Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- 1 Acute confusion: recognition
- 2 Antenatal and postnatal mental health
- 3 Attention-deficit hyperactivity disorder: provision of information
- 4 Bipolar depression: treatment
- 5 Bipolar disorder: management
- 6 Bipolar disorder: shared decision-making
- 7 Bipolar disorder: treatment
- 8 Chronic fatigue syndrome
- 9 Dementia: driving
- 10 Dementia: end-of-life care
- 11 Dementia: investigations
- 12 Depression: management in children and young people
- 13 Eating disorders: management
- 14 Epilepsy: management
- 15 Opiate dependence and pregnancy
- 16 Schizophrenia: family interventions
- 17 Schizophrenia: management
- 18 Schizophrenia: occupational achievements
- 19 Self-harm: assessment
- 20 Self-harm: assessment in children
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- Appendices
12 - Depression: management in children and young people
from I - Disorders
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- 1 Acute confusion: recognition
- 2 Antenatal and postnatal mental health
- 3 Attention-deficit hyperactivity disorder: provision of information
- 4 Bipolar depression: treatment
- 5 Bipolar disorder: management
- 6 Bipolar disorder: shared decision-making
- 7 Bipolar disorder: treatment
- 8 Chronic fatigue syndrome
- 9 Dementia: driving
- 10 Dementia: end-of-life care
- 11 Dementia: investigations
- 12 Depression: management in children and young people
- 13 Eating disorders: management
- 14 Epilepsy: management
- 15 Opiate dependence and pregnancy
- 16 Schizophrenia: family interventions
- 17 Schizophrenia: management
- 18 Schizophrenia: occupational achievements
- 19 Self-harm: assessment
- 20 Self-harm: assessment in children
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- Appendices
Summary
Setting
This audit is relevant to psychiatrists working in child and adolescent mental health services (CAMHS). It is most suited to out-patient settings.
Background
Depression has been dealt with in a variety of different ways in CAMHS. It is important to examine what happens in practice, and to monitor this regularly, according to best-practice guidelines. A 2005 guideline produced by the National Institute for Health and Clinical Excellence (NICE) attempted to standardise the approach to depression in terms of assessment and treatment according to the evidence base. More recent evidence, however, called some of those recommendations into question, including using medication as a second-line treatment for moderate to severe depression (Goodyer et al, 2007). However, several parts of the guideline are sound and can provide a useful benchmark for best practice in the areas of assessment and treatment.
Standards
Assessment standards
ᐅ The diagnosis of depression is clearly communicated in the letter to the referrer.
ᐅ Clinical notes contain the following information from assessment:
▹ comorbid conditions
▹ family context
▹ school context
▹ peer relationships.
Psychological treatment standards
ᐅ A relevant evidence-based treatment modality (e.g. cognitive–behavioural therapy or interpersonal psychotherapy) is clearly documented.
ᐅ Psychological treatment is reviewed regularly.
Medication treatment standards
ᐅ Fluoxetine is chosen as the first-line medication for depression.
ᐅ Medication is monitored regularly (at least monthly in the first 3 months).
ᐅ There is clear documentation of discussion of the risks and benefits.
The target is that all of the above standards are met.
Method
Data collection
Cases that had been coded on the CAMHS database as moderate or severe depressive disorder were collected. Information was obtained from the following sources: the assessment letter and subsequent letters for the first 3 months, including multidisciplinary review sheets.
Data analysis
The percentage of patients coded with a moderate or severe depressive disorder for whom the above standards were met was calculated.
Resources required
People
Data collection could be carried out by staff at multidisciplinary team meetings. A coordinator is needed to plan the data collection sessions, to design the pro formas and to analyse the data.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 43 - 44Publisher: Royal College of PsychiatristsPrint publication year: 2011