Major Depressive Disorder With Psychiatric Emergency in Hong Kong: A Review and Practice Recommendation of the Asian Association of Neuropsychopharmacology

Abstract

Psychiatric emergency (PE) as related to major depressive disorder (MDD) is most commonly understood as the presentation of suicidality or a risk of violence to others. However, MDD-PE can have a wide variety of clinical presentations. The challenges in treating PE arise from the difficulty in fully defining and diagnosing this condition, especially by emergency department and non-psychiatric medical personnel. Additionally, determining the appropriate level of care, as well as resource and other constraints, further complicates the management of MDD-PE. This manuscript reviews the definition, diagnosis, and management of MDD-PE globally, and provides recommendations for clinicians in the context of Hong Kong clinical practice. It reflects the outcomes of a meeting of psychiatrists in Hong Kong convened by the Asian Association of Neuropsychopharmacology. The primary goal of the diagnostic process is to determine a patient's level of risk to themselves and others. The main recommendations include educating clinicians on the diverse presentation of MDD-PE and non-clinical factors that may contribute to risk assessment-emphasizing contextual factors during history-taking. The recommendations also include the stratification of patients into three categories depending on (1) whether hospitalization is warranted and (2) the urgency and intensity of required intervention, with the aim of optimizing resources. Finally, the role of novel interventions, such as fast-acting or non-invasive ones, is discussed.

Keywords: diagnosis; hospitalization; major depressive disorder; psychiatric emergency services; suicide prevention.