Evidence based assessment/Prescription phase

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Prescription Phase[edit]

Overview[edit]

The prescription phase is the second phase of the Evidence-Based Assessment Approach. This phase begins at the intake interview building off of the prediction phase.[1] This phase is about figuring out what is the best direction to go in next by using gathered information so far for case conceptualization. Case conceptualization is a provisional map of a person’s presenting problems that describes the territory of the problems and explains the processes that likely caused and are maintaining the problems.[2] A good case conceptualization describes problems and processes in ways that are verifiable.” Good case conceptualization will provide a roadmap for intervention but it is always open for revisions or changes in directions.

Rationale[edit]

The big differences in treatment prescription are between externalizing and internalizing disorders[3], or perhaps between subtypes of conduct disorder versus other disruptive behavior disorders[4], or unipolar versus bipolar mood disorders[5][6]. The distinction between oppositional defiant disorder or disruptive behavior disorder not otherwise specified does not change the choice of treatment, so we do not lose predictive or prescriptive information by lumping them together[7]. If there is no electronic medical record, then some sort of random sampling of charts or cases can provide a good snapshot of services – perhaps drawing 5 or 10 percent of cases at a clinic from each month to get a picture of services throughout the year including the variation in referral patterns between the school year and summer.

Steps to put into practice[edit]

Tables and figures[edit]

Coverage of common diagnostic interviews[edit]

Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mini-International Neuropsychiatric Interview (M.I.N.I.) Schedule for Affective Disorders and Schizophrenia (SADS) Diagnostic Interview Schedule for Children (DISC) World Health Organization Composite International Diagnostic Interview (WHO-CIDI) Diagnostic Interview for Children and Adolescents (DICA) Child and Adolescent Psychiatric Assessment (CAPA)
Anorexia Nervosa Yes
Attention Deficit Hyperactivity Disorder Yes
Autism Spectrum Disorder Yes
Bipolar (adults)
Bipolar (child) Yes
Conduct disorder Yes
Depression (youth) Yes
Generalized anxiety disorder Yes
Non-suicidal self injury
Obsessive-compulsive disorder Yes
Oppositional defiant disorder Yes
Posttraumatic stress disorder Yes
Schizophrenia Yes
Simple phobia Yes
Social anxiety disorder Yes
Substance use disorder Yes
Traumatic brain injury

Performance of common diagnostic instruments[edit]

Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS PL) Semi-structured Interview[8] 6-18 45-75 minutes G A E G X Homepage

PDF

Diagnostic Interview for Children and Adolescents (DICA)

*not free

Structured Interview[9] Parent of 6-17 year old

Youth 9-17

70-120 minutes A A A G Homepage
Child and Adolescent Psychiatric Assessment (CAPA)

*not free

Structured diagnostic interview[10] 9-18 1.5 hours G A G G X Homepage

Child

Parent

Children's Depression Rating Scale - Revised (CDRS-R) Structured Interview[11] 6-12 15-20 minutes G A G G X
Structured Clinical Interview for DSM-V (SCID) Semi-structured interview to be administered by a clinician or an experienced rater[12] Adults

(Ages 18+)

1-2 hours G G G G Green tickY -Available for purchase from APA Publishing (Note: Not free)

-Modified PDF Version (not most recent version, SCID-I)

-Located on Penn Lab, See Appendix 1 for schizophrenia modules

SADS (Schedule for Affective Disorders and Schizophrenia) Interview (Patient) Adult 1-2 hours G G G G Green tickY
Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)[13] Interview Children 34 minutes[14] G-E[14] G-E[14]

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Psychometric properties of common diagnostic interviews[edit]

Screening Measure (Primary Reference) AUC LR+ Score LR- Score Clinical generalizeability Study description
Composite International Diagnostic Interview (CIDI) 3.0[15] Adolescent Reported: .57 (N=321) 8.36 (when classified positive by CIDI) 0.86 (when classified negative by CIDI) Moderate Utilized the NCS-A sample of 10,148 adolescents aged 13-17 and their parents.[16]
Parent Reported: .71 (N=321) 9.67 (when classified positive by CIDI) 0.56 (when classified negative by CIDI)
Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)[13] AUC= 0.81-.96 (diagnoses of these disorders: any mood, anxiety, substance use, ADHD or behavioral, and eating) and AUC=.94 (psychotic disorders) (N=226) Greater than or equal to 3.21 0.00 to max 0.31 Sample of 225 children and adolescents ages 6-17 which included 190 outpatients and 36 controls, recruited from South Florida psychiatric center.[14]

Note: “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

References[edit]

  1. Youngstrom, Eric A.; Meter, Anna Van; Frazier, Thomas W.; Hunsley, John; Prinstein, Mitchell J.; Ong, Mian-Li; Youngstrom, Jennifer K. (2017). "Evidence-Based Assessment as an Integrative Model for Applying Psychological Science to Guide the Voyage of Treatment" (in en). Clinical Psychology: Science and Practice 24 (4): 331–363. doi:10.1111/cpsp.12207. ISSN 1468-2850. https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12207. 
  2. Bieling, Peter J.; Kuyken, Willem (2003). "Is Cognitive Case Formulation Science or Science Fiction?" (in en). Clinical Psychology: Science and Practice 10 (1): 52–69. doi:10.1093/clipsy.10.1.52. ISSN 1468-2850. https://onlinelibrary.wiley.com/doi/abs/10.1093/clipsy.10.1.52. 
  3. Chorpita, B. F., Rotheram-Borus, M. J., Daleiden, E. L., Bernstein, A., Cromley, T., Swendeman, D., & Regan, J. (2011). The Old Solutions Are the New Problem: How Do We Better Use What We Already Know About Reducing the Burden of Mental Illness? Perspectives on Psychological Science, 6(5), 493-497. doi: 10.1177/1745691611418240
  4. Frick, P. J. (2012). Developmental pathways to conduct disorder: implications for future directions in research, assessment, and treatment. Journal of Clinical Child and Adolescent Psychology, 41(3), 378-389. doi: 10.1080/15374416.2012.664815
  5. Fristad, M. A., & Macpherson, H. A. (2014). Evidence-based psychosocial treatments for child and adolescent bipolar spectrum disorders. Journal of Clinical Child and Adolescent Psychology, 43(3), 339-355. doi: 10.1080/15374416.2013.822309
  6. Stark, K. D., Swearer, S., Delaune, M., Knox, L., & Winter, J. (1995). Depressive Disorders. In R. T. Ammerman & M. Hersen (Eds.), Handbook of child behavior therapy in the psychiatric setting (pp. 269-300). New York: Wiley.
  7. Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37(1), 215-237. doi: 10.1080/15374410701820117
  8. "Kiddie Schedule for Affective Disorders and Schizophrenia" (in en). Wikipedia. 2017-08-21. https://en.wikipedia.org/w/index.php?title=Kiddie_Schedule_for_Affective_Disorders_and_Schizophrenia&oldid=796460290. 
  9. "Diagnostic Interview for Children and Adolescents (DICA)" (in en). Journal of the American Academy of Child & Adolescent Psychiatry 39 (1): 59–66. 2000-01-01. doi:10.1097/00004583-200001000-00017. ISSN 0890-8567. https://www.sciencedirect.com/science/article/pii/S0890856709661013. 
  10. System, Duke University Health. "Duke Developmental Epidemiology Program". devepi.duhs.duke.edu. Retrieved 2018-03-01.
  11. Mayes, Taryn L.; Bernstein, Ira H.; Haley, Charlotte L.; Kennard, Betsy D.; Emslie, Graham J. (2010-12). "Psychometric Properties of the Children's Depression Rating Scale–Revised in Adolescents". Journal of Child and Adolescent Psychopharmacology 20 (6): 513–516. doi:10.1089/cap.2010.0063. ISSN 1044-5463. PMID 21186970. PMC PMC3003451. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003451/. 
  12. "Structured Clinical Interview for DSM-5 (SCID-5)". www.appi.org. Retrieved 2018-03-08.
  13. 13.0 13.1 Sheehan, David V.; Sheehan, Kathy H.; Shytle, R. Douglas; Janavs, Juris; Bannon, Yvonne; Rogers, Jamison E.; Milo, Karen M.; Stock, Saundra L. et al. (March 2010). "Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)". Journal of Clinical Psychiatry 71 (3): 313-26. doi:10.4088/JCP.09m05305whi. PMID 20331933. 
  14. 14.0 14.1 14.2 14.3 Sheehan, David V.; Sheehan, Kathy H.; Shytle, R. Douglas; Janavs, Juris; Bannon, Yvonne; Rogers, Jamison E.; Milo, Karen M.; Stock, Saundra L. et al. (March 2010). "Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)". Journal of Clinical Psychiatry 71 (3): 313-26. doi:10.4088/JCP.09m05305whi. PMID 20331933. 
  15. Merikangas, Kathleen; Avenevoli, Shelli; Costello, Jane; Koretz, Doreen; Kessler, Ronald C. (April 2009). "The National Comorbidity Survey Adolescent Supplement (NCS-A): I. Background and Measures". Journal of the American Academy of Child and Adolescent Psychiatry 48 (4): 367-9. doi:10.1097/CHI.0b013e31819996f1. PMID 19242382. PMC 2736858. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2736858/. 
  16. Green, Jennifer Greif; Avenevoli, Shelli; Finkelman, Matthew; Gruber, Michael J.; Kessler, Ronald C.; Merikangas, Kathleen R.; Sampson, Nancy A.; Zaslavsky, Alan M. (March 2010). "Attention deficit hyperactivity disorder: concordance of the adolescent version of the Composite International Diagnostic Interview Version 3.0 (CIDI) with the K-SADS in the US National Comorbidity Survey Replication Adolescent (NCS-A) supplement". International Journal of Methods in Psychiatric Research 19 (1): 34-49. doi:10.1002/mpr.303. PMID 20191660. PMC 2938790. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2938790/.