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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on June 5, 2011, at 0:03:59
New tool to guage remission rates in depression by MD's Phillipa
From Medscape Medical News > Psychiatry
Tool Improves Docs' Ability to Assess Depression Remission
Fran LowryAuthors and Disclosures
June 2, 2011 A new tool that asks patients questions about their emotions, happiness, resiliency, and sense of optimism about the future can help family physicians evaluate the extent to which a patients depression has improved, according to new research published in the May/June issue of General Hospital Psychiatry.
"This takes us the next step in our ability to not just assess how patients are doing on their depression symptoms but how theyre doing in terms of getting back to normal," Donald E. Nease, MD, a family physicianresearcher from the University of Michigan, Ann Arbor, told Medscape Medical News.
Dr. Donald E. NeasePrimary care providers are on the front lines of depression treatment, and the prevalence of major depressive disorder in primary care practices ranges from 6% to 14%.
Almost 10% of office visits in primary care are for depression, and primary care physicians prescribe more than half of all antidepressant medications.
Currently, doctors use the remission criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, but using additional symptoms can give a more thorough picture of whether the patient is actually in remission, he said.
"We had been using the 9-item Patient Health Questionnaire [PHQ-9] for depression monitoring for several years in our own family medicine practices here at the University of Michigan, and it is a very useful instrument when you are first getting a patient into treatment and looking at whether you are getting an adequate response," Dr. Nease explained.
"But we were quite aware that once a patient started to get close to the score of 10 on a PHQ-9, then the test began to lose some of its usefulness, he continued. We began to think that we need to assess more symptoms to flesh out what being back to normal really is, because when you think about it, being back to normal is more than just the absence of depression."
Improved Accuracy
Dr. Nease and colleagues developed the Remission Evaluation and Mood Inventory Tool (REMIT), which asks patients being treated for depression the following 5 questions:
Over the last 2 weeks
Did you feel happy?
Did you feel content?
Did you feel in control of your emotions?
Did you bounce back when things went wrong?
Did the future seem dark to you?
The patients are asked to circle the number, from 4 (none of the time) to 0 (all of the time), that corresponds to their answers.The researchers recruited 1000 patients to test both the PHQ-9 and REMIT and found that REMIT strongly added to their ability to figure out which patients were getting better.
By addition of the REMIT questions, about one third of patients with mild depression were not in remission, contrary to what their PHQ-9 score indicated. Additionally, about one third of moderately depressed patients were doing better than their PHQ-9 scores alone indicated.
"Using just the PHQ-9 score across our study population, we saw about 60% accuracy in reflecting a patients remission compared to the patients sense of his or her own recovery," Dr. Nease said. "If you add in the REMIT questions, we get above 70%"
Positive Feedback
Feedback, from both physicians and patients, has been positive, he added.
"We elicited feedback from some of our study subjects because we wanted to make sure that we were asking these questions in a way that made sense to patients, and we got very positive feedback from them, so we felt good about the fact that we had phrased these questions in a way that made sense and matched up with their experience."
Dr. Nease hopes that the tool will also prove useful for providing an early warning sign for relapse.
"Once someone reaches remission, they could be monitored with REMIT, and if we start to see the score change, that might be an early indicator of relapse and we might be able to intervene early," he said.
Commenting on the findings, Marsha Wittink, MD, from the University of Rochester Medical Center in Rochester, New York, said the study addresses "an important area of concern in addressing depression in primary care."
Dr. Wittink noted that primary care patients and their physicians have the complicated task of recognizing and managing depression in the context of other chronic medical conditions.
"Identifying when to treat, and indeed, when patients are sufficiently treated, remain major challenges when other medical conditions are present," she told Medscape Medical News.
"The REMIT tool holds promise as a way to help patients and their physicians determine together when patient-relevant outcomes of treatment have been met," Dr. Wittink said.
The study was funded by Eli Lilly. Dr. Nease and Dr. Wittink have disclosed no relevant financial relationships.
Posted by SLS on June 5, 2011, at 6:04:42
In reply to Tool To Guage Remission Rates Depression, posted by Phillipa on June 5, 2011, at 0:03:59
The concept of REMIT is great. The evaluative questions suck.
- Scott
Posted by Phillipa on June 5, 2011, at 10:49:59
In reply to Re: Tool To Guage Remission Rates Depression, posted by SLS on June 5, 2011, at 6:04:42
Scott to me shows what docs are being taught. So this get passed on to us. And if the doc feels great he assumes the patient is now fine also. New tools new theories. Phillipa
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