Analysing UK clinicians’ understanding of cognitive symptoms in major depression: A survey of primary care physicians and psychiatrists

Abstract

Background: Cognitive dysfunction occurs in depression and can persist into remission. It impacts on patient functioning but remains largely unrecognised, unmonitored and untreated. We explored understanding of cognitive dysfunction in depression among UK clinicians.Methods: A multi-step consultation process.Step 1: a multi-stakeholder steering committee identified key themes of burden, detection and management of cognitive dysfunction in depression, and developed statements on each to explore understanding and degree of agreement among clinicians.Step 2: 100 general practitioners (GPs) and 100 psychiatrists indicated their level of agreement with these statements.Step 3: the steering committee reviewed responses and highlighted priority areas for future education and research.Results: There was agreement that clinicians are not fully aware of cognitive dysfunction in depression. Views of the relationship between cognitive dysfunction and other depressive symptom severities was not consistent with the literature. In particular, there was a lack of recognition that some cognitive dysfunction can persist into remission. There was understandable uncertainty around treatment options, given the current limited evidence base. However, it was recognised that cognitive dysfunction is an area of unmet need and that there is a lack of objective tests of cognition appropriate for depressed patients that can be easily implemented in the clinic.Limitations: Respondents are likely to be 'led' by the direction of the statements they reviewed. The study did not involve patients and carers. Conclusions: UK clinicians should undergo training regarding cognitive dysfunction in depression, and further research is needed into its assessment, treatment and monitoring.

Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression

“…This finding is consistent with the results of several studies reporting persistence of cognitive symptoms in the remission phase (12, 25). The lower reporting of cognitive symptoms by HCPs in the remission phase could indicate less awareness and/or attention to these symptoms, as previously suggested by a survey of PCPs and psychiatrists in the United Kingdom (26). As cognitive symptoms of MDD are associated with psychosocial and functional impairment, low quality of life (4), and a higher risk of relapse (16), it is important that such symptoms are identified and managed.…”

Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ?

“…Patient-centered consulting approaches allow treatment to be based on individual patient symptoms and preferences, which may result in improved outcomes (36,37). Other studies have also reported low recognition by HCPs of cognitive symptoms in patients with MDD (38)(39)(40). A survey of Italian psychiatrists showed that, although psychiatrists considered cognitive symptoms among the most relevant residual symptoms in MDD, these symptoms were not always taken into consideration when selecting antidepressant therapy (38).…”

Challenges of residual symptoms and functioning in management of MDD

“…22 Currently, there is no consensus about the best tools or test battery to accurately and efficiently assess cognitive impairment associated with depression in clinical practice. Nor are there data to refute or confirm that the same tools can be used in younger and older adults, male and female.…”