[Depressive disorders. A diagnostic and therapeutic challenge also for primary care]

What Does the Public Know About Varying Depression Severity?-Results of a Population Survey

Objectives: In this study, we examine the public's knowledge about different levels of depression severity in Germany. Methods: Data stem from a national telephone survey in Germany. A total of 1,009 persons participated, response rate was 46.8%. A vignette was presented with signs of mild, moderate or severe depression. Participants were asked what they think the person has, which persons and services are helpful and how effective different treatment options are. Differences between the three vignettes were tested with 95% confidence intervals and χ ²-tests. Results: 55.3% of the respondents identified depression as the health problem in question. Participants who heard the vignette with moderate symptomatology recognized depression more often. Across groups, a general practitioner was named most frequently concerning helpful persons/services. Effectiveness of psychotherapy received high levels of approval, online therapy and books were less often rated as effective. There were only few significant differences between the three vignettes. Conclusions: This is the first study examining public depression literacy for different severity levels. Small differences between severity levels indicate a lack of knowledge, which may have adverse consequences for adherence to treatment, especially for mild depression.

[Internal medicine between soma and psyche : Functional bodily complaints and depressive disorders in outpatient care]

Somatoform disorders are encountered in primary medical care with above-average frequency but are too rarely named as such in the differential diagnostics. The prevalence is approximately 30 % with a predominance of female patients. This patient group puts the physician-patient relationship to the acid test from the very beginning due to the fixation on organ-related symptoms, the expectations of repeated instrumental diagnostics and the special way of acting. The consequences are frequent changes of physicians, chronification and disappointment on both sides; however, a workable physician-patient relationship can be developed through an empathic but critically distanced fundamental attitude of the general internist based on a biopsychosocial illness concept. In the further course corrections in the understanding and expression of the illness on the part of the patient can be achieved with a pacing and leading strategy and with psychoeducative measures. The primary psychologization of functional complaints will not satisfy the affected person but outpatient psychotherapy should be initiated only after the patient has been well-prepared. Measures with medications mostly remain unspecific and serve only for relief of symptoms. For comorbidities with anxiety and/or depressive disorders the use of selective serotonin reuptake inhibitors should be considered.

[Areas of work of a biopsychosocial oriented psychiatric consultation-liaison service: results from a prospective 2-year survey]

BACKGROUND

Since the establishment of the European Association of Consultation-Liaison Psychiatry and Psychosomatics in 1992, C/L psychiatry in European countries has been increasingly recognized as a subspecialty of clinical psychiatry and psychosomatic medicine. The study explored the areas of work of the biopsychosocial oriented psychiatric consultation - liaison (C/L) service at the university hospital LKH Graz (Austria).

METHODS

We conducted two prospective 1-year surveys over two years of observation. Survey I comprised 1,505 consecutive new consultations, and the more recent Survey II extended over 1,478 consecutive new referrals to our C/L service. Psychiatric referrals were analyzed with regard to demographic characteristics, referring departments, principal reasons for referral, diagnostic characteristics, and intervention patterns.

RESULTS

In both surveys, the most common patient to be referred was a middle-aged woman. Internal medicine consistently accounted for almost one third of all referrals, followed by neurology. The most prominent reasons for biopsychosocial referral were any signs of abnormal mood, behaviour, psychotic symptoms or cognitive impairments. The most common mental disorders according to ICD-10 were adjustment disorders, depressive disorders, and delirium. Psychopharmacotherapy and combined psycho- and pharmacotherapy were the most frequent actions in both surveys, followed by biopsychosocial evaluation pretransplant.

CONCLUSIONS

To ameliorate the provision of biopsychosocial care for general hospital patients, the need for specially planned biopsychosocial C/L services with equal involvement of specialists in medical psychology, C/L psychiatry, and clinical psychology should be underscored.