Anxiety and depression: new NICE guidance to help identify and respond to common mental health disorders.
(Care and treatment)
Depression, Mental (Care and treatment)
|Publication:||Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Ten Alps Publishing ISSN: 1462-2815|
|Issue:||Date: August, 2011 Source Volume: 84 Source Issue: 8|
|Geographic:||Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom|
Common mental health disorders can affect up to 15% of the population at any one time. They include depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and social anxiety disorder.
A new guideline from the National Institute for Health and Clinical Excellence (NICE) on the identification and pathways to care for common mental health disorders focuses on primary care. It highlights for those working in primary care and community health settings the need to be alert to potential signs and symptoms.
Health visitors, practice nurses, midwives, GPs and other healthcare professionals in community settings have a crucial role in helping to identify patients with common mental health problems so that they can access effective treatment.
For the identification of common mental health problems, be alert to:
* Possible symptoms of depression or anxiety, particularly in those with a past history of either of these conditions
* Potential feelings of depression in people who have a chronic physical health problem
* Possible anxiety problems in those who experienced a recent traumatic event
* Possible somatic symptoms that may be linked to anxiety or depression (physical symptoms that may have a psychological origin).
The following questions may be helpful when discussing emotional wellbeing with a patient, though the answers to these questions alone should not be taken as an indication of a diagnosis.
If you have concerns regarding a common mental health disorder, a mental health assessment should be performed by a competent practitioner. If this professional is not the person's GP, the GP should be informed of the referral.
For depression, consider asking:
* During the last month, have you often been bothered by feeling down, depressed or hopeless?
* And, during the last month, have you often been bothered by having little interest or pleasure in doing things?
For generalised anxiety disorder, consider asking how often over the last two weeks have they been bothered by:
* Feeling nervous, anxious or on edge
* Not being able to stop or control worrying.
The following additional question may also help:
* Do you find yourself avoiding places or activities and does this cause you problems?
People with a common mental health problem should be asked directly about suicidal thoughts and intent.
For those at risk, it is crucial to establish that they have adequate social support or help.
Antenatal and postnatal care
Any woman requiring a psychological intervention during pregnancy or the postnatal period should be seen for treatment within one month of her initial assessment.
The NICE guideline and implementation tools are available online, see: www.nice.org.uk/guidance/CG123
Senior implementation adviser, NICE
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