|A Therapeutic Primer for Primary Care Physicians: Part 3: Anxiety, Major Depression, Bipolar Disorder|
A Therapeutic Primer for Primary Care Physicians: Part 3: Anxiety, Major Depression, Bipolar Disorder
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In this podcast, Dr Lieberman discusses the associated features of three specific mental disorders: anxiety, major depressive disorder, and bipolar disorder. He offers practical techniques that can be used in diagnosing each of these disorders and provides suggestions for treatment.
|A||Accept the anxiety|
|W||Watch your anxiety; rate the anxiety on a scale from 0 to 10, and watch it change|
|A||Act with anxiety; act as if you are not anxious; breathe deeply and slowly|
|R||Repeat the steps until the anxiety goes down to a comfortable level|
|E||Expect the best|
Major depressive disorder
Undiagnosed depression is associated with increased symptomatology, decreased quality of life, and suicide. Using the BATHE technique will elicit the patient’s affect, and the 2-question screener discussed in the first podcast can confirm a diagnosis of depression.
1. In the past month have you been feeling down, blue, depressed, or hopeless?
2. In the past month have you lost interest in doing things that you formerly found pleasurable?
Suggestions for treatment
• See the patient regularly but keep sessions brief
• Set realistic expectations for both patient and practitioner
• Set small tasks for the patient to reverse feeling of worthlessness
• Give the patient permission to feel depressed: stop trying to cheer the patient up
• Provide behavioral suggestions and cognitive therapy along with pharmacotherapy
• Focus on the fact that although the patient has an illness, the illness will resolve
• Remember the power of “yet”
• Be supportive
• Set limits on the patient’s worrying and wallowing time
|D||Distractibility; poorly focused on multitasking|
|I||Insomnia; decreased need for sleep|
|G||Grandiosity; inflated self-esteem|
|F||Flight of ideas; complaints of racing thoughts|
|S||Speech pressured; more talkative|
|T||Thoughtlessness; risk-taking behavior|