Treatment guidelines for use in primary care are usually developed from an evidence base of clinical trials that are conducted within secondary care in patients who have clear-cut psychiatric diagnosis and who do not exhibit significant medical co-morbidity. In contrast, patients who present in primary care frequently exhibit one or more of the following:
• A mixture of anxiety and depressive symptoms that do not meet traditional diagnostic criteria
• A mixed picture of physical illness with an associated psychological component
• A psychological illness manifesting as somatic symptoms with or without behavioural changes.
• Psychosocial factors that impact negatively on quality of life
This complex picture poses a considerable challenge to the primary care physician who is often inexperienced in the evaluation of psychological illness and is usually labouring under severe time constraints.
This presentation will describe the Depression / Anxiety Pathway that has been developed in Surrey with the principal objectives to assist primary care physicians with:
• Diagnosis of psychiatric / psychological problem(s)
• Choice of the most suitable initial treatment option taking into consideration the patient’s current and lifetime co-morbidities and concomitant medication
• The decision pathway for second-line intervention should the initial treatment option prove ineffective and / or poorly tolerated
• Management of the psychiatric / psychological problem(s) to remission