Workplace : Depression Center, Prasrimahabhodi Psychiatric Hospital, Ubon

Ratchathani, Thailand

Background : Globally, depression is a leading cause of disability across

all age groups, currently ranked the fourth in terms of burden of disease and will

be ranked the second highest in 2020. Appropriate treatment and therapies are

more important for reducing depressive symptoms. Therefore, clinical practice

guideline of psychosocial intervention in depressive disorders should be

developed for psychiatric nurses in tertiary care centers.

Objective : To develop clinical practice guideline of psychosocial intervention

/therapy in depressive disorder for psychiatric nurses in tertiary care centers.

Material and method : Clinical practice guideline has been developed

through five main processes: 1. initial draft prepared by CPG meeting group

following careful review of existing practice and available published evidence

on topic. International evidence-based practice and consensus statements

considered and included as appropriate. All guidelines adapted to local

conditions. 2. Consultation with another group member and with an appropriate

external specialists where appropriate. 3. Test and evaluation with appropriate

sample. 4. Draft for implementation and evaluation after implementation.

5. Continues development after implementation.

Results : There are four processes of this clinical practice guideline

which are as follows: 1. Severity evaluation of depressive disorder. 2. Problem

evaluation related to depressive disorder. 3. Psychosocial therapy with severity;

mild to moderate disorder managed with exercise or problem-solving, moderate

to severe disorder managed with Cognitive-Behavior Therapy or Interpersonal

Therapy 4. Outcome evaluation was done by testing 22 depressive disorder

patients after therapy. There were 18 patients who received full course therapy

with psychosocial intervention. It is found that severity of depressive symptom

was reduced by 100 percent and satisfaction level of patients was found to be

100 percent.

Clinical practice guideline of psychosocial intervention in depressive disorders

for psychiatric nurses in tertiary care centersAuthors : Assoc.Prof.Dr.Somporn Rungreangkulkij, Dr.Thoranin Kongsuk, Mrs.Supattra Sukhawaha, Mrs.Jintana Leejongpermpoon, Miss.Supranee Phimtra, Miss.Kedsaraporn Kenbubpha,

Presenter : Kedsaraporn Kenbubpha, kkenbubpha@yahoo.com

Algorithm Psychosocial Intervention for MDD in Tertiary Care Settings

Patients come to health services

MILD(9Q=7-12)

Step I

Assessment

Step II

Planning

Step III

Intervention

Step IV

Evaluation

Non history diseases to

prohibit exercise and/or non

specific social problem

Present distorted of negative

thoughts and/or non specific

relationship problem

Present specific social problem and/or have diseases to

prohibit exercise

Present specific

relationship problem

Interpersonal Psychotherapy

(IPT)

Problem solving

therapy (PST)

Cognitive Behavioral

Therapy (CBT)

Exercise Therapy

(ET)

NO

YES

Case conference with Multidisciplinary health professionals for finding others

methods

Moderate(9Q= 13-18)

Severe(9Q≥19)

Psychiatrists diagnose to be major depressive disorder

Outcome assessment of therapy with 9Q at least 6 months continuous

Stop treatment

Assessment severity of depressive symptoms by using 9 - questions (9Q)

Assessment specific problem of depressive symptoms for choosing suitable therapy to depressed patients

9Q scores <7 or not?

to to

References

1. Mello M.F. et al. (2005). A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorder.Eur Arch Psychiatry Clin Neurosci.Vol 255;75-82 2. Luty S.E. et al. (2007); New Zealand. Randomized controlled trial of interpersonal psychotherapy and cognitive behavioral therapy for depression. British Journal of Psychiatry Vol.190; 496-502. 3. Bell A C, D’Zurilla T J (2009). Problem-solving therapy for depression: A metaanalysis. Clinical Psychology Review . Vol. 29; 348–353 4. Cape J (2010). Brief psychological therapies for anxiety and depression in primary care: metaanalysis and meta-regression. BMC Medicine. ; 8:38 5. Gellis Z.D.& Kenaley B. (2008). Problem-Solving Therapy for Depression in Adults: A Systematic Review. Social Work Practice. March Vol. 18 ( 2); 117-131 6. Peraton LG, Kumar S, And Machotka Z. (2010).Exercise parameters in the treatment of clinical depression: a systematic review of randomized controlled trials. Journal of Evaluation in Clinical. Vol.16 ; 597-624.

Conclusion and suggestion : This cl inical practice guideline

for psychiatric nurses was proved to be very effective in the reduction of

depressive symptoms, with 100 percent patient satisfaction. Therefore, this

guideline should be practiced in all secondary care centers and the nurses

in secondary care centers should be trained for correct and effective

implementation of this guideline.

Keywords : clinical practice guideline, psychosocial therapy, depressive

disorders, psychiatric nurses, tertiary care centers