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Chronic Pain & Mood Disorders

Greg Tippin, Ph.D., C.Psych.

Michael G. DeGroote Pain Clinic, Hamilton Health Sciences

McMaster University, Dept of Psychiatry & Behavioural Neurosciences

13 Jul 2022

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  • Relationships:

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    • Chronic Pain Centre of Excellence (CPCoE) for Canadian Veterans
    • Employee of Hamilton Health Sciences

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Presenter Disclosure of Affiliations

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Learning Objective

By the end of this presentation,

participants will be able to more effectively

identify and manage mood disorders.

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Depression

Bipolar

Prevalence

Assessment

Management

Barriers

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Mood Disorders

Depressive Disorders

Major Depressive Disorder

Persistent Depressive Disorder

Bipolar Disorders

Bipolar I Disorder

Bipolar II Disorder

Cyclothymia

Goodwin & Koukopoulos, 2007; Goodwin & Jamison, 2007

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Mood Disorders: Prevalence

Primary Care

Mood Disorders

7-14% Major Depression

2% Persistent Depression

1.8% Bipolar I + II + NOS

0.4-1% Cyclothymia

APA, 2013; Merikangas et al., 2007; Rucci, 2003; Schramm, Klein, Elsaesser, Furukawa, & Domschkle, 2020; Ustun & Von Korff, 1995

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Mood Disorders: Prevalence

Chronic Pain

Hooten, 2016; Rayner et al., 2016; Stubbs et al., 2014

Mood Problems with Chronic Pain

61% probable depression (PHQ-9)

34% severe depression (PHQ-9)

24% bipolar w/ chronic pain

14% bipolar w/ migraine

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Depression: Assessment

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Cut points

20 = Severe

15 = moderately-severe

10 = moderate

5 = mild

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Levis, Benedetti, & Thombs, 2019

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Depression: Management

Stepped Care

Self-Help Workbooks

Tele CBT/Coaching

  • CMHA BounceBack
  • Wellness Together Canada

Counselling

Referral outpatient program

Psychotropic

Ontario Structured Psychotherapy Program

Cut points

20 = Severe

15 = moderately-severe

10 = moderate

5 = mild

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Depression: �Assessment

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Bipolar: Assessment

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Bipolar: Management

National Institute for Health and Care Excellence; Merikangas et al., 2007; Viktorin et al., 2014

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Mood Disorders: Barriers

Knowledge

    • Misdiagnosis
    • Unsure access
    • Normalization of depression
    • Fear of consequences

Attitude

    • Help seeking
    • Pessimism of effectiveness
    • Lack of motivation
    • Stigma
    • Negative past experiences

Behaviour

    • Difficulty measuring care
    • Practice habits
    • Misdiagnosis

Organization

    • Cost
    • Resource limitations
    • Lack of available treatments

Chekroud et al., 2018; Coventry et al., 2011; Marcus Arnaez et al, 2019; Mohr et al., 2010; Perlis, 2005; Rochlen et al., 2010; Whitebird et al., 2013

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Takeaways

Prevalence: Common, though frequent oversight

Assessment: PHQ-9 / DASS-21

Management: Stepped-care

Barriers: Under identification, undertreatment

Depressive Disorders

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Takeaways

Prevalence: Less common, higher risk

Assessment: Mood Disorders Questionnaire (w/ caveat)

Management: Referral, psychoeducation

Barriers: Stigma, specialized care, misdiagnosis

Bipolar Disorders

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Resources

PHQ-9: https://www.phqscreeners.com

PHQ-9 Manual: https://www.phqscreeners.com/images/sites/g/files/g10016261/f/201412/instructions.pdf

Depression Anxiety Stress Scales: http://www2.psy.unsw.edu.au/dass/

Depue et al., (1981). General Behavior Inventory: https://cls.unc.edu/wp-content/uploads/sites/3019/2014/06/GBI_self_English_v1a.pdf

Mood Disorders Questionnaire: https://www.sadag.org/images/pdf/mdq.pdf

National Institute for Health and Care Excellence (NICE): Bipolar Disorder: Assessment and Management Clinical Guideline: https://www.nice.org.uk/guidance/cg185

CMHA BounceBack: https://bouncebackontario.ca/adults-19/

Wellness Together Canada: https://wellnesstogether.ca/en-CA

MindBeacon: https://www.mindbeacon.com

Centre for Clinical Interventions (Bipolar): https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Bipolar