SEMIOTICS, DIAGNOSTICS AND THERAPY TACTICS OF DEPRESSIVE DISORDERS IN CLINICAL MEDICINE

Study objectives are dedicated to brief synthesized establishment of diagnostics general standard, management and therapy of major depressive disorders (MDD) in clinical medicine to provide education in medical practice.Study methods are based on short-term, medium-term and long-term educational programs in 24 Russian and Ukraine cities, which were based on original educational programs under the direction of World Psychiatric Association (WPA) and International Committee For Prevention and Treatment of Depression (PTD). There, about 1450 doctors of different occupations were acquainted with the detection, management and treatment of MDD. The Russian version of WPA/PTD programs was created. The program of education included 4 modules. The Core module included an overview of the epidemiology, impact, concepts and classification, and etiology of depressive disorders as well as their recognition, diagnosis, and management in the primary care setting. The second module focused on depressive disorders in physical illness and covered those major illnesses for which is reasonable evidence for an association with depressive disorders. The third module included the development of the depressive disorders in older persons. The forth module included training physicians in mental health skills. 39 theme improvements for 858 primary care setting physicians within the framework of faculty training program of physicians’ development were the part of other programs of physicians’ occupations.Results. A number of highlights were included in the general algorithm of the educational programs. The creation of optimum «physician-depressive patient» contact demands a number of new skills to establish effective communication. These skills involve training of meeting of depressive patient and physician, the ability to follow a certain communication style; identify emotional, cognitive, psychomotor and nonverbal patterns of behavior. Besides that, the education included adherence to therapy and therapeutic alliance during the period of informed agreement. There was an education of fluent grasp of medicaments, which are the first choice in therapy. Integration of this knowledge is done during the periods of repeated interactive discussions of antidepressants’ effectiveness in depression therapy which is based on three-phased MDD therapy model. The process of working out the depressive patients’ management was based on systematization and diagnostic of depression disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or International Classification of Diseases, Revision 10); detailed discussions of manifestation and thorough depression symptomatology; management approaches in depression disorders, different in manifestation.Conclusion. The basis of physicians' education was the idea that depressive disorder in holistic approach can't be considered as an independent psychiatric disease in its mild and moderate forms of manifestation. Depression, along with coronary artery disease, cerebrovascular diseases, diabetes, osteoporosis, obesity and fatness should be considered by clinical medicine within one cluster of noninfectious multifactorial chronic diseases.

Download Full-text

Introduction

CNS Spectrums ◽

10.1017/s109285290002616x ◽

2007 ◽

Vol 12 (S13) ◽

pp. 3-3

Author(s):

Madhukar Trivedi

Keyword(s):

Primary Care ◽

Health Care ◽

Usual Care ◽

Health Care System ◽

Collaborative Care ◽

Depressive Disorders ◽

Care Setting ◽

Primary Care Setting ◽

Care Treatment ◽

Care Models

AbstractMajor depressive disorder (MDD) is often a chronic, recurrent, and debilitating disorder with a lifetime prevalence of 16.2% and a 12-month prevalence of 6.6% in the United States. The disorder is associated with high rates of comorbidity with other psychiatric disorders and general medical illnesses, lower rates of adherence to medication regimens, and poorer outcomes for chronic physical illness. While 51.6% of cases reporting MDD received health care treatment for the illness, only 21.7% of all MDD cases received minimal guideline-level treatment. Because the overwhelming majority of patients with depressive disorders are seen annually by their primary care physicians, the opportunity to diagnose and treat patients early in the course of their illness in the primary care setting is substantial, though largely unfulfilled by our current health care system. The goal of treatment is 2-fold: early and complete remission of symptoms of depression and eventual recovery to premorbid levels of functioning in response to acute-phase treatment, and prevention of relapse during the continuation phase or recurrence during the maintenance phase. However, only 25% to 50% of patients with MDD adhere to their antidepressant regimen for the length of time recommended by depression guidelines, and nearly 50% of depressed patients referred from primary care to specialty care treatment fail to complete the referral. Patients with chronic or treatment-resistant depression often require multiple trials using an algorithm-based approach involving more than one treatment strategy. Under conditions of usual care, 40% to 44% of patients with MDD treated with antidepressants in the primary care setting show a >50% improvement in depression scores at 4-month follow-up, compared with 70% to 75% of those treated using collaborative care models. This demonstrates the importance of factors other than antidepressant medication per se for achieving treatment effectiveness. Additional research is needed to evaluate longer-term outcomes of algorithm-based, stepped, collaborative care models that incorporate patient self-management in conjunction with usual care. Furthermore, the health care system must undergo major transformation to effectively treat depression, along with other chronic illnesses. The use of evidence-based treatment algorithms are discussed and recommendations are provided for patients and physicians based on collaborative care interventions that may be useful for improving the current management of depressive disorders.

Download Full-text

Impact on an integrated psychiatric pharmacy service in a primary care clinic

Mental Health Clinician ◽

10.9740/mhc.2019.07.269 ◽

2019 ◽

Vol 9 (4) ◽

pp. 269-274

Author(s):

Benjamin Chavez ◽

Emily Kosirog

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Care Setting ◽

Primary Care Setting ◽

Pharmacy Service ◽

Psychiatric Disease ◽

Care Practice ◽

Psychiatric Medication ◽

State Management ◽

Disease States

Abstract Introduction Traditionally, clinical pharmacists have been employed in the primary care setting to help manage chronic disease states, such as diabetes and hypertension. Although the benefits of pharmacists managing chronic conditions have been extensively published, published data for clinical pharmacist mental health services in primary care is limited to Veterans Affairs populations. This article describes a practice model in which pharmacists are providing psychiatric medication management and consultation in a federally qualified health center. Methods A period of 1 year from the psychiatric pharmacy service was analyzed from April 1, 2017, to March 31, 2018. Reports were generated that included information about psychiatric pharmacy consults, 1-on-1 psychiatric pharmacy visits, and psychotropic medication prescribing/dispensing trends. Each consult was further reviewed for additional details, including patient characteristics, medications prescribed, psychiatric diagnoses involved, and actions taken. Results A review of this pharmacy service showed significant pharmacist involvement in psychiatric medication consults and 1-on-1 visits. Common disease states consulted on were depressive disorders, anxiety disorders, and neurologic disorders, which reflects psychiatric disease states commonly seen in primary care practice. Provider satisfaction survey results showed that the service was valued and that providers felt their comfort in prescribing psychotropic medications improved due to the service. Discussion The service described here exemplifies the potential for pharmacists in the ambulatory care setting to expand beyond the traditional chronic disease state management. It also speaks to a potential role for psychiatric pharmacists in the primary care setting.

Download Full-text

Mental Disorders in Primary Care

10.1093/med/9780198746638.001.0001 ◽

2017 ◽

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Depressive Disorders ◽

Care Setting ◽

Primary Care Setting ◽

Evidence Based ◽

Psychotherapeutic Interventions ◽

Key Topics ◽

Care Costs

Mental disorders are highly prevalent in the primary care setting, yet are frequently misdiagnosed and often inappropriately treated. The presence of unrecognized or misdiagnosed mental disorders is associated with increased service utilization and health care costs, and can significantly impact the patient’s quality of life and risk of suicide. Mental Disorders in Primary Care offers readers with a comprehensive and evidence-based guide to the diagnosis and treatment of mental disorders in the primary care setting. This book contains 21 chapters on a variety of psychiatric disorders, such as depressive disorders and substance use disorders, and key topics for discussion such as drug interactions and psychotherapeutic interventions.

Download Full-text