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Living well with Multimorbidity and Depression Bhautesh Jani · Slide Courtesy: SSPC . The majority...
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Living well with Multimorbidity and Depression Bhautesh Jani
Transcript of Living well with Multimorbidity and Depression Bhautesh Jani · Slide Courtesy: SSPC . The majority...
Living well with Multimorbidity and Depression
Bhautesh Jani
GP in Bellshill, Lanarkshire
Clinical Academic in University of Glasgow
Research Interests: Multimorbidity, Depression
Introduction
Multimorbidity and Depression in Scotland
How does it matter to Amputee Patients?
Identifying Depression
Managing Depression
Role of Physiotherapists in Managing Depression
Overview
MULTIMORBIDITY AND
DEPRESSION
Multimorbidity in Scotland
Multimorbidity is the presence of two or more long
term conditions.
The Long Term Conditions Alliance Scotland call it
‘having multiple conditions’.
It matters because:
Living with multiple conditions is the norm rather
than the exception for many
Poor quality of life, more hospital admissions and
higher mortality
Health services are largely organised for single
diseases
Slide Courtesy: SSPC
The majority of over-65s have 2 or more conditions, and the majority of over-75s have
3 or more conditions
More people have 2 or more conditions than only have 1.
Multimorbidity is
common in Scotland
Most people with any long term
condition have multiple
conditions in Scotland
23
13
7
5
48
31
23
22
18
14
13
9
7
6
3
22
21
17
13
20
23
21
24
19
20
21
16
13
14
9
18
21
20
18
12
16
17
19
17
19
21
19
16
18
14
36
46
56
64
21
29
39
35
47
47
46
56
65
62
74
0% 20% 40% 60% 80% 100%
Depression
Schizophrenia/bipolar
Anxiety
Dementia
Asthma
Epilepsy
Cancer
Hypertension
COPD
Diabetes
Painful condition
Coronary heart disease
Atrial fibrillation
Stroke/TIA
Heart failure
Percentage of patients with each condition who have other conditions
This condition only This condition + 1 other + 2 others + 3 or more others
Slide Courtesy: SSPC
Most people with any long term
condition have multiple conditions
in Scotland
Slide Courtesy: SSPC
There are more people in Scotland with
Multimorbidity below 65 years than
above
Slide Courtesy: SSPC
Mental health problems and
Multimorbidity
Slide Courtesy: SSPC
More likely to have emergency and
potentially preventable admissions
3 59 14 21
3447
64
85100
151
20
31
51
74
115
151
200
242
318
342
479
0
100
200
300
400
500
600
0 1 2 3 4 5 6 7 8 9 10+
Ann
ual a
dmis
sion
rate
per
100
0 pa
tien
ts
No of conditions
Potentially preventable admission
Other emergency admissions
Slide Courtesy: SSPC
People with Multimorbidity do not feel
enabled by healthcare encounters
In a study of over 3,000 GP consultations, patients with
Multimorbidity (compared to those without) had :
More problems to discuss, which were more often complex (a mix of physical, psychological, and social);
Yet
Consultations were not longer for people with multi-morbidity; and
Patient enablement was low.
Slide Courtesy: SSPC
Mental Health in Scotland
Source: ISD Statistics
Mental Health in Scotland
Source: ISD Statistics
How does it matter for amputee patients?
Diabetes
Peripheral Vascular Disease
Major Trauma
Cancer
Commonest Causes of Amputation
Amputee Patients are more likely to have Multimorbidity
Mental health symptoms
in Amputee
Depression is likely to be a common co-morbid problem
in amputee patients
Identifying Depression
Low concentration
Fatigue
Insomnia
Loss of appetite or overeating
Body ache
Symptoms of Depression
Feeling of guilt
Irritability or restlessness
Hopelessness
Loss of interest in everything
No pleasure in life
Persistent sadness
Self harm thoughts
Suicide thoughts
Symptoms of Depression
Managing Depression
Selective Serotonin Reuptake Inhibitors
(e.g. Citalopram, fluoxetine)
Serotonin and Norepinephrine Reuptake Inhibitors
(e.g. Duloxetine, Venlafaxine)
Atypical Antidepressants
(e.g. Mirtazapine, Trazadone)
Tricyclic Antidepressants
(e.g. Amitriptyline, Imipramine)
Antidepressants
Cognitive Behaviour Therapy
Problem Solving Therapy
Nondirective Supportive Therapy
Behavioural Activation Therapy
Interpersonal Therapy
Psychodynamic Therapy
Social Skills Training
Mindfulness based therapy
Psychotherapy
Role of Physiotherapists
Persistent Phantom Pain
Poor functional recovery
Adjustment reaction/Denial
Poor coping skills
Social isolation
Non-compliance
&
Body language
Risk factors for Depression
in Amputee Patients
Screening for depression
But what else can you do?
How can you help reducing depressive symptoms?
Exercises vs. Medicines for
Depression
Blumenthal et al. Psychosom Med. 2007; 69(7): 587–596.
What do patients think?
Chartered Society of
Physiotherapy
You cannot go home without
take home messages!
Multi-morbidity and
depression likely to be
common in amputee
patients
Think of risk factors
Consider depression
screening or talking!
Exercise has an important
role in depression
management
Useful websites
Mind
Action on Depression
Living Life to the Full
NHS Choices
Royal College of
Psychiatrists
Contact
E-mail:
k
Thank You
