Design and defend a measurement-based care pathway (MEQ)

(i) MBC definition. Measurement-based care is the systematic, repeated use of validated symptom measures with results shared and used to change treatment (continue, optimise, switch, augment, step up). Filing scores without discussion or action is not MBC.[6]

(ii) Baseline interpretation and risk. PHQ-9 18 sits in the moderately severe band using Kroenke cut-points (5/10/15/20 for mild/moderate/moderately severe/severe) — not a diagnosis by itself. GAD-7 12 exceeds the original validation screening cut-point of 10 for possible GAD and indicates clinically important anxiety symptoms requiring full anxiety differential. Item 9 = 1 mandates structured suicide risk assessment (ideation intensity, intent, plan, means, protective factors, safety planning) regardless of total score.[1][2]

(iii) Clinician adjuncts. Add MADRS (change-sensitive design) or HAM-D (historical trial standard; Zimmerman severity bands 0–7 / 8–16 / 17–23 / ≥24 if quoting severity) to triangulate self-report, especially if insight, secondary gain, or somatic complexity is an issue. Document version, date, rater, and training assumption.[3][7]

(iv) 12-week algorithm. Measure every 2–4 weeks during titration; share trends; if inadequate improvement after an adequate dose/duration trial (often reassess by ~4–6 weeks and again toward 8–12 weeks), change treatment rather than drifting. Cite Guo 2015 MBC RCT advantage versus standard care and STAR*D/Trivedi MBC algorithms with modest step-1 remission and need for sequenced steps when non-remission is measured.[4][5]

(v) Psychometrics. Reliability (internal consistency, test–retest, inter-rater) vs validity (content, construct, criterion). Responsiveness/sensitivity to change (MADRS design intent). Optional high-yield: PANSS floor of 30 if asked about general scale literacy in psychosis services.[3]