The management of depression in the primary care setting should ideally take a biological, psychological, and sociological approach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychological therapies and psychosocial interventions improve the outcome of treatment when combined with pharmacotherapy. Clinical depression is treatable and thus efforts should be made to alleviate the suffering of patients with depression.
Cancer patients and suicide and depression ; Primary Health Care ; Management ; Depression motion ; Part

Myasthenia gravis (MG) is a rare autoimmune disorder characterised by fluctuating and variable combination of muscle weakness and fatigue. Most cases are due to T-cell mediated autoantibodies against post-synaptic acetylcholine receptors (AChR-Ab), thus preventing acetylcholine from binding and signalling skeletal muscle to contract. 1 The annual incidence is 7-23 new cases per million. 1 It can occur at any age but with two peaks; an early- onset (20-40 years) female-predominant and a late-onset (60-80 years) male-predominant peak. MG is classified into ocular and generalised (80%). More than half the patients initially present with ptosis and diplopia but half will progress to generalised disease with involvement of bulbar, limb and respiratory weakness. Those presenting as generalised MG can also develop eye signs later. 1 It is important to recognise MG early because it is highly treatable. Untreated disease leads to permanent weakness. 2 Treatment reduces mortality from life- threatening myasthenic crisis. 1,3 Misdiagnosis leads to potentially harmful interventions and inappropriate management. 4,5 Diagnosis in late-onset MG is easily missed 2,3,4,5 because of overlapping symptoms with other diseases common in the elderly. We report a case of delay and misdiagnosis in an elderly patient with co-morbidities.
Myasthenia Gravis

Background: Suicide may be conceptualized as an escape from intolerable predicaments, in particular, mental illness and environmental stressors. The operationalized predicaments of suicide (OPS) is a 4 category framework designed to assist in the classification of suicide. The objective was to examine whether this framework is potentially useful. Method: 18 psychiatrists from 6 different countries examined 12 written coroners’ reports of suicide and rated each report according to the OPS. 16 of these raters then also completed a qualitative questionnaire regarding the framework. Results: In 89.8% of cases the raters where able to make a decision regarding the drivers which led to the suicides. The respondents displayed modest inter-rater correlation (Kappa = 0.42; P < 0.0001). In the qualitative section, respondents supported the face validity of OPS and considered it potentially useful. Feedback allowed improved wording of the OPS instructions. Conclusion: The OPS has potential as a useful framework. The OPS instructions have been improved and further studies are justified.