關懷身邊情緒病患者

( 胡啟贇 洛杉磯加大醫學院臨床講師 )

眾所周知，由於亞裔對精神病的標籤及其相應的染名化，我們未有充分利用精神健康服務。根據一個全國性的調查結果顯示，患有情緒病的亞裔美國人願意接受藥物治療的人數比白人少24%。只有10%患有精神疾病的華人尋求心理或醫療保健。

加州當前經濟不景氣導致精神衛生經費的削減，許多原本在精神科門診接受護理的病患者現在只能在家庭醫生那裡繼續得到藥物治療。可是， 治療情緒病不僅需要藥物，更需要的是心理治療或輔導。相比精神科醫師有二十分鐘來單一專注於情緒病， 家庭科醫生很多時只有十五分鐘來醫治各種不同的疾病。此外，由於情緒病患者很容易提前終止用藥，往往會導致不良後果。UCLA的研究團隊利用洛杉磯患有情緒病的華人來研究這種現象。研究的題目是在沒有精神科醫師及任何心理輔導和援助下，有多少的粵語病人仍願意接受藥物治療？

根據 UCLA 2011年在醫院精神科學術期刊的研究顯示，原本在精神科門診接受護理的病患者，只有12%於三個月後仍然從家庭科醫生那裡服用藥物 (抗抑鬱藥)。令人不安的是，近90％的患者不再服用對治療情緒病有很明顯功效的抗抑鬱藥！

這結果揭示經濟衰退導致有需要的情緒病華人患者無法得到足夠的照顧。常見的情緒病只要得到適當治療，絕大部分患者都可以康復的。作為家庭成員，朋友，我們如何關懷情緒病背後的…他/她？

情緒病就像感冒一樣，每個人一生中都有可能因為承擔不了壓力而發生。情況有輕重，不一定每個人都需要求醫治療，但有足夠且正確的認識是必要的。如何能夠協助情緒病患者的病情得到控制，並能夠成功返回工作或學校？

1) 堅持治療：按醫師指示服用抗抑鬱藥。與精神科醫生和治療師建立積極的關係。不要因為短期的好轉便停止用藥！

2) 獲得全面護理：社交技巧訓練 (psychosocial rehabilitation)，職業康復，支持小組 (self-helpgroup)，及家庭參與是或不可缺的！

3) 絕不濫用藥物：認清吸毒的後果， 向毒品說不！

4) 家庭關係：家庭的壓力是一個強大的復發原因，而家庭教育和情感支持能降低復發率！

家庭教育是從理解情緒病開始。情緒病包括抑鬱症，躁鬱症，泛焦慮症，創傷後壓力症等等。心理輔導能幫助情緒病患者衝破心理關口。家人如能學懂一些心理輔導的技巧能進一步支持病患者，降低復發率。抑鬱症患者的思想方法會令患者更不快樂，感到痛苦和困擾。家人如知道的話就能夠使用心理輔導帶領病人進入正向思考。例如曾有一個受抑鬱困擾的年輕人，她覺得「自己像個廢人，可有可無。」這時候家人可使用心理輔導， 讓她認清自己負面的思想和情緒，找出不理性的思想陷阱。

(筆者將會於2011年1月22日 (星期六)晚上七時正舉行免費精神健康講座「關懷身邊情緒病」。地點是羅省華人宣道會 (320 Cypress Ave， Alhambra， CA91801) 。查詢: 626-300-9078)

How often do Chinese Americans stay on treatment after transitioning from outpatient mental health to primary care setting?

Gen Hosp Psychiatry. 2011 Jan-Feb;33(1):e5-6. (http://www.ncbi.nlm.nih.gov/pubmed/21353120)

Benjamin K.P. Woo, M.D. Department of Psychiatry, Olive View–UCLA Medical Center, Sylmar, CA 91342, USA

Tracy T. Lo, M.A. Fuller Graduate School of Psychology, Fuller Theological Seminary, Pasadena, CA, USA

Research has suggested Asian Americans are known to underutilized mental health services ^{[1], [2], [3]}. In a national representative sample, Asian Americans were less likely than Caucasians to use prescription drugs for mental illnesses by 23.6 percentage points [1]. Majority of Asian Americans who met criteria for a psychiatric disorder did not use specialty mental health services, and underutilization was particularly prominent among Asian-American immigrants [2]. Among the largest ethnic subgroup, the Chinese Americans, less than 10% of them with mental illnesses sought mental/medical care [3].

For Chinese Americans already receiving outpatient mental health care, frequent premature termination of care often leads to poor outcomes [4]. Le Meyer et al. [2] found that for foreign-born Asian Americans, use of primary care services was unrelated to mental health services use. The current economic downtown has led to cuts in mental health funding, leading to outpatient mental health patients losing their psychiatric services. In an attempt to avoid abrupt psychotropic discontinuation, transitioning these patients to their primary care providers may ensure continuity of care.

We collected data on the prevalence of mental health treatment dropout among a group of Chinese-speaking American clients transitioned from a Los Angeles community mental health center to primary care. There were 25 Chinese-speaking-only psychiatric patients who no longer qualify for specialized outpatient mental health services in the fourth quarter of 2009. All patients were referred back to their own primary care physicians for continuation of psychotropic treatment with a letter indicating discontinuation of psychiatric service. Medication dropout rate was determined by patient self-report. One of the authors (BW) reviewed and abstracted the medical charts of the patients.

Female subjects account for 68.0% (n=17) of the total sample, while 56.0% (n=14) were married. Seventy-two percent (n=18) and 28.0% (n=7) were diagnosed with depressive and anxiety disorders, respectively. All were taking SSRI antidepressants for at least 3 months. For the 18 patients with depressive disorders, the percentage of mild, moderate and severe depression was 28% (n=5), 61% (n=11) and 11% (n=2), respectively. The mean±S.D. for age and years in the US were 45.23±10.78 and 11.2±9.3 years, respectively. All patients identified Cantonese as their primary language, and all had Medicaid as their insurance. Every patient had seen their primary care providers in the past 1 year prior to their mental health clinic termination. However, only three (12.0%) of the 25 patients remained on psychotropic medications 2 months after transitioning to primary care.

We report these findings to shed light on the issue of mental health treatment dropout in an ethnic minority sample. Economic recession can take a toll on governmental agencies, leaving patients without adequate care. Due to their language and cultural barriers, Chinese-speaking-only patients may underutilize mental health services. To lessen such barriers and to foster continuity of care, patients in this sample were referred to their primary care physicians for continuing their psychotropic medication. Particularly troubling was the fact that nearly 90% of the patients in this study stopped taking psychotropic medication after leaving psychiatric care. Future studies should include the perspective of consumers and primary care physicians. It would be important to learn what factors may enhance continuity of psychiatric treatment in primary care setting for Chinese Americans. Without a comparison group, we were not able to determine whether the results indicate ethnic disparities vs. a failure to effectively transfer psychiatric patients to primary care. However, Satre et al. [5] found ethnic disparities in antidepressant use, particularly for Asian-American females. Lastly, studies should further evaluate the cost-effectiveness of behavioral health in primary care for Chinese Americans.

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REFERENCES:
[1] Han E., Liu G.G.: Racial disparities in prescription drug use for mental illness among population in US. J Ment Health Policy Econ 8. (3): 131-143.2005; Abstract
[2] Le Meyer O., Zane N., Cho Y.I., et al: Use of specialty mental health services by Asian Americans with psychiatric disorders. J Consult Clin Psychol 77. (5): 1000-1005.2009; Abstract
[3] Young K.N.: Help seeking for emotional/psychological problems among Chinese Americans in the Los Angeles area: an examination of the effects of acculturation, University of California at Los AngelesLos Angeles (CA)1998: 14.
[4] Kung W.: Chinese Americans' help seeking for emotional distress. Soc Serv Rev 77. 110-134.2003;
[5] Satre D.D., Campbell C.I., Gordon N.S., et al: Ethnic disparities in accessing treatment for depression and substance use disorders in an integrated health plan. Int J Psychiatry Med 40. (1): 57-76.2010; Abstract