Initial Assessment: Diagnosis

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Initial Assessment Diagnosis Disorder Specific
Measures
David M Clark National Clinical Advisor for
IAPT iapt_at_dh.gsi.gov.uk
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Why are diagnoses required?

• Monitoring Equity of access
• Individuals with the 9 different disorders
  covered by IAPT should have comparable access to
  the services. This can only be achieved if
  diagnoses are obtained and outreach for specific
  problems planned where there are inequalities.
• Implementing NICE Guidance
• Nice guidance is diagnosis based
• A compliment to, not instead of, a careful person
  centred assessment

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High PHQ GAD
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Establishing a Provisional Diagnosis

• Use all three MDS General Scales
• PHQ
• GAD
• Phobia Scales
• Be familiar with diagnostic features of each
  anxiety disorder and depression (ICD-10, DSM-IV)
• Ask screening questions for each disorder
  (provided), follow-up as required.
• Use a full diagnostic questionnaire (Zimerman,
  2001, Psychiatric Diagnostic Screening
  QuestionairePSDQ)

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Co-morbidity

• Very common
• Need to determine relationship between different
  disorders. Are they one problem (e.g social
  phobia with depression due to demoralization) or
  multiple problems.
• Key questions/ areas to explore
• Timeline. Did A precede B? Is A only present with
  B.
• Magic wand question
• Underlying common cognitive theme (e.g
  perfectionism)

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Why use Disorder Specific Measures?

• Some moderate to severe cases of anxiety disorder
  are NOT cases on the PHQ/GAD (because of
  extensive avoidance)
• 30 to 45 patients with social phobia (CADAT)
• 25 patients with panic disorder (CADAT)
• Disorder specific measures inform therapy targets
• Intrusions, avoidance, hyper-arousal in PTSD
• Disorder specific measures are often more
  sensitive to change
• Effect sizes Social Phobia 1.75, GAD 1.16, PHQ
  0.75

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Recommended Disorder Specific Measures
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Cut-Offs for Disorder Specific Measures

• Provided in your pack
• Recovery measure patient scores above the
  cut-off at pre-treatment and below the cut-off at
  exit from service (discharge or drop-out)