Common Mental Disorders Depression - New Zealand Doctor

Anxiety
Anxiety is often comorbid with depression and will generally resolve along with the
depression if managed in the same way. 65 Treatments for anxiety disorders include
simple educational strategies, behavioural interventions, cognitive behaviour therapy,
family therapy and (rarely) the use of anxiolytics. 188 Currently, there appears to be no
relevant guideline on this topic.
Conduct disorder
The origins of conduct disorder appear to involve an interaction of genetic/constitutional,
familial and social factors. 577 It is often associated with parental psychosocial or mental
problems and problems with parenting style. Practitioners should stress the need for
significant intervention. Suggested 577 management is as follows:
• assess severity and refer for treatment with a subspecialist as needed
• treat comorbid substance abuse first
• describe the likely long-term prognosis without intervention to caregiver
• structure children’s activities and implement consistent behaviour guidelines
• emphasise parental monitoring of children’s activities (where they are, who they
are with)
• encourage the enforcement of curfews
• encourage children’s involvement in structured and supervised peer activities
(eg, organised sports, scouting)
• discuss and demonstrate clear and specific parental communication techniques
• help caregivers establish appropriate rewards for desirable behaviour
• help establish realistic, clearly communicated consequences for non-compliance
• help establish daily routine of child-directed play activity with parent(s)
• consider pharmacotherapy for children who are highly aggressive or impulsive,
or both, or those with mood disorder.
A guideline on parent-training/education programmes in the management
of children with conduct disorder is online at: http://www.nice.org.uk/guidance/
index.jsp?action=download&o=33427
Dysthymia
The National Institute for Health and Clinical Excellence (NICE) guideline for children
and young people 66 suggests that in the absence of a published evidence base for
the treatment of dysthymia, the treatment of dysthymia, if clinically necessary, should
follow that for mild depression.
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Identification of Common Mental Disorders and Management of Depression in Primary Care