measures such as the Disorder-Specific Severity Measure. The measures are relevant to the clinicians in enhancing therapeutic effectiveness (Manley, 2004).  This section of the diagnosis procedure systematically reviews emotional and cognitive functioning of the patient. Maria describes herself as having anxiety, depression and sadness. DSM-5 will be important in addressing these issues and discover new areas that may be relevant to understanding her condition. However, the Severity Measure for depression will be focused on the core issue of depression. This measures the effects of the domestic violence and loneliness that Maria experiences and assesses their effects to her mental status.

References

American Psychiatric Association. (2016). Online Assessment Measures. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/dsm-5/online-assessment-measures

Clarke, D., & Kuhl, E. (2014). DSM-5 Cross-Cutting Symptom Measures: A Step Towards the Future of Psychiatric Care? World Psychiatry, 314-316.

Kronke, K., & Spitzer, R. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. National Sector for Biotechnology information, 606-613.

Manley, M. (2004). Diagnosis and Psychiatry: Examination of the Psychiatric Patient.