Or1340 Active Listening And Psycotherapy In Depressive Disorders-A Family Physician Approach

Nuno Basílio1 e Liliana Fernandes
1UCSP Barcarena
Introduction: Major depressive disorder accounts for about 10-20% of the pathology found in primary care. The first treatment option of the family physician (FP) is active listening therapy and cognitive-behavioural psychotherapy. The goal of this case report is to demonstrate the relevance of these skills for the FP in monitoring and supporting patients with such disorder.
Case presentation: Woman, 55 years, employed as cleaning maid, married with 3 children, from lower-middle social class and with smoking habits. Resort to an emergency FP appointment with a 2-months clinical picture of emotional instability, irritability, weight loss, work incapacity and suicidal ruminations with no plan. She didn’t identify trigger factors but expressed concern about the influence on her relationship with her husband. She was prescribed with 20mg clobazam OID for 8 days, trazodone 50mg OID and paroxetine 20mg OID and an appointment was scheduled within a week for reassessment. She came to the scheduled appointment with a note from Psychiatry Hospital Urgency, which she had been to, with the diagnosis of neurotic depression and medicated with sertraline 100mg OID and mirtazapine OID. Another appointment was scheduled within a month but the patient came earlier with maintenance of clinical symptoms. Then the FP referenced her to a Psychiatric appointment. She returned within a month medicated with valproic acid, clobazam, mirtazapine and quetiapine which she didn’t meet regularly, justified by the poor relationship with psychiatrist. The PF developed a genogram which identified a troubled adolescence with the foster family after her mother’s death and mistreatment at school. The relationship with the adoptive mother was important to her despite the coldness, and she was her caregiver during her last years of life, a fact that she relates to her current clinical condition. The active listening and support psychotherapy were repeated in subsequent appointments with great benefit to the patient. After 3 months, with increased adherence and timely adjustments of medication, the patient has improved her self-esteem and reduced emotional instability, denying suicidal ruminations.
Conclusion: Depressive disorders demand a holistic patient approach, both in diagnosis and in treatment. The current pharmacotherapy is only symptomatic, thus being therapeutic listening and psychotherapy two essential components in the long process of resolving these cases.
Active Listening; Psychotherapy; Depressive disorders