Psychological Assessment in Psychopharmacology

Abstract

A key element of supportive care is the reliable measurement of psychological health and psychosocial problems. This may include detection and measurement of frank psychiatric disorders as well as broader psychological symptoms and generalised distress. Many organisations have made recommendations for assessment of distress but despite the potential benefits uptake has been slow and evidence mixed. There is however momentum building for multi-domain screening for distress as the 6th vital sign. Psychosocial assessment can be pragmatically divided into screening, clinical assessment (case-finding) and assessment of adaptation and daily function. Screening for distress is designed to quickly ascertain which individuals in a large population need further assessment followed by specific additional care and intervention; however, the evidence base for screening needs to be improved. The target of screening may be mood disorders, distress, cognitive decline, unmet needs or a multi-domain approach. A multidimensional approach may be preferable and a multidimensional tool can be valuable as it can serve as a roadmap to a more effective way of addressing patient concerns in a timely way with appropriate referral to the right professional. Most forms of screening are seen as at least a slight burden to patients and clinicians. In some circumstances this burden can be significant and rate-limiting. Therefore screening implementation can be limited as much by acceptability as by accuracy. Screening for distress and/or psychological assessment should not be considered a one-off exercise but part of routine high quality

Psychosocial screening and assessment in oncology and palliative care settings

“…As reported by Mitchell et al (2011) and Mitchell and Bultz (2014) a number of data have been accumulated regarding the screening for depression and anxiety, with the Depression in Cancer Consensus Group reporting diagnostic validity studies involving at least 19 tools designed to help clinicians identify depression in cancer settings ( Mitchell et al, 2012 ). Two stem questions derived form the Patient Health Questionnaire (PHQ-2), the Beck Depression Inventory (BDI-II) where considered acceptable.…”

“…Cognitive disorders and impairment have been examined in cancer as possible consequences of treatment. Data regarding brief testing (bedside cognitive testing) exist with studies evaluating the sensitivity/specificity of well-known instruments, including the Mini-Mental State Examination (MMSE), which seems to be less accurate than other tools, the Addenbrooke’s Cognitive Assessment – Revised (ACE-R), the abbreviated mental test score (AMTS), and 6-item cognitive impairment test (6CIT; Mitchell and Bultz, 2014 ).…”

“…Assessment of coping, as the pattern of thoughts, beliefs, and behaviors in response to stressful events, is part of a diagnostic approach to cancer patients, since maladaptive styles among cancer patients are intrinsically related to psychopathology ( Grassi et al, 1993 ). According to the transactional theory of stress and coping (indicating that a stressor is initially appraised and, subsequently, the resources available to deal with the stressor are examined by the individual), several measures of coping have been developed ( Mitchell and Bultz, 2014 ). The Mental Adjustment to Cancer (MAC) scale and the shorter Mini-MAC version have been particularly used in cancer and palliative care settings with data showing the good property of the scale ( Greer et al, 1989 ; Watson and Homewood, 2008 ) in identifying specific styles of coping, including denial/avoidance (i.e., deliberate effort not to think about cancer as a way cope), fighting spirit (i.e., the tendency to see the illness as a challenge), fatalism (i.e., living in the moment and take one day at a time), helplessness/hopelessness (i.e., desperation and hopelessness regarding the illness and the future), and anxious preoccupation (i.e., the tendency to be anxious and extremely preoccupied about the illness).…”