North West Conference Reviews 2013
North West Spring Conference Review - 17 April 2013 in
No health without mental health? No mental health without physical
Dr Afshan Khawaja, Consultant Psychiatrist, Academic Secretary for
North West Division
The Spring Conference was
held on 17 April 2013 at Everton Football Club in Liverpool.
The theme “working towards better physical health in mental health
care settings” focussed on issues of physical health with
particular relevance to mental health patients and how
professionals could address these issues across care setting
interfaces. This was the first conference in the Mersey
region and it was well attended from delegates across the North
West and very well received.
The day was split into a
series of lectures and workshops.
Dr Khalid Khan,
Consultant Cardiologist from North Wales, started the day
with a lecture about cardiovascular disease and mental illness.
My important fact for the
day - Sudden death usually occurs early morning.
Does mental health lead to heart disease?
Increased rates of MI after bereavement, natural disasters, life
events, and for men following chronic stress, depression also a
known risk factor. Mental stress leads to increased
HR/BP/vascular tone/platelet aggregation/sympathetic activity.
Does heart disease lead to mental health disease?
Increased rates of
depression post MI/CABG, also predicts poor prognosis. Broken
heart syndrome – Takotsubo syndrome exists – a stress induced
cardiomyopathy that has a good prognosis.
Does psychiatric medication cause heart disease?
Known side effects e.g. Clozapine induced tachycardia, better long
term to have a pulse rate <70. However the decision to
stop or continue has to be on the basis of an individual
risk-benefit ratio. If concerned about cardiomyopathy a
normal ECG result is a good test for ruling out this condition.
Recommended a smart phone
application called QxMD for calculating QTc intervals. If
seeking cardiology opinion please send original ECGs or a good
quality scanned images rather than faxing.
Delegates were then
offered a choice of three workshops:
Wieck, Consultant Psychiatrist lead for North West Perinatal Mental
Health Services, provided a better understanding of
endocrine side-effects of antipsychotic medication, their
consequences and clinical management
Charlotte Wetton, project officer for Rethink, provided
information on how Rethink Mental Illness resources can help
professionals keep service-users informed, complete physical health
checks in mental health services and communicate across primary and
Senior Public Health Development Advisor in Substance
Misuse, focused on the physical health problems linked
with substance misuse. The impact on physical health can be
attributed directly or indirectly to the drug itself, the method of
using the drug and the lifestyle of the drug user.
Increasingly drug users have been diagnosed with health problems at
a very late stage which affects treatment cost and prognosis, this
session provided some indicators of disease essentially hidden
through a narrow focus on substance misuse.
Delegates were then
offered a further choice of three workshops:
Chris Clarke, Catherine Mills involved in the collaboration between
Everton and Mersey Care, described how they engaged
service users in a range of physical activity, training and social
interventions, utilising the powerful brand of an iconic Premier
League FC. The session gave an overview of the award winning
“Imagine your Goals” programme; “Healthy Blues” Over 40’s scheme;
“Pass on the Memories” Dementia Project and “Everton 4
Liz King, Anya
Telford, Michael Spence, MMHSCT NIHR joint project,
focused on a pilot project run by Manchester Mental Health and
Social Care Trust and the NIHR CLAHRC for Greater Manchester.
The aim was to develop and test an integrated model of physical
healthcare between a community mental health team in North
Manchester (CMHT) and participating GP surgeries.
Interventions involved the introduction of a CMHT based physical
health link worker who participated in multi-disciplinary team
meetings with primary care to coordinate care and agree shared
actions to improve service users’ physical health.
Dr Chris Daly,
Consultant Addiction Psychiatrist, covered the effects of
alcohol misuse on physical health
Heald, Consultant Endocrinologist in
Cheshire, opened the afternoon session with a lecture
which focussed on endocrine problems.
Prolactin – recommended
measuring at baseline and blood best taken at lunchtime. If
prolactin levels>2000mul patient should be investigated for a
pituitary-hypothalamic cause and needs referral for a MRI pituitary
scan. Check for macroprolactins – clumped hormone as this is
inactive but can cause raised blood levels. If increased
prolactin caused by antipsychotic use is causing symptoms treat
with reducing drug dose, using alternative drugs, adding sex
hormones, or a dopamine agonist.
Thyroid hormone – primary
disease usually the result of an autoimmune disease.
Recommended we treat for low to normal T4 if TSH raised with
levothyroxine. Cardiovascular Risk – our patients have a
number of modifiable risk factors e.g. obesity, smoking, diabetes,
hypertension, dyslipidaemia – these are cumulative in contributing
to the risk of heart disease and strokes – so reducing one can have
significant benefit for the patient. SMI patients are more
like secondary prevention populations (i.e. populations that
already have heart disease) rather than primary prevention
populations and should be prescribed statins on that basis. Refer
to the IDF (International Diabetes Federation) definition of
metabolic syndrome (central obesity plus any 2 of – raised
triglycerides, reduced HDL cholesterol, raised blood pressure or
raised fasting plasma glucose). We should be screening all
patients for an impaired glycaemic state which is reversible and
diabetes which will need treatment.
Dr Tom Tasker,
GPSI in Salford, provided the final lecture of the
Dr Tasker started with
reminding us of government documents related to physical health and
the QOF targets set for GPs (4-5 points for each target).
Everybody already aware of the NICE recommendation that all those
diagnosed with schizophrenia have an annual physical health check
and the recent concerns expressed by the Schizophrenia Commission
2012 about the poor physical health of our patients.
Dr Tasker described the
local work that was done with GMW and Salford PCT. This led
to the development of local guidelines and then a shared care
protocol with agreement that baseline testing completed in
secondary care and follow up in primary care. However they
faced significant challenges in communication especially as IT
systems used by the PCT were not accessible to the mental health
trust. In the end the PCT incentivised the facilitation of
the process by care co-ordinators by adding a CQUIN target for GMW
on BP monitoring.
Please see the following