Mood Disorders
Major Depressive Disorder
PHQ-9 (Patient Health Questionnaire – 9) | Assessing: Major Depressive Episode in General Population Cutoff > 10 draw attention to likely clinically significant condition |
Edinburgh Postnatal Depression Scale | Assessing: Post-partum depression Cutoff > 13 indicates likely depression |
Bipolar Disorder
MDQ (Mood Disorder Questionnaire) | Screen for Bipolar 1 Disorder (NOT Bipolar 2 Disorder) in Outpatients |
Young Mania Rating Scale | Assess Intensity of Mania / Hypomania in Patients (Time Frame – Last 48 hours); < 13 indicates remission |
Anxiety Disorders
GAD-7 (Generalized Anxiety Disorder -7) | scope: screen for generalized anxiety disorder; also validated screener for social anxiety, panic disorder, PTSD. Cutoff > 10 draw attention to likely clinically significant condition |
Liebowitz Social Anxiety Scale | scope: screen for social anxiety disorder; cut-off: if < 30, SAD is unlikely; if > 60 SAD probable |
Panic Disorder Severity Scale – Self Report | scope: screening for panic disorder cut-off: score > 9 suggest need for diagnostic assessment |
Trauma Related Disorders
PC-PTSD-5 (Primary Care PTSD Screen for DSM-V ) | scope: very brief screen for post traumatic stress disorder (PTSD) for primary care physicians . Cutoff > 4 (max 5) for men and 3 > for females. (if positive do PCL-5) |
PCL-5 (PTSD Checklist for DSM-5) | scope: provisional diagnosis for PTSD. Cutoff > 33-35 (max 80). Serial measurement of severity of symptoms. Need: Qualifying trauma, and at least one score of 2 in each of questions 1-5, 6-7, 8-14, 15-20. |
Attention-Deficit / Hyperactivity Disorder
Adult ADHD
Wender Utah Rating Scale (Long Form) | scope: to help validate history of childhood ADHD symptoms in adults. There are 60 questions, but only 25 relate to ADHD symptoms. Cutoff of > 46; sensitivity of 86%, specificity of 99% (in population without psychiatric co-moribidity) |
Wender Utah Rating Scale (Short Form) | scope: same as above. This includes only the ADHD related questions. Same cutoffs as above. |
Adult ADHD Self Report Scale (ASRS-v1.1) | scope: screener for symptoms of adult ADHD. Cutoff: 4 or more responses in shaded areas of part A indicative of ADHD symptoms in adults and warrant further investigation. |
Psychotic Disorders
BPSD (Brief Psychiatric Rating Scale) | scope: Most helpful in assessing treatment efficacy in psychosis. Based on clinician interview (+/- collateral) and observation of patient over 2-3 days. Measures 18 symptom constructs (each rated from 1 to 7). scoring: mildly ill > 31, mod ill >41, markedly ill > 53 |
Cognition
SLUMS (Saint Louis University Mental Status Exam) | scope: alternative to MMSE (now copyrighted) to detect mild cognitive impairment (MCI) and dementia. Takes 7-10min. Better than MMSE at detecting MCI. Validated in older adults. sensitivity: 80-90% Specificity: 75-85% |
Mini-Cog | scope: 3 min test to screen for cognitive impairment in older adults; normal > 3. Administration instructions. Scoring instructions. |
No Longer Easily Accessible or FREE | |
MOCA ( Montreal Cognitive Assessment) scope: developed for assessment | scope: developed for assessment of mild cognitive impairment; normal > 26/30 * training required for valid assessment although free for students/faculty. Note that the MOCA Is no longer freely available on the internet as a PDF (systemically taken down off of websites). Training required and MOCA is accessed through the official website only now. |
MMSE (Mini-Mental State Examination) | The Mini-Mental State Examination (MMSE) became copyrighted in 2000 when its rights were acquired by Psychological Assessment Resources, Inc. (PAR). Prior to this, the MMSE, originally developed in 1975 by Marshal Folstein, Susan Folstein, and Paul McHugh, was freely available for use in clinical and research settings. |
Substance Use
Clinical Institute Withdrawal Assessment – Alcohol Revised (CIWA – Ar) | scope: measures severity of alcohol withdrawal syndrome. Cutoff: less than 8-10 minimal to mild (no intervention usually required); between 11-15, moderate withdrawal; >15, severe withdrawal (Example treatment protocol) |