Lutchmun N. Depression in the physically ill in the primary care setting (diagnosis, treatment and prevention).

The aim of the study is to determine the incidence of depressive disorders in the medically ill primary care patient and in particular to ameliorate the diagnostic therapeutic and preventive approaches that are in present use at the primary care level. This study was carried out during a period of 3 years at the medical outpatient department of the second territorial policlinic in the Ukrainian capital of Kiev. 350 patients on a random selection basis between ages 18-67 years were included in the study among 186(58,1%) were females and 164(46,9%) males. According to the received data it was concluded that patients with cardiovascular diseases (27%) were prone to be depressed, followed by respiratory (21,1%) and cerebrovascular (16,4%) diseases. The clinical assessments consisted of psychopathological methods that is structured clinical interviews conducted by clinicians experienced in the diagnosis an assessment on depression using ICD-10 criteria for depressive disorders in their various forms i.e organic affective disorders (06.3), bipolar affective disorders (F31), Depressive episode (F32), Reccurent affective disorders (F33), Persistent mood affective disorders i.e cyclo, Dysthymia (F34). The psychometric instrument used was the clinician administered 21 items Hamilton Psychiatric Depression Rating Scale(HDRS) which emphasizes the somatic manifestation of depression and which is sensitive to changes experienced by patients in antidepressant drug therapy. After the 350 patients were assessed using the ICD-10 criteria for mood affective disorders it was found that 85(24,2%) met the criteria for depressive disorders of various origins and forms(F06.3), F31-F34). Accordingly 265(75,7%) of the patients did not meet criteria for mood affective disorders of any kind and they were used as comparison group instead. In order to cheer the efficacy of different types of treatment of depressive disorders in primary care, the patients were divided into 3 groups consisting of 28 patients each. The 1st group receivedpsycho-pharmacological treatments only, the 2nd group received psychotherapy and the 3rd group received neither psychotherapy nor psycho-pharmacological treatments. After one month of treatment it was noted that there was a definite (20%) amelioration in the 1st and 2nd group by comparison to the 3rd group and by the end of three months - 80% amelioration in the first 2 groups compared the 3rd group. The group receiving combined psychotherapy and psychotropic treatment had approximately the same results as the group receiving psychotropic medication only. One important point to be taken into consideration is the fact that with the amelioration of the patient's mental conditions, his physical symptoms improved considerably during treatment with antidepressants. At the end of the 3 year study it was concluded that (A) early diagnosis and treatment of depression in primary care plays a central role in the treatment of the primary physical disease diagnosed by the physician as well as (B) save doctor's time, useless investigations and patient's and government's funds. It was also found that SSRIs are the antidepressants of choice in the treatment of depression in primary care practice and that meeting groups of primary care patients definitely help them to cope with depression and that further training of primary care medical care practitioners in the diagnosis, treatment and preventive aspects of depression will by all means largely help the current methods in use at present.