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'Referral advice' recommendation details

Depression with a chronic physical health problem

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG91 Practitioners should be aware that patients with a chronic physical health problem are at a high risk of depression, particularly where there is functional impairment. Patients with a chronic physical health problem should be asked the two depression identification questions: During the last month, have you often been bothered by: - feeling down, depressed or hopeless? - having little interest or pleasure in doing things? If a patient with a chronic physical health problem answers 'yes' to either of these questions but the practitioner is not competent to perform a mental health assessment, they should refer the patient to an appropriate professional. If this professional is not the patient's general practitioner (GP), inform the general practitioner (GP) of the referral. Time frame not specified
CG91 If a patient with depression and a chronic physical health problem presents considerable immediate risk to themselves or others, refer them urgently to specialist mental health services. Advise a patient with depression and a chronic physical health problem, and their family or carer, to be vigilant for mood changes, negativity and hopelessness, and suicidal ideation, and to contact their practitioner if concerned. This is particularly important during high-risk periods, such as starting or changing treatment and at times of increased personal stress. If a patient with depression and a chronic physical health problem is assessed to be at risk of suicide: take into account toxicity in overdose if an antidepressant is prescribed or the patient is taking other medication; if necessary, limit the amount of drug(s) available, consider increasing the level of support, such as more frequent direct or telephone contacts or consider referral to specialist mental health services. Urgent
CG91 When an antidepressant is to be prescribed, be aware of drug interactions. Seek specialist advice if there is uncertainty. If necessary, refer the patient to specialist mental health services for continued prescribing. Time frame not specified
CG91 When assessing a patient with a chronic physical health problem and suspected depression, be aware of any learning disabilities or acquired cognitive impairments, and if necessary consider consulting with a relevant specialist when developing treatment plans and strategies. Time frame not specified
CG91 Patients with a chronic physical health problem should be asked the two depression identification questions: During the last month, have you often been bothered by: - feeling down, depressed or hopeless? - having little interest or pleasure in doing things? If they answer 'yes' to either of the questions, a practitioner who is competent to perform a mental health assessment should ask three further questions to improve the accuracy of the assessment of depression, specifically: ? during the last month, have you often been bothered by feelings of worthlessness? ? during the last month, have you often been bothered by poor concentration? ? during the last month, have you often been bothered by thoughts of death? They should review the patient's mental state and associated functional, interpersonal and social difficulties, consider the role of both the chronic physical health problem and any prescribed medication in the development or maintenance of the depression and ascertain that the optimal treatment for the physical health problem is being provided and adhered to, seeking specialist advice if necessary. Time frame not specified
CG91 Consider collaborative care for patients with moderate to severe depression and a chronic physical health problem with associated functional impairment whose depression has not responded to initial high-intensity psychological interventions, pharmacological treatment or a combination of psychological and pharmacological interventions. Time frame not specified
CG91 For patients with persistent subthreshold depressive symptoms or mild to moderate depression and a chronic physical health problem, and for patients with subthreshold depressive symptoms that complicate the care of the chronic physical health problem, consider offering one or more of the following interventions, guided by the patient's preference: - a structured group physical activity programme - a group-based peer support (self-help) programme - individual guided self-help based on the principles of cognitive behavioural therapy (CBT) - computerised cognitive behavioural therapy (CCBT). Time frame not specified
CG91 For patients with persistent subthreshold depressive symptoms or mild to moderate depression and a chronic physical health problem who have not benefited from a low-intensity psychosocial intervention, discuss the relative merits of different interventions with the patient and provide: an antidepressant (normally a selective serotonin reuptake inhibitor [SSRI]) or one of the following high-intensity psychological interventions: - group-based cognitive behavioural therapy (CBT) - individual cognitive behavioural therapy (CBT) or - behavioural couples therapy for people who have a regular partner and where the relationship may contribute to the development or maintenance of depression, or where involving the partner is considered to be of potential therapeutic benefit. For patients with initial presentation of moderate depression and a chronic physical health problem, offer the following choice of high-intensity psychological interventions: group-based cognitive behavioural therapy (CBT) or individual cognitive behavioural therapy (CBT) for patients who decline group-based cognitive behavioural therapy (CBT) or for whom it is not appropriate, or where a group is not available or behavioural couples therapy for people who have a regular partner and where the relationship may contribute to the development or maintenance of depression, or where involving the partner is considered to be of potential therapeutic benefit. Time frame not specified

This page was last updated: 22 August 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.