The College of Psychiatrists’ Winter Conference programme opened with a presentation on relational prescribing by Dr Dimitrios Chartonas, Consultant Psychiatrist with the personality disorder service, Camden and Islington NHS Foundation Trust, London, UK; and Mr David Rogalski, Lead Pharmacist and Independent Prescriber, Camden and Islington NHS Foundation Trust.
Both speakers examined evidence in the area, the complex issue of treatment resistance, and provided advice on how to adopt a relational approach to prescribing.
Mr Rogalski said evidence on how to prescribe is often overlooked in psychiatry. He said psychological factors often predominate in biological treatments.
He highlighted aspects such as provider variables, placebo research, regulatory change, alliance research, expectations and treatment, treatment preferences, and involving the patient in decision-making.
“More than 50 per cent of the positive outcomes of the medication [antidepressants] isn’t due to the pharmacological action of the medication, but the psychosocial factors around the medication,” Mr Rogalski said.
He remarked that “alliance” is not the same as “compliance” and argued that alliance directly correlated with treatment responses. Some of the many elements that fostered effective pharmacological alliance included warmth and presence, good communication, and shared decision-making, he said.
Research showed that patients who received their preferred treatment do better than those who do not. He said this highlights the importance of patient “buy-in” to their treatment.
He also noted the impact of medication use on the environment, outlining that medication use accounted for 25 per cent of the NHS’s carbon footprint.
Dr Chartonas noted how treatment resistance is a problem in psychiatry and one which has grown in recent decades.
Patient, clinician, and systemic factors all have a role in treatment resistance, he told delegates.
As clinicians, our feelings towards a patient can influence prescribing and contribute to the development of treatment resistance, he argued.
He urged prescribers to view “prescribing as partnership” and to work towards cultivating a pharmacotherapeutic alliance focusing on the “whole person” and not just their illness.
This presentation was followed by a talk by Ms Lesley Goodburn on the impact of storytelling as an improvement methodology.
Ms Goodburn spoke about the death of her husband, Seth, from pancreatic cancer and how this led to her work raising awareness.
She movingly highlighted how she set about improving end-of-life care and psychological, emotional, and physical supports for families and patients through the medium of storytelling.
The next session featured six NCHD oral presentations on a wide range of topics. These included a presentation by Dr Yvonne Hartnett, St Vincent’s University Hospital, Dublin, on the topic: ‘Prevalence of psychiatric pathology among gynaecology outpatients: Enhancing quality and integration of women’s mental healthcare (EQUATE)’.
Using validated scales, Dr Hartnett’s study aimed to measure the incidence and severity of depression, anxiety, and somatisation in a population attending gynaecology outpatient services; and to establish the level of untreated psychopathology in this cohort.
Some 333 women participated in the study, which found that 35.7 per cent had moderate or severe anxiety and almost 38 per cent had moderate or severe depression.
Dr Hartnett concluded there was a significant unmet need in this population and that a specialised liaison psychiatry service should be developed for those attending benign gynaecology. Dr Hartnett was later announced as the NCHD Oral Competition Winner at the conference.
A number of parallel sessions commenced after lunch. Dr Alicia Wrotniak, Consultant Psychiatrist with the Sligo/Leitrim Mental Health Service, gave a talk on physical health monitoring of patients with mental illness.
Dr Wrotniak outlined how people with mental illness can live up to 25 years less than the general population because they experience worse physical health outcomes.
Health systems can contribute to the disparity due to barriers, discrimination, a lack of integration, insufficient training of health professionals dealing with co-morbid conditions, and fragmented care. Physical health symptoms can often be wrongly attributed to mental illness, she added.
Dr Wrotniak cited various guidelines and tools available for the monitoring of physical health conditions in people with mental illness, including resources from the World Health Organisation and National Institute of Health and Care Excellence.
In particular, she noted that the HSE Diabetes Prevention Programme for adults at risk of type 2 diabetes had developed an adapted version of the programme for people with severe mental illness.
Dr Wrotniak added: “Supervised exercise training can improve psychiatric symptoms, cognition, and functioning across a range of mental health diagnoses.”
She advised that all health professionals have a responsibility to promote healthy living and perform regular physical health assessments of people with mental illness.
Another session took the form of an interactive workshop on managing a patient with severe mental illness in the perinatal period. This was led by Dr Chaitra Jairaj, Consultant Perinatal Psychiatrist, Coombe Hospital, Dublin and Midland Regional Hospital, Portlaoise; and Dr Catherine Hinds, Consultant Perinatal Psychiatrist, National Maternity Hospital, Holles Street, Dublin.
The speakers lamented the absence of a mother and baby unit in Ireland to treat pregnant and post-partum women with mental illness, noting that women who require care are currently admitted to adult psychiatry.
The workshop allowed participants to answer questions interactively and fostered small group discussions on how to best manage, diagnose, and treat the patient case scenario presented.
Other sessions focused on child art psychotherapy, media communication, attention skills, and the creative arts.
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