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Management of common mental disorders for psychogeriatric patients in Hong Kong — a comparison of two clinics

  • Mimi Mei Cheung Wong (a1), Pui-fai Pang (a1) and Michael Gar Chung Yiu (a1)
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Abstract
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This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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1 Common Mental Disorder Clinic, Kowloon West Cluster. Guideline for Common Mental Disorder Clinic Cross-cluster Referral. HAHO-COC-GL-Psy-010-V1.
2 Park, M, Unützer, J. Geriatric depression in primary care. Psychiatr Clin North Am 2011; 34: 469–87.
3 Unützer, J, Park, M. Strategies to improve the management of depression in primary care. Prim Care 2012; 39: 415–31.
4 Uppal, S, Jose, J, Banks, P, Mackay, E. Cost-effective analysis of conventional and nurse-led clinics for common otological procedures. J Laryngol Otol 2004; 118: 189–92.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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Management of common mental disorders for psychogeriatric patients in Hong Kong — a comparison of two clinics

  • Mimi Mei Cheung Wong (a1), Pui-fai Pang (a1) and Michael Gar Chung Yiu (a1)
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Management of Common Mental Disorders for Psychogeriatric patients in Hong Kong- a comparison of two clinics after one year of treatment

Mei Cheung Wong, Psychiatrist, United Christian Hospital, Hong Kong
Pui-fai Pang, Psychiatrist, United Christian Hospital, Hong Kong
Michael Gar Chung Yiu, Psychiatrist, United Christian Hospital, Hong Kong
25 February 2018

We would like to update the findings of our pilot study which compared the enhanced Common Mental Disorder Clinic (CMDC)1 and conventional Specialist Psychiatric Outpatient Clinic (SOPC) in the management of common mental disorders (CMDs) for psychogeriatric patients in our hospital in Hong Kong. In our last letter to the editor, different clinical factors were compared between the two groups at six-months’ post-treatment. This time, findings of one-year post-treatment were available.

The CMDC is a one-year program with multidisciplinary involvement. There were 30 patients in each group. After one year of treatment, only fifteen (50%) patients remained in the CMDC while 23 remained in the SOPC (p=.03). Ten (33.3%) patients completed the CMDC program and were successfully discharged from the CMDC. They did not require any medication for their CMDs. One patient refused to attend medical follow up. One patient was transferred from CMDC to SOPC, as she was found to have dementia. Another patient was transferred to the general outpatient clinic for continuation of treatment for her mixed anxiety and depressive disorder.

Concerning psychological intervention, half of the patients in the CMDC group (50%) were referred to a clinical psychologist (CP), while ten had good adherence to CP appointment. For the SOPC group, only three (10%) patients were referred to clinical psychologist (p<.05).

Concerning antidepressant use, the rate at one-year follow up was 11 (36.7%) for CMDC vs. 20 (69%) for SOPC patients (p=.02). Profiles of benzodiazepine and hypnotic use and prescription were similar prior to consultation, after the first consultation, six-months post follow-up, and one-year post follow-up. Eight (26.7%) patients did not require benzodiazepine and hypnotics after the first consultation for both groups. The reduction in benzodiazepine and hypnotics used was statistically significant (p=.04). At one year of treatment, ten (33.3%) patients were taking benzodiazepine and hypnotics for both groups.

In summary, psychiatrists of both clinics were able to reduce benzodiazepine/hypnotics use after the patients formally presented to the psychiatric clinic. Nearly half of the patients who were given benzodiazepine or hypnotics did not require it afterwards. Instead, about two thirds of them were treated with antidepressants. Significantly more patients did not require antidepressants at one-year post treatment in the CMDC group. There were also significantly more patients who did not require medical follow up at one-year for the CMDC group.

Remission of CMDs is possible for patients who completed the one-year CMDC. Its psychological and pharmacological component, as well as timely interventions have contributed to its success. The treating team and the patients are aware of the time-limited nature of the program and have expectations that suitable cases can be discharged from the program upon its completion. This helps to ensure that the clinic would not be overwhelmed by continual accumulation of cases. On the contrary, SOPC does not have a specified duration of treatment and the doctors are less ready to discharge patients from the clinic if they are stable on medical treatment. It is not common to refer back stable cases to primary care. Enhanced collaboration between SOPC and primary care in the management of CMDs can help to reduce the burden on SOPC, so that SOPC can have more capacity to deal with complicated and unstable cases.2 The acceptability of psychological interventions is expected to be better if they can be more tailored for elderly patients, in fact many older people expressed a preference for talking therapy.3

References

1. Common Mental Disorder Clinic, Kowloon West Cluster. Guideline for Common Mental Disorder Clinic Cross-cluster Referral. HAHO-COC-GL-Psy-010-V1.

2. Park M & Unützer J. Geriatric Depression in Primary Care. Psychiatr Clin North Am 2011 Jun; 34(2): 469-487.

3. Givens J, Datto C, Ruckdeschel K et al. Older patients’ aversion to antidepressants: a qualitative study. Journal of General Internal Medicine 2006;21:146–151.
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Conflict of interest: None declared

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