[NPInfo] manage depression in primary care

[Paula Sumner]

                                What's New in Depression   April 3, 2008              Helping non-psychiatric specialists manage depressive comorbidities
  Are there consultation opportunities in your local community, helping physicians in other specialties manage the depression that commonly arises as a comorbidity to the diseases they treat? A number of recent reports in the cardiology and rheumatology literature call on physicians in these fields to be more alert for significant depression among their patients who are seriously ill with cardiac or arthritic disorders. 
      For instance, Drs James Blumenthal and Wei Jiang from Duke University Medical Center, Durham, published a pair of articles in the March Cleveland Clinic Journal of Medicine reminding clinicians that depression not only occurs quite commonly among patients who have coronary heart disease but also that clinical depression is as important a primary risk factor as hypertension, smoking, elevated cholesterol, and other risk factors identified by the famous Framingham study of heart disease. And they review the evidence for various drug and non-drug therapeutic approaches. 
  Similarly, Dr Betty Sleath and colleagues from the University of North Carolina, Chapel Hill, reported that only 19% of patients who had moderate to severe symptoms of both rheumatoid arthritis and depression in their study discussed the depressive symptoms during their medical visits. In every case, the patients, not the health care professionals, brought up the mood disorder. 
  To provide a helpful consultation, of course, you will need to become very familiar with the pharmacotherapy of the combined depression and comorbid disease. And the requesting specialists may also want to know about the evidence base for both drug and non-drug approaches, even though the cross-disciplinary studies may be few in number. 
  Nevertheless, building up such expertise and relationships with other specialists can be another source of revenue and help to grow your professional practice, according to the practice management journal Physicians Practice. You may want to review the coding rules for consultations to avoid reimbursement pitfalls. However, excellent service that helps your non-psychiatric colleagues relieve depressive symptoms besetting their patients can make you a more valuable resource in your professional community. 
  —Stephen K. Murata 
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More on Depression>>     
   
  More on Depression from Psychiatric Times 
  Depression Management in Cancer Patients
Drs Kathleen Ell and Brenda Quon of the University of Southern California, Los Angeles, point out that depression is often underrecognized and undertreated in oncology even though 58% of cancer patients have depressive symptoms and 38% have major depression. In addition to reviewing pharmco- and psychotherapy, the authors also discuss ways the reduce barriers to care and also improve adherence.

HIV and Psychiatric Illness
Drs Edward Hammond and Glenn Treisman of the Johns Hopkins School of Medicine, Baltimore, note that there are an estimated 1,000,000 persons living with HIV/AIDS in the United States today. Depression remains one of the most important comorbidities but can be difficult to recognize due to similar symptoms from the HIV infection itself and it can contribute to poor adherence with complex medication regimens.

Lyme Disease, Comorbid Tick-Borne Diseases, and Neuropsychiatric Disorders
Dr Robert Bransfield of the International Lyme and Associated Diseases Society notes that fatigue and depression often present in difficult cases of Lyme and other tick-borne. Although depressive symptoms may regress with successful antibiotic therapy alone, combination drug treatment using psychotropics may be needed to manage the psychiatric problems.




Earn CME Today     Psychiatric Times CME offers 1.5 hours of Category 1 credit for the successful completion of: 
  Differentiating Chronic Depression From Personality Disorders 
  Drs. Amy Farabaugh, Maurizio Fava, and Jonathan Alpert of the Harvard Medical School, Boston, focus on the comorbidity of chronic depression and personality disorder, how various forms of the depression can be mistaken for personality disorder and how the true comorbidity can be treated. 
Click here to see our list of previous Psychiatric Times CME articles that are available online! 

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Paula J. Sumner RN, MSN, HTP, CHt
Healing Touch, Hypnotherapy, Emotional Freedom Technique, Reiki-2

919-969-9725

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