Clinical Case Database / Category: Patient Management

The case of a patient suffering from mixed anxiety and depression

Publication details

Dr Pablo Jeczmien MD MRCPsych
Foundation Years Journal, volume 5, issue 10, p.8 (123Doc Education, London, December 2011)

Abstract

David is a 64 years old retired engineer. He lives with his wife. They live alone and have a son who lives away from them. David was unfortunately diagnosed with Parkinson's disease in early 2009. He initially approached his general practitioner just after Christmas 2008 because of symptoms of feeling anxious and experiencing tremors of hand. He was treated for anxiety at the time. However, as the symptoms did not improve he was further investigated. Only then it became apparent that David was suffering from Parkinson's disease. A few months after starting his anti parkinsonian medication, he started feeling low in mood and found it difficult to sleep. He also found it difficult to concentrate and avoided going out, especially to public places. He used to enjoy hobbies such as gardening, but now he didn't feel like doing that anymore. As David and his wife were concerned about his mental health they asked to see their general practitioner.

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Authors

Dr Pablo Jeczmien MD MRCPsych

Honorary Clinical Senior Lecturer BSMS
Sussex Partnership NHS Foundation Trust'.

References

1. Reich SG et al. Ten most commonly asked questions about the psychiatric aspects of Parkinson's disease. Neurologist (2003; 9:50-6)
2. Michael Gelder, Paul Harrison, Philip Cowen et al. Shorter Oxford Textbook of Psychiatry. Chapter 11, page 230
3. Michael Gelder, Paul Harrison, Philip Cowen et al. Shorter Oxford Textbook of Psychiatry. Chapter 9, page 176-179
4. Swinson RP; The GAD-7 scale was accurate for diagnosing generalized anxiety disorder. Evid Based Med. 2006 Dec; 11(6): 184.
5. Spitzer RL, Kroenke K, Williams JB, et al; A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22; 166(10): 1092-7. [Abstract]
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7.Kroenke K, Spitzer RL, Williams JB; The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep; 16(9): 606-13. [Abstract]
8. Dietrich AJ, Oxman TE, Burns MR, et al; Application of a depression management office system in community practice: a demonstration. J Am Board Fam Pract. 2003 Mar-Apr; 16(2): 107-14. [Abstract]
9.Use of the PHQ-9 to make a tentative diagnosis of depression; The MacArthur Initiative on Depression in Primary Care Website.
10. The ICD-10 Classification of Mental and Behavioral Disorder ( Clinical Description and diagnostic guidelines ), Category other anxiety disorders, pages 72, 140, 149.
11. Michael Gelder, Paul Harrison, Philip Cowen et al. Shorter Oxford Textbook of Psychiatry.Chapter 17, page 410.
12. Depression: the treatment and management of depression in adults (update) (NICE clinical guideline 90). (Published December 2004; revised April 2007).
13. Depression in adults with a chronic physical health problem: treatment and management (NICE clinical guideline 91).

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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