Global Perspectives
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Depression & Anxiety In Pain Disorders
Recognition Of Depression And Anxiety In General Practice: Recognition of depression and anxiety is a key issue in general practices. If these disorders are not recognised they cannot be treated. There are a number of treatments of proven efficacy and some evidence to show that recognition improves outcome. Most episodes of depression and anxiety the "common mental disorders" are contained and managed in primary care. A study was conducted by Dr David Kessler and his team to examine the effect of patients' causal attributions of common somatic symptoms on recognition by general practitioners of cases of depression and anxiety and to test the hypothesis that normalizing attributions make recognition less likely. The rate of detection by general practitioners of cases of depression and anxiety as defined by the general health questionnaire4. General practitioners detected depression or anxiety in 56 (36%; 95% confidence interval 28% to 44%) of the 157 patients who scored highly on the general health questionnaire. Subjects with a normalizing attributional style were less likely to be detected as cases; doctors did not make any psychological diagnosis in 46 (85%; 73% to 93%) of 54 patients who had high questionnaire and high normalizing scores. Those with a psychologising style were more likely to be detected; doctors did not detect 21 (38%; 25% to 52%) of 55 patients who had high questionnaire and high psychologising scores. The somatisation scale was not associated with low detection rates. This pattern of results persisted after adjustment for age, sex, general health questionnaire score, and general practitioner4. Normalizing attributions minimizes symptoms and is non-pathological in character. The normalising attributional style is predominant in general practice attendees and is an important cause of low rates of detection of depression and anxiety 4. Conclusion: Increasing evidence suggests that neurobiological systems are dysregulated in RA. Cognitive and behavioral variables have been linked in various ways with negative affect and pain1. Accumulating evidence indicates that immune activation during various medical conditions is associated with a depressive syndrome. Antidepressants have effective protective and therapeutic effects on illness- and cytokine-mediated depressive episodes.3 GAD has rates of comorbidity that equal or exceed those of other anxiety disorders, and it is one of the most common comorbid conditions with other disorders. Different styles of symptom attribution are strongly associated with different rates of detection of depression and anxiety. Patients who make psychologising attributions are more likely to get a psychological diagnosis; the stronger their tendency to make such attributions the more likely such a diagnosis becomes4. Thus depression is a common, disturbing concomitant of medical conditions. However, because depression is often unrecognized and untreated in patients with pain, the prevalence reported in most studies is probably an underestimate. References:
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