CG123 Common mental health disorders - National Institute for ...

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Further assessment of risk and need for treatment, and routine outcome monitoringTable 29: Summary of selected text from recommendations relating tocomorbidities (by guideline)GuidelineRecommendationAlcohol-use For people who misuse alcohol and have comorbidDisorders (NICE, depression or anxiety disorders, treat the alcohol misuse2011b) first as this may lead to significant improvement in the depressionand anxiety. If depression or anxiety continues after 3 to 4 weeksof abstinence from alcohol, assess the depression or anxiety andconsider referral and treatment in line with the relevant NICEguideline for the particular disorder (Depression [NICE, 2009a]and Generalised Anxiety Disorder and Panic Disorder [With orWithout Agoraphobia] in Adults [NICE, 2011a]).Antenatal and None identifiedPostnatal MentalHealth (NICE, 2007a)(For common mentalhealth disorders only)Depression (NICE, When depression is accompanied by symptoms of anxiety,2009a) the first priority should usually be to treat the depression. Whenthe person has an anxiety disorder and comorbid depression ordepressive symptoms, consider treating the anxiety disorder first.Depression in When depression is accompanied by symptoms of anxiety,Adults with a the first priority should usually be to treat the depression. WhenChronic Physical the patient has an anxiety disorder and comorbid depression orHealth Problem depressive symptoms, consult the NICE guideline for the relevant(NICE, 2009b) anxiety disorder and consider treating the anxiety disorder first.When an antidepressant is to be prescribed for a patient, take intoaccount:• the presence of additional physical health disorders.Drug Misuse: None identifiedOpioid Detoxification(NICE, 2007c)Drug Misuse: Evidence-based psychological treatments (in particular, CBT) shouldPsychosocial be considered for the treatment of comorbid depression and anxietyInterventions disorders in line with existing NICE guidance for people who(NICE, 2007b) misuse cannabis or stimulants, and for those who have achievedabstinence or are stabilised on opioid maintenance treatment.Generalised Consider referral to secondary care if the person with GAD hasAnxiety Disorder severe anxiety with marked functional impairment in conjunctionand Panic Disorder with:(With or Without • a risk of self-harm or suicideAgoraphobia) in • significant comorbidityAdults (NICE, • complex physical health problems2011a) (GAD) • self-neglect.Continued155
Further assessment of risk and need for treatment, and routine outcome monitoringGuidelineTable 29: (Continued)RecommendationWhen providing treatment for people with GAD and a mild learningdisability or mild acquired cognitive impairment provide thesame interventions as for other people with GAD, or adjust themethod of delivery or duration.When assessing or providing an intervention for people withGAD and a moderate to severe learning disability or moderate tosevere acquired cognitive impairment, consider consulting with arelevant specialist.If a person with GAD also has a comorbid depressive or other anxietydisorder, treat the primary disorder first.Non-harmful alcohol misuse should not be a contraindication toactive treatment of GAD. For people with GAD with harmful anddependent alcohol misuse, treat the alcohol misuse first as this alonemay lead to significant improvement in the symptoms of GAD.Specialist mental health services should conduct a thorough,holistic reassessment of:• substance use• the role of agoraphobic and other avoidant symptoms• comorbidities.Obsessive-Adults with OCD with mild functional impairment whocompulsiveare unable to engage in low intensity CBT, or for whomDisorderlow intensity treatment has proved to be inadequate, should(NICE, 2005a) be offered the choice of either a course of SSRI or more intensiveCBT when OCD is associated with significant comorbidity orsevere impairment, consider:• SSRI or clomipramine• CBT (including ERP)• combination of SSRI or clomipramine and CBT (including ERP)• care coordination• augmentation strategies• admission• social care.Post-traumatic Stress When a patient presents with PTSD and depression, healthcareDisorder (NICE, professionals should consider treating the PTSD first.2005b)For people with PTSD who are so severely depressed that thismakes initial psychological treatment of PTSD very difficult,healthcare professionals should treat the depression first.For people with PTSD with drug or alcohol problems, healthcareprofessionals should treat the drug or alcohol problem first.When offering trauma-focused psychological interventions topeople with PTSD with comorbid personality disorder, healthcareprofessionals should consider extending the duration of treatment.Where sleep is a major problem for an adult with PTSD, hypnoticmedication may be appropriate for short-term use.156
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Commonmental healthdisordersTHE NIC
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© The British Psychological Societ
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Contents6 FURTHER ASSESSMENT OF RIS
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Guideline development group members
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Preface1 PREFACEThis guideline has
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Prefacecollaborative manner using t
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PrefaceThe experience of people wit
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Common mental health disorders2.2 T
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Common mental health disordersto ho
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Common mental health disordersManua
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Common mental health disordershighe
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Common mental health disordersNegat
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Common mental health disorderscours
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Common mental health disordersover
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Common mental health disorders2.2.6
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Common mental health disordersTable
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Common mental health disorders1996)
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Common mental health disordersSumma
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Common mental health disordersTable
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Common mental health disordersappli
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Common mental health disorderspatie
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Methods used to develop this guidel
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Access to healthcare4. ACCESS TO HE
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Access to healthcareunder the Menta
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Access to healthcare4.2.3 Studies c
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Access to healthcareIndividual-leve
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Access to healthcareJUNG2003 review
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Access to healthcareSCHEPPERS2006).
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Access to healthcare70Table 8: Clin
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Access to healthcareTable 9: Study
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Access to healthcareCHAPMAN2004 inc
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Access to healthcare4.4 SERVICE DEV
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Access to healthcareBEACH2006 [Beac
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Access to healthcareTable 12: Summa
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Access to healthcareAll studies wer
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Access to healthcarepractitioners h
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Access to healthcareIndividual-leve
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Access to healthcarefrom such popul
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Access to healthcarestructure and d
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Case identification and formal asse
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Systems for organising and developi
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Summary of recommendations8.1.1.6 S
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Summary of recommendationsFigure 12
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Summary of recommendations●Genera
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Summary of recommendations8.4 STEPS
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Summary of recommendations●●a g
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Summary of recommendationsDiscuss w
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Summary of recommendationsinclude p
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Appendices9 APPENDICESAppendix 1: S
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Appendix 1of a depressive disorder
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Appendix 1b) Assessment of anxiety
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Appendix 2APPENDIX 2:DECLARATIONS O
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Appendix 2Mr Mike BessantEmployment
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Appendix 2Personal non-pecuniary in
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Appendix 2Actions takenMr Rupert Su
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Appendix 2Personal family interestN
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Appendix 3APPENDIX 3:STAKEHOLDERS A
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Appendix 4ClinicalpopulationPeople
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Appendix 4Case identificationNo. Pr
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Appendix 5APPENDIX 5:REVIEW PROTOCO
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Appendix 7APPENDIX 7:METHODOLOGY CH
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Appendix 9APPENDIX 9:METHODOLOGY CH
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Appendix 92.10 Are all important pa
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Appendix 9case also excludes costs
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Appendix 9For consistency, the EQ-5
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Appendix 9Answer ‘yes’ if the a
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Appendix 9Answer ‘yes’ if the e
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Appendix 9Answer ‘yes’ if appro
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Appendix 10APPENDIX 10: EVIDENCE TA
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Appendix 11APPENDIX 11:HIGH PRIORIT
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Appendix 11discussion of options bu
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Appendix 13APPENDIX 13:GENERALIZED
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ReferencesAndlin-Sobocki, P., Jöns
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ReferencesBower, P., Gilbody, S., R
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ReferencesCooper, S., Smiley, E., M
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ReferencesEhlers A., Gene-Cos N. &
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ReferencesGiles, D. E., Jarrett, R.
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ReferencesHorowitz, M. J., Wilner,
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ReferencesKnapp, M. & Ilson, S. (20
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ReferencesMarks, J., Goldberg, D. P
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ReferencesNCCMH (forthcoming) Self-
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ReferencesOzer, E. J., Best, S. R.,
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ReferencesSartorius, N. (2002) Eine
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ReferencesTiemens, B. G., Ormel, J.
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ReferencesWilkinson, M. J. B. & Bar
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Glossarybeliefs and interpretations
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Glossaryto learn to become more awa
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Abbreviations12 ABBREVIATIONSADDADS
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AbbreviationsOASISOCDONSORPHQ (-A,
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