2 - GP Advice Summaries

Introduction

Summary advice on screening and management of common mental health problems in general practice.

This chapter is designed to provide general practitioners with brief and practical information on common mental health presentations amongst veterans. It comprises a series of summaries that outline screening, advice and referral options. They can easily be used during a 15 minute consultation, or when you need to develop a mental health plan.

The Veteran Mental Health Consultation Companion (VMHC2) is an application for iOS and Android tablet devices, developed by the Department of Veterans’ Affairs. It has been designed to assist mental health practitioners in the evidence-based assessment and treatment of their veteran patients. All of the screening tools included in this chapter are available in an interactive format using the app. VMHC2 is free and can be downloaded from the App Store or Google Play.

Read/download full GP summary introduction (PDF)

Depressive Disorders

Depressive disorders: Approximately 15 per cent of Australians will experience a depressive disorder at some point in their lives.Depression can involve low mood, a loss of interest in usually enjoyable activities, changes in sleep and appetite, and low energy. Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are the most effective treatments for depression.

Further Information - Depression

  • Depression Assessment and Treatment: Provides further information, clinical tools and resources to assist health practioners in the assessment and treatment of depression
  • Depression Clinical Resources: Provides health practioners clinical resource such as; factsheets, self-hep resources, online information and, consumer and carer guidelines.

Panic disorder and agoraphobia

Approximately one in thirty Australians will suffer from panic disorder at some point in their lives, while one in forty will experience agoraphobia. A panic attack is a sudden surge of intense fear that is accompanied by a number of somatic and cognitive symptoms e.g., racing heart, hyperventilation, fear of dying. Panic disorder is the experience of repeated unexpected panic attacks, combined with persistent concern about having another attack or the consequences of the attack.

Read/download full GP ummary on panic and agoraphobia (PDF)

Generalised anxiety disorder

Approximately six per cent of Australians will experience GAD at some point in their lives.

GAD involves:

  • persistent and excessive anxiety and worry about a range of events
  • symptoms associated with anxiety such as restlessness, fatigue, irritability, concentration or sleep difficulties.

Read/download full GP summary on GAD (PDF)

Social anxiety

Around one in twelve Australians will experience social anxiety at some point in their lives.

Symptoms include:

  • fear of social or performance situations in which a person worries about being scrutinised or negatively evaluated by others
  • avoidance of the feared situation, or intense fear and anxiety when exposed to it.

Commonly feared situations include meeting new people, speaking, eating or drinking in public

Read/download full GP summary on social anxiety (PDF)

Further Information - Anxiety

Anxiety Assessment and Treatment: Provides further information, clinical tools and resources to assist health practioners in the assessment and treatment of anxiety.

Anxiety Clinical Resources: Provides health practioners clinical resource such as; factsheets, self-hep resources, online information and, consumer and carer guidelines.

Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD): Although most people recover from experiencing a traumatic event, some will go on to develop a mental health problem such as depression or PTSD. Between 5 and 20 per cent of veterans will experience PTSD at some point in their lives.

Read/download full GP summary on PTSD (PDF)

Further Information - Posttraumatic Stress Disorder

PTSD Assessment and Treatment: Provides further information, clinical tools and resources to assist health practioners in the assessment and treatment of PTSD.

PTSD Clinical Resources: Provides health practioners clinical resource such as; factsheets, self-hep resources, online information and, consumer and carer guidelines.

Somatic Symptom Disorders

Somatic symptom disorders: Somatic symptom disorders include a range of presentations. In the veteran population, chronic pain problems, health anxiety (i.e., hypochondriasis) and psychological factors affecting existing medical conditions are the most likely presentations. Somatic symptoms are associated with high rates of comorbid anxiety and depression.

Read/download full GP summary on somatic symptom disorder (PDF)

Smoking

Smoking: Approximately 15 per cent of Australians over the age of 14 are daily smokers, although the rate has been declining. There is some indication that rates of smoking are higher for veterans (particularly for younger veterans) than for the general population.

Smoking has multiple long-term health impacts, and is a major contributor to preventable disease burden for veterans and their families.

Information, patient resources and assessment tools are available at at-ease.dva.gov.au or in the Appendices.

Read/download full GP summary on smoking (PDF)

Alcohol

Alcohol is a significant issue amongst veterans with about 3 in 10 drinking at risky levels. Alcohol misuse is associated with short-term harms such as accidental injury. It also has significant long-term health risks such as elevated blood pressure, liver problems, sleep difficulties, mood and anxiety problems and cognitive impairment.

Brief psychological interventions are effective and can be delivered by a GP. These include simple feedback about use, advice and goal setting.

Read/download full GP summary on alcohol (PDF)

Illicit and Prescribed Substances

Illicit drugs and prescription medications abuse:Around one third of Australians use illicit drugs at some point in their lives.

Cannabis is the most commonly used, followed by ecstasy, amphetamines and cocaine. Misuse of prescription medication, especially pain medication, appears to be a growing problem with veterans. Co-morbid mental health problems are common, particularly depression, alcohol abuse, anxiety and PTSD. Substance use and suicidal thoughts or behaviours are often related.

Read/download full GP summary on drugs

Further Information - Substance Use

Substance Use Assessment and Treatment: Provides further information, clinical tools and resources to assist health practioners in the assessment and treatment of Substance Use.

Substance Use Clinical Resources: Provides health practioners clinical resource such as; factsheets, self-hep resources, online information and, consumer and carer guidelines.

Grief

Complicated grief: Bereavement is a universal experience. However, sometimes sustained and intense grief can become a chronic debilitating condition. Approximately one in ten bereaved people experience complicated grief, with higher rates amongst those bereaved by disaster or violent death, or with parents who lose a child.

  • Complicated grief involves
  • prolonged experiences of grief, usually for more than one year
  • intense yearning for the deceased; rumination about the death
  • ongoing reactive distress related to the death e.g., anger, bitterness and self-blame
  • sense that life is futile or meaningless; detachment from others.

Read/download full GP summary on complicated grief

Problematic Anger

Problematic anger: Problematic anger and aggression are common problems for veterans and present a potential risk to others. The anger may well be treated as part of interventions for other disorders, such as PTSD or depression, but there may also be some benefit in using anger-specific interventions.

Cognitive behavioural therapy (CBT) interventions can be effective. If family violence is involved, referral to a practitioner with expertise in the area or a family violence program is recommended.

Read/download full GP summary on problematic anger (PDF)

Insomnia

Insomnia: Disturbed sleep is a common complaint among veterans.

It can be caused by illness, stress or by poor sleep habits. Sleep problems can also be related to mental health problems.

Given that depression, generalised anxiety, PTSD and alcohol misuse are relatively common in the veteran population, it is important to screen for these disorders if chronic sleep problems are detected. Self-management strategies encouraged by a GP are the first line intervention.

Read/download full GP summary on insomnia (PDF)

Gambling

Problem gambling: Problem gambling is characterised by difficulties to control gambling impulses.

This includes difficulties limiting the money and/or time spent gambling which then leads to negative consequences for the veteran and his or her friends, family or community.

Problem gambling is slightly more common in veterans than the general population, with around four per cent of Vietnam veterans experiencing problem gambling, compared to one to two per cent of the general population.

Read download full GP summary on problem gambling (PDF)

Further Information - Other Common Complains

Other Common Complaints Assessment and Treatment: Provides further information, clinical tools and resources to assist health practioners in the assessment and treatment of other common complaints.

Other Common Complaints Clinical Resources: Provides health practioners clinical resource such as; factsheets, self-hep resources, online information and, consumer and carer guidelines.