Quick Reference
Condensed clinical reference for the 15-minute visit.
The One Question That Opens the Door
“How are you doing — not your incision, not your scans — you? How is your mood? Are you feeling like yourself?”
This question takes 30 seconds. It communicates that their emotional life matters to you. For many patients, this is the first time a clinician has asked.
PCRES Administration Schedule
Available at pcres.org — free, 10–15 min. Thresholds below are proposed clinical guideposts pending formal psychometric validation.
When to Act
- Any domain ≤50% (proposed) → Clinical attention in that domain may be warranted
- Hope & Agency ≤35% (proposed) → Priority flag — consider immediate mood and suicide risk screening
- 3+ domains ≤50% (proposed) → Consider broader referral or team review
- ≥4 point drop between visits (proposed) → Meaningful change worth clinical review
Common Medication–Emotion Interactions
Dexamethasone
Mood swings, insomnia, agitation, euphoria; taper crash (fatigue, low mood, joint aches) — temporary but disorienting.
Levetiracetam (Keppra)
Irritability (sometimes severe), emotional blunting, cognitive distance — patients describe a “glass wall” between themselves and their emotions. Alternatives exist.
Opioids
Constipation (start stool softeners, hydration, fiber from day one — not after constipation develops); cognitive fog.
Referral Quick Guide
What to Say at Discharge
“What happened in your brain is going to affect how you feel — not just physically, but emotionally. That's not a complication. That's a normal part of what your brain is going through. We're going to check in on this at every visit.”