Common Mental Disorders Depression - New Zealand Doctor

Chapter 5 Recognition and assessment of common mental disorders in adults/pakeke
and alcohol problems and which they suggested could be used as a verbal screen,
though the questions have not been fully validated as standalone verbal questions.
These questions are specified in Box 5.2: Verbal 2–3 Question Screening Tools for
Common Mental Disorders.
Assessment of suicide risk
Assessment of suicide risk can be challenging as there is no evidence for absolute
markers that predict the presence or intensity of suicide risk, and assessment only
provides a snapshot of risk at a given time. Moreover, deliberate self-harm such as
superficial cutting may be used as a means of tension reduction, without intention to die.
The most immediately important factors to consider are contextual triggering factors and
current mental state. 162 Mental and physical illness are major risk factors, while the role
of social triggers is less prominent in older people. 162,326 The GDT notes that assessment
of suicide risk needs to be an ongoing aspect of monitoring, as new triggers can
supervene even if a person’s mental state is improving or staying the same.
Assessment of suicide risk represents an integration of the following factors: 162
• intent/definite plan
• lethality of likely means
• access to means
• presence of risk factors (eg, mental or physical illness, chronic pain, alcohol use)
• hopelessness
• psychosocial triggers
• lack or presence of protective factors.
Questions to assist in assessing risk of suicide may be found in Appendix C:
Assessment of Suicide Risk.
5.5 Reaching a diagnosis
A person with mental distress may or may not meet the criteria for a DSM-IV ®
diagnosis, as significant disability is often associated with mental disorders below
the diagnostic threshold, particularly in the mood and anxiety symptom domains. 4
The GDT recommends that in adults/pakeke the following criteria signify a need
for follow-up and possible intervention:
• safety: there is a perceived risk
• duration: problems last more than a few weeks
• intensity: symptoms are severe and fixed, with a loss of normal fluctuations
in mood and behaviour
Identification of Common Mental Disorders and Management of Depression in Primary Care 63