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Feature Article

Making sense of the complex depressed patient. Part 2: temperament and personality factors

Kay Wilhelm

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Abstract

Personality traits tend to be magnified in the presence of stress and depression – they ‘shape’ the presentation and add to the complexity of depressive episodes.

Key Points

  • A person’s temperament and personality style affects onset and course of illness, including depression, in that person.
  • People with some personality styles are very vulnerable to episodes of major depression as well as chronic low mood.
  • The combination of the patient’s temperament and attachment style predict the best approaches to managing depressive episodes and the likely problems that may be encountered.
  • Management of these depressions involves using a problem-based approach, identifying barriers, minimising harm and assessing the need and motivation for more long-term interventions.
  • Antidepressants may be used to treat a depressive episode; assist with mood regulation, anxiety and aggression; and help patients cope with disintegration under stress.
  • Case conferences, second opinions and supervision can all help to ‘lessen the load’. A team approach can be useful but requires an integrated management plan.
  • Different attachment styles invoke different emotional reactions from clinicians. GPs should consider the sorts of patients likely to ‘push their buttons’ and the best ways of responding.
  • Patients should be reappraised after the depression has lifted as some personality dysfunction may resolve and enduring traits may need addressing to diminish vulnerability to further episodes.

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