Wednesday, April 1, 2009

Measurement-based psychiatric practice

Henry A. Nasrallah, MD
, Editor-in-Chief

Can you imagine an internist starting insulin for a patient with diabetes without obtaining a baseline glucose level? How would that internist know from visit to visit whether treatment was working and to what extent? How would he or she know how and when to adjust the dose to achieve hyperglycemia remission and a normal serum level?

If our medical colleagues wouldn’t dream of treating patients without measuring the symptoms of illness, why should psychiatric practice be different? Why aren’t psychiatrists measuring patients’ depression, anxiety, mania, or psychosis before and after starting psychopharmacologic agents?

I recently surveyed a sample of Current Psychiatry readers, asking about their use of standard measurement instruments in clinical practice. I conducted this online survey as part of the needs assessment for a CME workshop I am planning at the University of Cincinnati. As I expected, most of the respondents indicated that they do not utilize any of 4 clinical rating scales routinely used in the evidence-based controlled trials required for FDA approval of psychiatric medications.

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1 comment:

  1. I would love to use the rating scales, but these are copyrighted and cost in hundreds of dollars to obtain the forms from publishers. For Part time Psychiatrists working in poorly funded Community Mental Health centers, these scales are not an option unless, they are easily accessible.

    There needs to be an article about this, detailing which scales are not copy righted
    (i know most are) and how to obtain copyright in order to use these as part of the medical record!