Iain

I am afraid I have simply not had much time to go onto CIS at all. This
is easier because the messages come up on e-mail. I shall pay a visit
soon though. If there are any postnsg for legal advice in my area of
work, then by all means  copy them to me and I shall try and
respond.Incidentally we now have an online free initial legal advice
section to our Web site.

Thanks for the references. If you have the papers in full, could I ask
Keith Park (who lives in Aughton) to pop in to borrow them?

The issue we were flagging is alleged over-diagnosis and over-treatment
in the younger age groups, thus the example of the jilted girl. I can
see less of a problem with the elderly in diagnosis, (although I would
have thought that medication options were less justified since for most
elderly it is often surely more a problem of how to run their lives in a
way that gives them something to do other than comntemplate death).

Similarly the non-UK studies are not of relevance since this is looked
at as a UK issue. It does not look as if any of those papers listed are
UK and non-elderly. Has there been anything?


Graham Ross
ALeRT
http://www.alertuk.com






Iain Kewley wrote:
>
> Graham,
>
> Have you given up on us in UKPROF on CIS? I'm sorry that you couldn't have
> access to our doctors only section
>
> << I would be delighted to read a study confirming your claim to gross
> underdiagnosis. >>
>
> Try these - a small selection of recent studies confirming this - but it is
> fairly well documented
>
> Rothschild AJ
> The diagnosis and treatment of late-life depression.
> In: J Clin Psychiatry (1996) 57 Suppl 5:5-11
>
>   Depression in the elderly occurs commonly and is a major public
>   health problem. Unfortunately, despite the availability of safe and
>   effective treatments, late-life depression is often underdiagnosed
>   because the symptoms are unrecognised by the patient and the health
>   care provider. Late-life depression is described in this review, with
>   a focus on symptoms, prevalence, diagnosis, and available treatment
>   modalities.
>
> Strauss PR  Gagiano CA  van Rensburg PH  de Wet KJ  Strauss HJ
> Identification of depression in a rural general practice.
> In: S Afr Med J (1995 Aug) 85(8):755-9
>
>   Major depression is underdiagnosed by general practitioners, but the
>   reasons for this are not clear. This study aimed to establish the
>   prevalence of major depression and coexisting generalised anxiety
>   disorder in a rural general practice in the Orange Free State. It
>   also assessed the predictive value of a screening questionnaire for
>   use by general practitioners. The two practitioners evaluated 858
>   patients over a 4-week period. Those who met the screening criteria,
>   together with a random sample of 60 patients who did not, were re-
>   evaluated by a registrar in psychiatry who was unaware of the
>   findings of his colleagues. Of the patients studied, 134 (15.6%) had
>   major depression; 59 of these (44.0%) also had coexisting generalised
>   anxiety disorder. The general practitioners had correctly diagnosed
>   major depression in 32 patients (3.7%) before the study started. The
>   screening questionnaire had a 42% chance of correctly identifying a
>   patient with depression and a 97% chance of correctly identifying a
>   patient who did not have major depression. Both practitioners were
>   equally capable at identifying major depression. The study confirmed
>   both the high prevalence of depression in a rural general practice
>   and its low identification rate. It also showed the advantage of
>   using a screening questionnaire to alert practitioners to the
>   possibility of depression in their patients.
>
> Fernandez F  Levy JK  Lachar BL  Small GW
> The management of depression and anxiety in the elderly.
> In: J Clin Psychiatry (1995) 56 Suppl 2:20-9
>
>   The most common psychiatric disorders in later life, with the
>   exception of dementia, are depression and anxiety. Often
>   underdiagnosed or simply accepted with resignation as an inevitable
>   part of aging or as an unavoidable complication of other
>   constitutional illnesses, these disorders contribute to excess
>   disability in older patients and further compromise their quality of
>   life. This report discusses depression and anxiety in the growing
>   elderly population--its prevalence, detection methods, diagnostic
>   considerations, and present interventions.
>
> Hall RC  Wise MG
> The clinical and financial burden of mood disorders. Cost and
>      outcome.
> In: Psychosomatics (1995 Mar-Apr) 36(2):S11-8
>
>   Depressive disorders are a chronic, recurrent, and severe burden to
>   both patients and their families. Depressive disorders represent a
>   major national public health problem, ranking within the top 10 most
>   costly diseases in the United States. In 1990, depressive disorders
>   afflicted at least 11 million Americans and cost the U.S. economy an
>   estimated $44 billion. In addition, affective disorders are
>   associated with increased accident rates, increased rates of
>   substance abuse (especially alcoholism), increased medical
>   hospitalisation, and an increase in somatic illnesses and outpatient
>   medical utilisation. Despite their ranking as a major health problem,
>   depressive disorders are often undersign and undertreated. Brief
>   treatment strategies that focus only on acute episodes are often
>   ineffective and result in chronic impairment, impairing performance
>   at work and socially. Inadequate treatment increases costs,
>   suffering, and lost productivity. Recent data suggest that effective
>   treatment of depression requires long-term, skillful follow-up and
>   active pharmacotherapy.
>
> Capriotti T
> Unrecognized depression in the elderly: a nursing assessment
>      challenge.
> In: Medsurg Nurs (1995 Feb) 4(1):47-54
>
>   Depression in the elderly has been widely underdiagnosed and
>   undertreated. Geriatric depression has a unique presentation that
>   differs from the hallmarks of depressive illness documented in the
>   Diagnostic and Statistical Manual of Mental Disorders (DSM IV)
>   (American Psychiatric Association, 1994). The "masked" presentation
>   of depression in the elderly contributes to problems with accurate
>   assessment, prompt diagnosis, and treatment. Without treatment, there
>   are serious negative consequences for elderly clients such as
>   cognitive impairment, physical disability, social isolation, and
>   suicide. Enhancing professional nurses' awareness of this
>   underscoring mental health problem among elderly patients is a
>   significant priority.
>
> These are just some for the past 18 months
>
> Best wishes
>
> Iain
>


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