Topic: Anxiety and Depression

Common mental health problems such as depression, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder, and social phobia may affect up to 15% of the population at any one time. The severity of symptoms experienced will vary considerably, but all of these conditions can be associated with significant long-term disability. Good communication skills including active listening are key components for building a trusting relationship with patients, for example through demonstrating empathy, by making eye contact and explaining and talking through diagnoses, symptom profiles, and possible treatment options. The evidence base shows that adopting a collaborative approach with patients can help facilitate a greater engagement from them in any resulting treatments.

Jerome is a 35-year-old welder who lives with his partner and two children aged 3 and 5 years. Jerome has come to see you at your primary care clinic as he is feeling tired all the time. Medical history Jerome has a history of anxiety and depression. He joined your clinic as a patient 5 years ago, at which time he was taking sertraline for moderately severe depression and associated panic attacks. This was prescribed by his previous provider. The sertraline was effective and Jerome stopped taking the medication after 6 months of treatment. He has not returned to the clinic since that time. Jerome is otherwise physically fit and well and is not prescribed any medication. On examination, Jerome describes a lack of drive and energy for the past six weeks. He feels stressed at having to face his job, but is still going to work. Jerome admits trying to cope with disrupted sleep patterns by drinking more alcohol than usual. He is now drinking 3 bottles of beer every night instead of only twice per week as he used to. His physical examination is normal but he appears to be sad and apathetic.

1. What will be your approach to addressing Jerome’s anxiety and depression?
2. What assessment and screening tools will you use to support your diagnosis?
3. What might be the physiological causes of Jerome’s anxiety and depression?
4. Does Jerome fit into a DSM-5 category/classification?
5. What is your plan of care for Jerome? Please support with up-to-date evidence-based standard of care guidelines.