Common Mental Disorders Depression - New Zealand Doctor

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Patient report and clinical assessment can be used to monitor response to treatment. Practitioners should also consider the use of a tool, such as the PHQ-9 to assist in the monitoring of treatment response. 321 In the opinion of the GDT, the Kessler Psychological Distress Scale (K10) may also be useful for monitoring response to treatment. A PHQ-9 score of
Chapter 6 Management of depression in adults/pakeke Mild depression Provided there are no high-risk features, appropriate first-line management for mild depression is active support and advice on exercise and self-management, with consideration of referral to other psychosocial helping agencies as applicable (eg, family services, employment counselling). 346 In the opinion of the GDT, the practitioner should review the patient at 2–4 weeks and if symptoms have resolved it is appropriate to resume routine management within primary care without any additional mental health follow-up, provided the patient agrees with this approach and understands the need to report any recurrence of symptoms. If the patient does not report substantial improvement (≥ 50% reduction in symptoms) within 2–4 weeks, treatment should be intensified, in accordance with the principles of ‘stepped care’. 65 Intensified treatment comprises an extended consultation with a member of the primary care team, with a review and extension of self-management and other measures taken to date. Although provision of extended consultations can be difficult due to time and funding constraints, there is growing evidence that longer consultations have the potential to improve mental health outcomes. 261 A structured problem-solving intervention should be considered, 65 preferably delivered by a member of the primary care team. Further information on structured problem-solving therapy is provided in the following section on management of moderate and severe depression. If the patient does not report substantial improvement within 6 weeks, or if he/she deteriorates, the GDT advises that the patient should be treated as for moderate depression. Moderate and severe depression Most adults/pakeke with uncomplicated depression can be treated in primary care regardless of severity. A patient with moderate depression may have significant difficulty continuing with normal activities, while a patient with severe depression will have significant functional disability, which in extreme cases can result in total incapacity. Strong feelings of worthlessness and guilt and the presence of suicidal thoughts are common. 327 All patients with moderate or severe depression should be followed up by the practitioner within 1–2 weeks. An immediate referral to secondary care mental health services is required if a patient develops any of the following high-risk features, at any stage: 65 • serious suicidal intent • psychotic symptoms • severe and persistent self-neglect (eg, not eating). Also see 5.6, Determining Severity and When to Refer for guidance on when to refer or consider referral to secondary care mental health services. Identification of Common Mental Disorders and Management of Depression in Primary Care 73
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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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to informed consent. 152 There is a
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Page 72 and 73: Box 4.1 Whänau Ora The concept of
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Page 122 and 123: Secondary care evidence Based on ev
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Page 130 and 131: This evidence comprised two recent
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Page 145 and 146: 9 Models of care 9.1 Introduction V
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Chapter 9 Models of care • networ
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Chapter 9 Models of care service as
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Quality improvement collaboratives
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NZGG has been funded to develop sum
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Appendix A: Guideline development p
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Appendix B: Evidence and recommenda
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Appendix C: Assessment of suicide r
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Appendix D: Assessment tools for co
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Anxiety Anxiety is often comorbid w
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Appendix F: Self-management resourc
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Information about mental disorders
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Dysthymia Dysthymia is a chronic lo
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Glossary, abbreviations and acronym
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References 1. The MaGPIe Research G
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References 38. Tse S, Tong K, Hong
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References 72. Kendler K, Kuhn J, P
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References 107. Halligan SL, Murray
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References 143. Dejesus RS, Vickers
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References 179. Shaffer D, Scott M,
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References 215. Garralda ME, Bowman
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References 249. Zwaanswijk M, Verha
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References 283. Linde K, Berner M,
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References 318. Henkel V, Mergl R,
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References 353. Rush AJ. STAR*D: wh
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References 386. Ward E, King M, Llo
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References 417. Kirsch I, Deacon BJ
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References 451. Zigmond AS, Snaith
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References 486. Appleby L, Warner R
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References 520. Irwin M, Artin KH,
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References 557. Agnew F, Pulotu-End
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Common Mental Disorders Depression - New Zealand Doctor

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