Evaluate: Measuring Response and Adjusting
What the Evaluate domain rewards
Evaluation questions test whether you can measure outcomes, recognize adverse effects, and adjust the plan. Know expected timelines: antidepressants take 2–4 weeks for early effect and 6–8 weeks for full response; antipsychotics show response over days to weeks; lithium levels are checked about 5 days after initiation and after dose changes. Use validated measures (PHQ-9, GAD-7, AIMS for tardive dyskinesia, metabolic panels for antipsychotics, lithium levels, TSH/renal function). Recognize partial response, remission, relapse, and recovery as distinct outcomes.
Traps to expect
- Premature switching: changing an antidepressant at 2 weeks without adequate dose or duration is usually wrong unless intolerable side effects occur.
- Missing adverse effects: akathisia mistaken for worsening anxiety; serotonin syndrome; NMS; tardive dyskinesia; SSRI-induced hyponatremia; lithium toxicity (tremor, confusion, vomiting).
- Nonadherence: evaluate adherence and side effects before escalating dose.
- Monitoring gaps: antipsychotics require weight, glucose, and lipids; lithium requires levels and thyroid/renal checks.
- Functional outcomes: symptom scales alone are insufficient; assess function, sleep, work, and relationships.
Rule of thumb
Before changing therapy, ask three questions: Has enough time passed? Was the dose adequate? Is the patient taking it? If yes to all three and response is inadequate, then adjust.
Worked example
A patient on fluoxetine 20 mg for 4 weeks reports PHQ-9 dropping from 18 to 12. Answer: this is a partial response at an adequate duration; continue and consider dose optimization or adding psychotherapy rather than switching classes immediately.