RESUMO
Major depression is a common, disabling condition seen frequently in primary care practices. Non-psychiatrist ambulatory providers are increasingly responsible for diagnosing, and primarily managing patients suffering from major depressive disorder (MDD). The goal of this review is to help primary care providers to understand the natural history of MDD, identify practical tools for screening, and a thoughtful approach to management. Clinically challenging topics like co-morbid conditions, treatment resistant depression and pharmacotherapy selection with consideration to side effects and medication interactions, are also covered.
Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Atenção Primária à Saúde , Transtornos de Adaptação/diagnóstico , Consumo de Bebidas Alcoólicas/efeitos adversos , Antidepressivos/uso terapêutico , Luto , Transtorno Depressivo Maior/epidemiologia , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Dieta , Interações Medicamentosas , Resistência a Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Exercício Físico , Pesar , Humanos , Estilo de Vida , Programas de Rastreamento , Personalidade , Psicoterapia , Medição de Risco , Fatores de Risco , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Ideação Suicida , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study aimed to describe the obstacles and solutions in developing and implementing a prospective obstetric database registry that collects biopsychosocial data on women during pregnancy and postpartum. The clinical goals of the registry were to improve both diagnosis of mental health and substance use problems and access to mental health care during pregnancy. The research goals were to examine the impact of psychiatric illness and substance use on birth outcomes. STUDY SETTING AND REGISTRY DESIGN: A questionnaire that contained validated instruments for mental health, substance use and psychosocial stressors was developed and administered to all pregnant women in an academic medical center obstetric clinic. Results were incorporated with reminder and decision support systems to ensure active follow-up of patients with mental health needs. Automated medical record information was collected for future analysis of outcomes. PROGRAM IMPLEMENTATION: Barriers to program implementation were overcome by a multifaceted intervention that included educational outreach to patients, providers and staff; integration of the registry into preexisting clinical protocols; reminder systems at workstations; provision of mental health decision support through perinatal social work and psychiatric consultation; and utilization of a "stepped-care" model to delivering mental health services. CONCLUSION: A mental health registry that merges clinical and research needs can be successfully integrated into the obstetric clinic setting.