Episode Description
In this high-yield episode, we break down five psychiatric screeners every primary care and outpatient provider should have in their toolbox: the PHQ-9, GAD-7, C-SSRS, Rapid Mood Screener, and Maclean Screening Instrument for BPD. You’ll learn when and how to use each screener to streamline your workflow, sharpen your diagnostic thinking, and navigate complex mental health presentations. Whether you’re managing depression, anxiety, suicidality, bipolar disorder, or borderline traits, these tools can help you focus your assessment and guide smarter treatment decisions–without adding to your cognitive load or taxing your time.
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Learning Objectives
By the end of this episode, you’ll be able to:
- Identify a go-to psychiatric screener for depression, anxiety, suicidality, bipolar disorder, and borderline personality disorder in primary care.
- Determine when to use each screener—before, during, or between visits—to streamline your workflow.
- Apply targeted screening to help distinguish between complex conditions such as bipolar disorder and borderline personality disorder.
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Direct Links to Self-Report Psychiatric Screeners
Clinical Tools and Resources – Available to Free Members
When to Use Screeners
You won’t screen for everything at every visit. Instead, let clinical context guide you:
- Routine screening for depression and anxiety aligns with USPSTF recommendations (e.g., PHQ-9, GAD-7).
- Targeted screening for bipolar disorder, BPD, or suicide risk is best used when something in the history raises concern.
- Screeners can be used before, during, or between visits—offering diagnostic insights without forcing rushed decisions.
The Five Screeners You Need
Here are the five tools covered in this episode, with brief context for each:
- Patient Health Questionnaire-9 (PHQ-9) (Depression)
Well-validated, brief, and already standard in many clinics. Helps assess symptom burden and track treatment response. - Generalized Anxiety Disorder-7 (GAD-7) (Anxiety)
Also widely used and validated. Strong complement to the PHQ-9 for routine screening and monitoring. - Columbia-Suicide Severity Rating Scale (C-SSRS) (Suicidality)
A structured 6-question screener that helps classify suicide risk (low, moderate, high) and provides guidance on next steps. Ideal when suicidality is endorsed on the PHQ-9 or in conversation. - Rapid Mood Screener (RMS) (Bipolar Disorder)
Designed to distinguish unipolar depression from bipolar depression. Particularly useful when you’re unsure whether a patient’s depressive symptoms may be part of a bipolar picture. - Maclean Screening Instrument for BPD (MSI-BPD) (Borderline Personality Disorder)
Screens for BPD using questions tied to DSM-5 criteria. Especially useful when trying to differentiate BPD from bipolar disorder in patients with emotional lability, impulsivity, and complex mood histories.
Screening to Support Diagnostic Thinking
Screeners don’t replace diagnosis, but they offer direction:
- A high PHQ-9 and GAD-7 may justify starting an antidepressant regardless of precise diagnosis.
- A positive RMS can steer you toward considering mood stabilizers.
- Administering both the RMS and Maclean instruments can help distinguish bipolar disorder from BPD—something that many bipolar screeners alone fail to do, as BPD can generate false positives.
Case-Based Screener Use
Key Takeaways
A streamlined set of five psychiatric screeners can go a long way in managing mental health concerns in primary care. Use them selectively, guided by clinical presentation. Screeners are especially powerful when deployed outside the time crunch of the office visit—between appointments or as follow-ups. They’re not diagnostic in isolation, but they are powerful tools to sharpen your clinical instincts and support better treatment decisions.
Disclaimer
The content provided by Collaborative Psychiatry is for educational purposes only and is intended to support, not replace, clinical judgment. This material is not medical advice and does not establish a physician-patient relationship.
The creator of this content has no relevant financial relationships or conflicts of interest to disclose.
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