190539 - Camille thinks she is depressed

This activity follows the case of Camille, a 26-year-old nurse, who has a history of depression and has come to the practice because she thinks her symptoms are returning.
The activity explores the assessment and diagnosis of both depression and bipolar disorder, how to distinguish between the two and the evidence based treatments that are available.

Relevance to General Practice

The majority of people with bipolar disorder spend more of their lives experiencing depressed mood rather than mood elevation. They also generally do not recognise or spontaneously report prior hypomania, as these periods are often seen as periods of normal happiness. As a result, a diagnosis of bipolar disorder can be delayed for many years.
Bipolar disorder has a major impact on a person’s life and those affected are much more likely to attempt suicide than those people with unipolar depression. Evidence-based treatments for bipolar depression also differ from unipolar depression, so an accurate recognition of bipolar disorder in a patient with current depressive symptoms is important.
General practitioners are often consulted for both unipolar and bipolar depression, so are well placed to distinguish between these conditions and provide care relative to the patient’s circumstances.

Learning outcomes

• Explain how to assess patients for depression and bipolar disorder.
• Outline the diagnostic criteria for depression and bipolar disorder.
• Distinguish unipolar depression from bipolar depression.
• Discuss how to assess suicide risk in a person with depression or bipolar disorder.
• Describe the evidence-based treatments for bipolar depression.
• Domains of General Practice

  D1. Communication skills and the patient-doctor relationship

  • Communication is clear, respectful, empathic and appropriate to the person and their sociocultural context

  D2. Applied professional knowledge and skills

  • A comprehensive, clearly documented biopsychosocial history is taken from the patient

  D3. Population health and the context of general practice

  • The patterns and prevalence of disease are incorporated into screening and management practices

  D4. Professional and ethical role

  • Professional knowledge and skills are reviewed and developed

  D5. Organisational and legal dimensions

  Curriculum Contextual Units
  • Adult health
  • Psychological health