How to write a Diagnostic Tools nursing Paper

How to write a Diagnostic Tools nursing Paper

The patient health questionnaire (PHQ-9) is an easy-to-use questionnaire that can be self-administered for the screening for depression.  It is also used to monitor depression severity and treatment response. According to studies, it has a sensitivity of 94% and a specificity of 61% (Levis et al., 2019). Especially when used in adults. The tool is one of the most validated in mental health. The tool has nine items directed towards the diagnostic criteria of the major depressive disorder according to DSM-IV.  In addition to its high sensitivity, the tool is easiest to use when monitoring or diagnosing depression in patients.

Advantages of PHQ-9

PHQ-9 has various advantages over other diagnostic tools. Firstly the tool has a shorter depression rating scale.  The scale is short and has only nine distinct and personalized elements to major depressive disorder (Levis et al., 2019). Secondly, the tool can be self-administered, administered by telephone, or in-person by a physician. This allows for flexibility and equity in healthcare. Most tools require the patients to be physically present in the healthcare setting, making PHQ-9 more favorable.  Thirdly the tool facilitates the diagnosis of major depressive disorder based on the current diagnostic criteria. All its rating criteria are common symptoms related to depressive disorders.  Additionally, the tool can indicate the severity of the depression, unlike many other criteria which only confirm the diagnosis. The tool is well validated for use for multiple populations regardless of their physical characteristics. This means that the tool can be used for elderly individuals, adolescents, or even geriatric patients from diverse settings.

How to use the tool

The tool has nine criteria numbered 1 t0 9.  The time limit for the presenting symptoms is around two years; the nurse directs the question beginning with “Over the last 2 weeks, how often have you been bothered by the 9 major depressive diagnostic criteria”. The scores are numbered o to 3, with 0 representing not at all, 1 representing several days, 2 representing more than half the days, and finally, three representing nearly every day. The questions include the following:  little interest or pleasure in doing things, feeling hopeless, depressed, and down, trouble staying or falling asleep, or oversleeping. lacking energy or feeling fatigued, overeating or poor appetite, feeling you are letting your family down, or that you are a failure or feeling bad about yourself, difficulty concentrating., speaking, or moving so slowly that other people can notice or being fidgety, restless, or moving up and about., and finally having thoughts of being better off dead or self-harming behavior.  The assessor can also ask the patient how often the checked disorder is interfering with their daily life.

                                                      Interpreting The Tool

If in criteria one to 9 the patient checks at least four 2 or 3 scores in 1 to 8 and 1, 2, and 3 in criteria nine and including questions 1 and 2, then the patient is considered depressed.  To find out the severity, the scores are added.  If the patient checks more than five in the same criteria for a depressive disorder, then the patient is considered to have a major depressive disorder. Healthcare providers should make sure the client understands the tool for a more accurate diagnosis. In monitoring the progress to treatment, a baseline score can be taken when the patient starts therapy then it can be constantly be measured to see if the scores reduced.

Treatment Plan

The treatment of depression involves the use of various interventions.  In a patient with depression, based on the tool, I will utilize psychotherapies, pharmacotherapies, and electroconvulsive therapy if the first two approaches are ineffective. Numerous psychotherapeutic approaches can be used in managing depression in patients. They include art therapy, drama therapy, cognitive therapy, and family therapy (Boers et al., 2019).  Therapies have various advantages. Firstly, psychotherapy helps individuals become aware of ways of thinking that may be automatic but harmful and inaccurate. Nurse therapist helps individuals find ways to question their thoughts and understand how their emotions and thoughts may impact their behaviors.  After understanding the influence of their behaviors and thoughts, individuals can establish ways to alter self-defeating patterns. For example, when working in the psychiatric ward during a clinical placement, I encountered a patient with claustrophobia.  I involved the patient in therapy sessions.  I helped the patient to identify situations that trigger undue anxiety. I then helped the patient identify unhelpful thought patterns and help him replace the thoughts with more adaptive ways of thinking about those situations.  Finally, the client became comfortable with those situations and was able to cope with the personality disorder.

Psychotherapy also helps individuals identify ways to cope with stress. Stress is the feeling of physical or emotional tension commonly associated with depression. Psychotherapy is essential in dealing with most stressful situations.  Psychotherapy will allow individuals to examine the deeper issues that contribute to stress in their lives. Understanding these issues will enable individuals to avoid stress.  The issues that contribute to stress include toxic relationships, unresolved conflicts, financial difficulties, family issues, and internal pressure. Thirdly, psychotherapy examines in-depth an individual’s interaction while offering guidance with social and communication skills. Psychotherapy helps individuals with antisocial behaviors be able to establish relationships with other individuals. Additionally, psychotherapy can help mend broken relationships between family members and close confidants.

Psychotherapy enables individuals to develop various coping strategies that will enable them to deal with other troubling issues in their lives related to depression.  Psychotherapy sessions also focus on providing individuals with emotional support by comforting them.  Cognitive therapy is the most commonly used psychotherapeutic intervention in depression.   It enables patients to address cognitive distortions. Various studies have compared the use of cognitive-behavioral therapy alone or in combination with medications. The studies found that a combination of CBT with medication therapy effectively managed depression in patients (Dawson, 2018). The use of antidepressants is also effective in managing patients with depression.  The recommended antidepressants include mirtazapine, nefazodone, venlafaxine, duloxetine, sertraline, escitalopram, paroxetine, fluoxetine, clomipramine, and imipramine (Selph & McDonagh, 2019).  According to studies treating patients with fluoxetine and cognitive behavioral therapy offered the highest response rates to treatment. The use of CBT alone is not efficacious. One of the major controversies in using antidepressants is the high risk of suicidal ideation. Hence patients using antidepressant therapy should be monitored during beginning therapy and the period of adjusting therapy.

When using antidepressants, the patient’s health education should be done. They include: Teach the patient about adverse reactions and help them identify serious adverse reactions. Advice the patient to seek health attention or consult a pharmacist when they develop rashes, hives, joint pain, swelling of the face, difficulty in breathing, shortness of breath, seizures, abdominal bleeding or bruising, etc. these are the signs and symptoms of an allergic reaction related to antidepressants. Teach the patient the importance of adherence and appropriate taking of medication. The patient should take antidepressants as prescribed by the doctor to minimize the worse symptoms or side effects.

Electroconvulsive therapy can also be used to manage depressions if other approaches are not effective. According to a study, the response rate of ECT ranges between 64 and 100(Li et al., 2020).  The procedure is done under general anesthesia.  Small electric currents are passed through the patient’s brain to trigger a brief seizure. The procedure appears to cause changes in the chemical functioning of the body which further reverses certain symptoms of depression. However, there is a high potential for adverse effects. Adverse effects may be life-threatening (Moreno-Ortega et al., 2019). They include prolonged seizures, premature termination of treatment, and fatality. Various long-term cognitive effects have also been reported.

References

Boers, E., Afzali, M. H., Newton, N., & Conrod, P. (2019). Association of screen time and depression in adolescence. JAMA Pediatrics, 173(9), 853-859. http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2019.1759

Dawson, R. S. (2018). Depression in children and adolescents: The pediatrician at the front lines. Pediatric Annals, 47(7), e261-e265.

Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ, 365.

Moreno-Ortega, M., Prudic, J., Rowny, S., Patel, G. H., Kangarlu, A., Lee, S., & Javitt, D. C. (2019). Resting-state functional connectivity predictors of treatment response to electroconvulsive therapy in depression. Scientific Reports, 9(1), 1-19. https://doi.org/10.1038/s41598-019-41175-4

Selph, S., & McDonagh, M. S. (2019). Depression in children and adolescents: Evaluation and treatment. American Family Physician, 100(10), 609-617. https://www.aafp.org/afp/2019/1115/p609.html

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