Taking Patients’ "Pulse" With Vital Statistics in Mental Health Treatment

Would a primary care physician see a patient without first taking their blood pressure, temperature, heart rate, or other vitals? When psychiatrists don't use screening tools like the Mood Disorder Questionnaire (MDQ) or the Patient Health Questionnaire (PHQ-9), they are similarly missing out on essential information, according to Gregory Mattingly, MD, associate clinical professor at Washington University, St. Louis, Missouri. Psych Congress Network sat down with Dr Mattingly after his Psych Congress 2022 session "Not Getting Better! Diagnostic Conundrums and Treatment Considerations in Mood Disorders" to hear what else he had to say about the "vital statistics" clinicians should use in mental health treatment. 

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Gregory Mattingly, MD, is a physician and principal investigator in clinical trials for Midwest Research Group. He is also a founding partner of St Charles Psychiatric Associates where he treats children, adolescents, and adults. A St Louis native, he earned his medical degree and received a Fulbright scholarship while attending Washington University. Dr Mattingly is board certified in adult and adolescent psychiatry and is a diplomat of the National Board of Medical Examiners. He is an associate clinical professor at Washington University where he teaches psychopharmacology courses for third-year medical students. Dr Mattingly has been a principal investigator in over 200 clinical trials focusing on ADHD, anxiety disorders, major depression, bipolar disorder, and schizophrenia. Having served on numerous national and international advisory panels, Dr Mattingly has received awards and distinctions for clinical leadership and neuroscience research. Dr Mattingly currently serves as the President-Elect for The American Professional Society of ADHD and Related Disorders and is a certified evaluator for the NFL regarding ADHD and head concussions. He also serves on the board of Headway House, a community support program for individuals with chronic mental illness. 

Read the Transcript:

I'm Dr Greg Mattingly, an associate clinical professor at the Washington University School of Medicine and president of the Midwest Research Group in St. Louis, Missouri.

A key takehome from this year's Psych Congress was learning how to incorporate vital statistics. If you were going to see your internist, it's your yearly physical, you're coming to see him because you're having a problem, what would you think of a primary care physician who didn't want to know your blood pressure, your heart rate, your temperature, your weight? And he sat down with you and said, "So Greg, how you doing?" without wanting to know anything else about you. You'd probably think, "Shouldn't he be checking a few things? Aren't there some things you should know? Maybe we should get some lab tests." The same is true when it comes to mental health patients. We have our own set of vital statistics. Vital statistics that help you to do a better job, vital statistics that help you to save time, vital statistics that help to make sure you don't miss anything.

So the mental health vital statistics, I want to encourage everyone to use. Number 1 is the PHQ-9. It's free, it's downloadable, it's a quality measure, it doesn't take any time. And item number 9 is suicidality. So by definition, you've screened every patient for the possibility of suicidal thoughts. On a new patient, our second vital statistic is the MDQ or one of the bipolar measures. Used to use it for screening. If the score is more than 7, there's an 85-90% chance there may be bipolar disorder as part of your differential diagnosis. So which version of depression is it? I'll know that right away. Number 3 on our vital statistics. So we've moved beyond blood pressure and pulse. Now, let's get the weight. I want to know your anxiety levels. Let's do the GAD-7. Low anxiety, middle anxiety, high anxiety. Let's measure that because anxiety predicts negative outcomes, increases the risk of suicidality in our patients.

And then finally, our last vital statistic, I have to know about cognition. So in our case, we do the ADHD-RS for every new patient. Because I want to measure cognition, not just in ADHD, but cognition in depression, mood disorders, anxiety disorders. So knowing those vital statistics, PHQ-9, MDQ, GAD-7, ADHD-RS. It makes your visit more efficient, it makes sure you don't miss anything, and it's also educational for the patients. I've had patients come in, chief complaint, major depression. They fill out their PHQ-9. They said, "You know that other scale? God, I seem to have all that stuff. My wife looked at it, she goes, "You definitely have all that stuff." "What was that? Oh, that's a screener for a different version of depression. Something we call bipolar disorder." So use those vital statistics, help to improve the care for your patients. It's a way to augment your visits, and it's never been more important than for those of you that are doing telepsychiatry. So thank you. And the importance of vital statistics.