Module 5: Managing Co Morbidities - MDD Minds

Summary

Module 5 of the Major Depressive Disorder course focuses on managing comorbidities in primary care, emphasizing the importance of recognizing and treating both mental and physical health disorders in patients with depression. The module covers common comorbidities such as anxiety, substance use disorders, PTSD, personality disorders, and physical conditions like diabetes and heart disease. It explores how family doctors can effectively partner with patients to manage these conditions, offering insights into screenings, interventions, and collaborative care approaches. The module also includes a case study of Kofi, a patient with diabetes and depression, showcasing practical management strategies.

Takeaways

• 😀 Takeaway 1: Family doctors should consider managing both mental and physical comorbidities in patients with major depressive disorder (MDD), as it is common for these patients to have additional health issues.
• 😀 Takeaway 2: Common comorbidities with MDD include substance use disorders, PTSD, personality disorders, and various physical health issues such as gastrointestinal, dermatological, and cardiometabolic disorders.
• 😀 Takeaway 3: Symptoms of depression and anxiety often overlap, with up to 50% of patients experiencing both conditions, making it essential to address both in treatment plans.
• 😀 Takeaway 4: Alcohol misuse frequently coexists with depression, and it can exacerbate the symptoms of MDD, leading to long-term physical health complications like liver disease, stroke, and dementia.
• 😀 Takeaway 5: Screening for alcohol misuse using tools like the CAGE questionnaire and the AUDIT helps family doctors identify problematic drinking behavior, which should be followed up with further evaluation and interventions.
• 😀 Takeaway 6: Post-traumatic stress disorder (PTSD) can be triggered by traumatic events and often coexists with MDD, and it is important to use validated screening tools such as the PCL-5 to detect PTSD in primary care settings.
• 😀 Takeaway 7: Personality disorders, such as borderline and antisocial personality disorders, are marked by unstable emotions and problematic relationships, and treatment usually involves long-term psychotherapy like cognitive-behavioral therapy (CBT).
• 😀 Takeaway 8: Physical comorbidities such as cardiovascular disease, diabetes, and musculoskeletal disorders often occur alongside depression and may contribute to or be worsened by depressive symptoms.
• 😀 Takeaway 9: Family doctors should use a collaborative approach to treat both physical and mental health conditions, including managing comorbidities like diabetes or arthritis in patients with depression to improve overall health outcomes.
• 😀 Takeaway 10: Effective management of depression in patients with chronic conditions involves a combination of psychotherapy, medication, and lifestyle changes, such as sleep hygiene, exercise, and relaxation techniques, as demonstrated with Kofi's treatment plan.

Q & A

What is the focus of Module 5 in the Major Depressive Disorder course?

Module 5 focuses on managing comorbidities in patients with Major Depressive Disorder (MDD) in Primary Care settings. It covers common mental and physical comorbidities and how family doctors can manage them.

What are some of the common mental comorbidities discussed in Module 5?

Common mental comorbidities include anxiety disorders, substance use disorders, post-traumatic stress disorder (PTSD), and personality disorders.

How are anxiety disorders and MDD related?

Anxiety disorders, such as generalized anxiety disorder and panic disorder, are common in Primary Care settings and often coexist with MDD. There is a significant overlap between symptoms, making it essential to treat both disorders simultaneously.

What is the role of the GAD-7 in screening for anxiety disorders?

The GAD-7 (Generalized Anxiety Disorder scale) is a validated self-report tool used to screen, diagnose, and assess the severity of anxiety disorders. It is commonly used in Primary Care settings to identify anxiety symptoms.

How does substance use, particularly alcohol misuse, interact with depression?

Alcohol misuse is often seen in patients with depression, as it may be used as a form of self-medication to relieve depressive symptoms. However, excessive alcohol use can worsen depression and lead to additional health problems.

What are the effects of alcohol misuse in conjunction with depression?

Long-term alcohol misuse can lead to high blood pressure, stroke, pancreatitis, liver disease, breast cancer, bowel cancer, dementia, impotence, and infertility, all of which can exacerbate depression.

What are the key components of the CAGE questionnaire?

The CAGE questionnaire consists of four questions designed to screen for alcohol use disorder. The key words in these questions are: Cut, Annoyed, Guilty, and Eyeopener.

What are the symptoms of Post-Traumatic Stress Disorder (PTSD)?

Symptoms of PTSD include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about a traumatic event, which may be experienced or witnessed by the individual.

How is PTSD diagnosed and managed in Primary Care settings?

PTSD is diagnosed using tools like the PCL-5 (Primary Care PTSD screen for DSM-5), which helps identify probable PTSD in patients. Management typically involves psychotherapy, and sometimes medication, depending on the severity of symptoms.

What is the significance of comorbid physical health conditions in patients with depression?

Physical health conditions, such as cardiometabolic disorders, diabetes, and respiratory diseases, are commonly associated with depression. Managing these comorbidities effectively can improve both physical health and depressive symptoms.

How does family medicine approach managing comorbidities like depression and diabetes in patients like Kofi?

In cases like Kofi’s, family doctors can collaborate with patients to address both depression and diabetes. Non-drug interventions like motivational interviewing, sleep hygiene, exercise, and relaxation techniques are paired with medication to manage these conditions effectively.

What are the steps in integrating mental health care into primary health care, as discussed in the five-step approach?

The five-step approach includes: 1) Suspecting mental health problems, 2) Screening for mental health issues, 3) Scoping the best service for severe problems, 4) Diagnosing depression or anxiety, and 5) Deciding on a management strategy.