Psychological assessment tools

Why should dermatologists worry about psychological assessment tools in their practice? Pamela Schell Werschler, Psy.D., MSN, ARNP, DNC, answered this question in her presentation, “Survey of Assessment Tools in Dermatologic Practice,” at the recent inaugural Aesthetic + Medical Dermatology Symposia, held in Coeur d’Alene, Idaho, in May.

According to Dr. Werschler, a psychologist and nurse practitioner specializing in dermatology at Werschler Aesthetics, Spokane, Wash., “Dermatological diseases often co-exist along with conditions such as major depressive disorder, obsessive-compulsive disorder, body dysmorphic disorder and a plethora of other psychiatric illnesses.”

She notes that a recent study of 114 people with dermatological disorders showed that 39 - nearly 35% - reported depression. By comparison, only about 7% of adults in the U.S. general population report depression, according to National Institute of Mental Health statistics.

“This isn’t surprising,” Dr. Werschler says. “How do acne, alopecia areata, eczema, HSV breakouts, hyperhidrosis, lupus, melasma, nail fungus, pruritis, psoriasis, rosacea, scarring, skin cancer, sexually transmitted diseases, urticaria, warts and don’t forget age-related changes - how do they make any of us feel?”

She says there’s an extensive list of psychiatric diagnoses dermatologists are likely see in combination with their patients’ dermatological condition. These disorders include obsessive-compulsive, body dysmorphic, trichotillomania (hair-pulling), excoriation (picking at the skin), substance/medication-induced obsessive-compulsive behavior, avoidant/restrictive food intake, anorexia nervosa, bulimia, binge eating, gender dysphoria, generalized anxiety, post-traumatic stress disorder - the list goes on and on.

In This Article

The Assessment Tools

Procedure-Specific Tools

The Assessment Tools

The crux of the presentation was Dr. Werschler’s discussion of the most useful psychological assessment tools. For patients with depressive symptoms, she recommends:

• The Beck Depression Inventory II (BDI-II) (Beck, Steer, Ball, & Ranieri, 1996) - Appropriate for patients ages 13 to 80, it’s the most widely used clinically administered instrument for the assessment of depression.

• BDI-Fast Screen for Medical Patients (Beck, Steer, & Brown, 2000) - Contains just seven questions; also appropriate for patients ages 13 to 80.

• Hamilton Rating Scale for Depression-Revised (HAM-D) (Warren, 1994) - With 21 questions, it’s designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss and somatic symptoms.

• Children’s Depression Inventory-2 (CDI-2) (Kovacks, 2004) - Appropriate for ages seven to 17, the short version uses 12 questions, takes 5 to 10 minutes to administer and focuses on emotional and functional symptoms.

Procedure-Specific Tools

Procedure-Specific Tools

Dr. Werschler also recommends these dermatologic- and cosmetic-procedure-specific assessment tools:

• Dermatology Life Quality Index (DLQI) (Finlay & Kahn, 1992) - A self-reporting questionnaire frequently used in research to assess the potential impact of dermatological disorders, medications and devices on patients’ quality of life.

• The Cosmetic Procedure Screening Scale (COPS) (Veale et al., 2012) - For the aesthetic provider, the most concerning diagnosis is body dysmorphic disorder. COPS is a self-reporting scale designed to screen for symptoms of BDD in cosmetic settings. Scores of 40 or higher indicate a BDD diagnosis. The scale can be repeated during treatment and used as a measure of outcome. It is free to use but should be cited if used.

“It’s important to treat the patient in a holistic manner, including how they may feel about their diagnosis,” Dr. Werschler says in summary. “And a crucial part of doing this is to employ appropriate psychological assessment tools.”