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

doi:10.1017/CBO9780511543654.006

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

Published online by Cambridge University Press: 18 December 2009

Carolyn A. Chew-Graham ,

Robert Baldwin and

Greta Rait and

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
Elizabeth Murray: Affiliation:
General Practitioner and Reader in Primary Care, Royal Free and University College, Medical School London
James Oliver: Affiliation:
Substance Abuse Counsellor Lonsdale Medical Centre, London
Avril Danczak: Affiliation:
General Practitioner and GP Tutor and Trainer Manchester Primary Care Trust
Mike Cheshire: Affiliation:
Consultant Physician in Medicine Elderly, Central Manchester and Manchester, Children's Hospital Trust
Joanne Protheroe: Affiliation:
General Practitioner and Clinical Research Fellow, Primary Care Research Group, School of Community Based Medicine, University of Manchester
David Challis: Affiliation:
Professor of Community Care Research
Jane Hughes: Affiliation:
Lecturer in Community Care Research, Personal Social Services Research Unit, University of Manchester
Greta Rait: Affiliation:
General Practitioner and Senior Lecturer Primary Care, Royal Free University College, Medical School, London
Ahmed I. Lambat: Affiliation:
Manager and Social Work Practice Teacher, Manchester

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Summary

The next commentaries illustrate the management of patients with increasingly complex problems where the management needs to be integrated with other professionals.

Hidden alcohol consumption

Mrs Ruth M is a 79-year-old lady who attends the practice infrequently, only when she needs her blood checking for thyroid function (she has been on thyroxine for 10 years) and her flu vaccine with the practice nurse. She makes an appointment with her GP as she has been feeling really run down recently and wonders if the dose of thyroxine needs changing. She is having difficulty sleeping and has tended to withdraw from her usual activities (going to the library and reading, meeting her friends for a drink in their local pub). She admits to the GP that she does ‘enjoy a tipple’ and feels that she might have been drinking more than usual in the past few months. She often has a drink with her mid-morning coffee as it stops her feeling so awful, and she has always had a couple of whiskies in the evening to help her sleep, but that doesn't seem to be working at the moment.

What factors should be taken into account in the assessment of this patient's mood?

How should Mrs RM be investigated?

Who might the GP work with in the management of this patient?

Assessment

Background

Mrs RM has probably found it difficult to admit to feeling low and run down, and is likely to have delayed coming to the doctor.

Type: Chapter
Information: Integrated Management of Depression in the Elderly , pp. 55 - 82

DOI: https://doi.org/10.1017/CBO9780511543654.006 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

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