Managing Depression with Compassion: A PLAB 2 Guide to Mental Health

Summary:

This scenario involves a patient presenting with low mood and possible depression, compounded by alcohol use. The candidate must perform appropriate data gathering, explore contributing factors, perform necessary examinations, and develop a comprehensive management plan, including support services and follow-up.

Key Points:

Data Gathering and Patient Identification

Confirm both name and age as patient identifiers to ensure you're addressing the correct patient.
Use provided identifiers at the start of the consultation.

Mental Health Assessment

Explore depressive symptoms thoroughly (e.g. mood, sleep, appetite, interest, energy).
Rule out organic causes with vitals and general physical examination.
Consider risk assessment (e.g. suicidal ideation, self-harm).
Alcohol use: Gather details about frequency, quantity, and impact.

Physical Examination

Always mention a focused examination when the patient is present.
Even a brief mention like “I'll check your vitals and do a general examination” is sufficient.
Refer to findings handed over during the station, if available.

Management and Safety Netting

Offer relevant leaflets or information pamphlets (e.g. mental health, alcohol support).
Schedule a follow-up appointment, especially in mental health cases and when medications like SSRIs are involved.
Emphasize the need to monitor medication compliance and side effects.

Alcohol and Medication Interaction

Discuss how alcohol interferes with antidepressant efficacy and can worsen depressive symptoms.
Avoid labeling the patient with an alcohol problem unless assessed with a structured tool (e.g. AUDIT questionnaire).
Instead of naming a specific service (e.g. "Drug and Alcohol Service"), say: “I will refer you to a clinic that supports people in cutting down alcohol use.”

Important Considerations:

Avoid sounding judgmental. Rephrase questions like “You don’t have friends?” to more supportive statements.
Use non-verbal empathy (nods, soft tone) instead of overused stock phrases.
Do not refer patients directly to the internet—use trusted professional resources or support groups like Alcoholics Anonymous or Drinkline.

Diagnostic Approach:

Confirm identity (name, age).
Take a focused psychiatric history (depression screen, risk assessment).
Explore alcohol consumption and its context.
Rule out physical comorbidities with basic physical examination.
Consider screening tools if addiction suspected (e.g. AUDIT).

Management:

Education: Explain the diagnosis and treatment options clearly.
Medication: SSRIs if indicated, with discussion on benefits, side effects, and interaction with alcohol.
Support Services: Offer referral to general support groups or specialist clinics, avoiding unnecessary specifics unless confident.
Follow-Up: Emphasize importance of follow-up for medication compliance and reassessment.
Lifestyle Advice: Encourage reduced alcohol intake; offer practical help.

Communication Skills:

Use clear, empathetic language without being condescending.
Respond to patient concerns with solutions, not more questions.
Be careful with tone—avoid sounding scripted or dismissive.
Signpost clearly when shifting topics (e.g., “Now I’d like to ask about your lifestyle”).

Ethical Considerations:

Maintain patient confidentiality (assumed unless specific concern).
Ensure informed consent before examination or referral.
Respect patient’s autonomy—support without imposing.
Avoid overpromising referrals or interventions beyond your scope.

Additional Resources:

NICE Guidelines on Depression in Adults
GMC Good Medical Practice – Domains 1 & 2 on clinical care and communication
Drinkline: National alcohol helpline (UK)
Alcoholics Anonymous UK