Common Mental Disorders Depression - New Zealand Doctor

More documents

Recommendations

Info

Box 3.2 Asking about sexual identity In order to give a young person the opportunity to acknowledge their sexual identity, the practitioner could say: • How do you feel about relationships in general/about your own sexuality? • Some people are getting involved in sexual relationships. Have you had a sexual experience with a guy or girl or both? i Ask for permission to pass relevant information to other health professionals involved in the young person’s care. This may save them the stress of having to explain themselves anew. ii i Access Seru. Improving young people’s access to health care through general practice: a guide for general practitioners and divisions of general practice; 1999. 194 ii Neville S, Henrickson M. Perceptions of lesbian, gay and bisexual people of primary healthcare services. J Adv Nurs 2006;55(4):407–15. 119 Box 3.3 HEARTS Currently, there is no well-established acronym that can be used to structure a psychosocial interview with young children and their family/whänau. However, the HEARTS acronym is suggested by the GDT: Home: conduct, general behaviour, ‘manageability’ Education: any concerns about behaviour/progress Activities: attention span, ability to finish tasks, friendships Relationships with peers/parents: any big changes in the family, any bullying Temper: mood Size: weight gain, appetite Children tend to provide different information from their parents, so it is helpful to gather information from both sources. Mäori and Pacific peoples have collective societies 14,199 and whänau have a central role in providing a sense of identity, security and belonging for young people/ rangatahi/tamariki. 200 Although, in general, rangatahi and tamariki value the whänau environment highly 195 and it is a strong, positive influence, 174 the whänau potential to nurture is threatened by socioeconomic deprivation. 174 A large percentage of Mäori rangatahi and tamariki are part of whänau who struggle to meet their daily financial needs and may be unable to function effectively in supporting them. 201 Many Mäori families are no longer linked to hapü and iwi structures or engaged in kohanga reo or marae activities. 202 Similarly, Pacific families may be fragmented, with little family or church support. 203 28 Identification of Common Mental Disorders and Management of Depression in Primary Care
Chapter 3 Recognition and assessment of common mental disorders in young people/rangatahi/tamariki Whänau is a much wider concept than the nuclear family. It approximates what non-Mäori would generally understand to be an extended family. For Mäori, whänau provides care, nurturing, identity and a sense of belonging and purpose. 204 The goal of health for Mäori is whänau ora: ‘Mäori families supported to achieve their maximum health and wellbeing’. 202 Practitioners assessing younger children/tamariki (up to about 12 years) are largely reliant on collaboration with parents or caregivers and should see families together unless there is obvious parent-child conflict, in which case a brief interview with the child/tamariki alone could be considered. 205 A supportive and cooperative relationship with an adolescent/rangatahi requires an assurance of privacy and confidentiality. 188 Adolescents presenting in primary care should routinely be offered individual time with a practitioner. 66 It may be helpful to gain a parental perspective as well, particularly for younger adolescents/rangatahi (about 12–15 years). Adolescents/rangatahi have been noted to be fairly reliable informants with regard to describing their feelings, but may be less accurate in reporting externalising behaviour, such as aggression or mood swings. 206 Confidentiality The practitioner should discuss with a young person/rangatahi/tamariki their right not to have personal information disclosed without their permission, along with the limits to this right. The exceptions to absolute confidentiality are the ‘Three Harms’: if someone might harm the young person, or if they might harm themselves or harm someone else, it is necessary, justifiable and legally defensible to discuss the situation with other appropriate professionals. 207 Box 3.4 contains an example of a statement that could be used to explain the limits of confidentiality in a clinical consultation. A careful discussion of confidentiality will help to build trust and will increase the likelihood that the young person/rangatahi will keep follow-up appointments. 208 A study of Pacific health care practices notes that patient confidentiality can be contradictory to Pacific (and Mäori) expectations of involving significant others. The authors of the study suggest that the practitioner should aim to engage parents positively in cultural and educational areas, without revealing details of the consultations/sessions. 14 Box 3.4 Explaining the limits of confidentiality ‘What you say is confidential to the service, unless I believe that you are at serious risk of harm to yourself, harm to others or harm from others. In such a case I will take the necessary steps to protect your safety, although wherever possible I will discuss this with you beforehand.’ Source: New Zealand Guidelines Group, Ministry of Health. The assessment and management of people at risk of suicide. Wellington: New Zealand Guidelines Group; 2003. 162 Identification of Common Mental Disorders and Management of Depression in Primary Care 29
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: 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 93 and 94: 6 Management of depression in adult
Page 95 and 96: Chapter 6 Management of depression
Page 105 and 106:
Chapter 6 Management of depression
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?