Psychiatric Pharmacy Conference 2003

Supplementary prescribing was the subject of the key-note speech delivered by Dr Jim Smith, Chief Pharmaceutical Officer for England in the Department of Health at the opening session of the United Kingdom Psychiatric Pharmacy Group (UKPPG) Conference held in Reading early in October. This was topical not just because of Section 63 of the Health and Social Care Act 2001 and the regulations which followed in December 2002 allowing supplementary prescribing by pharmacists for the first time, but also because of the Position Statement on Specialist Pharmacist Prescribing in Mental Health and Learning Disabilities (www.ukppg.org.uk) released in September jointly by the UKPPG and College of Mental Health Pharmacists (CMHP). This document sets the scene for supplementary prescribing by pharmacists in mental health, describing additional competencies required and outlining the structure and environment in which such activities should take place. This was followed the next day by a debate "This house believes that prescribing should be left to doctors" Proposed by a consultant psychiatrist and seconded by a mental health pharmacist, much to the surprise of many, the motion was won by a significant majority, despite the efforts of the opposing team, again a consultant psychiatrist and specialist pharmacist.

Partial Agonists

After the opening session there followed a session on the pharmacology of partial agonists. Dr Nicholas Lintzeris from the National Addiction Centre, Institute of Psychiatry, gave an expert overview of the pharmacology of buprenorphine, its clinical applications and evidence base as well as the pertinent issues for pharmacists in the use of buprenorphine in the management of opiate dependence in the UK. Dr Mike Travis, also from the Institute of Psychiatry, then reviewed the pharmacology of aripiprazole, the first of a new generation of antipsychotics shortly to be available. Supplementing this first day of the conference this year were Industry sponsored satellite symposia on partial agonist treatment of psychosis, the maintenance of clozapine patients in the community and antipsychotic induced glucose intolerance.

The next morning opened with oral presentations of research conducted by pharmacists and technicians. This session was chaired by Professor William H.Benefield Jr. from Texas who summed up the morning as well as the debate which followed, by presenting an overview of the changes which have occurred in the United States during the last thirty years where pharmacist as well as psychologist prescribing has become a reality for many clinicians. He spoke of his personal experiences as a prescribing pharmacist in a psychiatric setting in Texas. and gave an insight into what we in the UK may have to look forward to.

The afternoon was taken up by poster sessions followed by workshops. Topics included critical appraisal, eating disorders, the National Minimum Care Standards and rapid tranquillisation. During the Conference dinner that evening, prizes for oral presentations were presented to Shubra Mace, Joan Miller and Janice McEwan, while Kiran Parmar, Pat Morgan and Gail Healy won prizes for their posters. Gail Healy was also the fist recipient of a new award, the Pre-registration Pharmacist Bursary Award. This was presented to Gail for an audit of antipsychotc prescribing. This award is for the best project conducted in mental health by a pre-registration pharmacy student during their pre-registration year. Shazia Ghaffour was runner up. Finally, the Chairman's award for a "life-time's contribution to psychiatric pharmacy" went to Dr David Taylor, Chief Pharmacist of the South London and Maudsley NHS Trust and President of the College of Mental Heath Pharmacists.

A Carer's Perspective - the Brett Hill Memorial Award

The Sunday session was chaired by Professor Antony Sheehan, chief Executive of the National Institute of Mental Health for England (NIMHE). He introduced Dr David Shiers, co-incidentally also a friend and colleague, who delivered the Brett Hill Memorial Lecture. David, a general practitioner, spoke most movingly of his role as both carer and professional in the mental illness of his daughter Mary. He described how difficult it had been even for him to get appropriate care and treatment for her at the beginning and what a profound effect her refractory schizophrenia had on the family who felt that the system let them down. The story has a happy ending in that finally on effective treatment, Mary is now flourishing with a small voluntary job and a place of her own in the community.

Prescribing in Pregnancy and Breastfeeding

The last two presentations provided vital information for those pharmacists faced with therapeutic dilemmas concerning sexual dysfunction as a side effect of psychotropic medication and mother and baby services. Dr Maureen Wilkinson, consultant psychiatrist and perinatal lead for the Cheshire and Wirral Partnership Trust considered in detail the issues around prescribing in pregnancy and during breast feeding. She warned of the general risks of pregnancy and then went on to describe the additional risks posed by certain psychotropics prescribed both early and later in a pregnancy. She then considered all the major classes of psychotropics in turn concluding that conventional or older treatments may generally be considered to be safer unless there is evidence to the contrary and the National Teratology service can provide this where it exists. In conclusion, her overall message was that as in any clinical situation the risks must be balanced with potential benefits and as always the minimum effective dose must be prescribed.

Drug-induced Sexual Dysfunction

Dr Shubulade Smith, a Consultant Psychiatrist who runs a busy community team in Lambeth as well as an acute adult ward at the Maudesly, finally considered drug induced sexual dysfunction. She showed how certain antidepressants and antipsychotics interfere with the different phases of sexual function via both central and peripheral mechanisms. This may be through one of several neurotransmitter systems. She then indicated which were the worst offenders, stated that mood stabilisers had a minimal effect on sexual function and described the effects recreational drugs, such as heroin, cannabis and ecstasy had in this respect. She then went on to described how strategies such as dose reduction and switching may be employed to overcome such drug-induced sexual dysfunction.