Managing depression after stroke. Presented by Maree Hackett

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Managing depression after stroke. Presented by Maree Hackett"

Transcription

1 Managing depression after stroke Presented by Maree Hackett

2 After stroke Physical changes We can see these Depression Emotionalism Anxiety Confusion Communication problems

3 What is depression? Category A symptoms Depressed (dysphoric mood) OR Loss of interest/pleasure (anhedonia) Category B symptoms At least four present most days for 2 weeks Sleep disturbance Change in appetite Agitation Loss of energy Guilt or worthlessness Difficulty concentrating Thoughts of death These feelings are persistent and they start to interfere with peoples day-to-day lives.

4 Depression: classification Syndrome Constellation of signs & symptoms Semi-structured interview (DSM/ICD diagnosis) *Chinese menu style Symptom burden Affective, behavioural, somatic, negative cognitions Questionnaires, interviewer administered, self-completed *Symptoms only: not ill & don t seek help, +clinical impairment: ill & seek help

5 0-28 days 28 d 6 months > 6 months Hackett et al, Stroke 2005;36:

6 Depression is poorly managed, why? Think it s normal after stroke Aren t aware of their symptoms Aware, but embarrassed to tell others (stigma) Unsure of treatment Think they are abnormal Doctor/health care professional/family don't recognise symptoms Doctor/health care professional doesn t have time to assess Doctor/health care professional/family don t know how to treat Put on treatment but never followed up

7 Why do we care? Poor progression through rehabilitation Worse physical function Impaired cognitive function Increased carer stress?greater risk of morbidity and mortality (suicide)

8 Q1: Screening for depression Should we check every person with stroke and assess them for symptoms of depression?

9 Does screening work (in non-mental health settings)? There is no impact on recognition, treatment or outcome of depression, unless Treating clinician is alerted to high scorers AND Treating clinician is supported by a programme of care (treatment is monitored with clear stopping rules) Gilbody et al, CMAJ 2008; 178 (8). doi: /cmaj

10 What screening tool to use? Compared: Patient Health Questionnaire 2 item (PHQ-2) Patient Health Questionnaire 9 item (PHQ-9) Hospital Anxiety and Depression Scale (HADS) Beck Depression Inventory-II (BDI-II) Distress thermometer Kessler 10 (K-10) Against Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID): Major Depressive Episode [criterion standard] Turner et al, Depression screening in stroke: a comparison of alternative measures with the SCID (Major Depressive Episode) as criterion standard. Stroke 2012;43:

11 Management options: Conservative management (i.e. do nothing) Self management (e.g. alcohol) Herbal or natural remedies (e.g. St. Johns Wort) Support (e.g. all staff) Counselling (e.g. social workers) Psychotherapy/talking therapy (e.g. cognitive therapy) Antidepressants (e.g. SSRI, TCA)

12 Cochrane Reviews Pharmaceutical agent versus placebo Psychological intervention vs. usual care or attention control PREVENT depression after stroke (no depression at trial entry) TREAT depression after stroke (depressed at trial entry) All randomised controlled trials (RCTs) Stroke (WHO definition), excluding subarachnoid haemorrhage Original reviews 2004, updated 2008, 2013 updates underway!

13 Defining psychological interventions Includes information and education, advice, listening, emotional support direct patient-professional interaction therapist: trained, supervised develop social problem-solving skills, emotional impact of stroke structured, timetabled as a talking therapy Excludes information/education only evaluations of people and approaches unless there s a specific description of psychological therapy

14 Q2: Can we prevent depression after stroke?

15 Prevention: Psychotherapy (alone) 2004 (1 trial, 450 people) 1º No evidence of preventing depression 2º Evidence of response: mean change (-2.64 to -0.18) 2º Evidence of response: mean difference (-2.31 to -0.03) 2008 (4 trials, 902 people) 1º Evidence of preventing depression OR 0.64 (0.42 to 0.98) 2º Evidence of response: mean change (-2.33 to -0.40) 2º Evidence of response: mean difference (-2.31 to -0.03) Hackett et al, Cochrane Database of Systematic Reviews: 2008, Issue 1. Art. No.: CD

16 Prevention: Pharmacotherapy 2004 (10 trials, 479 people + 1 psychostimulant, 21 people) 1º No evidence of preventing depression 2º No evidence of response 2008 (11 trials, 591 people + 1 psychostimulant, 21 people) 1º No evidence of preventing depression 2º No evidence of response Hackett et al, Cochrane Database of Systematic Reviews: 2008, Issue 1. Art. No.: CD

17 Q3: Can we treat depression after stroke?

18 Treatment: Psychotherapy (alone) 2004 (2 trials, 121 people) 1º No evidence of remission of depression 2º No evidence of response on continuous measures 2008 (4 trials, 445 people) 1º No evidence of remission of depression 2º No evidence of response on continuous measures Hackett et al, Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003437

19 Treatment: Pharmacotherapy 2004 (7 trials, 615 people) 1º No evidence of remission of depression 2º Some improvement in mood scores but data not pooled 2008 (12 trials, 1121 people + 1 combination, 45 people) 1º Evidence of remission Odds Ratio 0.47 (95% CI 0.22 to 0.98) 2º Evidence of response (50% scores) OR 0.22 (0.09 to 0.52) 2º Evidence of harm (Adverse Events) OR 1.71 (1.34 to 2.18) Hackett et al, Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003437

20 Variation in trial quality Participants range in time since stroke, several days to 13 years Method of randomisation Seldom concealed Number of participants underpowered for more meaningful binary endpoints unable to control for confounders Interventions varied, treatment was generally short outcome assessors may know treatment allocation Analysis selective reporting of multiple outcomes, measured multiple ways high loss to follow-up, not intention-to-treat adverse events not systematically recorded or reported

21 Summary of use of antidepressants in psychiatric (not just stroke) research Most RCTs provide outcomes at 6-8 weeks Placebo response is 30-40% Antidepressant response is 50-60% with no clear difference between classes of antidepressant Total dropouts at 6-8 weeks are 30% for TCA, and 27% for SSRI Minimal or no response in mild or moderate depression but is substantial in severe depression (Fournier et al, JAMA. 2010;303:47-53)

22 Some options: NICE guidelines Watchful waiting (mild to moderate depression) 1/3 depressive episodes will recover spontaneously or with placebo treatment within a month Guided self help (mild depression), computerised CBT, exercise Short-term psychological treatment (mild and moderate depression), PST, CBT, counselling: 6-8 sesssion/10 weeks Antidepressants (for moderate and severe depression) Only use an antidepressant as part of a therapeutic programme Don t start an antidepressants without a clear (written) stopping protocol

23 Has our research had an impact? Our three Cochrane reviews on the management of depression and emotionalism following stroke, are cited in the Australian New Zealand United Kingdom Scottish & American stroke management guidelines and in the 2007 Lancet series on Global Mental Health.

24 Has our research had an impact? Australian guidelines 2010

25 FOCUS (UK) and AFFINITY (Aus) Assessment of Fluoxetine IN stroke recovery (AFFINITY) Fluoxetine Or Control Under Supervision (FOCUS) 1 To determine if taking fluoxetine, 20 mg, once daily, for 6 months, started 2-15 days post acute stroke improves participants functional outcome

26 Thank you for listening any questions?

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions Major Depressive Disorder Major Depressive Disorder (MDD) Guideline Diagnostic omenclature for Clinical Depressive Conditions Conditions Diagnostic Criteria Duration Major Depression 5 of the following

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE 1 DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for depression and any history of depression? 2. Did staff

More information

Step 2: Recognised depression in adults persistent subthreshold depressive symptoms or mild to moderate depression

Step 2: Recognised depression in adults persistent subthreshold depressive symptoms or mild to moderate depression Step 2: Recognised depression in adults persistent subthreshold depressive symptoms or mild to moderate depression A NICE pathway brings together all NICE guidance, quality standards and materials to support

More information

Depre r s e sio i n o i n i a dults Yousuf Al Farsi

Depre r s e sio i n o i n i a dults Yousuf Al Farsi Depression in adults Yousuf Al Farsi Objectives 1. Aetiology 2. Classification 3. Major depression 4. Screening 5. Differential diagnosis 6. Treatment approach 7. When to refer 8. Complication 9. Prognosis

More information

in young people Management of depression in primary care Key recommendations: 1 Management

in young people Management of depression in primary care Key recommendations: 1 Management Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

More information

Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing

Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing Overview Depression is significantly higher among elderly adults receiving home healthcare, particularly among

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

See also www.thiswayup.org.au/clinic for an online treatment course.

See also www.thiswayup.org.au/clinic for an online treatment course. Depression What is depression? Depression is one of the common human emotional states. It is common to experience feelings of sadness and tiredness in response to life events, such as losses or disappointments.

More information

Recognition and Treatment of Depression in Parkinson s Disease

Recognition and Treatment of Depression in Parkinson s Disease Recognition and Treatment of Depression in Parkinson s Disease Web Ross VA Pacific Islands Health Care System What is depression? Depression is a serious medical condition that affects a person s feelings,

More information

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,

More information

Assessment of depression in adults in primary care

Assessment of depression in adults in primary care Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and

More information

Treatment Interventions for Suicide Prevention. Kate Comtois, PhD, MPH University of Washington

Treatment Interventions for Suicide Prevention. Kate Comtois, PhD, MPH University of Washington Treatment Interventions for Suicide Prevention Kate Comtois, PhD, MPH University of Washington Suicide prevention has many forms Treating Depression Gatekeeper Training Public health or injury prevention

More information

Algorithm for Initiating Antidepressant Therapy in Depression

Algorithm for Initiating Antidepressant Therapy in Depression Algorithm for Initiating Antidepressant Therapy in Depression Refer for psychotherapy if patient preference or add cognitive behavioural office skills to antidepressant medication Moderate to Severe depression

More information

Depression Assessment & Treatment

Depression Assessment & Treatment Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting

More information

Depression in Adults

Depression in Adults Depression in Adults A chapter of Croydon s mental health Joint Strategic Needs Assessment 2012/13 Health and Wellbeing Board 5 December 2012 Bernadette Alves, Locum Consultant in Public Health Croydon

More information

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study Amanda Dudley, Bruce Tonge, Sarah Ford, Glenn Melvin, & Michael Gordon Centre for Developmental Psychiatry & Psychology

More information

CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS

CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS Dept of Public Health Sciences February 6, 2015 Yeates Conwell, MD Dept of Psychiatry, University of Rochester Shulin Chen,

More information

Addendum to clinical guideline 28, depression in children and young people

Addendum to clinical guideline 28, depression in children and young people : National Institute for Health and Care Excellence Final Addendum to clinical guideline 28, depression in children and young people Clinical guideline addendum 28. Methods, evidence and recommendations

More information

Step 4: Complex and severe depression in adults

Step 4: Complex and severe depression in adults Step 4: Complex and severe depression in adults A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

Post-traumatic stress disorder overview

Post-traumatic stress disorder overview Post-traumatic stress disorder overview A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment. 6.1 Anxiety Depression - Adults Anxiety is a condition characterized by persistent worry or unease and is usually accompanied by fear, panic, irritability, poor sleep, poor concentration and avoidance,

More information

Costing statement: Depression: the treatment and management of depression in adults. (update) and

Costing statement: Depression: the treatment and management of depression in adults. (update) and Costing statement: Depression: the treatment and management of depression in adults (update) and Depression in adults with a chronic physical health problem: treatment and management Summary It has not

More information

Common mental health disorders

Common mental health disorders Issue date: May 2011 Common mental health disorders Identification and pathways to care NICE clinical guideline 123 Developed by the National Collaborating Centre for Mental Health NICE clinical guideline

More information

Depression Flow Chart

Depression Flow Chart Depression Flow Chart SCREEN FOR DEPRESSION ANNUALLY Assess for depression annually with the PHQ-9. Maintain a high index of suspicion in high risk older adults. Consider suicide risk and contributing

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Mental Health Needs Assessment Personality Disorder Prevalence and models of care

Mental Health Needs Assessment Personality Disorder Prevalence and models of care Mental Health Needs Assessment Personality Disorder Prevalence and models of care Introduction and definitions Personality disorders are a complex group of conditions identified through how an individual

More information

Challenges to Detection and Management of PTSD in Primary Care

Challenges to Detection and Management of PTSD in Primary Care Challenges to Detection and Management of PTSD in Primary Care Karen H. Seal, MD, MPH University of California, San Francisco San Francisco VA Medical Center General Internal Medicine Section PTSD is Prevalent

More information

Psychosocial treatment of late-life depression with comorbid anxiety

Psychosocial treatment of late-life depression with comorbid anxiety Psychosocial treatment of late-life depression with comorbid anxiety Viviana Wuthrich Centre for Emotional Health Macquarie University, Sydney, Australia Why Comorbidity? Comorbidity is Common Common disorders,

More information

Self-management strategies for mild to moderate depression

Self-management strategies for mild to moderate depression Department of Epidemiology & Public Health Lunchtime seminar, 18 th Feb 2014 Self-management strategies for mild to moderate depression The internet-based ifightdepression tool Dr Celine Larkin National

More information

Evidence based therapy for children and young people

Evidence based therapy for children and young people Evidence based therapy for children and young people Paul Stallard, Professor of Child & Family Mental Health, University of Bath Head of Psychological Therapies, OBMH Overview Focus on childhood anxiety

More information

Screening and treatment to prevent depression in retirees (age over 65 years)

Screening and treatment to prevent depression in retirees (age over 65 years) Screening and treatment to prevent depression in retirees (age over 65 years) Matrix Insight, in collaboration with Imperial College London, Kings College London and Bazian Ltd, were commissioned by Health

More information

Database of randomized trials of psychotherapy for adult depression

Database of randomized trials of psychotherapy for adult depression Database of randomized trials of psychotherapy for adult depression In this document you find information about the database of 352 randomized controlled trials on psychotherapy for adult depression. This

More information

MOLINA HEALTHCARE OF CALIFORNIA

MOLINA HEALTHCARE OF CALIFORNIA MOLINA HEALTHCARE OF CALIFORNIA MAJOR DEPRESSION IN ADULTS IN PRIMARY CARE HEALTH CARE GUIDELINE (ICSI) Health Care Guideline Twelfth Edition May 2009. The guideline was reviewed and adopted by the Molina

More information

Amendments to recommendations concerning venlafaxine

Amendments to recommendations concerning venlafaxine Amendments to recommendations concerning venlafaxine On 31 May 2006 the MHRA issued revised prescribing advice for venlafaxine*. This amendment brings the guideline into line with the new advice but does

More information

Depression: management of depression in primary and secondary care

Depression: management of depression in primary and secondary care Issue date: December 2004 Quick reference guide Depression: management of depression in primary and secondary care Clinical Guideline 23 Developed by the National Collaborating Centre for Mental Health

More information

mpv`elildf`^i=qob^qjbkqp=ñçê= ^åñáéíó=~åç=aééêéëëáçå h~íó=dê~òéäêççâ `äáåáå~ä=ié~çi=dêééåïáåü=qáãé=qç=q~äâ `çåëìäí~åí=`äáåáå~ä=mëóåüçäçöáëí

mpv`elildf`^i=qob^qjbkqp=ñçê= ^åñáéíó=~åç=aééêéëëáçå h~íó=dê~òéäêççâ `äáåáå~ä=ié~çi=dêééåïáåü=qáãé=qç=q~äâ `çåëìäí~åí=`äáåáå~ä=mëóåüçäçöáëí mpv`elildf`^i=qob^qjbkqp=ñçê= ^åñáéíó=~åç=aééêéëëáçå h~íó=dê~òéäêççâ `äáåáå~ä=ié~çi=dêééåïáåü=qáãé=qç=q~äâ `çåëìäí~åí=`äáåáå~ä=mëóåüçäçöáëí Plan of the presentation Summary of NICE recommended psychological

More information

Cochrane Review: Psychological treatments for depression and anxiety in dementia and mild cognitive impairment

Cochrane Review: Psychological treatments for depression and anxiety in dementia and mild cognitive impairment 23 rd Alzheimer Europe Conference St. Julian's, Malta, 2013 Cochrane Review: Psychological treatments for depression and anxiety in dementia and mild cognitive impairment Orgeta V, Qazi A, Spector A E,

More information

Some helpful reminders on depression in children and young people. Maria Moldavsky Consultant Child and Adolescent Psychiatrist

Some helpful reminders on depression in children and young people. Maria Moldavsky Consultant Child and Adolescent Psychiatrist Some helpful reminders on depression in children and young people Maria Moldavsky Consultant Child and Adolescent Psychiatrist The clinical picture What art and my patients taught me Albert Durer (1471-1528)

More information

TREATING MAJOR DEPRESSIVE DISORDER

TREATING MAJOR DEPRESSIVE DISORDER TREATING MAJOR DEPRESSIVE DISORDER A Quick Reference Guide Based on Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition, originally published in April 2000.

More information

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1 What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

More information

WHICH talking therapy for depression?

WHICH talking therapy for depression? WHICH talking therapy for depression? A guide to understanding the different psychological therapies you may be offered to treat your depression 1 Contents Introduction 3 Cognitive Behavioural Therapy

More information

A Depression Education Toolkit

A Depression Education Toolkit A Depression Education Toolkit Facts about Depression in Older Adults What is Depression? Depression is a medical illness. When sadness persists or interferes with everyday life, it may be depression.

More information

Mild head injury: How mild is it?

Mild head injury: How mild is it? Mild head injury: How mild is it? Carly Dutton; Gemma Foster & Stephen Spoors Sunderland and Gateshead Community Acquired Brain Injury Service (CABIS), Northumberland, Tyne and Wear NHS Foundation Trust

More information

Depression in adults with a chronic physical health problem

Depression in adults with a chronic physical health problem Depression in adults with a chronic physical health problem Treatment and management Issued: October 2009 NICE clinical guideline 91 guidance.nice.org.uk/cg91 NICE has accredited the process used by the

More information

Pragmatic Evidence Based Review Depression in moderate to severe TBI

Pragmatic Evidence Based Review Depression in moderate to severe TBI Pragmatic Evidence Based Review Depression in moderate to severe TBI Reviewer Emma Scheib Date Report Completed July 2011 Purpose The purpose of the current report is to summarise the research on depression

More information

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION Executive summary of recommendations Details of recommendations can be found in the main text at the pages indicated. Clinical evaluation D The basic

More information

Understanding. Depression. The Road to Feeling Better Helping Yourself. Your Treatment Options A Note for Family Members

Understanding. Depression. The Road to Feeling Better Helping Yourself. Your Treatment Options A Note for Family Members TM Understanding Depression The Road to Feeling Better Helping Yourself Your Treatment Options A Note for Family Members Understanding Depression Depression is a biological illness. It affects more than

More information

Major Depressive Disorders Questions submitted for consideration by workshop participants

Major Depressive Disorders Questions submitted for consideration by workshop participants Major Depressive Disorders Questions submitted for consideration by workshop participants Prioritizing Comparative Effectiveness Research Questions: PCORI Stakeholder Workshops June 9, 2015 Patient-Centered

More information

Under the Start Your Search Now box, you may search by author, title and key words.

Under the Start Your Search Now box, you may search by author, title and key words. VISTAS Online VISTAS Online is an innovative publication produced for the American Counseling Association by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to

More information

Recognizing and Treating Depression in Children and Adolescents.

Recognizing and Treating Depression in Children and Adolescents. Recognizing and Treating Depression in Children and Adolescents. KAREN KANDO, MD Division of Child and Adolescent Psychiatry Center for Neuroscience and Behavioral Medicine Phoenix Children s Hospital

More information

Depression in children and adolescents

Depression in children and adolescents Patient information from the BMJ Group Depression in children and adolescents Depression is an illness that affects people of all ages, including children and teenagers. It can stop a child or teenager

More information

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 This document is intended to be used with the Somerset Dual Diagnosis Operational Working guide. This document provides principles governing joint working

More information

Depression, Mental Health and Native American Youth

Depression, Mental Health and Native American Youth Depression, Mental Health and Native American Youth Aisha Mays, MD UCSF Department of Family And Community Medicine Native American Health Center Oakland, CA July 8, 2015 Presenter Disclosures No relationships

More information

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller School of Medicine/University of Miami Question 1 You

More information

Eating Disorder Treatment Protocol

Eating Disorder Treatment Protocol Eating Disorder Treatment Protocol All Team Members: Patient Self-Management Education & Support Eating Disorders are incredibly debilitating and are associated with significant medical and psychosocial

More information

Mid Essex. Specialist Psychosis Service

Mid Essex. Specialist Psychosis Service Mid Essex Specialist Psychosis Service What is psychosis? Why have you been referred to us? Psychosis is general term used to describe a number of symptoms. Some of the symptoms of psychosis include: False

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information

Antidepressants and suicidal thoughts and behaviour. Pharmacovigilance Working Party. January 2008

Antidepressants and suicidal thoughts and behaviour. Pharmacovigilance Working Party. January 2008 Antidepressants and suicidal thoughts and behaviour Pharmacovigilance Working Party January 2008 PhVWP PAR January 2008 Page 1/15 1. Introduction The Pharmacovigilance Working Party has on a number of

More information

Depression & Multiple Sclerosis

Depression & Multiple Sclerosis Depression & Multiple Sclerosis Managing specific issues Aaron, diagnosed in 1995. The words depressed and depression are used so casually in everyday conversation that their meaning has become murky.

More information

A Guide to Depression

A Guide to Depression A Guide to Depression Depression is common. Symptoms can affect dayto-day life and can become very distressing. Treatments include talking treatments and antidepressant medicines. Treatment takes time

More information

Depression. Spirella Building, Letchworth, SG6 4ET 01462 476700 www.mstrust.org.uk reg charity no. 1088353

Depression. Spirella Building, Letchworth, SG6 4ET 01462 476700 www.mstrust.org.uk reg charity no. 1088353 Depression Spirella Building, Letchworth, SG6 4ET 01462 476700 www.mstrust.org.uk reg charity no. 1088353 Depression and MS Date of issue: March 2010 Review date: March 2011 Contents Introduction 2 1.

More information

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Please fax with CCHP prior authorization form to 608-252-0853

More information

A Bird s s Eye View of depression and unexplained somatic symptoms in primary care

A Bird s s Eye View of depression and unexplained somatic symptoms in primary care A Bird s s Eye View of depression and unexplained somatic symptoms in primary care Wanchai, Hong Kong 2 nd March 2005 David Goldberg Institute of Psychiatry King s s College, London Six parts to the lecture:

More information

PCORE Depression Post Survey

PCORE Depression Post Survey PCORE Depression Post Survey 1. Please enter your UNI. 467 answered question 467 skipped question 0 2. Please fill in the name of institution you are working at for your Clerkship. 467 answered question

More information

Retrospective case record audit: service users who ended therapy

Retrospective case record audit: service users who ended therapy Retrospective case record audit: service users who ended therapy How to submit your data to NAPT: Your service lead has agreed with the NAPT Team how your service's audit data will be submitted. Please

More information

SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES

SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES Psychological therapies are increasingly viewed as an important part of both mental and physical healthcare, and there is a growing demand for

More information

Dr Steve Moss BSc MSc Phd, Consultant Research Psychologist attached to the Estia Centre, Guys Hospital, London.

Dr Steve Moss BSc MSc Phd, Consultant Research Psychologist attached to the Estia Centre, Guys Hospital, London. INFORMATION SHEET Mental health problems in people with learning disabilities Dr Steve Moss BSc MSc Phd, Consultant Research Psychologist attached to the Estia Centre, Guys Hospital, London. In the whole

More information

B i p o l a r D i s o r d e r

B i p o l a r D i s o r d e r B i p o l a r D i s o r d e r Professor Ian Jones Director National Centre for Mental Health www.ncmh.info @ncmh_wales /WalesMentalHealth 029 2074 4392 info@ncmh.info Robert Schumann 1810-1856 Schumann's

More information

Asthma, anxiety & depression

Asthma, anxiety & depression Anxiety and are common in people with asthma. The good news is that there are effective treatments both for asthma and for anxiety and. With careful management, the symptoms of anxiety and can be treated

More information

Depression. Information for primary health practitioners. Published by the New Zealand Guidelines Group

Depression. Information for primary health practitioners. Published by the New Zealand Guidelines Group Depression Information for primary health practitioners Published by the New Zealand Guidelines Group The National Depression Initiative (NDI) is a campaign to help reduce the impact of depression on the

More information

Co-Occurring Disorders

Co-Occurring Disorders Co-Occurring Disorders PACCT 2011 CAROLYN FRANZEN Learning Objectives List common examples of mental health problems associated with substance abuse disorders Describe risk factors that contribute to the

More information

Anxiety and depression appropriate terms for cancer survivorship research?

Anxiety and depression appropriate terms for cancer survivorship research? Anxiety and depression appropriate terms for cancer survivorship research? Jon Håvard Loge Regional Centre for Excellence in Palliative Care, Dept. of Oncol., Oslo University Hospital/ Dept. of Behavioural

More information

TREATMENT-RESISTANT DEPRESSION AND ANXIETY

TREATMENT-RESISTANT DEPRESSION AND ANXIETY University of Washington 2012 TREATMENT-RESISTANT DEPRESSION AND ANXIETY Catherine Howe, MD, PhD University of Washington School of Medicine Definition of treatment resistance Failure to remit after 2

More information

Care Programme Approach (CPA)

Care Programme Approach (CPA) Care Programme Approach (CPA) The Care Programme Approach (CPA) is used to plan many people s mental health care. This factsheet explains what it is, when you should get and when it might stop. The Care

More information

Exercise therapy and the treatment of mild or moderate depression in primary care

Exercise therapy and the treatment of mild or moderate depression in primary care Exercise therapy and the treatment of mild or moderate depression in primary care Up and running? Executive summary Why isn t exercise referral offered by GPs? According to our research, only 42% of GPs

More information

What are the best treatments?

What are the best treatments? What are the best treatments? Description of Condition Depression is a common medical condition with a lifetime prevalence in the United States of 15% among adults. Symptoms include feelings of sadness,

More information

Revised 7/05. Copyright 2005 St. Jude Children's Research Hospital www.stjude.org Page 1 of 6

Revised 7/05. Copyright 2005 St. Jude Children's Research Hospital www.stjude.org Page 1 of 6 Antidepressants are drugs used, most often, to treat depression. Depression is a complex illness that involves sad and hopeless feelings that do not go away. Doctors sometimes order these drugs for other

More information

Symptoms of mania can include: 3

Symptoms of mania can include: 3 Bipolar Disorder This factsheet gives information on bipolar disorder. It explains the symptoms of bipolar disorder, treatments and ways to manage symptoms. It also covers what treatment the National Institute

More information

TREATING ASPD IN THE COMMUNITY: FURTHERING THE PD OFFENDER STRATEGY. Jessica Yakeley Portman Clinic Tavistock and Portman NHS Foundation Trust

TREATING ASPD IN THE COMMUNITY: FURTHERING THE PD OFFENDER STRATEGY. Jessica Yakeley Portman Clinic Tavistock and Portman NHS Foundation Trust TREATING ASPD IN THE COMMUNITY: FURTHERING THE PD OFFENDER STRATEGY Jessica Yakeley Portman Clinic Tavistock and Portman NHS Foundation Trust Treating the untreatable? Lack of evidence base for ASPD Only

More information

Depression Screening in Primary Care

Depression Screening in Primary Care Depression Screening in Primary Care Toni Johnson, MD Kristen Palcisco, BA, MSN, APRN MetroHealth System Our Vision Make Greater Cleveland a healthier place to live and a better place to do business. 2

More information

Caring for depression

Caring for depression Caring for depression Aetna Health Connections SM Disease Management Program Get information. Get help. Get better. 21.05.300.1 B (6/08) Get back to being you How this guide can help you Having an ongoing

More information

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999 Feeling Moody? Is it just a bad mood or is it a disorder? Major Depressive Disorder Prevalence: 7%; 18-29 years old; Female>Male DDx: Manic episodes with irritable mood or mixed episodes, mood disorder

More information

Depression in children and young people. Identification and management in primary, community and secondary care

Depression in children and young people. Identification and management in primary, community and secondary care NICE guideline May 2005 Issue date: September 2005 Depression in children and young people Identification and management in primary, community and secondary care Clinical Guideline 28 Developed by the

More information

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

Alzheimer s and Depression: What is the Connection?

Alzheimer s and Depression: What is the Connection? Alzheimer s and Depression: What is the Connection? Ladson Hinton MD Professor and Director of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Director, Education Core, Alzheimer

More information

MANAGING DEPRESSIVE SYMPTOMS IN SUBSTANCE ABUSE CLIENTS DURING EARLY RECOVERY

MANAGING DEPRESSIVE SYMPTOMS IN SUBSTANCE ABUSE CLIENTS DURING EARLY RECOVERY MANAGING DEPRESSIVE SYMPTOMS IN SUBSTANCE ABUSE CLIENTS DURING EARLY RECOVERY Presented by: William L. Mock, Ph.D., LISW,LICDC, SAP Professional Training Associates Inc North Ridgeville, Ohio 1 (216) 299-9506

More information

Contents. Overview Treatments Inpatient Services Day Programs The Clinic What are the Costs? How to Get Started How to Find Us

Contents. Overview Treatments Inpatient Services Day Programs The Clinic What are the Costs? How to Get Started How to Find Us Lakeside Clinic Contents Overview Treatments Inpatient Services Day Programs The Clinic What are the Costs? How to Get Started How to Find Us Overview At some point in their lives, as many as one-in-five

More information

Making sense of cognitive behaviour therapy (CBT)

Making sense of cognitive behaviour therapy (CBT) Making sense of cognitive behaviour therapy (CBT) Making sense of cognitive behaviour therapy What is cognitive behaviour therapy? 4 How does negative thinking start? 6 What type of problems can CBT help

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

CHRONIC PAIN AND RECOVERY CENTER

CHRONIC PAIN AND RECOVERY CENTER CHRONIC PAIN AND RECOVERY CENTER Exceptional Care in an Exceptional Setting Silver Hill Hospital is an academic affiliate of Yale University School of Medicine, Department of Psychiatry. SILVER HILL HOSPITAL

More information

Postnatal depression is an illness. It is not a sign that you don't love your baby or can't look after your baby properly.

Postnatal depression is an illness. It is not a sign that you don't love your baby or can't look after your baby properly. Patient information from the BMJ Group Postnatal depression Postnatal depression is an illness that women can get after having a baby. If you have it, you may feel sad and anxious, and find it hard to

More information

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults Professional Reference Series Depression and Anxiety, Volume 1 Depression and Anxiety Prevention for Older Adults TA C M I S S I O N The mission of the Older Americans Substance Abuse and Mental Health

More information

About Postpartum Depression and other Perinatal Mood Disorders

About Postpartum Depression and other Perinatal Mood Disorders About Postpartum Depression and other Perinatal Mood Disorders The entire period of pregnancy up to one year after delivery is described as the perinatal period. Many physical and emotional changes occur

More information

Depression in patients with coronary heart disease (CHD): screening, referral and treatment. 2014 Na)onal Heart Founda)on of Australia

Depression in patients with coronary heart disease (CHD): screening, referral and treatment. 2014 Na)onal Heart Founda)on of Australia Depression in patients with coronary heart disease (CHD): screening, referral and treatment Screening, referral and treatment for depression in patients with CHD A consensus statement from the National

More information

NICE clinical guideline 90

NICE clinical guideline 90 Depression in adults The treatment and management of depression in adults Issued: October 2009 NICE clinical guideline 90 guidance.nice.org.uk/cg90 NHS Evidence has accredited the process used by the Centre

More information

Medication or. treatment of depression and. Dr. Declan Aherne. Psychotherapist

Medication or. treatment of depression and. Dr. Declan Aherne. Psychotherapist Medication or psychotherapy in the treatment of depression and anxiety i t? by Dr. Declan Aherne Cli i l Psychologist Clinical P h l i t and d Psychotherapist Summary y of presentation p 4. Pharmac. Inductry

More information

Borderline personality disorder

Borderline personality disorder Borderline personality disorder Treatment and management Issued: January 2009 NICE clinical guideline 78 guidance.nice.org.uk/cg78 NICE 2009 Contents Introduction... 3 Person-centred care... 5 Key priorities

More information

Depression & Multiple Sclerosis. Managing Specific Issues

Depression & Multiple Sclerosis. Managing Specific Issues Depression & Multiple Sclerosis Managing Specific Issues Feeling blue The words depressed and depression are used so casually in everyday conversation that their meaning has become murky. True depression

More information

Clinical Audit: Prescribing antipsychotic medication for people with dementia

Clinical Audit: Prescribing antipsychotic medication for people with dementia Clinical Audit: Prescribing antipsychotic medication for people with dementia Trust, team and patient information Q1. Patient's DIS number... Q2. Patient s residence: Home Residential Home Nursing Home

More information