Important considerations from the outset are:

• Is the patient a suicide risk?

• Does the patient require inpatient assessment?

• Is referral to a specialist psychiatrist indicated?

If the symptoms are major and the patient appears in poor health or is a suicide risk, referral is appropriate.

The basic treatments are:

• Psychotherapy, including education, reassurance and support. All patients require minor psychotherapy. More sophisticated techniques such as cognitive or behavioural therapy may be used for selected patients. Cognitive therapy basically involves teaching patients new ways of positive thinking, which have to be relevant and achievable for the patient. Patients need to be able to recognise their own negative cognitions including their anxieties and worries.

• Pharmacological agents.

• Electroconvulsive treatment.

Note: Reassurance and support are needed for all depressed patients.

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Dealing With Back Pain

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