Svab: Depression and Physical Health Co-Morbidity – Everybody’s Problem

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Wonca Working Party on Mental Health
World mental Health Day

presentation Prof Igor Svab (Slovenia)
Depression and Physical Health Co-Morbidity – Everybody’s Problem

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  • 06 San Francisco Apr 10/14/10
  • Svab: Depression and Physical Health Co-Morbidity – Everybody’s Problem

    1. 1. Depression and Physical Health Co-Morbidity : 3 cases and 3 lessons Igor Švab
    2. 2. CASE 1 <ul><li>A 55-year old patient has a history of long-term depression. </li></ul><ul><li>She is also a smoker and she is overweight </li></ul><ul><li>Last month she has developed a myocardial infarction with a subsequent heart failure </li></ul><ul><li>Because of that she can not walk the stairs and is increasingly confined to her home, which is making her depression worse. </li></ul><ul><li>A vicious circle has developed. </li></ul>
    3. 3. PHYSICAL HEALTH PROBLEMS ARE COMMON IN PEOPLE WITH DEPRESSION <ul><li>LESSON 1: </li></ul>
    4. 4. Why? <ul><li>D epressed moods initiate a cascade of adverse changes in endocrine and immune functioning, and create increased susceptibility to a range of physical illnesses. </li></ul><ul><li>D epression can reduce adherence to medication therapies. </li></ul><ul><li>People with mental disorders sometimes have trouble accessing needed physical health care. </li></ul>
    5. 5. <ul><li>As a result, people with depression are more likely than others to develop significant physical health conditions and they have a mortality rate higher than the general population. </li></ul>
    6. 6. CASE 2 <ul><li>A 44-year old secretary had breast cancer. </li></ul><ul><li>There was no relapse, but she is still worried that the disease will return. </li></ul><ul><li>She thinks she is not attractive any more and that her husband has lost interest in her. She worrries that he will find another woman. </li></ul><ul><li>She is also worried that she will not be able to work in the office. </li></ul><ul><li>Because of these worries, she has problem sleeping and concentrating. She has lost her appetite and her weight has decreased. She fears that her weight loss is due to undiscovered cancer. </li></ul>
    7. 7. DEPRESSION IS COMMON IN PEOPLE WITH PHYSICAL DISORDERS <ul><li>LESSON 2: </li></ul>
    8. 8. Depression is common in people with physical disorders <ul><li>Depression, anxiety and cognitive impairment are the most common consequences of physical health problems. </li></ul><ul><li>For example, in a large-scale national community survey, 52% of people with cardiovascular disease displayed symptoms of depression and among these, 30% met the criteria for a major depressive episode. </li></ul>
    9. 9. CASE 3 <ul><li>This patient suffers from a wide range of problems. </li></ul><ul><li>Most of them are not listed in any of the medical textbooks. They include bizarre patterns of chest pain, severe cases of unexplained headache, abdominal cramps, tingling in ears, problems with breathing, cough and muscle weakness. </li></ul><ul><li>Over the years the patient has undergone many diagnostic procedures, but the findings are always normal. </li></ul><ul><li>He says: “I am terribly ill and you do not believe me. One day I will die and you will be sorry”. </li></ul><ul><li>As far as I know, he is still alive… </li></ul>
    10. 10. DEPRESSION CAN BE SOMATICIZED <ul><li>LESSON 3: </li></ul>
    11. 11. Depression can be somaticized <ul><li>Around one third of all somatic symptoms are medically unexplained in general health care settings. These medically unexplained symptoms include pain, fatigue and dizziness or syndromes such irritable bowel syndrome, fibromyalgia or chronic fatigue syndrome. They are often (15%) coupled with psychological stress and help-seeking behaviour. </li></ul>
    12. 12. CONCLUSION
    13. 13. Appropriate r ole s <ul><li>Primary care: </li></ul><ul><li>person-focused care over time, </li></ul><ul><li>first-contact access, </li></ul><ul><li>ongoing care of all but uncommon problems, </li></ul><ul><li>coordination of care </li></ul><ul><li>Specialist care: </li></ul><ul><li>s hort-term consultation for diagnosis or initiation of management </li></ul><ul><li>r ecurrent consultation for advice on continuing management </li></ul><ul><li>l ong-term referral for unusual conditions </li></ul>
    14. 14. CONCLUSION <ul><li>Most comorbid conditions require the coordinated and holistic treatment of both physical and mental health symptoms, and primary care is best placed to provide this type of service </li></ul>

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