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Ebook ABC of anxiety and depression: Part 2

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Ebook ABC of anxiety and depression: Part 2

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2OVERVIEW•Patients with long-term cooiticns have a high prevalence of comorbd depression and anxiety.•Presentoton of orooety and depression in people w

ith long-term conditions (LTCs) can by atypical•Causes of anxiety and depression eidude societal factors and other negative life events, as well as th Ebook ABC of anxiety and depression: Part 2

e king-term condition.•Patient, professional, organisational and societal factors are barriers to effective diagnosis and management of anxiety and de

Ebook ABC of anxiety and depression: Part 2

pression in LTCs.•The management of depression and anwty in patients with long-term conditions may be improved through the adoption of common principl

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2nd can be more difficult to detect and treat. Less attention has been given to anxiety, but anxiety and depression often coexist, and mixed presentati

ons are common in primary care. Anxiety symptoms can have significant overlap with those of the physical illness, particularly chest pain m those with Ebook ABC of anxiety and depression: Part 2

cardiac disease and shortness, of breath in chronic obstructive pulmonary disease (COPD) and asthma.Case study: HanifHanif 6 78 years cM aid came to

Ebook ABC of anxiety and depression: Part 2

England 40 years ago. He set up a business a-.d was proud to trjy number 60 Broad Street. He has had diabetes for at least 20 years, and wasn't surpri

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2wife who was diagnosed about 14 years ago and doesn't seem to bother He was so angry when It was he who had a heart attack 4 years ago - It just came

cut of the blue when he was dggng in the garden. The hospital staff were wonderful. but after he was sent home, he fell no one realy bothered about hi Ebook ABC of anxiety and depression: Part 2

m. ard since then he fas been so worried about whathe can and can't do. His wife accuses him of beng lazy and hts sen tells him he is OK. Only hs gran

Ebook ABC of anxiety and depression: Part 2

d-daughter, hkirnah. seems to care for hm;she 5 always so attentive and sits with him when he gets upsetThe nature of the problemHanlf's symptoms - an

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2sorder? Depression can be difficult to recognise in the presence of long-term physical conditions - because there is overlap of physical symptoms such

as lethargy or poor sleep; the presenting symptoms of depression are varied and not clearly defined, and patients may be reluctant to talk about emot Ebook ABC of anxiety and depression: Part 2

ional problems with healthcare professionals.Hantf s non-specific symptoms should be followed up with more specific inquiry about his mood, since he i

Ebook ABC of anxiety and depression: Part 2

s functionally impaired by his emotional state and is fearful of activity rather than being limited solely by his heart disease. Case-finding question

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2nce of coexisting depression.Depression associated with long-term conditions IS associated with a significant increase In morbidity and mortality (Box

6.1). The best evidence is in conditions such as cardiac disease and diabetes, but tile risks are present in any chronic condition such as psoriasis, Ebook ABC of anxiety and depression: Part 2

chronic pain and COPD. There may be physiological explanations for this comorbidity - chrome depression IS associated with a persistent endocrine str

Ebook ABC of anxiety and depression: Part 2

ess response and with a low-grade inflammatory response - but more immediately relevant clinically are factors such as reduced adherence to treatment,

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2n adherence, difficulties in self-management and reduced physical activity (Box 6.1).People with comorbld depression and anxiety can present with func

tional impairment that appears to be out of proportion to the clinical severity of physical illness, and case identification should take Into account Ebook ABC of anxiety and depression: Part 2

not just 'symptom count’ but the severity of emotionally related disability.ABC of Anxiety and Dcprefiion. First Edition. Edited bjr Linda Gaik and Ca

Ebook ABC of anxiety and depression: Part 2

rolyn Chew-Graham. © 2014 John Wiley & Sons, Ltd Published 2014 by lohn Wiley i( Sons. Ltd.2324ABC of Anxiety and DepressionBox 6 ■ Consequences of co

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2.•Incrivwrd morbidity•Incremed iiKxldlityTheories about aetiologyPeople with chronic illness also Sutter the same losses, role changes and stresses as

the normal population, and not all anxl ely and depression will be related to the physical condition. Even so, the prevalence of mood disorder in phy Ebook ABC of anxiety and depression: Part 2

sical illness is two to three times that in the general population. This higher preva lence is usually attributed to the specific meaning for the indi

Ebook ABC of anxiety and depression: Part 2

vidual and impact upon their life of the long-term condition, which may represent a threat that causes anxiety or anger and irritability in response

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2ing; and humiliation over the loss of position in society Of family and undermining the sense of self. The psychological challenges posed by illnesses

may lead to depression or anxiety if the individual is not able to mount an effective coping response.Professional views on the causes of depression Ebook ABC of anxiety and depression: Part 2

associated with LTCi tend to emphasise poor coping with the challenges of (he Illness. increased vulnerability and poor social support. However, patie

Ebook ABC of anxiety and depression: Part 2

nts do not necessarily understand their distress as a discrete state that might be diagnosed, labelled and treated. They may be reluctant to admit the

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2ssion', and fear further medicali-sation of their situation with tablets.Patients may recognise the psychological stress of chronic illness as a cause

of how they are feeling emotionally, with dlag nosis often being a life-changing event that forces people to face mortality and potential disability. Ebook ABC of anxiety and depression: Part 2

Adapting to a Li e is a constant source of stress to some people, with resulting difficulties In understanding how to manage It and feelings of guilt

Ebook ABC of anxiety and depression: Part 2

when not following lifestyle restrictions. However, not uncommonly, a person may have multiple interacting reasons for feeling low, including social

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

Ebook ABC of anxiety and depression: Part 2onsidered as causes by sufferers, but not ‘justifiable’ ones as they could, in the mind of the sufferer, potentially be resolved by some action on the

part of the person themselves.Loss of health and fear for his future are likely causes for 1 lanif’s distress. His view of these matters should he ex Ebook ABC of anxiety and depression: Part 2

plored. His story also raises an important question about whether. Since retirement, he has been able to establish a role for himself cither in his fa

Ebook ABC of anxiety and depression: Part 2

mily or in his wider social networkCase-finding

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

CHAPTER 6Anxiety and Depression: Long-Term ConditionsSarah Alderson and Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UKO

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