Diagnosing and treating depression in primary care patients: Looking beyond physical complaints

Alarcon, Fabricio J.; Isaacson, J. Harry; Franco-Bronson, Kathleen

doi:10.3949/ccjm.65.5.251

“…Prevalence rates in samples of medical outpatients are higher than in community samples [7,8,4] with reports that up to 30% of women primary care patients may experience depression [9]. Importantly, depressed patients who present in primary care settings frequently complain of somatic symptoms, such as fatigue, sleep problems, headaches, backaches, muscle pains, or abdominal pain, in lieu of complaints about feeling 'depressed' [10][11][12][13]. Gynecologists, whose patients are all women, can expect to regularly encounter depression in their practices.…”

Section: Major Depressive Disorder (Mdd) and Premenstrual Dysphoric Dmentioning

confidence: 97%

Obstetrician-gynecologists' decision making about the diagnosis of major depressive disorder and premenstrual dysphoric disorder

Hill

¹

,

Gray

²

,

Carter

³

et al. 2005

Journal of Psychosomatic Obstetrics & Gynecology

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Major depressive disorder (MDD) is underdiagnosed and undertreated in ambulatory care settings including gynecologic practices. Far less is known about the diagnosis of Premenstrual Dysphoric Disorder (PMDD). Three hundred and thirty-five gynecologists responded to mailed questionnaires that used descriptive scenarios as analogues to clinical cases. Questionnaire recipients were randomly selected to receive either a MDD or PMDD version of the questionnaire. Respondents were less accurate when diagnosing MDD cases (48% accuracy; p = 0.526), than PMDD cases (80% accuracy; p < 0.001), but were significantly more confident about their probability ratings of MDD cases, t = 2.57, p < 0.02. Qualitative analysis suggested that less accurate MDD respondents did not prioritize case data according to DSM-IV criteria, whereas almost all PMDD respondents made use of valid reasoning strategies. Respondents did not take base rates into account when deciding about the probability of either affective disorder. Results imply that gynecologists employ cognitive strategies that result in accurate diagnostic judgments about PMDD, but overconfidence, lack of attention to DSM-IV criteria and base rate neglect could hinder clinical decisions about MDD, and may contribute to underdiagnosis of depression.

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“…Such overlapping and atypical symptoms complicate the picture and make adequate detection and treatment of depression more challenging. It has been noted that older patients tend to report only somatic symptoms of depression (Alarcon, Isaacson, & Franco-Bronson, 1998), and they often mistakenly attribute their symptoms to the normal aging process. Remick (2002) argued that major clinical errors on the part of professionals and reluctance to report symptoms on the part of older adults has lead to inadequate recognition and treatment of major mood disorders within the older adult population.…”

Section: Recognition Of Late-life Depression: Treatment Barriersmentioning

confidence: 99%

Late-Life Depression: Detection, Risk Reduction, and Somatic Intervention

Delano-Wood¹

2005

Clinical Psychology: Science and Practice

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In light of recent statistics suggesting that geriatric depression is highly prevalent, complicates and promotes medical illness, and strongly impacts quality of life, this paper explores numerous aspects of depression in late life, including proper detection and treatment barriers, risk reduction, and somatic intervention. Additionally, the relationship between depression and morbidity is highlighted given that the prevalence of depressive symptoms increases in older adults with medical disorders and greatly impacts outcome. Finally, empirically supported somatic treatments and their side effects are discussed with emphasis on the efficacy and effectiveness of pharmacotherapy, electroconvulsive therapy (ECT), exercise, and phototherapy (bright light therapy).

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“…Such overlapping and atypical symptoms complicate the picture and make adequate detection and treatment of depression more challenging. It has been noted that older patients tend to report only somatic symptoms of depression (Alarcon, Isaacson, & Franco‐Bronson, 1998), and they often mistakenly attribute their symptoms to the normal aging process.…”

Section: Recognition Of Late‐life Depression: Treatment Barriersmentioning

confidence: 99%

Late-Life Depression: Detection, Risk Reduction, and Somatic Intervention.

Delano‐Wood

¹

,

Abeles

²

2005

Clinical Psychology: Science and Practice

View full text Add to dashboard Cite

In light of recent statistics suggesting that geriatric depression is highly prevalent, complicates and promotes medical illness, and strongly impacts quality of life, this paper explores numerous aspects of depression in late life, including proper detection and treatment barriers, risk reduction, and somatic intervention. Additionally, the relationship between depression and morbidity is highlighted given that the prevalence of depressive symptoms increases in older adults with medical disorders and greatly impacts outcome. Finally, empirically supported somatic treatments and their side effects are discussed with emphasis on the efficacy and effectiveness of pharmacotherapy, electroconvulsive therapy (ECT), exercise, and phototherapy (bright light therapy).

show abstract

Diagnosing and treating depression in primary care patients: Looking beyond physical complaints

Cited by 7 publications

References 0 publications

Obstetrician-gynecologists' decision making about the diagnosis of major depressive disorder and premenstrual dysphoric disorder

Obstetrician-gynecologists' decision making about the diagnosis of major depressive disorder and premenstrual dysphoric disorder

Late-Life Depression: Detection, Risk Reduction, and Somatic Intervention

Late-Life Depression: Detection, Risk Reduction, and Somatic Intervention.

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