Common Mental Disorders Depression - New Zealand Doctor

More documents

Recommendations

Info

Appendix A: Guideline development process Clinical questions The Guideline Development Team (GDT) developed the following clinical questions: 1. What risk factors are associated with depression in children/adolescents/adults? 2. How do children/adolescents/adults with common mental disorders present in primary care? 3. Does routine screening for depression/common mental disorders/postnatal depression in children/adolescents/adults in primary care lead to improved outcomes? 4. What is the validity and utility of case-finding tools for assessment of depression, anxiety and dysthymia (either alone or with other common mental disorders) in children/adolescents/adults in primary care? 5. In children/adolescents/adults managed in primary care for depression do the following interventions improve outcomes: • a healthy lifestyle (eg, complementary and alternative medicines, exercise, etc) • guided self-help • psychological therapies • pharmacological therapies? 6. In children/adolescents/adults managed in primary care for depression, which models of liaison/teamwork/service delivery have the best outcomes (in general, and specifically for Mäori and Pacific peoples)? Evidence collation and appraisal To address the clinical questions, New Zealand Guidelines Group (NZGG) used the AGREE instrument 573 to appraise the following international guidelines for the quality of their methodologies: Agency for Healthcare Research and Quality (AHRQ) 2002, 176 National Institute for Health and Clinical Excellence (NICE) 2004, 65 NICE 2005, 66 NICE 2007. 101 They were assessed as being well-developed and suitable for updating where they addressed one or more of the clinical questions. The GDT determined that questions 3 to 5 required an updated search and systematic review, while questions 1, 2 and 6 could be answered with reference to the abovementioned international guidelines, supplemented by a narrative review of New Zealand literature and literature published since the guidelines. 132 Identification of Common Mental Disorders and Management of Depression in Primary Care
Appendix A Guideline development process The research team determined inclusion criteria for studies pertaining to questions 3 to 6 and designed literature searches. The full searches and inclusion criteria for studies are available on the NZGG website (http://www.nzgg.org.nz). Searches of electronic databases were undertaken and studies were retrieved and appraised using Scottish Intercollegiate Guidelines Network (SIGN) tools (see Appendix B: Evidence and Recommendation Grading System). The characteristics and results of studies selected for inclusion were summarised in evidence tables, which are available on the NZGG website (http://www.nzgg.org.nz). A considered judgment form 574 was then prepared, taking into account the quality, volume, consistency, applicability and clinical impact of the evidence available. The review of the evidence confirmed that more research is needed in many areas relating to common mental disorders. Primary care based evidence is particularly sparse. Studies conducted in primary care were prioritised, but where evidence from this setting was lacking, relevant evidence from other settings was taken into consideration in the considered judgment process. Recommendation development The GDT developed consensus recommendations following a review and discussion of the evidence as expressed in the evidence tables and considered judgment forms. Recommendations are graded based on the level to which they are supported by the evidence (see Appendix B: Evidence and Recommendation Grading System). Two expert subgroups were convened to consider the evidence and draft recommendations for the specific populations of youth (children and adolescents) and older adults. The subgroups comprised both GDT members and external experts. Their recommendations were discussed and finalised by the full GDT. Validation and finalisation NZGG drafted the guideline with support from GDT members, expert contributors and Mäori perspectives from the NZGG Board of Directors. The guideline was circulated nationally for feedback. Following consideration of the feedback, the guideline was redrafted. Significant changes were made to Chapter 7, following advice from a maternal mental health specialist, the New Zealand College of Midwives, the Royal New Zealand Plunket Society and general practitioners with an interest in this area. Identification of Common Mental Disorders and Management of Depression in Primary Care 133
Page 1:
Identification of Common Mental Dis
Page 4 and 5:
Statement of intent Evidence-based
Page 6 and 7:
Endorsements Te Ao Maramatanga New
Page 8 and 9:
3.6 Clinical features of common men
Page 10 and 11:
List of figures 3.1 When to refer a
Page 13 and 14:
About the guideline Foreword The Ne
Page 15 and 16:
About the guideline Guideline devel
Page 17 and 18:
About the guideline Paediatric subg
Page 19:
About the guideline Royal New Zeala
Page 22 and 23:
Algorithm 1 Management of depressio
Page 24 and 25:
Algorithm 2a Management of severe d
Page 26 and 27:
Algorithm 2c Management of mild dep
Page 28 and 29:
• limited access to psychiatrists
Page 30 and 31:
Asian peoples About 7% of the New Z
Page 32 and 33:
12-month period amongst adults atte
Page 34 and 35:
Table 1.2 Prevalence of common ment
Page 36 and 37:
1.4 Etiology of common mental disor
Page 38 and 39:
The ‘hopelessness theory’ 94 co
Page 40 and 41:
Sexuality Data from the Christchurc
Page 42 and 43:
Since those who are affected by sui
Page 44 and 45:
2.3 Managing depression: the steppe
Page 46 and 47:
to informed consent. 152 There is a
Page 49 and 50:
3 Recognition and assessment of com
Page 51 and 52:
Chapter 3 Recognition and assessmen
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67:
Page 70 and 71:
Good practice points Management of
Page 72 and 73:
Box 4.1 Whänau Ora The concept of
Page 74 and 75:
If the young person/rangatahi/tamar
Page 76 and 77:
Exercise There was insufficient evi
Page 78 and 79:
at any timepoint. Treatment as usua
Page 81 and 82:
5 Recognition and assessment of com
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
6 Management of depression in adult
Page 95 and 96:
Chapter 6 Management of depression
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108: Chapter 6 Management of depression
Page 115: Chapter 6 Management of depression
Page 118 and 119: Recommendations continued... Women
Page 120 and 121: during pregnancy, of which up to 6%
Page 122 and 123: Secondary care evidence Based on ev
Page 124 and 125: Advice for women It may be helpful
Page 126 and 127: Social networks appear to be an inf
Page 128 and 129: eastfeeding, or not breastfeeding,
Page 130 and 131: This evidence comprised two recent
Page 132 and 133: There is also some evidence that th
Page 135 and 136: 8 Special issues: older adults/ kor
Page 137 and 138: Chapter 8 Special issues: older adu
Page 145 and 146: 9 Models of care 9.1 Introduction V
Page 147 and 148: Chapter 9 Models of care were reduc
Page 149 and 150: Chapter 9 Models of care • networ
Page 151: Chapter 9 Models of care service as
Page 154 and 155: Quality improvement collaboratives
Page 156 and 157: NZGG has been funded to develop sum
Page 160 and 161: Appendix B: Evidence and recommenda
Page 162 and 163: Appendix C: Assessment of suicide r
Page 164 and 165: Appendix D: Assessment tools for co
Page 166 and 167: Anxiety Anxiety is often comorbid w
Page 168 and 169: Appendix F: Self-management resourc
Page 170 and 171: Information about mental disorders
Page 172 and 173: Dysthymia Dysthymia is a chronic lo
Page 175 and 176: Glossary, abbreviations and acronym
Page 181 and 182: References 1. The MaGPIe Research G
Page 183 and 184: References 38. Tse S, Tong K, Hong
Page 185 and 186: References 72. Kendler K, Kuhn J, P
Page 187 and 188: References 107. Halligan SL, Murray
Page 189 and 190: References 143. Dejesus RS, Vickers
Page 191 and 192: References 179. Shaffer D, Scott M,
Page 193 and 194: References 215. Garralda ME, Bowman
Page 195 and 196: References 249. Zwaanswijk M, Verha
Page 197 and 198: References 283. Linde K, Berner M,
Page 199 and 200: References 318. Henkel V, Mergl R,
Page 201 and 202: References 353. Rush AJ. STAR*D: wh
Page 203 and 204: References 386. Ward E, King M, Llo
Page 205 and 206: References 417. Kirsch I, Deacon BJ
Page 207 and 208: References 451. Zigmond AS, Snaith
Page 209 and 210:
References 486. Appleby L, Warner R
Page 211 and 212:
References 520. Irwin M, Artin KH,
Page 213 and 214:
References 557. Agnew F, Pulotu-End
Page 216:
www.nzgg.co.nz www.moh.govt.nz
show all

Common Mental Disorders Depression - New Zealand Doctor

Create successful ePaper yourself

Delete template?

Save as template?