Symptom assessment

The therapeutic effects of psychopharmaceuticals are expressed as changes in well-being and behavior. The clinical testing of new substances therefore involves the reliable determination of these modifications in a form that can subsequently undergo statistical analysis. Three basic types of methods are available for this purpose questioning of the patients themselves (or other procedures to determine subjective effects) behavioral observations of various degrees of complexity and test procedures for specific mental functions. 

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Because CKD often presents without symptoms, assessment for CKD relies on appropriate screening strategies in all... 

Clinicians should use standardized psychiatric rating scales to rate response objectively. The four-item Positive Symptom Rating Scale and the Brief Negative Symptom Assessment are scales that are brief enough to be useful in the outpatient setting. 

Ascertainment of treatment-emergent side effects requires a baseline symptom assessment before treatment is begun and at regular intervals thereafter. An ideal way to monitor side effects is to use medication-specific side effect scales that are designed for a particular drug class. These combine physical and behavioral symptoms with information obtained from the medical evaluation of the patient. Rating scales may help differentiate treatment-emergent side effects from an exacerbation of a symptom present at baseline, or from other causes of physical or behavioral symptoms. They may also help the family and the child accurately identify and label these side effects and then discuss them with the physician. 

An efficacy outcome measure (e.g. change from baseline in a symptom assessment instrument, response rate according to a predefined response criterion, remission rate, time to response, time to relapse according to predefined relapse criteria, etc.). For Phase III trials the primary endpoint should be a clinical event (such as full recovery) or clinical improvement relevant to the patient (e.g. disappearance of specific symptoms). 

Advise the person on allergen avoidance and how best to achieve this (e.g. pollen count highest in the evening so advise closing of windows at night). Drug treatment is also usually necessary to help with symptoms. Assess the type and severity of the allergic rhinitis ... 

Evaluate for therapeutic response (i.e., relief of GI symptoms). Assess for GI discomfort, nausea, and diarrhea. 

Chang, V.T. Hwang, S.S. Feuerman, M. Kasimis, B.S. Thaler, H.T. The memorial symptom assessment scale short form (MSAS-SF) validity and reliability. Cancer 2000, 89 (5), 1162-1171. 

FIGURE 66-2. Brief clinical assessments for monitoring antipsychotic response in schizophrenia. To enhance consistency in ratings, the structured probes in the administration manual should be used each time the scales are used. (Data from Miller et aP and Miller et al. The complete administration manual for the Positive Symptom Rating Scale and the Brief Negative Symptom Assessment can be accessed from the appendices in the TIMA Procedure Manual Schizophrenia Module at http-//www.dshs.state.tx.us/ mhprograms/timasczman.pdf. This rating scale is in the public domain and may be reproduced with appropriate citation of the authors and source.)... 

Brief Negative Symptom Assessment (BNSA) Use each item s anchor points to rate the patient. 1 Prolonged time to respond 1 2 3 4 5 6... 

Lundback B, Nystrom L, Rosenhall L, Stjemberg N (1991) Obstructive lung disease in northern Sweden respiratory symptoms assessed in a postal survey, Eur Respir J 4 257-266 McGarvey LP, Ing AJ (2004) Idiopathic cough, prevalence and underlying mechanisms, Pulm... 

Receiving updated medical information about the patient s condition or new medicines. Symptom assessment such as cramps, prolonged bleeding from puncture sites, or fluid loss due to diarrhea. If the patient complains of cold fingers on the side of the access, a glove should be used during the winter. 

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