Common Mental Disorders Depression - New Zealand Doctor

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Dysthymia Dysthymia is a chronic lowering of mood that does not fulfil the criteria for recurrent depressive disorder in terms of either severity or duration of individual episodes. There are variable phases of minor depression and comparative normality. Despite tiredness, feeling down and not enjoying very much, people with dysthymia are usually able to cope with everyday life. 65 DSM criteria for dysthymia in adults require a duration of at least 2 years. 255 The management of dysthymia is discussed briefly in the Royal Australian and New Zealand College of Psychiatrists’ clinical practice guidelines for depression, at: http://www.ranzcp.org/pdffiles/cpgs/Depression%20Clinican%20Full.pdf Further information given below is derived from the relevant sections of two guidelines and a Cochrane systematic review. No guidelines were found specifically on the management of dysthymia. The information below derives from the relevant sections of two guidelines and a Cochrane systematic review. beyondblue Guideline Treat dysthymia as for moderate depression with an antidepressant or one of the brief psychological therapies. Monitor for side effects (at least twice a week by telephone) and encourage compliance with the selected treatment. If after 6–8 weeks symptoms still persist, consider changing to a second- or third-line treatment option. 529 National Guidelines for Seniors’ Mental Health, Canada – applies to older adults People with dysthymic disorder should be treated with pharmacological therapy, with or without psychotherapy, with periodic reassessment to measure response. [B] 510 In specific clinical situations, for example where patients do not wish to take antidepressants, psychotherapy may be used alone with periodic reassessment to measure response. 510 Lima 2005 A Cochrane review of pharmacotherapy for dysthymia 579 found that antidepressants are effective in the treatment of dysthymia with no differences between and within drug classes. Tricyclic antidepressants are more likely to cause adverse events and dropouts. There is little information on quality of life and medium- or long-term outcome. 146 Identification of Common Mental Disorders and Management of Depression in Primary Care
Appendix H: Assessing for cognitive impairment in older adults Practical screening instruments by clinical issue and appropriate test Want to find cognitive impairment of at least moderate severity • Mini-Mental State Examination Suspicion of mild impairment or highly educated patient • Hopkins Verbal Learning Test, or • Word List Acquisition Test Very little time available • Memory Impairment Screen, or • Clock Drawing Test Plenty of time available • Cambridge Cognitive Examination • Modified Mini-Mental State Examination • Community Screening Interview for Dementia, or 523 • Montreal Cognitive Assessment Identification of Common Mental Disorders and Management of Depression in Primary Care 147
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Identification of Common Mental Dis
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Statement of intent Evidence-based
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Endorsements Te Ao Maramatanga New
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3.6 Clinical features of common men
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List of figures 3.1 When to refer a
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About the guideline Foreword The Ne
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About the guideline Guideline devel
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About the guideline Paediatric subg
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About the guideline Royal New Zeala
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Algorithm 1 Management of depressio
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Algorithm 2a Management of severe d
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Algorithm 2c Management of mild dep
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• limited access to psychiatrists
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Asian peoples About 7% of the New Z
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12-month period amongst adults atte
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Table 1.2 Prevalence of common ment
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1.4 Etiology of common mental disor
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The ‘hopelessness theory’ 94 co
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Sexuality Data from the Christchurc
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Since those who are affected by sui
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2.3 Managing depression: the steppe
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3 Recognition and assessment of com
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Good practice points Management of
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Box 4.1 Whänau Ora The concept of
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If the young person/rangatahi/tamar
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Exercise There was insufficient evi
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at any timepoint. Treatment as usua
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Chapter 6 Management of depression
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Recommendations continued... Women
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during pregnancy, of which up to 6%
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Page 189 and 190: References 143. Dejesus RS, Vickers
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Page 193 and 194: References 215. Garralda ME, Bowman
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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
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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
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Common Mental Disorders Depression - New Zealand Doctor

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