Management of Painful Physical Symptoms Associated With Depression and Mood Disorders

CNS Spectrums ◽  
2005 ◽  
Vol 10 (S19) ◽  
pp. 1-16 ◽  
Author(s):  
Thomas N. Wise ◽  
Lesley M. Arnold ◽  
Vladimir Maletic ◽  
David L. Ginsberg
Keyword(s):  
Primary Care ◽  
Neuropathic Pain ◽  
Mood Disorders ◽  
Primary Care Physicians ◽  
Depressive Disorders ◽  
Pain Perception ◽  
Antidepressant Treatment ◽  
Physical Symptoms ◽  
Emotional Symptoms ◽  
Primary Care Settings

AbstractDepression is a common, recurring illness that continues to be underdiagnosed and undertreated in both psychiatric and primary care settings. It is increasingly being recognized that painful physical symptoms, which commonly exist comorbid with depressive disorders, play a role in complicating diagnosis of depression. Patients tend to discuss physical pain with primary care physicians and emotional pain with psychiatrists, often oblivious to the fact that both may be aspects of one disorder. Those who present with somatic complaints are three times less likely to be accurately diagnosed than patients with psychosocial complaints. However, thorough evaluation of mood and anxiety disorders in primary care is sparse due to the limited time primary care physicians can spend with each patient. Better recognition and treatment of both physical and emotional symptoms associated with mood disorders may increase a patient's chance of achieving remission, which is the optimum therapeutic goal.Abnormalities of serotonin and noradrenaline are strongly associated with depression and are thought to play a role in pain perception. Brain-derived neurotrophic factor, which is increased with antidepressant treatment, appears to influence regulation of mood and perception of pain. Clinical evidence indicates that dual-acting agents may have an advantage in modulating pain over those agents that increase either serotonin or noradrenaline alone. The novel dual-acting agents, such as venlafaxine and duloxetine, are better tolerated than tricyclic antidepressants and monoamine oxidase inhibitors. These agents have demonstrated efficacy in depression and in diabetic neuropathic pain independently. Therefore, unless otherwise stated, all inferences to studies of pain in this monograph refer to neuropathic pain in nondepressed patients.

Understandings of depression among community members and primary healthcare attendees in rural Ethiopia: A qualitative study

2021 ◽  
pp. 136346152110643
Author(s):  
Bethlehem Tekola ◽  
Rosie Mayston ◽  
Tigist Eshetu ◽  
Rahel Birhane ◽  
Barkot Milkias ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Disorders ◽  
Medical Intervention ◽  
Community Members ◽  
Group Discussions ◽  
Individual Interviews ◽  
Rural Ethiopia ◽  
Primary Care Settings ◽  
Prevalence Of Depression ◽  
Community Data

Available evidence in Africa suggests that the prevalence of depression in primary care settings is high but it often goes unrecognized. In this study, we explored how depression is conceptualized and communicated among community members and primary care attendees diagnosed with depression in rural Ethiopia with the view to informing the development of interventions to improve detection. We conducted individual interviews with purposively selected primary care attendees with depression (n = 28; 16 females and 12 males) and focus group discussions (FGDs) with males, females, and priests (n = 21) selected based on their knowledge of their community. Data were analyzed using thematic analysis. None of the community members identified depression as a mental illness. They considered depressive symptoms presented in a vignette as part of a normal reaction to the stresses of life. They considered medical intervention only when the woman's condition in the vignette deteriorated and “affected her mind.” In contrast, participants with depression talked about their condition as illness. Symptoms spontaneously reported by these participants only partially matched symptoms listed in the current diagnostic criteria for depressive disorders. In all participants’ accounts, spiritual explanations and traditional healing were prominent. The severity of symptoms mediates the decision to seek medical help. Improved detection may require an understanding of local conceptualizations in order to negotiate an intervention that is acceptable to affected people.

Common Therapeutic Issues and Patient Questions

2017 ◽  
pp. 97-116
Author(s):  
Myrna M. Weissman ◽  
John C. Markowitz ◽  
Gerald L. Klerman
Keyword(s):  
Primary Care ◽  
Personality Disorder ◽  
Psychiatric Illness ◽  
Rating Scales ◽  
Physical Symptoms ◽  
Poor Adherence ◽  
Biological Basis ◽  
Primary Care Settings ◽  
Alcohol And Drugs ◽  
Technical Issues

This chapter reviews common therapeutic issues and various questions asked by patients during IPT. Common therapeutic issues include deciding whether a patient’s main problem is a psychiatric illness or a personality disorder, dealing effectively with passive or intellectualizing patients, keeping to the agreed-on focus and time limit of treatment, and making therapeutic use of silence in session. Technical issues such as rating scales and recording sessions are discussed, and IPT was contrasted with other types of psychotherapy such as CBT. Common patient questions include how IPT works, therapist credentials, lateness to sessions, family members attending treatment sessions, the genetic and biological basis of depression, the use of alcohol and drugs, recurrence of depression, and suicide. Some problems that are more often seen in primary care settings are also covered, such as depression manifesting through physical symptoms and poor adherence to treatment.

scholarly journals Hepatitis C Virus Testing Perspectives Among Primary Care Physicians in Four Large Primary Care Settings

2014 ◽  
Vol 16 (2) ◽  
pp. 256-263 ◽  
Author(s):  
Amy Jewett ◽  
Arika Garg ◽  
Katherine Meyer ◽  
Laura Danielle Wagner ◽  
Katherine Krauskopf ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Primary Care Physicians ◽  
Primary Care Settings ◽  
Large Primary ◽  
Virus Testing

Depression as a Systemic Illness

2018 ◽  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Collaborative Care ◽  
Primary Care Physicians ◽  
Depressive Disorders ◽  
Developed Countries ◽  
Care Physician ◽  
World Health ◽  
Mental Health Training ◽  
The World

Depression has been declared by the World Health Organization in March of 2017 to be the illness with the greatest burden of disease in the world. This volume attempts to examine the current state of our understanding of depressive disorders, from the animal models, allostatie load, patterns of recurrence, effects on other illnesses, for example, cancer, neurological, cardiovascular, wound healing, etc. It is from this perspective that the editors declare that depression is a systemic illness, not just a mental disorder. Therefore, primary care physicians need to know how to diagnose, treat, and refer when necessary for the non-complicated, non-refractory forms of depression. From this perspective models of mental health training for the primary care physician are reviewed. Then a new model, the medical model, a step beyond collaborative care is described. Non complicated depressive illness needs to be addressed by the primary care physician much as they do asthma, diabetes, hyptertension, and congestive heart failure. Even collaborative care models are unable as the number of psychiatrists is too few even in developed countries, let alone in developing ones to work with primary care. Medical schools and residency training programs need to incorporate curriculum and clinical experiences to accommodate developing expertise to diagnose, treat, and refer when necessary in this most common medical malady. Finally, a modified electronic medical record is proposed as a collaborating agent for the primary care physician.

scholarly journals Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study)

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023637 ◽  
Author(s):  
Kamma Sundgaard Lund ◽  
Volkert Siersma ◽  
John Brodersen ◽  
Frans Boch Waldorff
Keyword(s):  
Primary Care ◽  
Adverse Effects ◽  
Intervention Group ◽  
Physical Symptoms ◽  
Menopausal Symptoms ◽  
Control Group ◽  
Acupuncture Points ◽  
Hot Flushes ◽  
Emotional Symptoms ◽  
Sleeping Problems

ObjectiveTo investigate the efficacy of a standardised brief acupuncture approach for women with moderate-to-severe menopausal symptoms.DesignRandomised and controlled, with 1:1 allocation to the intervention group or the control group. The assessor and the statistician were blinded.SettingNine Danish primary care practices.Participants70 women with moderate-to-severe menopausal symptoms and nine general practitioners with accredited education in acupuncture.InterventionThe acupuncture style was western medical with a standardised approach in the predefined acupuncture points CV-3, CV-4, LR-8, SP-6 and SP-9. The intervention group received one treatment for five consecutive weeks. The control group was offered treatment after 6 weeks.Main outcome measuresOutcomes were the differences between the randomisation groups in changes to mean scores using the scales in the MenoScores Questionnaire, measured from baseline to week 6. The primary outcome was the hot flushes scale; the secondary outcomes were the other scales in the questionnaire. All analyses were based on intention-to-treat analysis.Results36 participants received the intervention, and 34 participants were in the control group. Four participants dropped out before week 6. The acupuncture intervention significantly decreased hot flushes: Δ −1.6 (95% CI [−2.3 to −0.8]; p<0.0001), day-and-night sweats: Δ −1.2 (95% CI [−2.0 to −0.4]; p=0.0056), general sweating: Δ −0.9(95% CI [−1.6 to −0.2]; p=0.0086), menopausal-specific sleeping problems: Δ −1.8 (95% CI [−2.7 to −1.0]; p<0.0001), emotional symptoms: Δ −3.4 (95% CI [−5.3 to −1.4]; p=0.0008), physical symptoms: Δ −1.7 (95% CI [−3 to −0.4]; p=0.010) and skin and hair symptoms: Δ −1.5 (95% CI [−2.5 to −0.6]; p=0.0021) compared with the control group at the 6-week follow-up. The pattern of decrease in hot flushes, emotional symptoms, skin and hair symptoms was already apparent 3 weeks into the study. Mild potential adverse effects were reported by four participants, but no severe adverse effects were reported.ConclusionsThe standardised and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention. No severe adverse effects were reported.Trial registration numberNCT02746497; Results.

A Web Based Education Program in Adolescent Depression and Suicide for Primary Care Physicians

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Kutcher
Keyword(s):  
Primary Care ◽  
Education Program ◽  
Primary Care Physicians ◽  
Educational Program ◽  
Adolescent Depression ◽  
Web Based ◽  
Primary Care Settings ◽  
Care Intervention ◽  
Clinical Tools ◽  
Web Based Education

Adolescent depression and suicide are two important and related issues that can be effectively addressed by primary care physicians who have received appropriate training which includes the use of simple clinical tools that can be applied in usual primary care settings. This presentation reviews the evidence pertaining to primary care intervention for adolescent depression and suicide and provides a detailed description of a new Canadian web-based educational program for primary care physicians in the domain of adolescent depression and suicide.

scholarly journals Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review

10.2196/30479 ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. e30479
Author(s):  
Rhiannon Martel ◽  
Matthew Shepherd ◽  
Felicity Goodyear-Smith
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Risk Behavior ◽  
Primary Care Providers ◽  
Physical Symptoms ◽  
Screening Tools ◽  
Care Providers ◽  
Primary Care Settings ◽  
Behavior Issues ◽  
Sensitive Issues

Background Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods Electronic databases—MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews—were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work.

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