Here - Surrey and Borders Partnership NHS Foundation Trust

Research and Audit
rate of false negatives is consistently low
(Twiss J et al, 2008). It is therefore
recommended that all patients screening
positive for BPD on the MDQ (using a
cut off of 9 positive responses as a
positive test) should be referred for
diagnostic assessment by a professional
mental health worker. Additionally a
large study in a USA health centre with 1
million adult members identified that by
administering one off screening for BPD
to patients presenting with depressive
symptoms, and following up positive
screening results with a referral to a
psychiatrist, reduced 5 year health care
costs for that health centre by an
estimated $1.94 million. This reduction
was mostly due the difference in
treatment costs between recognized
versus unrecognized BPD sufferers
(Menzin J et al, 2009).
The importance of screening for
hypomania/mania is that BPD sufferers
are often misdiagnosed as suffering from
unipolar depression, frequently leading
to incorrect treatment. A single episode
of mania constitutes a diagnosis of BPD,
whilst an episode of hypomania should
increase vigilance in looking out for
future episodes of depression.
Aims and Objectives of the
Audit
The purpose of the audit was to assess
whether patients presenting to primary
care practices within our catchment area
were being screened for BPD.
Additionally we wanted to establish how
effective our service was at correctly
identifying both true BPD sufferers, and
those suffering from other mental health
conditions. We intend to examine this
data and consider whether further
awareness and screening is required.
To summarize, our study aimed to
answer 3 questions: Within the context
of our service-
1. Do primary care physicians and
Mental Health Nurse Practitioners
(MHNPs), specialist psychiatric nurses
working in both primary and
secondary care, screen for BPD?
2. Does screening for BPD increase the
likelihood of identifying this
condition?
3. Is there a good correlation between
the diagnosis proposed by GPs and
MHNPs and the final diagnosis made
by the psychiatrist?
Standard
Currently no gold standard or NICE
guidelines exist regarding screening for
BPD in primary care; therefore we did
not stipulate the use of a specific
screening tool for our study. There are
also no globally agreed cut-off points for
what constitutes an acceptable
screening test, although most
researchers would agree that any good
screening measure should have both a
low false positive rate and a low false
negative rate. The actual values that a
researcher may deem acceptable are
related to several variables, such as
prevalence of condition, cost of
screening and burden associated with
missing the condition vs. burden
associated with over diagnosing the
condition (Simon S, 2007). For the
purposes of our study, we set 80%
sensitivity and 80% specificity as the
standard, based upon levels set in other
published research (Twiss J et al, 2008).
Although these are arbitrary cut-off
values, they are in line with generally
accepted standards for psychiatric
screening tests.
Although we did not require the use of a
specific screening tool for this study, we
previously mentioned that a brief and
acceptable screening tool is available,
and we may consider using this tool
routinely in the future.
10 Surrey and Borders Online Journal www.sabp.nhs.uk/journal