Depressiooni ravimine esmatasandil

Depressioon on üks sagedasem krooniline retsidiveeruv psühhiaatriline häire esmatasandi arstiabi kasutajatel. Töös uuriti perearstide ravimieelistusi depressiooni ravimisel koos eelistuse põhjendusega ning võrreldi perearstide ja psühhiaatrite määratud ravimeid. Selgus, et perearstid diagnoosisid üle poole ambulatoorselt diagnoositud depressioonidest ja nad määrasid 65% antidepressantidest. Perearstid eelistasid depressiooni ravida selektiivsete serotoniini tagasihaarde inhibiitorite (SSRI) rühma kuuluvate ravimitega, mis moodustasid 76,8% nende määratud antidepressantidest. Perearstide ravimieelistused olid kooskõlas patsiendile spetsiifilise ravimi ratsionaalse valiku teguritega. Eesti Arst 2005; 84 (7): 481–48

Depressiooni esinemine perearsti patsientidel

Depressioon on maailmas üks sagedasemaid psüühikahäireid ja prognoositakse, et aastaks 2020 on see südameveresoonkonnahaiguste järel olulisel kohal ka töövõimetuse põhjustajana. Seetõttu on oluline teada, milline on depressiooni esinemissagedus ning millised on selle häirega seostuvad põhilised tegurid. Üle-euroopalise depressiooni riskitegurite uurimisprojekti PREDICT raames Eestis tehtud uuring näitas, et depressiooni on esinenud viimase kuue kuu jooksul ligikaudu veerandil perearsti patsientidest ning viimase kuu jooksul peaaegu igal seitsmendal patsiendil. Sagedamini seostusid depressiooniga sellised tegurid nagu naissugu, töötus, pikaajaline raske haigus, majanduslik toimetulek ning negatiivsete elusündmuste olemasolu. Eesti Arst 2006; 85 (12): 811–81

Kokkuvõte kliinilisest auditist „Depressiooni diagnostika ja ravi esmatasandil“

Eesti Arst 2017; 96(2):69–7

Kokkuvõte kliinilisest auditist „Ärevushäire käsitlus esmatasandil“

Eesti Arst 2018; 97(7):353–35

Kokkuvõte kliinilisest auditist „Ärevushäire käsitlus esmatasandil“

Eesti Arst 2018; 97(7):353–35

Family doctors' problems and motivating factors in management of depression

BACKGROUND: Depression is a frequent psychiatric disorder, and depressive patient may be more problematic for the family doctors (FD) than a patient suffering from a somatic disease. Treatment of patients with depressive disorders is a relatively new task for Estonian FDs. The aim of our study was to find out the family doctors' attitudes to depression related problems, their readiness, motivating factors and problems in the treatment of depressive patients as well as the existence of relevant knowledge. METHODS: In 2002, altogether 500 FDs in Estonia were invited to take part in a tailor-made questionnaire survey, of which 205 agreed to participate. RESULTS: Of the respondents 185(90%) considered management of depressive patients and their treatment to be the task of FDs. One hundred and eighty FDs (88%) were themselves ready to deal with depressed patients, and 200(98%) of them actually treated such patients. Commitment to the interests of the patients, better cooperation with successfully treated patients, the patients' higher confidence in FDs and disappearance of somatic complaints during the treatment of depression were the motivating factors for FDs. FDs listed several important problems interfering with their work with depressive patients: limited time for one patient, patients' attitudes towards the diagnosis of depression, doctors' difficulties to change the underlying causes of depression, discontinuation of the treatment due to high expenses and length. Although 115(56%) respondents maintained that they had sufficient knowledge for diagnostics and treatment of depression, 181(88%) were of the opinion that they needed additional training. CONCLUSION: FDs are ready to manage patients who might suffer from depression and are motivated by good doctor-patient relationship. However, majority of them feel that they need additional training

A Review Article on Internet-based Psychological Interventions in Primary Care. What is the Global Experience? How Reliable are Results from RCTs? Lessons Learned from the European, US and Australian Case Studies

In the context of the EU’s Digital Single Market (eHealth) Strategy, the deployment of digital tools for patients’ empowerment and person-centred care is of high demand and importance. Shifting from treatment to health promotion and disease prevention, a variety of internet-based cognitive behavioural therapy programmes have been proven to be effective for managing common mental health disorders in secondary care even hough the effectiveness and the clinical use of internet-based cognitive behavioural therapy programmes alone in primary care have not been approved yet. Additionally, such interventions are neither included in the international clinical guidelines for treating common mental health disorders nor regulated by Member States as a healthcare service. Despite that, the UK National Health Service and the Swedish National Board of Health and Welfare endorse the use of internet-based cognitive behavioural therapy as a first treatment option. The aim of this research is to investigate the global experience of internet-based cognitive behavioural therapy programmes in controlled and real-life conditions in general practice and to evaluate the reliability of the results and concomitantly their compliance with the European Commission’s eHealth Strategy. A systematic review of quantitative studies was conducted from January 2007 to December 2017. The results indicated that unsupported internet-based cognitive behavioural therapy programmes alone are less effective than combined therapy options for treatment purposes, if no additional therapy is prescribed. Guided internet-based cognitive behavioural therapy may supplement traditional treatment methods resulting in improving the control of mental disorders, but are unable to demonstrate consistent quality or replace face-to-face therapy

L'Éducation psychomotrice à l'école élémentaire

Eesti Arst 2011; 90(9):431–44