Integrated Management of Depression in the Elderly

Author: Carolyn A. Chew-Graham; Robert Baldwin; Alistair Burns  

Publisher: Cambridge University Press‎

Publication year: 2008

E-ISBN: 9780511389467

P-ISBN(Paperback): 9780521689809

Subject: R749.4 affective psychosis

Keyword: 神经病学与精神病学

Language: ENG

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Integrated Management of Depression in the Elderly

Description

Depression is one of the most common mental health problems facing older people, and it is often unrecognised and usually under-treated. Integrated Management of Depression in the Elderly provides an entirely new approach to understanding late-life depression, by using a series of case studies with commentaries from practitioners internationally. The book covers the epidemiology, presentation and diagnosis of depression in older people and outlines current evidence for effective management drawing on recently published work. The substantive part of the book presents ten case studies of increasing complexity, each case has a commentary from a primary care clinician and a health or social care professional, to outline how professionals should work together to manage the patient within their community. Contributions from world experts give the book an international appeal. It will appeal to a wide audience of health and social care professionals together with psychiatrists-in-training.

Chapter

USA

The aetiology of depression in later life

Presentation of depression in later life

Core symptoms

Clinical presentation of depression in later life

Making the diagnosis of depression in later life

Rating scales

Clinical evaluation

Depression in older people from different ethnic groups

Background

Prevalence and risk factors for depression

Symptoms and course of depression

Considerations in the assessment

Depression screening scales for ethnic elders

Management issues

Working with the family

REFERENCES

2 Management of late-life depression

Introduction

General principles of treatment

Goals of treatment

The stepped care approach to the management of depression

Self-help

Implementing self-help

Practical considerations of the stepped care approach

The collaborative care approach

Pharmacotherapy

Initiating treatment with an antidepressant

Efficacy

Side effects of medication

Patients who do not respond

Sources of treatment variability in older patients

Psychological interventions

Social interventions

REFERENCES

3 Management of late-life depression in primary care: case studies UK

Case 3.1 A request for sleeping tablets

Assessment

Eliciting Mr SY’s perspective

Assessing mood and eliciting symptoms of depression

Assessing physical problems

Assessing risk

Management

Appropriate referral

Case 3.2 Loneliness and grief

Assessment

Grief, complicated grief or depression?

Social and personal context

Examination and investigations

Management options

What should I do?

What next?

The Positive Thoughts course

Case 3.3 Panic attacks

Editors’ comments

Notes on Case 3.1

Notes on Case 3.2

Notes on Case 3.3

REFERENCES

4 Management of more complicated depression in primary care: case studies UK

Case 4.1 Hidden alcohol consumption

Assessment

Background

The aim of the assessment

Assessment of depression

Assessment of the alcohol problem

Assessment of physical health

Treatment

Treatment of depression

Treatment for alcohol problems

Addressing underlying factors

In the longer term

Case 4.2 Physical co-morbidity

Assessment

Management

Collaboration between primary and secondary care

Barriers to effective management

Summary

Case 4.3 Carers and families

Follow-up

Introduction

Assessment

Treatment modalities

Inter-agency working

Links to national policy

Barriers and facilitating factors

Case 4.4 Ethnically sensitive management

Context and assessment

Treatments

Supporting professionals and commissioners of mental health services

Challenges

Editors’ comments

Notes on Case 4.1

Notes on Case 4.2

Notes on Case 4.3

Notes on Case 4.4

REFERENCES

5 Management of late-life depression across primary and secondary care: case studies UK

Case 5.1 Depression with psychotic features

Assessment

Case 5.2 Risk of self-harm

Assessment

Management

Case 5.3 Depression and forgetfulness

Editors’ comments

Notes on Case 5.1

Notes on Case 5.2

Notes on Case 5.3

REFERENCES

6 Management of late-life depression around the world: summary of international commentaries

International commentaries for the integrated management of depression

Case 6.1 Breathlessness and irritability

Health-care systems

The presentation of depression

Assessment

Management

Systems working together

Barriers to effective treatment of older depressed patients

Protocols, guidelines and initiatives

REFERENCES

7 Resources

Screening for depression in older people

Assessment of severity

Practice guidelines (practitioner resources)

Treatment of depression

Bipolar disorder

Patient education material

Relevant literature and online resources

Self-help material and groups

Self-help manuals

Services for older people with depression

Legal framework

Mental capacity

Mental health law

Protocols and pathways

REFERENCES

FURTHER READING

Appendix: International commentaries

Australia

Assessment

Australian health-care system

Management

Guidelines

Roles of primary and secondary care

REFERENCES

Bulgaria

Diagnosis

Assessment

Management

Canada

Co-morbid depression

Canadian health-care system

Guidelines for assessment and management of depression in Canada

Treatment approaches

Over-diagnosis

Referral to secondary care

REFERENCES

Denmark

The Danish health-care system

Presentation of depression

Assessment

Non-drug treatment

First-line drug treatment

Guidelines

Collaboration

Outpatients

Inpatients

Information for patients

Barriers to effective treatment

France

Pathways of care

Presentation

Diagnosis

Diagnosis and management

Barriers to effective management

Hong Kong

Health-care system in Hong Kong

Presentation

Models of management

Assessment

Management

Barriers to effective treatment

REFERENCES

Japan

Presentation

Assessment

Management

REFERENCES

The Netherlands

The Dutch health-care system

Guidelines

Assessment by the GP

The role of the psychiatrist

Therapeutic options

REFERENCES

Norway

Norwegian health-care system

Assessment

Management

Admission

Romania

Mental health-care system in Romania

Presentation

Management

REFERENCES

Spain

Spanish health-care system

Presentation of depression

Assessment

Management

A team approach

Barriers to treatment

REFERENCES

United States of America

Health-care system

Diagnosis

Management

Guidelines

Barriers to optimal care

Patient resources

REFERENCES

Index

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