InnovAiT: Education and inspiration for general practice

The term ‘personality’ refers to the enduring characteristics which influence the way a person thinks, feels or behaves in a wide variety of circumstances. A personality is deemed to be ‘disordered’ when it causes suffering to that person or to other people. The Department of Health estimates that 10–13% of the adult population have personality disorders, and it is therefore extremely important that GPs are aware of current thinking regarding the classification, diagnosis and treatment of these complex conditions.

Depression is the most common mental illness in the elderly, with an estimated 15% of the elderly population living in the community having clinically significant depressive symptoms. It is of medical and social importance as it is associated with increased morbidity and mortality, poor quality of life and increased social dependence. Recognition of depression in this age group has been found to be poor, with more patients presenting with somatic physical symptoms. Treatment can also be difficult compared with younger patients, with increased prevalence of side effects of medication, polypharmacy and poor compliance. Primary care practitioners are therefore crucial in the detection and early instigation of appropriate treatment. This article looks at the risk factors, presentation and treatment options for depression in the elderly age group.

This article provides an overview of the diagnosis and management of depression, focusing on the primary care setting. We also discuss suicidal behaviour, which may be a symptom of depressive disorder but can also be indicative of other difficulties. Therapeutic interventions for suicidal behaviour are described.

Skin malignancies are extremely common with over 100 000 new cases diagnosed in the UK every year. Skin lesions may be a presenting complaint or identified as an incidental finding during consultation.

Fatigue is the most common symptom experienced by patients with chronic progressive illnesses such as cancer, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and multiple sclerosis (MS). While it is normal to feel fatigue when the body or mind has been exerted, pathological fatigue is pervasive, may occur with little or no exertion and may not be relieved by sleep or rest. Fatigue has both physical and psychological components. It may manifest physically as a feeling of weakness or psychologically as mental tiredness, lack of motivation and reduced concentration.

With a rapidly ageing population, it is widely accepted that many more of us will become carers of a family member before needing care ourselves later in life. With anticipated medical advances and higher expectations with regard to quality of life, it is estimated that one in three of us will become a carer at some point. This article aims to define who carers are and their importance to the well-being of the general population, describe their health-related problems and explore the different ways GP surgeries can support them.

Prescribing is a fundamental activity of general practice and prescriptions are a major cost to the health service. Yet the art and practical details of prescribing are rarely learnt in medical school; junior doctors lack confidence in writing prescriptions (Illing, 2008). Prescribing is not straightforward and involves a complicated decision-making process, by both patient and doctor, whose intricacies and governing factors are not yet well understood but where inadequate skills translate to suboptimal prescribing (Jackson et al., 2002). The prescribing process is not simply about choosing a medicine and writing a prescription.