‘Mental Illness: Everybody’s business, nobody’s child’
Dr Rosanna Moore reflects on the 2018 Spike Milligan competition hosted by the College of Psychiatrists of Ireland
On 28 November, four Queen’s University medical students took part in the annual Spike Milligan public speaking competition. Louis-Philippe Delaugere and Christopher O’Hagan, the two speakers, were assisted by fellow 4th year students, Jordan Bamford and Umeswari Kandasamy, who helped prepare the script.
The event, held at the Button factory in Dublin, was very well-attended and had a great atmosphere, helped along by Dr. Matthew Sadlier’s witty chairing. Every University with a medical school in Ireland was represented with Queen’s returning after a year of absence in 2017. Attending with the students, as a trainee and previous participant, I was very impressed with the standard of the performances and by how much the competition had developed over the years.
The theme of this year’s competition was ‘Mental Illness: Everybody’s business, nobody’s child’. This challenging topic was tackled in a range of ways by each University in a 10-minute presentation. Our own students looked at how mental illness was managed throughout the world and included fictional worlds such as Hogwart's School.
They expanded on the idea that it should be the government’s responsibility for caring for people or ‘children’ with mental illness. The judges highlighted the excellent examples of Hogwart's with JK Rowling speaking recently about her own experience of mental illness and New Zealand, where individuals such as Sir John Kirwan have spoken about battles with mental illness within the sport of rugby.
The Queen’s students gave an excellent performance, however, they lost out to their peers at the University of Limerick, who gave a very original performance which was simultaneously comedic and thought provoking.
The runner’s up from Cork University also gave a very well-polished performance, as did all the other universities involved.
"An entertaining and informative day"
Dr Patrick Renshaw reviews our most recent Intellectual Disability meeting which took place at Clifton House on 3 December.
Following on from the success of September’s Intellectual Disability seminar, a further event was held on 3rd December 2018 at Clifton House. This half-day conference focused on epilepsy, and brought together a range of engaging and interesting speakers.
We would like to thank Professor McClelland for so ably deputising at short notice for Dr Haffey to provide a talk on electroencephalography (EEG). The EEG examples and interpretations of results perfectly illustrated the continuing significance of this investigation which was first used by Hans Berger nearly a century ago. These examples also highlighted varying differential diagnoses including drug intoxication and dementia and reinforced the importance of detailed information on EEG request forms.
Dr Sandya Tirupathi, Paediatric Neurologist, provided a helpful recap of the revised classification of seizures. The three new sub-types being; focal, generalised and of unknown onset. The level of awareness and possible presence of motor features represented important distinguishing criteria. Dr Tirupathi also discussed treatment options to include pharmacological, surgical interventions and a ketogenic diet.
We were privileged to welcome Dr Monica Mohan to Belfast. Dr Mohan is a Neuropsychiatrist, currently working in the North Bristol NHS Trust. Her interactive talk showed a number of video recordings of patients from her ward who were under investigation for epilepsy. These videos gave the audience the opportunity to describe and identify seizure types according to the new classification system, which solidified what we had learnt from Dr Tirupathi.
Dr Bernadette Salisbury added to the holistic theme of the day and provided a useful insight into the neuropsychological consequences of epilepsy. The main factors affecting cognition (seizure type, duration, frequency and age of onset), adverse syndromes (West syndrome, Lennox-Gestaut) and the cognitive and behavioural effects of antiepileptic drugs were all discussed.
Following that, Dr Arun Subramanian showed his creative side when describing the mechanisms of action of AEDs with his computer drawings of synapses and voltage gated channels particularly impressive!
Dr Simon Patterson finished off a great morning by recapping the NICE guidelines on epilepsy, with a special focus on treatment within ID Psychiatry. The importance of risk assessments for bathing, eating and using potentially hazardous equipment was reinforced. Dr Patterson also shared his work following the completion of a regional epilepsy survey which identified the stretched resources in investigation and treatment of epilepsy within Northern Ireland and the desire for further training on the topic among Psychiatrists in the region.
Overall, the day offered a fantastic opportunity to learn more about a challenging condition with such a high prevalence among our patients. The six talks illustrated how we can help improve the quality of life of patients and their families with prompt identification and appropriate management.
Finally, we would like to thank all of the speakers and the customary professionalism of the team at Clifton House for putting on such an entertaining and informative day.
"Successful and enjoyable from start to finish"
Intellectual Disability Meeting Blog - Niall Duffy CT2
Did you miss the Intellectual Disability event on 7 September? Never fear, this blog will bring you up to speed.
The day began with an engaging talk on the pharmacological treatment of depression by Dr Chris Kelly. His presentation encouraged open discussion among colleagues on their own clinical experience. Some food for thought for future treatment, indeed, could medications such as ketamine be successfully used?
Dr Claire McKenna took the lead in the ice breaker challenge - those chocolate treats were quite literally flying into the hands of the competitive crowd.
Dr O’ Tony Neill spoke of the pharmacological treatment of refractory schizophrenia. He described schizophrenia as a disorder with four main components, that being, affective, psychotic, negative and cognitive. In treatment, the main focus is on the psychotic component and we considered the need to enhance cognitive processing in schizophrenia for better outcomes. I listened with interest to Tony's theory - perhaps, in future, genetic screening will play a role to predict risk and optimise timely intervention? Watch this space!
We were delighted that colleagues from the NTW Trust in Newcastle-upon-Tyne travelled across to share their amazing work in Stopping the Over-Medication of People (STOMP) with a learning disability or autism. In a room with keen psychiatrists, they had undivided attention as they spoke of the successful reduction of their caseload to 75%.
We learned that physical health monitoring takes place on site, with all patients receiving individualised relapse plans and early identification of those appropriate for discharge. I was struck by Pharmacist David Gerrard’s presentation and the alarming figure of 30,000 prescriptions of psychotropic drugs being given to patients with a learning disability daily in the UK - notably they don’t have a psychiatric diagnosis. For my future practice, it will remind me to think of the patient’s best interests and whether they truly need all of the medications prescribed.
Clinical Specialist OT Moira Scanlon helped us to understand the principles of sensory integration and application to our patients. I’m predicting, having imparted her knowledge, the number of people receiving sensory assessments is set to rise! Adolescent Forensic Consultant Dr Gill Bell explained how her population group is changing with increased levels of personality disorder and autism in her inpatient unit.
CAMHS ID Consultant Dr Heather Hanna, and clinical psychologist Dr O’ Loan, spoke about meeting and promoting the mental health needs of children and adults with intellectual disabilities. The Bamford Review has provided a key driver for services in establishing the recovery model. As trainees, I feel this is essential to promote for every patient.
The day came to an end with an interesting talk from Forensic Consultant Dr Adrian East on Fitness to Stand Trial. He reminded us of the four main Pritchard Rules in this regard effectively using examples of case studies related to the rules. One of the take home messages of the day for me was just because you’re found unfit to plead once, does not mean you’ll be found unfit again.
Overall, I found the day successful and enjoyable from start to finish. There was hard hitting information on overprescribing of medication, up to date literature, and what the future of ID psychiatry may hold. If you’re interested in interactive speakers who present relevant and topical information, then you should attend the next ID meeting on 3 December. For me the day provided a new slant on intellectual disabilities and solidified the sense of community within the ID team.
RCPsych NI Academic Committee
RCPsych NI's Academic Committee held its first meeting for the 2018/2019 academic year in Clifton House on 5 September.
Under the stewardship of Dr Tony O' Neill, the committee's principal purpose is to oversee the administration of undergraduate psychiatry teaching at Queen's, together with promoting integration between joint appointment trainees and consultant staff involved in teaching.
The committee seeks to improve communication across postgraduate training and to consider relevant issues and develop further areas of research within psychiatry, including others involved or with an interest in this area. In addition, the committee aims to improve communication across teaching, training and research in QUB, NIMDTA, trusts and the college.
Membership consists of consultants involved formally in undergraduate QUB teaching and trainees with recognised joint appointment posts and other academic posts such as in ICATS, ACL and ACF. This will be widened out to others involved in teaching, training and research.
The Committee meets on the first Wednesday of each month in Clifton House at 12:00 noon.
Body Dysmorphic Disorder - Masterclass 12 June
Professor David Veale provided an excellent insight into the subject of Body Dysmorphic Disorder (BDD) at Clifton House at our Masterclass on 12 June.
This is an intriguing topic and that fact was reflected in the large attendance at the class. David's presentation explored the nature of BDD and the range of treatments provided. He explained that BDD was, in essence, a body image problem, defined as a preoccupation with one or more perceived defects in one’s appearance which other people can hardly notice or do not believe to be important.
Professor Veale outlined the impact that BDD has on individuals and how many social or public situations make them extremely uncomfortable. People comparing themselves against models in magazines or people in the street is a common feature of BDD, he explained, with many preoccupied with some aspect of their face or believing they have multiple defects.
Interestingly, David explained that it not known what proportion of the population suffers from BDD, although it is recognised to be a hidden disorder. Surveys have put the prevalence of BDD at about 1-2% of the population - notably it is equally common in men and women.
The talk was followed by an excellent question and answer session and more information on BDD can be found on Professor Veale's website.
Pictured above are Dr Lynch, together with Professor Veale and Drs Trimble and Lewis.