MS an Mental Health. Alison Carolan MS Mental Health Nurse Kings College Hospital. IMPARTS December 2013

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1 MS an Mental Health Alison Carolan MS Mental Health Nurse Kings College Hospital IMPARTS December 2013

2 MS and Mental Health MS is an autoimmune disease MS carries high risk of common mental disorders and psychiatric comorbidity The relationship between psychiatric morbidity and psychological problems in MS is likely to be multifactorial: as a result of chemical changes/neuropathological/ neurobiological process triggered in those susceptible biologically/genetically as a response to illness changes and demands/reactive to countless psychosocial factors Access to treatment for depression and anxiety could significantly impact mortality rates, outcomes of disease burden and suicide risk

3 How does it start? Common initial symptoms Sensory disturbance Weakness Poor balance Loss of vision or double vision Time course Gradual onset of symptoms (over hours / days) Symptoms plateau (days / weeks) Resolution: complete or partial (weeks / months) ( RRMS) Prevalence 2.5million people worldwide 85,000 in UK (1 in 8 )

4 Disability Types of MS RELAPSING-REMITTING MULTIPLE SCLEROSIS BENIGN MULTIPLE SCLEROSIS SECONDARY PROGRESSIVE MULTIPLE SCLEROSIS PRIMARY PROGRESSIVE MULTIPLE SCLEROSIS Time

5 Mental Health in MS MS lifetime prevalence Gen pop Depression 40-50% (20% a/p) 10-20% (3-10% a/p) Suicide Suicidal intent x higher 6.4% attempts 28.6% 0.1% 1% attempts 3.8% Anxiety 36% (14% a/p) 21% (12% a/p) GAD 18.6% (10% a/p) 5.1% (1.5% a/p) Psychosis 3% 1%

6 Mental Health in MS Cognitive impairment 65% 3.2% Fatigue 75% 23.7% Euphoria PBA Iatronegnic effects of symptom management meds 25% 10% / /

7 How to deliver an integrated approach? The NHS & services have been changing Primary care to mental health via GP & self referral to IAPT/ IPTS (3 rd wave therapies) Community Mental Health Services - severe 3 rd sector Private healthcare stepped care approach works best, but so do other ideas from Physical and mental health care:one agenda KHP day Oct 2013 MS Mental Health Nurses - 2 benchmarking projects and

8 Kings MS Mental Health Service Referral from MS professional Assessed by MS Mental Health Nurse mood, functioning, risk, MS symptoms, work & social adjustment, medications Discharged Treatment plan Stepped care model - measures Self help / self management Psychosocial support, SaMS, LTC, PIU, Home visit. Cognitive Therapy Liaison Review outcomes Signposting & Referral on i.e. IAPT, Kings therapy project Neuropsychiatry Psych Med MS groups Trials Voc rehab M-CBT in PPMS UWaT

9 IMPARTS Meetings for referral algorithm development Delivery of ipad with measures: PHQ -9 Depression GAD 7 Anxiety Hosp Anxiety & Depression Scale Work and Social Adjustment Scale CORE 10 Dep, anxiety, function, risk, trauma Chalder fatigue scale & Jenkins sleep scale Work and social adjustment

10 IMPARTS February & March Literature development Focus Group service users Feedback from MS Team 8 th March Training Mental Health Focus Day

11

12 Pilot for ipad introduction Suite 5 waiting room for 3 MS clinics (over 20 pts) PIU 1 MS MH clinic Access to EPR Leaflet & monitoring

13 MS clinic data 37 results 16 x Dr Brex, 14 x Dr Silber, 5 x Pauline Shaw, MS Specialist Nurse Depression 5% 2 pwms scored over 15 inc 2 risk Anxiety 11% 4 pwms scored over 10 HADS 47% 14/30 pwms scored over 10 total score CORE 10 55% - (17/31) 13 pwms scored over 10 inc 1 risk, 2 pwms scored over 20 inc 1 risk 2 pwms scored over 30 inc 2 risk Fatigue 71% - 22/31 pwms scored over 12 Sleep 61% - 19 pwms scored over 5 WSAS 62% - 18/29 pwms scored over 10 (Nb CORE 10 picked up 1 additional pw risk on score of under 10)

14 MS clinic data 37 patients (some missing results) Dr Brex x 16, Dr Silber x 14, Pauline Shaw x 5 Proportion % 60 55% 61% 62% 50 47% % 11% 0 Depression (PHQ-9 15) Anxiety (GAD-7 9) HADS ( 10) Core10 ( 10) Fatigue ( 12) Sleep ( 5) WSAS ( 10)

15 MS mental health clinic data 21 patients 15f/6m Dr Brex x 6 & Dr Silber x 15 Depression 33% 7/21 pwms scored over 15 Anxiety 38% 8/21 pwms scored over 10 HADS 66% 14/21 pwms scored over 10 total score CORE 10 76% 16/21 pwms scored over 10 50% 8/16 with risk issues Fatigue 66% 14/21 pwms scored over 12 Sleep 77% 14/20 pwms scored over 5 WSAS 52 % 11/21 pwms scored over 10

16 MS mental health clinic data 21 patients 15f/6m Dr Brex x 6 & Dr Silber x Proportion 80 76% 77% 70 66% 66% % 40 33% 38% Proportion Depression (PHQ-9 15) Anxiety (GAD- 7 9) HADS ( 10) Core10 ( 10) Fatigue ( 12) Sleep ( 5) WSAS ( 10)

17 Interventions Epr clinic note Clinic letter Referral into MS Mental Health Clinic Thank you for completing the screening questionnaires at your recent visit to Kings. I have attached some information for you, your scores indicated that you are experiencing some symptoms of anxiety and/or lowered mood, the leaflet is designed to guide you towards some resources that may be useful. Leaflet Referral to

18 Conclusions Mental health problems are common in PwMS Development of a signposting leaflet has been helpful Developing discussions with services who could take referrals for tx underway Need to develop waiting room screening Trial toolkit Revised measures to include smoking.

19 Thank you h/imparts/index.aspx

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