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Feb 12 2018 – Mood Disorder Case

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Download Document: Recommendations Feb 12 2018

Date: Feb 12 2018

PLEASE NOTE that Project ECHO® Care of the Elderly case recommendations do not create or otherwise    establish  a  provider-patient relationship between any   ECHO Care of the Elderly Hub team member/presenters and any patient whose case is being presented in a Project ECHO® setting.

All resources are posted in the COP website, under “Jan 22 2018 Responsive Behaviors”. You must be logged in to view articles:

Case Synopsis:

50-64 y.o. Female with longstanding chronic pain secondary to severe osteoarthritis and fibromyalgia, complicated by anxiety, low mood, insomnia and family discord. She was started on opioids and clonazepam by her previous physician.

1) Resources for non-pharmacological pain/mood management that I can use with the patient in office and she can use at home.

2) Medication suggestions re: panic attacks/anxiety, fibromyalgia and OA.

Summary of Recommendations:

Further investigations/workup

  1. Connect with previous family doctor, possibly a phone conversation to corroborate past medical history
  2. Ongoing assessment with client using pain inventory, mood (PHQ9/GDS) and Caregiver burnout. Potentially using caregiver burnout as a driver.
  3. Assess risk factors for depression, SIGECAPS, losses such as death of husband, job or access to grandchildren, fear for daughter being diagnosed with a hereditary illness
  4. Further exploration of poor sleep, ?apnea
  5. Further exploration of chronic anemia, ?multiple myeloma, other causes of blood loss
  6. Consider discussing colonoscopy with client once, considering change in pt/physician relationship status
  7. Ontario Telemedicine Network (OTN) consults with a psychiatrist, in office with primary care MD. Furthermore, may consider palliative care consult via OTN for pain assessment.
  8. Work on small goals one at a time ex. Walk through discussion topics from the fountain of health or use strategies from Mind over mood, Mood Gym App- start small – review one chapter at a time see how it goes.
  9. Consider Arthritis Society 1-day Fibromyalgia program, as attendance to fibromyalgia/arthritic program can have minimal attendance.
  10. Encourage physical activity programs that are manageable for client such as aquafit.
  11. Further explore potential social supports, as well as previous relationship with husband.
  12. Further explore potential community resources for some iADLs assistance and respite
  13. Consider engaging with the LHIN to complete a coordinated care plans

Pharmacologic recommendations

  1. Consider decreasing Cymbalta dose, while keeping cognizant of patient’s pain and mood symptoms.
  2. Review medications and anticholinergic burden, ?tolterodine added on as result of other medications.
  3. Continue to work on gradual dose reduction of Percocet and clonazepam as you have trialed



  • Foundation of health: Optimal Aging: 5 Domains
  • SIGECAPS- Slide
  • BC resources– self help, Change ways- Process maps
  • Mind over mood
  • Mood Gym App