Screening for bipolar disorders: Clinical utilization of the Mood Disorders Questionnaire on an inpatient mood disorders unit.

BACKGROUND: The Mood Disorders Questionnaire (MDQ) is a widely used screening instrument for bipolar disorders. The MDQ has seldom been used in the inpatient setting, and we report a clinical, real-world inpatient validation. METHODS: Between April 2011 and August 2013, patients admitted to the inpatient Mood Disorders Unit completed an MDQ as part of their admission process. Patients with a discharge diagnosis of unipolar or bipolar disorders were included. The sensitivity and specificity were calculated for each number of questionnaire items checked positive, as well as the symptoms clustered around the same time and with moderate impairment in functioning. RESULTS: A total of 1330 patient MDQ's were identified, and after excluding incomplete MDQ's and non-unipolar or bipolar diagnoses (e.g. anxiety, adjustment, or schizoaffective diagnoses), 860 MDQ's remained. One hundred fifty four patients (18%) were diagnosed with bipolar disorder, and 706 (82%) with unipolar depressive disorder. The average length of stay was 7.6 days. The optimal cutoff score was 8, resulting in a sensitivity/specificity of 86%/71%, compared to 92%/64% with a cutoff of 7. LIMITATIONS: Retrospective study using clinical diagnoses instead of research instrument diagnoses. CONCLUSIONS: The sensitivity of the MDQ in an inpatient mood disorders setting was higher than an outpatient psychiatric population, but the specificity was lower. A cutoff of 8 instead of the recommended outpatient cutoff of 7 was optimal. In today's busy clinical practices, a screening instrument for bipolar disorder is still useful, and the MDQ can be effectively utilized on an inpatient psychiatry mood disorders unit.

Comparing the Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire (PHQ-9) depression measures in an integrated mood disorders practice.

BACKGROUND: Patient self-assessment instruments are useful in screening, tracking, and documenting the course of depressive symptoms with minimal clinician time. Two popular instruments are the Beck Depression Inventory (BDI-II) and the Patient Health Questionnaire (PHQ-9). We compared the performance of these two instruments in a mood disorders setting. METHODS: A retrospective study of 625 patients who completed a PHQ-9 and BDI-II as part of routine clinical care (1) during initial outpatient evaluation between 2008 and 2009, and (2) on admission to an inpatient mood disorders unit between 2006 and 2009. Pearson correlation coefficients for total PHQ-9 and BDI-II scores were calculated for all patients, the outpatients, and the inpatients. RESULTS: Overall r=0.77, indicating strong correlation, more in the outpatients (n=287, r=0.81) than the inpatients (n=338, r=0.67). Mean PHQ-9 and BDI-II scores for the outpatients were 15.1 (SD 7.4) and 27.8 (SD 14.1) corresponding to "moderately severe" and "moderate" categories respectively; for inpatients, 18.9 (SD 5.7) and 33.8 (SD 11.5) corresponding to "moderately severe" and "severe." LIMITATIONS: Retrospective design and no monitoring of which instrument was completed first in case that influenced patient response to the second instrument CONCLUSIONS: PHQ-9 and BDI-II scores, as continuous but not categorical variables, in a mood disorders subspeciality setting are closely correlated and essentially interchangeable. There are practical applications to our findings, as the PHQ-9 is shorter and free.

Cytochrome P450 testing for better psychiatric care.

Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental health professionals prescribe psychiatric medications for their patients. Cytochrome P450 testing uses a blood sample to determine an individual's required dosage of identified drugs that are metabolized by the two enzymes. To provide care for patients and families, nurses should be able to demonstrate identified essential nursing competencies related to genetics and genomics, which include an understanding of cytochrome P450 testing. As patient advocates, nurses are expected to understand how to identify patients most likely to benefit from CYP2D6 and CYP2C19 testing, how to ensure informed consent for such testing, and how to educate patients about testing and test results.