1. ASSESSMENT TOOLS Annabel Price

2. Diagnostic Tests Establish a diagnosis in symptomatic patients Screen for disease in symptomatic patients Provide prognostic information in patients with established disease Monitor therapy by either benefit or side effects Confirm that someone is free from disease

3. Evaluating Diagnostic Tests All diagnostic tests are proxy measures that need to be evaluated (validated) against a definitive or gold standard (e.g. pathological specimens for malignancies) to determine presence or absence of disease Why is this difficult for psychiatric disorders? What ‘gold standards’ are used?

4. Evaluating Diagnostic Tests II Sensitivity=proportion of people with the illness who have a positive result Specificity=proportion of people without the illness who have a negative result True positive (a) False positive (b) False negative (c) True negative (d) Gold standard +veGold standard -ve Test +ve Test -ve

5. Some tests for cognitive impairment Clock drawing test Mini Mental State Examination AMTS

6. Confusion Assessment Method (CAM) Recommended by NICE http://www.nice.org.uk/guidance/CG103/Guidance http://www.nice.org.uk/guidance/CG103/Guidance Recommended following recent systematic review of evidence (Wong 2010) Takes 5-10 minutes to complete Sensitivity of 94% (95% CI 91-97%) and specificity of 89% (95% CI 85- 94%) Manual freely available on web http://hospitalelderlifeprogram.org/pdf/The%20Confusion%20Assessm ent%20Method.pdf http://hospitalelderlifeprogram.org/pdf/The%20Confusion%20Assessm ent%20Method.pdf Designed to be scored based on observations made during formal cognitive assessment e.g. MMSE/digit span Based on 4 features of delirium: acute onset/fluctuating course, inattention, disorganised thinking, altered level of consciousness Algorithm should be applied directly after patient contact