Recovery From Depression

Transcription

1 Recovery From Depression Optimising Primary Care Management Dr Andrew Smithers Mental Health and LD Lead Coventry & Rugby CCG

2 CLINICAL TRIALS EXCELLENCE THE PHYSICIAN - LED NETWORK

3 Introduction Primarily a Primary Care Problem Prevalence: 3-10% of population in 1 year Prevalence: 2.3% 2 of population in 1 week Between 1:4 & 1:10 consultations are for MDD 1 to 4 new presentations per week Presentation physical or somatic features Depression vs. Anxiety

4 Core Symptoms Depressed mood Markedly diminished interest or pleasure in all, or almost all, activities Significant weight loss, or decrease or increase in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate, or indecisiveness Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt

5 Aims of Diagnosis Establish the presence of depressive complaints Identify the core symptoms of depression three = probably depression four = treatable depression Establish duration > 4 weeks Investigate psychosocial elements of causality Reactive vs: Endogenous Patients expectations Exclude other causes

6 Prevalence of Depression in Primary Care Historical Data is old Trends in Consultation Rates in General Practice The burden of psychiatric disorder in primary care. International Review of Psychiatry, 1992 National Statistics Journal ( ) My own and colleagues perception that Mental Health related consultations rate is increasing Pressure on secondary care is unprecedented Pressure on Primary Care is unprecedented Secondary Care waiting times are unacceptable Crisis Team referrals are problematic IAPT waiting times are unacceptable DOH funding is inhumanely unacceptable Cinderella Service Society is unacceptable Impact of Social Media

7 Data Analysis Presentations to Primary Care primarily because of poor mental wellbeing and/or defined mental illness. 2 month period Demographics Utilisation of Read codes Utilisation of Prescribing and referrals Consultations with Health Care Professionals

8 Overall consultation data where specific M/H Read codes exist Total consults October Total M/H consults October Percentage that were of M/H - 9.8% Total consults November 1658 Total M/H consults November 158 Percentage that were of M/H - 9.5%

9 Low mood Anxiety with Stress related problem ADHD PND Insomnia Memory loss OCD Psychoses (all) Guilty ideas Morbin thoughts / [X]Psychogenic Emotional problem / Personality disorder Blunted affect Substance abuse Bereavement reaction Read Code Usage (by consultation) October November Column1

10 Consultations by Gender October November Male Female

11 Consultations by Age November October

12 Depressive Anxiety symptoms Stress related OCD / Phobia / Memory / Demenia Sleep / insomnia ASD / ADHD Alcohol related Psychoses Behavioural Bereavement / Non-Read coded Consultations with Mental Health Content October November

13 Overall consultation data where Read coded and free text M/H data exist Total consults October Total M/H consults October Percentage that were of M/H % Total consults November 1658 Total M/H consults November 291 Percentage that were of M/H %

14 Observations from the audit Rates for neurotic disorders (depression and anxiety) have risen since the 2001 data, many factors: Increased awareness and lowered stigma Financial crash of 2008 Large ethnic difference between patients consulting and local population Wide variety of diagnostic and symptom codes used Peak incidence in age range None coded mental health data increased consultation rates by almost double

15 The 10 Minute Consultation Impossible Telephone triage vs standard booking 4 minute history Double appointment for new presentation Continuity of care Telephone follow-up vs F2F Involve Primary Care Health workers Bathe Technique

16 Bathe Technique B: Background What is going on in your life? A: Affect How do you feel about that? T: Trouble What troubles you the most about that? H: Handling How are you handling that? E: Empathy That must be very difficult for you From The Fifteen Minute Hour by Stuart and Liebermann 4 th Edition

17 Treatment Listen Therapy Talk Therapy Drug Therapy Alternative Therapy Psychological Therapy Third Sector Referral to Secondary Care S/H, psychotic Sx, Rx resistance, severe complex Private referral

18 NICE Recommended Treatment Person Centred Care Low-intensity psychosocial interventions Drug Treatment Combination treatment (drugs, CBT & IPT) Continuation and relapse prevention Psychological interventions for relapse prevention

19 Treatment of Depression

20 Third Sector and Voluntary Organisations Mind (and Depression Alliance) Rethink British Association for Counselling and Psychotherapy Mental Health Foundation PANDAS Foundation Together Local groups (Coundon Councillors, Light House, Tamarind Centre, Lamb Street The Pod

21 General Advice and Support Citizens Advice Young Minds Childline Nightline Age Concern Relate CRUSE Carers UK

22 Alternative Treatments Acupuncture Aromatherapy Breathing Exercises Exercise Meditation Nutrition and Diet Therapy EFT/EMDR Mindfulness Self Love and self help Homoeopathy

23 Recovery from Depression 3 Steps to Recovery What is the patient feeling What does the patient want What can the patient do about it Adequate treatment Open door policy MOT review and self resilience Recognition of vulnerability Mindfulness Exercise, exposure to green and blue Giving back

24 Well John, in the past two years you ve gone from being extremely depressed to being basically unhappy like the rest of us. My work here is done. NICE Subthreshold Depressive Symptoms.