Integrated Management of Depression in the Elderly

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
UK contributors......Page 8
Canada......Page 11
Hong Kong......Page 12
Norway......Page 13
USA......Page 14
Foreword......Page 15
Preface......Page 17
Acknowledgements......Page 18
The epidemiology of depression in later life......Page 19
The aetiology of depression in later life......Page 21
Clinical presentation of depression in later life......Page 23
Making the diagnosis of depression in later life......Page 25
Clinical evaluation......Page 26
Prevalence and risk factors for depression......Page 27
Symptoms and course of depression......Page 29
Depression screening scales for ethnic elders......Page 30
Working with the family......Page 31
REFERENCES......Page 32
Goals of treatment......Page 35
The stepped care approach to the management of depression......Page 36
Self-help......Page 38
Implementing self-help......Page 39
The collaborative care approach......Page 40
Initiating treatment with an antidepressant......Page 41
Efficacy......Page 42
Side effects of medication......Page 44
Patients who do not respond......Page 45
Sources of treatment variability in older patients......Page 46
Psychological interventions......Page 47
REFERENCES......Page 48
Case 3.1 A request for sleeping tablets......Page 51
Assessment......Page 54
Management......Page 55
Appropriate referral......Page 56
Case 3.2 Loneliness and grief......Page 57
Grief, complicated grief or depression?......Page 58
Management options......Page 59
What next?......Page 60
The Positive Thoughts course......Page 61
Case 3.3 Panic attacks......Page 63
Notes on Case 3.2......Page 69
REFERENCES......Page 70
Background......Page 73
Assessment of depression......Page 74
Assessment of the alcohol problem......Page 75
Treatment of depression......Page 76
Treatment for alcohol problems......Page 77
Case 4.2 Physical co-morbidity......Page 78
Management......Page 79
Barriers to effective management......Page 80
Summary......Page 81
Case 4.3 Carers and families......Page 85
Introduction......Page 87
Treatment modalities......Page 88
Inter-agency working......Page 89
Links to national policy......Page 90
Barriers and facilitating factors......Page 91
Context and assessment......Page 92
Treatments......Page 93
Challenges......Page 96
Notes on Case 4.2......Page 97
REFERENCES......Page 98
Case 5.1 Depression with psychotic features......Page 101
Assessment......Page 104
Case 5.2 Risk of self-harm......Page 106
Assessment......Page 107
Management......Page 109
Case 5.3 Depression and forgetfulness......Page 111
Notes on Case 5.2......Page 117
REFERENCES......Page 118
Case 6.1 Breathlessness and irritability......Page 120
Health-care systems......Page 121
Assessment......Page 122
Management......Page 124
Barriers to effective treatment of older depressed patients......Page 126
Protocols, guidelines and initiatives......Page 127
REFERENCES......Page 130
Screening for depression in older people......Page 132
Treatment of depression......Page 138
Relevant literature and online resources......Page 145
Self-help material and groups......Page 149
Services for older people with depression......Page 150
Mental health law......Page 152
Protocols and pathways......Page 154
REFERENCES......Page 155
FURTHER READING......Page 156
Australian health-care system......Page 158
Management......Page 159
Roles of primary and secondary care......Page 160
Diagnosis......Page 161
Management......Page 162
Referral to secondary care......Page 163
Guidelines for assessment and management of depression in Canada......Page 164
REFERENCES......Page 166
Assessment......Page 167
Outpatients......Page 168
Barriers to effective treatment......Page 169
Diagnosis......Page 170
Barriers to effective management......Page 171
Presentation......Page 173
Assessment......Page 174
Barriers to effective treatment......Page 175
Assessment......Page 176
Management......Page 177
REFERENCES......Page 178
The Dutch health-care system......Page 179
Assessment by the GP......Page 180
Therapeutic options......Page 182
REFERENCES......Page 183
Management......Page 184
Admission......Page 185
Mental health-care system in Romania......Page 186
Presentation......Page 187
Management......Page 188
Presentation of depression......Page 189
Assessment......Page 190
A team approach......Page 191
REFERENCES......Page 192
Diagnosis......Page 193
Guidelines......Page 194
REFERENCES......Page 195
Index......Page 196