What testing is available for mental disorders?

Available Testing for Mental Disorders

There are multiple validated screening and diagnostic tools available for mental disorders, with selection based on the specific disorder being assessed and patient characteristics. 1

Screening Tools for Common Mental Disorders

Depression Screening

• Patient Health Questionnaire (PHQ):
  • PHQ-2: Two simple questions about mood and anhedonia with excellent sensitivity (nearly 100%) 1
  • PHQ-9: More comprehensive assessment for those with positive PHQ-2 1
• Other validated depression screening tools:
  • Zung Self-Depression Scale
  • Beck Depression Inventory
  • Center for Epidemiologic Study Depression Scale
  • Geriatric Depression Screen (for older adults) 1

Cognitive Impairment Screening

• Mini-Cog: Rapid 3-minute test with 76% sensitivity and 89% specificity for dementia 1
  • Consists of 3-item recall and clock drawing test
  • Score <3 indicates possible dementia
• Montreal Cognitive Assessment (MoCA): More comprehensive with 88% classification accuracy 1
• Memory Impairment Screen: Alternative for patients with motor disabilities 1
• AD8: Informant-based questionnaire when patient participation is limited 1

Anxiety Screening

• Hospital Anxiety and Depression Scale (HADS) 1
• Beck Anxiety Inventory (BAI) 1

Delirium Screening

• Confusion Assessment Method (CAM): Specifically for delirium detection 1

Diagnostic Evaluation Process

1. Initial Screening: Use brief validated tools appropriate to suspected condition

   • For depression: PHQ-2 followed by PHQ-9 if positive 1
   • For cognitive concerns: Mini-Cog or MoCA 1

2. Diagnostic Interview: All positive screening tests should trigger full diagnostic interviews using standard diagnostic criteria (DSM-5) 1

   • Assess severity and comorbid psychological conditions
   • Evaluate for specific depressive disorders, anxiety disorders, or cognitive conditions

3. Specialized Assessment:

   • Neurological examination: Essential when cognitive impairment is suspected 1
     • Test for parkinsonism, motor neuron signs, eye movement abnormalities
   • Multidomain mental status tests: For comprehensive cognitive assessment 1

Classification Systems for Mental Disorders

Mental disorders are formally classified using:

• International Classification of Diseases (ICD-11): International standard
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Primary system in the US 2

Implementation Considerations

• Sensitivity and specificity of screening tools vary (sensitivity 43-100%, specificity 38-99%) 1
• Cultural considerations are important as cut-points may vary significantly across populations 1
• Follow-up systems must be in place to ensure positive screening results lead to proper diagnosis and treatment 1

Common Pitfalls to Avoid

• Relying solely on screening without diagnostic confirmation: Screening tools are not diagnostic 1
• Using inappropriate cut-points: Thresholds may vary by population, age group, and setting 1
• Failing to consider comorbidities: Mental disorders frequently co-occur 2
• Overlooking cultural context: Symptoms may present differently across cultures 1
• Missing physical causes: Always consider medical conditions that can mimic mental disorders 1

Special Populations

• Older adults: Use age-appropriate tools like Geriatric Depression Scale 1
• Children and adolescents: Evidence for routine screening is limited; predictive value of tests is lower than in adults 1
• Patients with cognitive limitations: Consider informant-based assessments like AD8 1

Mental disorder testing should be followed by appropriate diagnostic evaluation and treatment planning to improve morbidity, mortality, and quality of life outcomes.