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

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Summary of recommendations● refer for group CBT (including ERP) (note, group formats may delivermore than 10 hours of therapy) 68 .8.4.2.7 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]) 69 .8.4.3 Step 3: Treatment and referral advice for persistent subthresholddepressive symptoms or mild to moderate common mental healthdisorders with inadequate response to initial interventions, ormoderate 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.8.4.3.1 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) 70 .8.4.3.2 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 70 .8.4.3.3 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 71 .8.4.3.4 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.68 Adapted from Obsessive-compulsive Disorder (NICE, 2005a).69 Adapted from Post-traumatic Stress Disorder (NICE, 2005b).70 Adapted from Depression (NICE, 2009a).71 Adapted from Depression in Adults with a Chronic Physical Health Problem (NICE, 2009b).225
Summary of recommendationsDiscuss with the person the uncertainty of the effectiveness of counsellingand psychodynamic psychotherapy in treating depression 72 .8.4.3.5 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 73 .8.4.3.6 For people with moderate to severe panic disorder (with or without agoraphobia),consider referral for:● CBT or●an antidepressant if the disorder is long-standing or the person has notbenefitted from or has declined psychological interventions 73 .8.4.3.7 For people with OCD and moderate or severe functional impairment, andin particular where there is significant comorbidity with other commonmental health disorders, offer or refer for:● CBT (including ERP) or antidepressant medication for moderateimpairment●CBT (including ERP) combined with antidepressant medication andcase management for severe impairment.Offer home-based treatment where the person is unable or reluctant toattend a clinic or has specific problems (for example, hoarding) 74 .8.4.3.8 For people with long-standing OCD or with symptoms that are severelydisabling and restrict their life, consider referral to a specialist mentalhealth service 74 .8.4.3.9 For people with OCD who have not benefitted from two courses of CBT(including ERP) combined with antidepressant medication, refer to a servicewith specialist expertise in OCD 74 .8.4.3.10 For people with PTSD, offer or refer for a psychological intervention(trauma-focused CBT or EMDR). Do not delay the intervention or referral,particularly for people with severe and escalating symptoms in the firstmonth after the traumatic event 75 .8.4.3.11 For people with PTSD, offer or refer for drug treatment only if a persondeclines an offer of a psychological intervention or expresses a preferencefor drug treatment 75 .72 Adapted from Depression (NICE, 2009a).73 Adapted from Generalised Anxiety Disorder and Panic Disorder (With or Without Agoraphobia) inAdults (NICE, 2011a).74 Adapted from Obsessive-compulsive Disorder (NICE, 2005a).75 Adapted from Post-traumatic Stress Disorder (NICE, 2006b).226
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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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Page 175 and 176: Further assessment of risk and need
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Page 219 and 220: Summary of recommendationsFigure 12
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Page 223 and 224: Summary of recommendations8.4 STEPS
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Page 231 and 232: Appendices9 APPENDICESAppendix 1: S
Page 233 and 234: Appendix 1of a depressive disorder
Page 235 and 236: Appendix 1b) Assessment of anxiety
Page 237 and 238: Appendix 2APPENDIX 2:DECLARATIONS O
Page 239 and 240: Appendix 2Mr Mike BessantEmployment
Page 241 and 242: Appendix 2Personal non-pecuniary in
Page 243 and 244: Appendix 2Actions takenMr Rupert Su
Page 245 and 246: Appendix 2Personal family interestN
Page 247 and 248: Appendix 3APPENDIX 3:STAKEHOLDERS A
Page 249 and 250: Appendix 4ClinicalpopulationPeople
Page 251 and 252: Appendix 4Case identificationNo. Pr
Page 253 and 254: Appendix 5APPENDIX 5:REVIEW PROTOCO
Page 255 and 256: Appendix 7APPENDIX 7:METHODOLOGY CH
Page 257 and 258: Appendix 9APPENDIX 9:METHODOLOGY CH
Page 259 and 260: Appendix 92.10 Are all important pa
Page 261 and 262: Appendix 9case also excludes costs
Page 263 and 264: Appendix 9For consistency, the EQ-5
Page 265 and 266: Appendix 9Answer ‘yes’ if the a
Page 267 and 268: Appendix 9Answer ‘yes’ if the e
Page 269 and 270: Appendix 9Answer ‘yes’ if appro
Page 271 and 272: Appendix 10APPENDIX 10: EVIDENCE TA
Page 273 and 274: Appendix 11APPENDIX 11:HIGH PRIORIT
Page 275 and 276: 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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