As mental health professionals, we're always seeking ways to improve our diagnostic accuracy and treatment efficacy. The DSM-5-TR Level 1 Cross-Cutting Symptom Measure (DSM-XC) is a valuable tool in our assessment arsenal but it is not meant to be diagnostic on its own. So what comes next?

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The American Psychiatric Association (APA) maintains a list of “Level 2” measures recommended for use based on responses to the DSM-5-TR Level 1 Cross-Cutting Symptom Measure (DSM-XC). Not every domain has an official Level 2 measure. This guide covers the recommended Level 2 measures as well as additional measures that could be helpful.

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Many of the measures listed below are included in Osmind’s Psychiatry EHR — or coming soon — to make implementation a breeze.

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The Importance of Domain-Specific Follow-up

The DSM-XC is the our best analog to the stethescope of psychiary; it provides a broad overview of a patient's mental health symptoms—but it's just the beginning. The real value comes from diving deeper into any of the 13 specific domains where patients show elevated scores. This is where domain-specific follow-up measures become essential.

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Depression

• APA primary measure if rated 2 (mild) or higher on either item: PHQ-9

• APA additional option: PROMIS Emotional Distress—Depression—Short Form

• Additional clinician-rated measure: Montgomery-Asberg Depression Rating Scale (MADRS)

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Anger

• APA measure if rated 2 (mild) or higher: PROMIS Emotional Distress-Anger-Short Form

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Mania

• APA measure if rated 2 (mild) or higher on either item: Altman Self-Rating Mania Scale (ASRM)

• Additional clinician-rated option: Young Mania Rating Scale (YMRS) (conducted in session)

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Anxiety

• APA  measure if rated 2 (mild) or higher on any item: PROMIS Emotional Distress—Anxiety—Short Form

• Additional measure: GAD-7

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Somatic Symptoms

• APA measure if rated 2 (mild) or higher on either item: Patient Health Questionnaire 15 Somatic Symptoms Severity Scale  (PHQ-15)

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Suicidal Ideation & Self-Harm

• APA recommendation if rated 1 (slight) or higher: Clinician evaluation warranted

• Additional measure: Columbia-Suicide Severity Rating Scale (C-SSRS)

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Psychosis

• APA recommendation if rated 1 (slight) or higher on either item: Clinician evaluation warranted

• Additional clinician-rated measure: Brief Psychiatric Rating Scale (BPRS) (conducted in session)

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Sleep Disturbance

• APA measure if rated 2 (mild) or higher: PROMIS-Sleep Disturbance-Short Form (coming soon to Osmind)

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Memory

• APA recommendation if rated 2 (mild) or higher: Clinician evaluation warranted

• Additional clinician-administered measure:  Montreal Cognitive Assessment (MoCA) (App Available which has a free tier)

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Obsessive-Compulsive Symptoms

• APA recommendation if rated (2) mild or higher on either item: LEVEL 2—Repetitive Thoughts and Behaviors—Adult (Adapted from the Florida Obessive-Compulsive Inventory Severity Scale [Part B]

• Additional clinician-administered measure: Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (conducted in session. Available in Osmind)

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Dissociation

• APA recommendation if rated 2 (mild) or higher: Clinician evaluation warranted

• Additional measure: Dissociative Experiences Scale-II (DES-2) (coming soon to Osmind)

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Personality Functioning

• APA recommendation if rated 2(mild) or higher on either item: Clinician evaluation warranted

• Additional measure: McLean Screening Instrument for Borderline Personality Disorder

• Additional Measure: Meaning in Life Questionnaire

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Substance Use

• APA recommendation if rated 1 (slight) or higher on any items:  LEVEL 2—Substance Abuse—Adult (adapted from NIDA-modified ASSIST)

• Additional measure if rated 1 (slight) or higher on alcohol use question: CAGE questionnaire

• Additional measure if rated 1 (slight) or higher on illicit drug use question: DAST-10

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Additional APA Recommended Measure

• World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) - sent to all patients.

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How often should you send Level 2 measures?

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1. Initial assessment: Send relevant measures before the first visit to establish a baseline. We recommend sending the DSM-XC first and then reviewing the responses to determine if Level 2 measures are warranted. Set expectations with patients regarding the rationale for sending these additional measures or wait until meeting with the patient.
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2. Ongoing monitoring: Administer the DSM-XC every 30 days for complex patients, or every 60-90 days for lower acuity cases. Administer Level 2 measures as needed based on clinical judgment.

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How should you interpret results and track progress?

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When interpreting these measures:

1. Use patients as their own control: Look for changes in scores over time rather than focusing solely on absolute values.
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2. Analyze trends: Pay attention to overall score trends across measures to gauge general psychopathology burden.
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3. Individualize interpretation: Consider each patient's unique context when interpreting changes in scores.

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How can you make measurement-based care and assessment easy with tech?

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Osmind, our all-in-one psychiatry EHR, offers several features to streamline your assessment process:

• Automated questionnaire administration: Automatically schedule your choice of 50+ questionnaires at pre-determined intervals. Patients can complete surveys at their convenience via a dedicated secure mobile app.
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• Intuitive data visualization: Track patient progress over time with graphing tools, allowing you to see survey results at a glance.
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• Customizable charting templates: Efficiently document findings from follow-up measures using 60+ customizable note templates.
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• Smart alerts: Get notified when patients may need more support when they fall below a certain baseline.
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• Secure messaging: Keep patients on track with HIPAA-compliant communication tools.

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Administering the DSM-XC is just the first step in comprehensive psychiatric assessment. By following up with these targeted, domain-specific measures and leveraging Osmind, you gain a deeper understanding of your patients' needs and tailor treatments accordingly.

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Put Measurement-based care on autopilot and join the community of forward-thinking clinicians who are transforming patient care. With the right tools, you're not just keeping up with the future of psychiatry—you're charting it.