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

doi:10.1017/CBO9780511543654.005

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

Published online by Cambridge University Press: 18 December 2009

Carolyn A. Chew-Graham ,

Robert Baldwin and

Alistair Burns

Ceri Dornan ,

Helen Pusey ,

Christopher Dowrick ,

Sue Martin ,

Ruth Thompson and

Michael Morley

Show author details

Carolyn A. Chew-Graham: Affiliation:
University of Manchester
Robert Baldwin: Affiliation:
Manchester Mental Health and Social Care NHS Trust
Alistair Burns: Affiliation:
University of Manchester
Ceri Dornan: Affiliation:
General Practitioner and GP with Special Interest (Mental Health), Manchester Primary Care Trust
Helen Pusey: Affiliation:
Lecturer in Nursing University of Manchester
Christopher Dowrick: Affiliation:
General Practitioner and Professor of Primary Care, University of Liverpool
Sue Martin: Affiliation:
Independent Practitioner and Trainer Liverpool
Ruth Thompson: Affiliation:
General Practitioner Manchester
Michael Morley: Affiliation:
Consultant Clinical Psychologist, Manchester Mental Health and Social Care Trust

Book contents

Get access

Summary

In order to illustrate the integrated management of depression in older people in UK primary care, we asked contributors to provide commentaries on a selection of cases drawn from real-life scenarios. The following three chapters contain these commentaries together with a summary by the editors. The first three cases illustrate the management of patients with mild to moderate depressive symptoms in primary care.

A request for sleeping tablets

Mr Seth Y, aged 69 years, presents to his GP complaining that he can't sleep. He admits to feeling upset and worried, although he doesn't know why. He denies that anything has recently happened to him, but the practice receptionist is aware that his son and family have emigrated to New Zealand, and both Mr and Mrs Y have admitted to the staff at the desk that they miss their grandchildren. He comes to see the GP to ask for some sleeping tablets.

Mr SY doesn't often attend the practice, he has been on Losartan for hypertension for five years and his recent review with the nurse (including cholesterol and renal function) was satisfactory.

Please describe the assessment of Mr SY in the GP consultation. Discuss the options available for the management of the patient. Besides medication, what strategies are available for the management of Mr SY's insomnia?

Mr SY does not attend surgery frequently, so his request for sleeping tablets would seem unusual and arouse my curiosity.

Type: Chapter
Information: Integrated Management of Depression in the Elderly , pp. 33 - 54

DOI: https://doi.org/10.1017/CBO9780511543654.005 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Audit Commission (1999) First Assessment: A Review of District Nursing in England and Wales. London: Audit Commission.

Banerjee, S., Shamash, K., Macdonald, A. J. D., Mann, A. H. (1996) Randomized controlled trial of effect of intervention by psychogeriatric team on depression in frail elderly people at home. Br. Med. J. 313, 1058–61.Google Scholar

Beck, A. T., Rush, A. J., Shaw, B. F., et al. (1979) Cognitive Therapy of Depression. New York: John Wiley.

BMA and NHS Employers (2006) Revisions to the GMS Contract, 2006/7: Delivering Investment in General Practice. London: British Medical Association.

Bower, P., Gilbody, S. (2005) Stepped care in psychological therapies: access, effectiveness and efficiency: narrative literature review. Br. J. Psychiatry 186, 11–17.Google Scholar

Burroughs, H., Morley, M., Lovell, K., et al. (2006) ‘Justifiable depression’: how health professionals and patients view late-life depression – a qualitative study. Fam. Practice 23, 369–77.Google Scholar

D'Ath, P., Katona, P., Mullan, E., Evans, S., Katona, C. (1994) Screening, detection and management of depression in elderly primary care attendees: the acceptability and performance of the 15-item geriatric Depression Scale (GDS15) and the development of short versions. Fam. Practice 11, 260–6.Google Scholar

Department of Health (2001) National Service Framework for Older People. London: HMSO.

Department of Health (2006) Improving Access to Psychological Therapies. London: The Stationery Office.

Dowrick, C. (2004) Beyond Depression: A New Approach to Understanding and Management. Oxford, UK: Oxford University Press.

Dowrick, C., Dunn, G., Dalgard, O. S., et al. (2000) Problem-solving treatment and group psycho-education for depression: a multicentre randomized controlled trial. Br. Med. J. 321, 1450–4.Google Scholar

Forte, A. L., Hill, M., Pazder, R., et al. (2004) Bereavement care interventions: a systematic review. Biomed. Centr. Palliat. Care 3, 3.Google Scholar

Horowitz, M. J., Siegel, B., Holen, A., et al. (1997) Diagnostic criteria for complicated grief disorder. Am. J. Psychiatry 174, 67–73.Google Scholar

Jones, E., Asen, E. (1999) Systemic Couple Therapy and Depression. London: Karnac.

Katona, C., Freeling, P., Hinchcliffe, K. (1995). Recognition and management of depression in late life in general practice: consensus statement. Prim. Care Psychiatry 1, 107–13.Google Scholar

Khan, A., Khan, S., Brown, W. A. (2002) Are placebo controls necessary to test new antidepressants and anxiolytics?Int. J. Neuropsychopharmacol. 3, 193–7.Google Scholar

Kirsch, I., Moore, T. J., Scoboria, A., et al. (2002) The Emperor's New Drugs: an analysis of antidepressant medication data submitted to the US Food and Drug Administration. Prevention and Treatment 5, Article 23.Google Scholar

Klerman, G. L., Weissman, M. M.Rounsaville, B. J., et al. (1984) Interpersonal Psychotherapy of Depression. New York: Basic Books.

Laidlaw, K., Thompson, L. W., Dick-Sisin, L., Gallagher-Thompson, D. (2003) Cognitive Behaviour Therapy with Older People. Chichester, UK: John Wiley.

Lehtinen, V., Michalak, E., Wilkinson, C., et al. (2003) Urban–rural differences in the occurrence of depressive disorder in Europe: evidence from the ODIN study. Soc. Psychiatry Psychiatr. Epidemiol. 38, 283–9.Google Scholar

Lewinsohn P. M. (1975) The behavioral study and treatment of depression. In Progress in Behavior Modification, vol. 1, eds. Hersen, M., Eisler, R. M. and Miller, P. M.. New York: Academic Press, pp. 19–64.

Masten, A. S. (2001) Ordinary magic: resilience processes in development. Am. Psychol. 56, 227–38.Google Scholar

Morriss, R. K., Gask, L. (2002) Treatment of patients with somatized mental disorder: effects of reattribution training on outcomes under the direct control of the family doctor. Psychosomatics 43, 394–9.Google Scholar

Parkes, Murray C. (1998) Bereavement: Studies of Grief in Adult Life, 3rd edn. London: Routledge/Psychology Press.

NICE (2004a) Depression: Management of Depression in Primary and Secondary Care, Clinical Guideline No. 23. London: National Institute for Health and Clinical Excellence.

NICE (2004b). Anxiety: Management of Anxiety in Adults in Primary, Secondary and Community care, Clinical Guideline NO. 22. London: National Institute for Health and Clinical Excellence.

Onrust, S., Cuijpers, P., Smit, F., et al. (2006) Predictors of psychological adjustment after bereavement. Int. Psychogeriatrics 14, 1–15.Google Scholar

Peterson, C., Seligman, M. (2004) Character Strengths and Virtues: A Handbook and Classification. Washington, DC: American Psychological Association.

Shear, K., Frank, E., Houck, P. R., Reynolds, C. F. (2005) Treatment of complicated grief: a randomized controlled trial. J. Am. Med. Assoc. 293, 2601–8.Google Scholar

Shiekh J., Yesavage J. (1986) Geriatric Depression Scale: recent findings and development of a short version. In Clinical Gerontology: A Guide to Assessment and Intervention, ed. Brink, T.. New York: Howarth Press, pp. 165–75.

Sorock, G. S., Shimkin, E. E. (1988) Benzodiazepine sedatives and the risk of falling in a community-dwelling elderly cohort. Arch. Intern. Med. 148, 2441–4.Google Scholar

Sullivan, M., Katon, W., Russo, J., et al. (2003) Patients' beliefs predict response to paroxetine among primary care patients with dysthymia and minor depression. J. Am. Board Fam. Pract. 16, 22–31.Google Scholar

Walsh, B. T., Seidman, S. N., Sysko, R., et al. (2002) Placebo response in studies of major depression. J. Am. Med. Assoc. 287, 1840–7.Google Scholar