Prof Donal O’Shea: Weight gain a ‘particular problem’ with antipsychotics

By Catherine Reilly

Psychiatry has until recently ignored the issue of weight gain associated with antipsychotic medications, according to Prof Donal O’Shea, Consultant Endocrinologist and Physician based in St Columcille’s Hospital, Loughlinstown, and St Vincent’s University Hospital.

Prof O’Shea, who was invited by the College of Psychiatrists of Ireland (CPsychI) to speak on ‘Weight Gain in the Treatment of Mental Health’ at its recent Spring Conference told Irish Medical Times: “We know that if you follow patients who start antipsychotic medications for their mental health disorder, they will put on in four years an average of about 20 kilos… so there is significant weight gain associated with antipsychotic medications.”

He said weight gain was “a particular problem” with anti-psychotic medication and less so with antidepressant medication. In general, patients with mental health problems had issues with weight gain, he said.

Prof O’Shea added that many of the deaths in patients with a history of psychotic illness were not directly due to their mental health problem, but rather connected to being overweight and obese and developing conditions such as diabetes, heart disease and cancer.

This was an issue that psychiatrists globally had not acknowledged until very recently, said Prof O’Shea, but there was now a greater recognition of the seriousness of the situation.

Advocates on this issue within the profession of psychiatry and “an exaggeration of the global epidemic of obesity” within this patient group had contributed to better acknowledgement, he said.

Prof O’Shea’s presentation at the CPsychI explored the role of the psychiatrist in the prevention of weight gain associated with the treatment of mental health conditions and the need for all healthcare professionals to advocate for the prevention of obesity.

Asked what specifically was being done to prevent weight gain associated with treatment of mental health problems in Ireland, Prof O’Shea responded “not enough”.

However, one new development involved his team at the weight management clinic in St Columcille’s, which is engaging with Saint John of God Hospital to devise a programme to examine ways of preventing weight gain in mental health treatment. This programme is at the developmental stage, said Prof O’Shea.

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Photo by John Powell / Rex Features

By Catherine Reilly.

The College of Psychiatrists of Ireland (CPsychI) has formalised its stance on pharmaceutical funding and sponsorship through a new position paper.

The move follows the passing of a motion by the CPsychI’s Council in September 2010, which stated that the College would cease receiving any sponsorship from pharmaceutical companies of its academic meetings or other activities.

Dr Anthony McCarthy, CPsychI President, said the College was pleased to be the first medical professional organisation in Ireland, to his knowledge, “to undertake development of such a position”. He said the College “refuses all funding from pharmaceutical [companies] for any of its activities”.

The position paper, titled ‘The Relationship Between Psychiatrists, the College of Psychiatrists of Ireland and the Pharmaceutical Industry’, was launched at the CPsychI’s recent Spring Conference in Athlone. It stated that the CPsychI recognises the “great benefits” achieved through advances in pharmacotherapy, many of which have been dependent on the pharmaceutical industry’s  “commitment to research and development”.

However, it noted that the CPsychI was also aware of the “risks of conflicts of interests, and the importance for psychiatry to be able to form an independent appraisal of the value of specific drugs”. Research had “overwhelmingly” demonstrated that clinicians were “influenced by the pharmaceutical industry’s marketing strategies, which have an impact on prescribing practices”, it stated.

The paper provided information and guidance to psychiatrists and trainees, reviewed CPsychI activities in their relationships with the pharmaceutical industry and provided guidance to academic psychiatrists.

A review of existing documents includes the CPsychI’s handbook, which gives details on the accreditation of professional competence meetings. The handbook states that meetings organised and funded by a pharmaceutical company cannot be approved for external CPD credits, but that meetings organised by clinicians with unrestricted funding from a pharmaceutical company can be submitted to CPsychI for approval for external CPD credits.

The CPsychI’s “information and guidance” for psychiatrists and trainees cited in the position paper underlined that psychiatrists attending internal or external activities as part of the professional competence activities “should ensure that the educational component of such activities is not influenced by pharmaceutical companies”.

In addition, they should only agree to participate in pharmaceutical company-sponsored meetings (as speakers or attendees) if they were “entirely satisfied” that the meetings have an “entirely educational” rather than promotional purpose and are sponsored through an unrestricted educational grant.

Guidance to academic psychiatrists and NCHDs engaged in research stated that there should be “full declaration and transparency of the relationship in any such research with the pharmaceutical organisations” and that psychiatrists participating in research should not receive personal payment for carrying out commercially-funded research.

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Poster winners, L to R: Judges Dr William Flannery and Dr Sabina Fahy; winners Dr Mary Butler (Audit); and Dr Hugh Ramsey (Health Services Research/Service User Category); and College President Dr Anthony McCarthy

By Catherine Reilly.

Patient confidentiality is sometimes used as “an excuse” by psychiatrists not to engage with carers of patients who have waived confidentiality, a new paper published by the College of Psychiatrists of Ireland (CPsychI) has stated.

The discussion paper, ‘Who Cares? Listening to the Needs and Experiences of Carers of People with Mental Illness’, was prepared by the carers’ subgroup of REFOCUS (Recovery Experience Forum of Carers and Users of Services).

CPsychI’s REFOCUS group is comprised of 10 service users and 10 family members and is collaborating with the College to improve psychiatrist training and identify ways of advancing mental health services.

The issue of confidentiality was “sometimes hidden behind” in order to inhibit a wider engagement between the clinician and the carer, stated the paper. There was “absolutely no reason” for such “diffidence” on the part of the clinician, where the patient had given consent to their carer being fully engaged in instances where the carer also wished it, although the  “time-consuming” nature of such engagement for psychiatrists was referenced.

If carers were to be fully informed in instances of patient agreement, there may be a need for protocols to put this into practice, it suggested.  While carers “fully respect the right to privacy of patients”, they wish to support the patient and clinician in the process of recovery and, in this context, “the provision of appropriate and agreed information is crucial”.

The paper said protocols might investigate the possibility of “bounded confidentiality” — whereby a “sample consent form would be provided to the patient which would set out areas capable of  being discussed with a carer and areas which the patient might not want to be discussed. It is recognised that such a protocol would not be necessary in all, or perhaps even the majority, of cases”.

When the patient withholds consent, “there would be no question of a waiver of confidentiality”.

The paper noted that a difficulty could arise where the patient was too ill to give informed consent to the waiver, but that there were mechanisms that addressed the issue of incapacity and these may be further developed in the proposed Assisted Decision-making (Capacity) Bill.

One approach could be to provide for the possibility of an “advance directive” recorded on the patient file while the patient was well, “or the waiver of confidentiality might be allowed where an appropriate process is in place”.

Elsewhere, the paper referred to the biannual rotation of registrars causing “extraordinary frustration” for patients and carers, as case histories “have to be recited over and over again”.

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From left to right: Dr Diarmuid O’Shea, Prof Greg Swanwick, Dr Niamh O’Regan, Dr Aoibhinn Lynch, Dr Sean Kennelly, Dr Aoife Ní Chorcoráin

The RCPI and the College of Psychiatrists of Ireland (CPsychI) on Monday (May 26) launched the first jointly developed e-learning course entitled ‘Delirium; Recognition and Response’, which aims to support doctors with the understanding, identification and management of delirium.

Delirium, a condition that affects 20 per cent of all adult hospital inpatients, can be missed or misdiagnosed in two-thirds of cases.

“Delirium may be seen and treated collaboratively between medical and psychiatry specialties, therefore we felt it may be useful to teach trainees collaboratively,” explained Prof Greg Swanwick, Dean of Education, CPsychI.

“We hope that this initiative will be the first of many such collaborations between the postgraduate medical training bodies with the twin goals of providing a world class standard of medical education and improving graduate retention while realising maximum benefit from investment in medical training,” added Dr Diarmuid O’Shea, Vice President of Education and Professional Development, RCPI.

The e-learning module was designed by a steering group of four clinicians from geriatric medicine and psychiatry with a special interest in delirium, with the objective of providing the necessary tools and information to enable a better understanding of delirium, aid in its identification and diagnosis and assist doctors in preventing or managing delirium right throughout the patient’s hospital journey from arrival to discharge.

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Lloyd Mudiwa

Dr Matthew Sadlier

The College of Psychiatrists of Ireland’s 2014 Spike Milligan Public Speaking Competition will take place next month in Dublin on the theme of the carer.

Organised to raise public awareness of mental health and to promote communication skills around mental health issues among medical students, the popular annual event will see students from Ireland’s seven medical schools compete for the Dick Joynt Trophy and Sculpture as well as a cash prize and a place at one of the College’s upcoming conferences.

This year teams of two students from each of the medical schools at UCC, the University of Limerick, NUI Galway, TCD, UCD, the RCSI and Queen’s University, Belfast will debate the following: ‘There are only four kinds of people in the world — those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need caregivers’ (Rosalynn Carter): True or Trite?’

Consultant Psychiatrist Dr Matthew Sadlier will chair the competition.

The free event will take place on November 27, 2014 at 6.30pm in the Smock Alley Theatre, in Dublin.

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Prof Kelly, Editor-In-Chief, Irish Journal of Psychological Medicine

Dr John Lally has been selected as winner of the John Dunne Medal 2013 for “an important and invaluable contribution to the literature on Ireland’s psychiatric services”, the College of Psychiatrists of Ireland has announced.

Dr Lally’s paper, entitled ‘Patient satisfaction with psychiatric outpatient care in a university hospital setting’, co-written with Dr Fintan Byrne, Dr Eimear McGuire and Prof Colm McDonald, was published in the Irish Journal of Psychological Medicine last December.

Dr Lally is undertaking a Clinical Fellowship in the Department of Psychosis in King’s University, London. He completed his Basic Specialist Training on the Western Scheme in Galway and was accepted as an MRCPsych Trainee in 2010.

“The paper by Dr Lally and colleagues is an important and invaluable contribution to the literature on Ireland’s psychiatric services. This paper richly merits this prize and will help shape Irish mental health services into the future,” said Prof Brendan Kelly, Editor-In-Chief of the Irish Journal of Psychological Medicine.

The prize is now in its 25th year and awards originality and outstanding contributions to the field of psychiatric research. It was established in 1989 to honour Dr John Dunne, first Professor of Psychiatry in Ireland and President of the Royal Medico-Psychological Association in 1955.

The prize is open to all trainees from Ireland, Northern Ireland and Britain. To be eligible, a trainee much have made a significant contribution (though not necessarily as first author) to an original paper published by the Journal over the year.

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Lloyd Mudiwa

Pictured in the Sugar Club in Dublin were (l-r): Jenny Fitzgibbon and Ming Cai, winners from NUI Galway; Dr Ruth Murphy, NUI Galway Team Coordinator; and Dr Ruth Loane, CPsychI President

Medical students from NUI Galway Jenny Fitzgibbon and Ming Cai have taken home the top prize at the annual Spike Milligan Public Speaking Competition, hosted by the College of Psychiatrists of Ireland (CPsychI).

First held in 1999 as part of the Changing Minds Campaign of the College, the competition addresses the so-called stigma associated with mental health problems. This year teams of two from UCC, UL, NUI Galway, TCD, UCD, the RCSI and Queen’s University Belfast (QUB) — this year’s runners-up — spoke on the topic ‘People ask all the time how I’m doing, but the truth is, they don’t really want to know’ — a quote from Jodi Picoult, Handle with Care.

The students presented on this statement, as part of the College theme for 2015, ‘Caring for Carers’.

CPsychI President Dr Ruth Loane said: “Carers are key participants in the recovery process and these present-ations dramatically illustrated the potential pain and loneliness of their role. The involvement of students from all Irish medical schools is heartening as regards the comprehension of the carers role from our future doctors.”

College Director of Communications and Public Education Dr John Hillery added that the Spike Milligan participants continued to provoke and amaze, and this year’s competitors raised the bar again in terms of content and presentation. “The work and contribution of carers is still not sufficiently recognised, but the students illustrated the issues in a way that demonstrated the practical steps we can all take to support people we know who are caring for loved ones.”

The aim of the competition is to foster and promote communication skills among doctors in training — with a focus on mental health.
It is also an opportunity for public outreach and engagement on matters concerning mental health issues, with teams encouraged to demonstrate clear, reflective communication skills in a way that will inspire and inform a public audience.

The award is named in recognition of the late Spike Milligan’s work in destigmatising mental illness. This year the judging panel consisted of Old Age Psychiatrist Dr Mia McLoughlin, Trainee Psychiatrist Dr Rosie Plunkett and member of REFOCUS (Recovery Experience Forum of Carers and Users of Services) Christine McCabe.

REFOCUS is a committee of the College made up of 10 service users and 10 family members who have had experience of using the mental health services or of having a relative who has used services.

The committee was established in late 2011, in the spirit of the recovery ethos, to improve the collaboration between the College members and those who use mental health services.

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Dr John Hillery

The professional body for psychiatrists in Ireland, the College of Psychiatrists of Ireland (CPsychI), has warned the Department of Health that existing mental health services lack sufficient capacity to absorb asylum seekers and refugees given that some of them will require help to overcome any trauma they endured on having to flee their home countries.

This followed last Sep-tember’s special Cabinet decision that Ireland will welcome 4,000 refugees as part of the country’s response to the current crisis, with reception and orientation centres set up around the country, to provide a “safe haven” for persons seeking international protection”.

It was projected that even more than 4,000 could eventually be accepted because of further family reunifications.

CPsychI’s Director of Communication and Public Education Dr John Hillery, a consultant psychiatrist, stressed the need for planned and funded structures, protocols and services to deal with the mental health needs of refugees and asylum seekers as the current mental health services did not have the capacity to absorb asylum seekers and refugees.

The College raised the mental health support needs of refugees and asylum seekers in a letter to Siobhan O’Halloran, Chief Nursing Officer, and Dr Tony Holohan, Chief Medical Officer, both in the Department of Health.

The Minister for Health Dr Leo Varadkar has already signed regulations to exempt asylum seekers living in direct provision from the prescription charge levied on medical-card holders based on a recommendation by a working group which highlighted concerns of asylum seekers with chronic health issues who struggle paying the charge from their weekly support of €19.10.

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Lloyd Mudiwa

The Council of the College of Psychiatrists of Ireland (CPsychI) has approved a report on how Early Intervention in Psychosis (EIP), one of the five mental health programmes set up by a joint initiative between the HSE Clinical Strategy and Programmes Division and the College, could be introduced in Ireland, IMT reports.

CPsychI set up an Early Intervention (EI) working group to make recommendations on how EIP could be introduced, which sought expert opinion from international leaders in the field and drew upon experience from the development of EIP services overseas in the past 30 years.

“The report on Early Intervention in Psychosis has been approved by the College’s Council but it has been returned to the HSE and won’t be made available until after their approval,” a spokesperson for CPsychI told IMT last week.

Dr Paddy Power, Consultant Child and Adolescent, Adult Psychiatrist at St Patrick’s University Hospital, Dublin, will address the next challenge of successfully implementing EIP nationally at the College’s forthcoming two-day Spring Conference being held in the Carton House Hotel, Maynooth, starting from April 7.

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Lloyd Mudiwa

The College of Psychiatrists of Ireland (CPsychI) has named Dr Cornelia Carey winner of the John Dunne Medal 2015, for outstanding trainee contribution to psychiatric research, IMT reports.

Dr Carey, who is currently employed in St James’s Hospital, also sits on the CPsychI Trainee Committee. She will also sit on this year’s judging panel for the Spike Milligan Public Speaking Competition (see IMT ‘Medical schools to battle at Spike Milligan Debate’ 18/11/2016).

Dr Carey was selected as this year’s winner for her paper entitled ‘Are psychiatric team meetings patient-centred? A cross-sectional survey on patient views regarding multidisciplinary team meetings’. The survey’s aim was to examine inpatient experience of multidisciplinary team meetings and identify factors that significantly alter this experience.

Associate Editor of the Irish Journal of Psychological Medicine (IJPM) Dr Brian Hallahan presented Dr Carey with the medal at the annual CPsychI and RCPsych NI Joint Winter Conference at the Slieve Russell Hotel in Cavan on November 11.

Dr John Lyne, IJPM Editor-In-Chief, said: “‘Congratulations to Dr Cornelia Carey who was the 2015 winner of the John Dunne Medal for best research published by a psychiatry trainee in the IJPM.

“This medal represents quality in research and it is hoped that this will encourage further research from trainee psychiatrists in Ireland and the UK.”

The award-winning research was co-authored by Dr John Lally and Dr Adam Abba-Aji, and appeared in the IJPM in June of 2015.

Established in 1989 to honour Prof John Dunne, first Professor of Psychiatry in Ireland and President of the Royal Medico-Psychological Association in 1955, the prize acknowledges original and outstanding contributions to the field of psychiatric research.

The prize is open to all trainees from Ireland, Northern Ireland and Britain. To be eligible, a trainee must have made a significant contribution (though not necessarily as first author) to an original paper published by the Journal over the year.

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Medical students from Queen’s University Belfast (QUB) have won the 2016 Spike Milligan Public Speaking Competition hosted by the College of Psychiatrists of Ireland (CPsychI).

The team from QUB included Swati Vara and Catherine Eves, and they faced tough competition from the RCSI, whose focus on mental health issues as a consequence of lower socio-economic standing earned them the runners-up prize.

Teams of two from UL, NUI Galway, TCD, the RCSI and QUB spoke on the topic of ‘All Changed, Changed utterly” (Yeats, Easter 1916): 1916-2016 Mental Illness and Recovery – All the Children of the Nation Treated Equally Now?’, highlighting issues like stigma, Traveller rights, unemployment, and social codes of masculinity.

This year the judging panel consisted of CPsychI REFOCUS (Recovery Experience Forum of Carers and Users of Services) members Dr Marina Bowe, Consultant Psychiatrist, and Rick Rossiter, as well as trainee psychiatrist and recent winner of the John Dunne Medal for psychiatric research Dr Cornelia Carey.

The award is named after the late Spike Milligan, who worked tirelessly as an advocate for those affected by mental ill health.

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The College of Psychiatrists of Ireland (CPsychI) has elected Dr John Hillery as its new President to serve until 2020.

Dr Hillery, Consultant Psy
chiatrist at Stewart’s Hospital in Dublin and former President of the Medical Council, replaces Dr Ruth Loane as President.

Thanking his predecessor and the membership, Dr Hillery said the body was a young College that in a short time, in “a challenging financial and philosophical environment”, had successfully introduced practical innovation to the training and education of psychiatrists.

“I look forward to working with colleagues and other stakeholders, especially patients and their relatives, to support psychiatrists in Ireland, both trainees and specialists, in their aim to deliver the best possible treatment to people with mental illness in what remains a challenging environment for health professionals, patients and carers,” he stated.

The College has also elected Dr William Flannery as Vice-President for the next three years.

Dr Flannery is currently Chair of the College’s Postgraduate Training Committee and a consultant psychiatrist in the addiction services.

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