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

Case identification and formal assessmentunrecognised unless clinicians specifically look out for these disorders during routineconsultations (Kroenke et al., 1997).Based upon surveys in hospital settings, OCD is also common among people withchronic physical health problems. For example 20% of UK dermatology outpatients(Fineberg et al., 2003) and 32% of people presenting to rheumatologists and dermatologistswith systemic lupus erythematosis (Slattery et al., 2004) met criteria for OCD.The nature of some symptoms of panic attacks, such as palpitations, tachycardia,shortness of breath and chest pain, may lead some individuals to think that they areexperiencing a potentially life threatening illness such as a heart attack. This oftenresults in presentation to accident and emergency departments. It has been estimatedthat between 18 and 25% of patients who present to emergency or outpatient cardiologysettings meet the criteria for panic disorder (Huffman & Pollack, 2003), which isoften not recognised.The problem of under-recognition for anxiety disorders has recently been highlightedby evidence that the prevalence of PTSD is significantly under-recognisedin primary care (Ehlers et al., 2009). Many individuals will consult their GP shortlyafter experiencing a traumatic event, but will not present a complaint or request forhelp specifically related to the psychological aspects of the trauma; for example, anindividual who has been physically assaulted, or involved in a road traffic accidentor an accident at work might present requiring attention to the physical injuriessustained. Similarly, individuals who have been involved in traumatic life eventsoften present at local emergency departments, notification of which is sent to GPs.In both anxiety and depressive disorders, the initial presentation and complaintmay take the form of somatic symptoms alone, such as lethargy or poor sleep in thecase of depression and palpitations or muscular tension in the case of anxiety disorders.In light of this fact, consideration should be given to these symptoms as possibleindicators of a common mental health disorder, in particular where no physicalcause of these symptoms is apparent. Finally, as was also noted in Chapter 2, onemajor reason for poor recognition of common mental health disorders has been foundto be a lack of effective consultation skills on the part of some GPs.5.2 CASE IDENTIFICATION5.2.1 IntroductionThe first NICE guideline on depression, Depression: Management of Depression inPrimary and Secondary Care (NICE, 2004b; NCCMH, 2004a), in addition to otherNICE mental health guidelines, considered the case for general population screening fora number of mental health disorders, and concluded that it should only be undertakenfor specific high-risk populations where benefits of early identification outweigh thedownsides, such as people with a history of depression, significant physical illnessescausing disability or other mental health problems such as dementia. The criteria bywhich NICE judged the value of this approach was set out by the UK NHS NationalScreening Committee. Additional experience on the use of case identification strategies92