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

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Further assessment of risk and need for treatment, and routine outcome monitoring●6.3.8.12 For pregnant women who have subthreshold symptoms of depressionand/or anxiety that significantly interfere with personal and social functioning,consider providing or referring for:● individual brief psychological treatment (four to six sessions), such asinterpersonal therapy (IPT) or CBT for women who have had a previousepisode of depression or anxietysocial support during pregnancy and the postnatal period for women whohave not had a previous episode of depression or anxiety; such supportmay consist of regular informal individual or group-based support 31 .6.3.8.13 Do not offer antidepressants routinely for people with persistent subthresholddepressive symptoms or mild depression, but consider them for, orrefer for an assessment, people with:● initial presentation of subthreshold depressive symptoms that havebeen present for a long period (typically at least 2 years) or● subthreshold depressive symptoms or mild depression that persist(s)after other interventions or● a past history of moderate or severe depression or● mild depression that complicates the care of a physical health problem 32 .6.3.8.14 For people with generalised anxiety disorder that has not improved afterpsychoeducation and active monitoring, offer or refer for one of the followinglow-intensity interventions:● individual non-facilitated self-help● individual facilitated self-help● psychoeducational groups 33 .6.3.8.15 For people with mild to moderate panic disorder, offer or refer for one ofthe following low-intensity interventions:● individual non-facilitated self-help● individual facilitated self-help.6.3.8.16 For people with mild to moderate OCD:● offer or refer for individual CBT including exposure and responseprevention (ERP) of limited duration (typically up to 10 hours), whichcould be provided using self-help materials or by telephone or● refer for group CBT (including ERP) (note, group formats may delivermore than 10 hours of therapy) 34 .6.3.8.17 For people with PTSD, including those with mild to moderate PTSD, referfor a formal psychological intervention (trauma-focused CBT or eyemovement desensitisation and reprocessing [EMDR]) 35 .31 Adapted from Antenatal and Postnatal Mental Health (NICE, 2007a).32 Adapted from Depression (NICE, 2009a) and Depression in Adults with a Chronic Physical HealthProblem (NICE, 2009b).33 Adapted from Generalised Anxiety Disorder and Panic Disorder (with or without Agoraphobia) in Adults(NICE, 2011a).34 Adapted from Obsessive-compulsive Disorder (NICE, 2005a).35 Adapted from Post-traumatic Stress Disorder (NICE, 2005b).177
Further assessment of risk and need for treatment, and routine outcome monitoringStep 3: Treatment and referral advice for persistent subthreshold depressive symptomsor mild to moderate common mental health disorders with inadequate response to initialinterventions, or moderate to severe common mental health disordersIf there has been an inadequate response following the delivery of a first-line treatmentfor persistent subthreshold depressive symptoms or mild to moderate commonmental health disorders, a range of psychological, pharmacological or combinedinterventions may be considered. This section also recommends interventions orprovides referral advice for first presentation of moderate to severe common mentalhealth disorders.6.3.8.18 For people with persistent subthreshold depressive symptoms or mild tomoderate depression that has not responded to a low-intensity intervention,offer or refer for:●●antidepressant medication ora psychological intervention (CBT, IPT, behavioural activation orbehavioural couples therapy) 36 .6.3.8.19 For people with an initial presentation of moderate or severe depression,offer or refer for a psychological intervention (CBT or IPT) in combinationwith an antidepressant 36 .6.3.8.20 For people with moderate to severe depression and a chronic physicalhealth problem consider referral to collaborative care if there has been no,or only a limited, response to psychological or drug treatment alone orcombined in the current or in a past episode 37 .6.3.8.21 For people with depression who decline an antidepressant, CBT, IPT,behavioural activation and behavioural couples therapy, consider providingor referring for:● counselling for people with persistent subthreshold depressive symptomsor mild to moderate depression●short-term psychodynamic psychotherapy for people with mild tomoderate depression.Discuss with the person the uncertainty of the effectiveness of counsellingand psychodynamic psychotherapy in treating depression 36 .6.3.8.22 For people with generalised anxiety disorder who have marked functionalimpairment or have not responded to a low-intensity intervention, offer orrefer for one of the following:● CBT or● applied relaxation or● if the person prefers, drug treatment 38 .36 Adapted from Depression (NICE, 2009a).37 Adapted from Depression in Adults with a Chronic Physical Health Problem (NICE, 2009b).38 Adapted from Generalised Anxiety Disorder and Panic Disorder (with or without Agoraphobia) in Adults(NICE, 2011a).178
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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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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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