Common Mental Disorders Depression - New Zealand Doctor

More documents

Recommendations

Info

New Zealand ‘Get Checked’ programme provides a suitable opportunity for an annual mental health assessment of people with diabetes, which could be usefully applied to other chronic disease management programmes. Annual screening is considered good practice by the GDT. 297 Targeted screening for depression and anxiety should include the use of verbal 2–3 question screening tools. These tools have been validated to screen for anxiety 298 and depression. 299 There is also promising evidence to support the use of two questions to screen for substance abuse 300,301 (see 5.4, Assessment Tools: Evidence Review) and Box 5.1 Screening for common mental disorders in primary care Consider screening with verbal 2–3 question screening tools:* • people with chronic illness eg, long-term physical or mental conditions causing disability, i such as coronary heart disease, diabetes, respiratory disease, hypertension, chronic pain or dementia † † ii • people with multiple symptoms † iii • people with physical or intellectual disability † i,iv • Mäori, particularly Mäori women † v,vi • people with a history of mental disorder or suicide attempt † ii • people with recent significant loss, bereavement or major negative life event † • older adults/koroua/kuia in residential care vii ‡ • people not seen for a year or more iv ‡ • new patients iv viii • women in the antenatal or postnatal period. * See Box 5.2 for verbal 2–3 question screens for common mental disorders. † There is a high prevalence of mental disorders in these groups. ‡ A disorder is more likely to be missed in these groups. # The potential impact of a missed disorder is particularly serious in this group. Sources: i Oakley Browne MA, Wells JE, Scott KM. (eds). Te Rau Hinengaro: the New Zealand Mental Health Survey. Wellington: Ministry of Health; 2006. 34 ii Institute for Clinical Systems Improvement. Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement; 2006. 255 iii Cooper S, Smiley E, Morrison J, et al. Br J Psychiatry 2007;190:27-35. 303 iv Bushnell J, MaGPIe Research Group. Br J Gen Pract 2004;54(508):838-42. 2 v National Institute for Health and Clinical Excellence. Depression: management of depression in primary and secondary care. National Clinical Practice Guideline Number 23. London; 2004. 65 vi Beautrais AL, Wells JE, Mcgee MA, et al. Aust N Z J Psychiatry 2006;40 (10):896-904. 121 vii Kuruvilla G, Davidson T, McCabe MP, et al. Aust N Z J Psychiatry 2006;40(Supplement 1):A50. 110 viii National Institute for Health and Clinical Excellence. Antenatal and postnatal mental health. London; 2007. 101 58 Identification of Common Mental Disorders and Management of Depression in Primary Care
Chapter 5 Recognition and assessment of common mental disorders in adults/pakeke the GDT encourages the use of this screening tool for the targeted screening of alcohol and drug use. If the initial screening questions return a positive response, a third question inquiring whether help is needed (‘Is this something with which you would like help?’) is likely to improve the predictive value of the tools. 302 Box 5.2 Verbal 2–3 Question Screening Tools for Common Mental Disorders details the relevant questions for the depression, anxiety and substance abuse screening tools, as well as suggested further action if they elicit a positive response. 5.3 Further assessment where there is concern Practitioners should consider using verbal 2–3 question screening tools to assess for depression, anxiety or alcohol or drug problems in any adult if concerned about their psychosocial wellbeing, whether or not they belong to a high-risk group (see Box 5.2). If a person responds positively to screening questions or there are other factors that arouse concern about psychosocial issues, it is good practice to explore problem areas thoroughly. For Mäori and Pacific patients, in particular, roles and responsibilities within the family/whänau and wider community may take precedence over individual wellbeing, and the practitioner should consider this when taking a history. 17,19 Use of a formal assessment tool could be considered, though such tools should not be viewed as a substitute for thorough clinical assessment. A large number of tools have been validated (see 5.4, Assessment Tools: Evidence Review). It is suggested that a practitioner wishing to use such tools becomes familiar with a limited repertoire. Selected tools for assessing common mental disorders are listed in Box 5.3. The GDT notes that the ICD-10 or DSM-IV ® criteria for depression, anxiety and substance abuse may be useful to frame a dialogue about specific symptoms. 243,306 The practitioner should review any medications or medical conditions that might cause depression or account for the symptoms and perform laboratory tests as indicated (eg, for thyroid hormone levels). 9 Discussion of the following factors will help to put current problems into context: 162 • duration of symptoms and what interventions (if any) have been tried • functional impairment • family and personal history of similar episodes and how they were managed • any precipitating factors such as psychosocial stressors (eg, domestic violence, sexual abuse) • any perpetuating factors (eg, cognitions that they are ‘useless’) • protective resources, both internal (such as self-insight) and external (such as helpful social supports) • any experience of manic episodes • any suicidal ideation or attempts. Identification of Common Mental Disorders and Management of Depression in Primary Care 59
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 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: Chapter 5 Recognition and assessmen
Page 93 and 94: 6 Management of depression in adult
Page 95 and 96: 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 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?