Common Mental Disorders Depression - New Zealand Doctor

More documents

Recommendations

Info

Algorithm 2c Management of mild depression in adults in primary care Yes No Yes No xx Identification of Common Mental Disorders and Management of Depression in Primary Care
1 Background 1.1 Primary care challenges The identification and management of mental disorders in primary care is a challenging and complex process. Mental disorders are extremely common in this setting, with over one third of adults attending primary care likely to have met the criteria for a DSM-IV ® diagnosis within the past 12 months. 1 The identification of common mental disorders is dependent on a number of factors, not least the availability of treatment resources that make identification worthwhile. There is evidence that identification rates might be improved by encouraging disclosure, fostering continuity of care and having a high index of suspicion with patients who have known risk factors for common mental disorders. 2 However, practitioners rarely address mental disorders in isolation from other health problems and must prioritise between competing clinician, patient and practice needs, often within difficult time and resource constraints. Low identification rates of mental disorders can be attributed partly to a process of prioritisation, whereby practitioners treat only those with marked mental distress and address other more urgent problems in patients with minimal functional impairment. 3 Presentations of psychosocial distress in primary care often do not correspond well with standard diagnostic criteria, as subthreshold conditions are often associated with significant functional impairment, while people meeting diagnostic criteria are not always as disabled. 4,5 There is ongoing debate about diagnostic cut-off points. 6,7 A high proportion of patients in primary care practice present with medically unexplained symptoms, that is, a mix of physical and psychological symptoms with no identifiable pathology. 8 Although practitioners recognise that in most cases medically unexplained symptoms are an expression of psychosocial distress, it can be difficult to know what approach to take. A sense of frustration (and concern about missing a possible biomedical disease) can make the patient-practitioner relationship difficult. 8 A British Columbia guideline on depression 9 claims that even when depression has been recognised, treatment is often suboptimal. The guideline suggests that this is due to the following problems, several of which may apply in New Zealand: • patient reluctance to seek and/or comply with treatment, due to the stigma associated with mental disorders • inadequate dosage and duration of antidepressant therapy • failure to educate patients about the nature of depression and to support self-management • failure to recommend evidence-based psychotherapy Identification of Common Mental Disorders and Management of Depression in Primary Care 1
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 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 67: Chapter 3 Recognition and assessmen
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:
Chapter 5 Recognition and assessmen
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:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115:
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 139 and 140:
Page 141 and 142:
Page 143 and 144:
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 158 and 159:
Appendix A: Guideline development p
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 177 and 178:
Page 179 and 180:
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?