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Patients with Mood Disorders |
Health Literacy
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Patient and families should be educated on:
• The causes, symptoms and natural history of major depression
• Treatment options (trial and error approach)
• What to expect during the course of treatment
• How to monitor symptoms and side effects
• Follow-up protocols (office visits and/or telephone contacts)
• Early warning signs of relapse or recurrence
• Length of treatment.
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3 |
Patients with Mood Disorders |
Accessibility
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Percent of individuals in high risk groups below with documented screening for major depression at least on one occasion :
• Substance abuse or substance abuse withdrawal
• Other psychiatric illnesses
• Own or family history of depression
• Major loss/traumatic events or life changes
• Multiple (greater than 5/year) medical visits or multiple unexplained symptoms
• Work or relationship dysfunction.
• Cardiac disease, diabetes or other major physical illnesses
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4 |
Patients with Acute Conditions |
Patient-Centeredness, Patients with Mood Disorders
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Additional support (e.g., more frequent direct contacts with primary health care staff or telephone contacts) should be considered for patients with depression who are assessed to be at high risk of suicide.
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Patients with Acute Conditions |
Accessibility, Patients with Mood Disorders
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People presenting with suicidal, assaultive or homicidal thoughts and/or plans, which make the clinician uncertain of safety of the patient or others: Proportion who receive same-day specialized mental health care.
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13 |
Shared Care |
Patients with Chronic Conditions, Patients with Mood Disorders
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Availability of chronic disease management strategies (including collaborative care) and additional strategies (such as self-management) improves the detection and care of patients with depression.
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14 |
Patients with Mood Disorders |
Continuity, Patient-Centeredness
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Frequency of contact for people with major depression should be weekly for severe depressive symptoms; every 2-4 weeks if mild or moderate symptoms are present.
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17 |
Patients with Comorbid Conditions |
Competence, Patients with Mood Disorders
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Physical health checks should pay particular attention to hormonal disorders (e.g., diabetes and hyperprolactinemia), heart disease risk factors (e.g., blood pressure and lipids), side effects of medication, and lifestyle factors (e.g., smoking). These must be recorded in the notes.
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18 |
Patients with Mood Disorders |
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Treatment changes occur for non-responsive depression (e.g., no or minimal response after 4-8 weeks of antidepressant treatment).
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23 |
Shared Care |
Patients with Mood Disorders
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Availability of stepped (matching of service to needs/ treatment failures) collaborative care can improve the care and outcome of depression, anxiety disorders, comorbid conditions, substance use and mental health disorders for children, adolescents, and adults in primary health care.
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39 |
Patients with Comorbid Conditions |
Patients with Anxiety Disorders, Patients with Mood Disorders
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Consider the possibility of mood, anxiety or somatoform disorders, particularly in the presence of medically unexplained heart system, digestive system and nervous system symptoms or emergency room visits for medically unexplained physical symptoms.
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40 |
Early Detection |
Accessibility, Patients with Mood Disorders
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For individuals affirming one of the two key symptoms of depression (Over the past month, have you been bothered by little interest or pleasure in doing things? By feeling down, depressed or hopeless?), clinicians should consider using a quantitative questionnaire (e.g., Patient Health Questionnaire-9 (PHQ-9)) to further assess whether the patient has sufficient symptoms to warrant a diagnosis of clinical major depression and a full clinical interview.
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48 |
Patients with Mood Disorders |
Health Promotion
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Percent of individuals with major depression with documentation (on at least one occasion) of discussion regarding the benefits of exercise and the factors that would increase its effectiveness (e.g., realistic expectations, frequency and intensity of exercise development of a feasible plan).
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52 |
Patients with Mood Disorders |
Continuity
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Use of evidence-based relapse prevention interventions (e.g., depression prevention specialist follow-up phone calls) for patients who have recovered from major depression.
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56 |
Psychotherapy |
Patients with Mood Disorders, Continuity
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Where patients have responded to a course of individual cognitive behavioural therapy (CBT), consideration should be given to follow-up sessions, which typically consist of 2 to 4 sessions over 12 months.
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57 |
Competence |
Patients with Mood Disorders, Patients with Comorbid Conditions
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Training and supervision for primary health care providers on how to build a therapeutic alliance with adults suffering from serious and persistent mental illness and physical comorbidities.
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58 |
Patients with Mood Disorders |
Competence
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Percent of individuals with major depression who have been evaluated for manic or hypomanic episodes.
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61 |
Youth |
Patients with Mood Disorders
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Multimodal quality improvement initiatives lasting 6 months or longer that foster access to evidence-based counseling/psychotherapy for children and youth with depression should be undertaken.
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67 |
Health Conditions |
Patients with Mood Disorders
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Percentage of adult patients with major depression who show a marked improvement on standardized measures (e.g., Patient Health Questionnaire -9 (PHQ-9) score less than 5, The Hamilton Depression Rating Scale (Ham-D) score of 7 or less) within 6 months of initiating treatment.
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78 |
Equity |
Patients with Mood Disorders, Competence
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Availability of specialized staff who can act as case managers and coordinate treatment between providers for minority populations.
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92 |
Patients with Mood Disorders |
Psychotherapy, Medication
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In moderate to severe depression, antidepressant medication should be routinely offered to all patients before psychological interventions.
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103 |
Youth |
Self-Management Support, Patients with Mood Disorders
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Self care manual for adults and adolescents with any and all forms of depression is offered.
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124 |
Psychotherapy |
Patients with Mood Disorders, Self-Management Support
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Clients with major depression should be referred to freely available web-based, self administered, cognitive behavioural therapy (CBT) based programs (e.g., http://moodgym.anu.edu.au/).
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