Responding to the Influence of Dangerous Consumption Industries on Policy and Practice
PJ Adams
Centre for Addiction Research & School of Population Health, University of Auckland, New Zealand
Background: Government policies that aim to reduce harm from tobacco, alcohol, gambling, addictive pharmaceuticals and unhealthy food have consistently favored individually focused and less effective strategies such as awareness campaigns and behavior change initiatives. This is not accidental. These industries invest in a wide range of ways of influencing policy makers.
Objectives: To examine ways in which mental health professionals contribute to industry influence.
Methods: The presentation is based on study of industry tactics and influence-forming practices as described in my book, Moral Jeopardy: The Risks of Accepting Money from the Alcohol, Tobacco and Gambling Industries (Cambridge UP, 2016).
Findings: Key areas where those working in the health sector contribute to industry influence include: researchers funded either directly or indirectly by industry sources; acceptance of gifts and favors; links with and endorsements of industry public relation activities; contributions to the marketing and sale of unhealthy commodities; participating in industry-supported or -led forums and by not speaking out about the health impacts of particular consumptions.
Conclusions: Mental health practitioners, researchers and administrators need to be aware of their own potential to contribute to industry influence and favor exchange and to adopt policy and processes prevent them from contributing further to the interests of dangerous consumption industries.
Medical Cannabis for Chronic Pain: An Evidence-based, Canadian Perspective
R Anglin1,2,3,4
1University of Western Australia, Perth, Australia
2Notre Dame University, Perth, Australia
3McMaster University, Hamilton, Canada, Ontario
4Fiona Stanley Hospital, Perth, Australia
Background: Unauthorized use of cannabis by patients for pain is widespread in Australia and across the world. Other countries such as Canada have increased the availability of medical cannabis over the last two decades, and Australia has followed suit but with varying regulations in different states. There are conflicting opinions on the efficacy of medical cannabis for chronic pain and the best way to regulate and authorize use of cannabis based products.
Objectives: To review the evidence for cannabis in the treatment of chronic pain To discuss the Canadian experience of widespread use of medical cannabis
Methods: Recent systematic reviews, narrative reviews and relative policies, position papers and legislation on the use of cannabis in chronic pain in Australia and Canada were synthesized and critically reviewed.
Findings: Recent systematic reviews on the use of medical cannabis in chronic pain are of varying quality, with many at high risk of bias. Overall, the effectiveness of cannabis for neuropathic pain, non-cancer and cancer pain and other chronic pain such as fibromyalgia is unclear, while there are recognized adverse effects. Canada granted access to cannabis for medical purposes in 2001. Since the introduction of widespread access to medical cannabis there has been an overall increase in cannabis use in the population and there has been criticism of liberal prescribing practices.
Conclusions: There is no clear evidence that medical cannabis is effective in treating chronic pain, and further high quality studies are needed to guide physicians. The Canadian experience may offer insight into the relative merits of careful authorization pathways versus widespread access to medical cannabis.
Pain Education for Low Back Pain – it is Worth My Time?
James H McAuley1,2
1University of New South Wales, Sydney, Australia2NeuRA, Sydney, Australia
Background: Around 80% of people develop at least one episode of low back pain during their life. A substantial proportion develop chronic low back pain where recovery is slow and associated with debilitating pain and flare ups. All clinical guidelines for the management of low back pain suggest that all patients should be provided with advice and education. However, it is not clear what type of education the clinician should provide, and how to optimize its effects.
Objectives: This talk will provide a clinical update on contemporary approaches of patient education for chronic pain. What is the best style of patient education? Can educating a patient about their pain reduce their pain lead to reduced pain and disability? What is the role of education to reassure a patient?
Methods: Different approaches to patient education for patients with acute or chronic pain will be described and evaluated.
Findings: Educating a patient about their pain, using concepts from pain science, is an effective intervention for chronic pain. New evidence from a recently completed randomized clinical trial of patient education to prevent the development of chronic low back pain will be presented. Lessons from this trial will provide valuable insights on how to present patient education to patients with low back pain.
Conclusions: Educating patients about their pain, using concepts from pain neuroscience, is highly promising new approach to reduce pain and disability of patients with low back pain.
Gambling Disorder
S Rodda1,2
1University of Auckland, Auckland, New Zealand
2Turning Point, Melbourne, Australia
Background: Gambling Disorder is a serious public health issue affecting not just the gambler but also family, friends and the wider community. Recently Gambling Disorder was reclassified from an Impulse Control Disorder (DSM-IV) to a Behavioral Addiction (DSM-5).
Objectives: The aim of this clinical update is to provide a general overview of the contemporary evidence base for the identification and treatment of Gambling Disorder.
Methods: This review draws together the most recent findings in gambling research. This includes findings from meta-analyses and systematic reviews, empirical research as well as clinical case studies.
Findings: The latest information will be presented on the reclassification of gambling in the DSM-5 and we will also examine the latest research on early risk and protective factors. The update then provides information from a large scale study on co-occurring mental health disorders. It also presents the findings of a study on screening for Gambling Disorder in mental health services. New research on harm to others will also be presented. This update concludes with an overview of the latest research on treatment approaches including brief interventions.
Conclusions: This clinical update provides information on the latest evidence for identifying, managing and treating Gambling Disorder. Resources to aid practice will also be provided.
Living Well with Psychosis through the Life Cycle: One Woman’S Narrative
SE Romans
University of Otago, Wellington, New Zealand
Background: This illustrated presentation will review current best practice and the epidemiological science pertaining to women and psychosis, drawing heavily on the writings of Mary Seeman professor emerita at the University of Toronto, a mentor of one of the presenters.
Methods: We will follow the development of one woman whose health, physical and mental, we have helped manage over several years.
The presentation will be in four parts, linked to developmental phases of her life as she establishes multiple identities as daughter, partner, worker, citizen and mother.
Initial diagnosis
Establishing adult roles
Contemplating and achieving motherhood
The future
The presentation discusses pre-conception decisions about embarking on parenthood and the dilemma of continued use of antipsychotic drugs against discontinuation of antipsychotic drugs in pregnancy.
Decisions about medication use at the time of conception and in pregnancy need to be evidence based and involve weighing the indications and potential benefits with the potential harm to mother and child. Evidence suggests that women who take antipsychotic medications are at higher risk for some adverse maternal and perinatal outcomes when compared with the general population such as gestational diabetes, hypertension, preterm birth and the need for obstetrical interventions.
Postnatally, a woman on antipsychotic medication faces additional challenges when caring for her infant and herself.
Conclusions: We aim to identify therapeutic and unhelpful factors in our heroine and contextualize these in the current literature.
Multidisciplinary Pain Management Approaches for Chronic Pain: What Do Psychiatrists Need to Know?
PG Vroegop1,2
1Chronic Pain Service/Psychological Medicine, Counties Manukau Health, Auckland, New Zealand
2Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
Background: Chronic pain causes significant disability in the New Zealand population, with 21% of the population experiencing persistent pain with significant disability. The WHO notes that 4 out of the top 6 leading causes for the global burden of disease in the world are conditions that cause chronic pain. People with chronic pain present with significantly higher rates of mental health problems. Although short term-pain is a useful “alarm system” warning of damage to the body, persistent pain usually isn’t helpful. Long exposure to pain causes significant stress and associated comorbidities including anxiety, depression, and cognitive problems, and subsequent sleep problems, damage to whanau relationships, and loss of income.
Objectives:
Describe the approaches and review the evidence for multidisciplinary management of chronic pain
Describe the extent of psychiatric comorbidity in people with chronic pain
Discuss the role of the psychiatrist in a pain service
Methods: Systematic reviews, relevant policies, narrative experiences and position papers around multidisciplinary treatment of chronic pain were synthesized and critically reviewed.
Findings: The evidence base for management of chronic pain is for behavioural and psychological interventions, with a core emphasis on graded activation and self-management skills, which requires a conceptual shift to a rehabilitation model. There is less evidence for pharmacological management.
Conclusions: There is clear evidence that multidisciplinary team management is effective in treating chronic pain, and that treatment of comorbid mental health issues enhance outcomes. The psychiatrist has an important role to play in specialist chronic pain services.
Electroconvulsive Therapy: Maximizing Benefits and Minimizing Adverse Effects
A Weiss1, S Waite2,3, S Hussain4,5
1Section of Electroconvulsive Therapy and Neurostimulation, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2The Queen Elizabeth Hospital, Adelaide, Australia
3The University of Adelaide, Adelaide, Australia
4Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
5Sir Charles Gairdner Hospital, Perth, Australia
Background: Electroconvulsive therapy (ECT) remains the most effective method of treating major depression and other severe psychiatric disorders. One of the main concerns about ECT is the potential for cognitive adverse effects. To promote ECT techniques aimed at recovery that promote the lowest cognitive impairment while retaining efficacy, the Section of Electroconvulsive Therapy and Neurostimulation of the Royal Australian and New Zealand College of Psychiatrists has developed a professional practice guideline (PPG) that aims to summarize current evidence and guide practitioners using ECT to deliver optimal outcomes.
Objectives: This update aims to improve the understanding of clinical indications for ECT, the potential complications and contraindications to treatment. It will provide an opportunity for psychiatrists to become familiar with recent advances in ECT treatment approaches, including the effects of varying electrode placement, stimulus parameters and frequency to ensure that the technical procedure is applied optimally for any given patient.
Methods: Relevant literature and case examples will be presented to illustrate the patient factors that may impact on the choice of ECT and the patient’s potential vulnerability to cognitive and physical adverse effects. The parameters of ECT practice that will be discussed include electrode placement, pulse width, anaesthetic management, monitoring of outcomes and the role of continuation and maintenance ECT. There will also be a discussion about strategies to improve outcomes in high-risk groups (such as pregnant patients, the elderly and people with medical comorbidity), through optimal application of anaesthetic procedures and concurrent mediations. Furthermore, an overview will be presented of the potential use of biomarkers to predict the response to ECT. Participants will be encouraged to contribute and use case material to inform discussion.
Findings: ECT is a constantly evolving practice, and ongoing research in the area continues to provide potential for treatment refinement and improvement, including novel approaches to ECT.
Conclusions: Psychiatrists are encouraged to improve their knowledge of ECT, to follow evidence-based practice and to collaborate with colleagues to make the determination as to when ECT is indicated and what modality of ECT to use.
