Why Assess

Prior to beginning acute-phase cognitive therapy (A-CT; the treatment phase focused on symptom reduction and skills acquisition), an initial diagnostic evaluation is essential (for an overview see Jarrett, 1995). During this evaluation the clinician determines whether a mood disorder is present and characterizes its severity, current subtype (e.g., single vs. recurrent episodes), and lifetime course, as well as its association with other concurrent or past psychiatric disorders. Eliciting information regarding temporal associations with developmental hurdles, psychosocial stressors (e.g., past physical and/or emotional trauma or maltreatment), and functioning, and past response to treatment is key. Evaluating the history of family members' psychiatric illnesses and treatment history is also important. Patients (or, when available, the family members themselves) are given referrals for currently ill but untreated family members.

The evaluator shares the diagnoses, treatment alternatives, and prognoses with patients (and, when appropriate, with significant others) using the medical model as detailed by Klerman, Weissman, Rounsaville, and Cheveron (1984) and Jarrett (1995). Patients and their significant other(s) learn that recurrent depression is a disorder (rather than a character flaw) that carries risks requiring symptom detection, lifetime assessment, and follow-up. Psychoeducation about mood disorders and how depressions can be treated effectively is an important component of obtaining informed consent for treatment from patients and their significant others. Over the course of evaluation and treatment, continuous review of the definition of the syndrome and symptoms of major depressive disorder (MDD) helps to prepare patients to recognize the signs and symptoms of recurrent depression over the lifespan. They learn that early detection facilitates effective treatment for depression. Videotapes, pamphlets, handouts, books, and selected websites (e.g., the home page of the NIMH [National Institute of Mental Health]) aid busy clinicians in providing this information to patients and their families.

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