Psychiatric Pharmacy Conference 2004

Friday 1st to Sunday 3rd October 2004 Wokefield Conference Centre, Berkshire

Major sponsors:

  • Janssen-Cilag/Organon
  • Eli Lilly & Co Ltd
  • Lundbeck Ltd
  • Sanofi-Synthelabo
  • AstraZeneca UK Ltd

Exhibitors:

  • Boeringher (with Lilly)
  • Denfleet Pharma Ltd
  • IVAX/Genthon
  • Schering Plough Pharmaceuticals
  • Wyeth Pharmaceuticals
  • Novartis
  • NIMHE
  • Organon
  • Shire
  • Cambridge Laboratories

Friday 1st October:

Morning Satellite symposium, Eli Lilly Pharmaceuticals UK Ltd

Morning Satellite symposium, Sanofi

Friday symposium: Bipolar disorder

Chairman Dr Bruce Moore, Consultant Psychiatrist and Clinical Director, Five Boroughs Partnership NHS Trust
Introduction by Graham Newton, Chairman, UKPPG


Stephen Bazire

Tony Hale

Vicky Lawson

Peter Kinderman

Bruce Moore

Saturday 2nd October:

Breakfast Satellite symposium, Lundbeck Ltd "What is the the Pharmacological rationale of escitalopram?" Dr Sandra Hogg

Saturday morning session
Chaired by Roslyn Hope, Workforce Lead, West Midlands Mental Health Development Centre, NIMHE


Karen Allison

Bren Holmes and Stephen Bazire receiving the AstraZeneca-UKPPG travel award from Dr Malcolm Barrett-Johnson

Prof. David Cousins

Phil Cummings

Dr Dave Branford
 

Saturday afternoon workshops

Reception and Conference dinner, with prize awards

Graham Newton and Dave Branford presented prizes to the first prize poster (Carol Paton, Radia Esop and Chike Okocha from Oxleas Trust), Ranjita Dhital (?), highly commended to Ian Maidment (Canterbury), Nikki Holmes (NZ) and Maisa Shie (Netherlands) and first prize oral presentation (Joan Miller, Salford), the pre-registration pharmacist project award to Farah Baig (???) and joint runner-up to Eva Brennan (Cambridge) and Jennifer Pringle (???).


Joan Miller, with Dave Banford getting in on the act

Carol Paton and Radia Esop, the latter still gamely attending the conference despite being in the late stages of pregnancy

Graham, ????, Ian Maidment and Nikki Holmes

Eva Brennan ???

Stephen Bazire (right) being presented with the annual Chairman's Award for outstanding achievement, which he received only a matter of hours before his 50th birthday, in honour of which he was presented with a cake. After the exertions of the previous couple of days, he still had enough puff to blow out the candles, which Pat Morgan seems to think is hilarious.


(Oxford), Jennifer Southern (Chester), Rosie Partner (Vale of Aylesbury PCT), Anne Marie McAlonan (E&N Herts NHS Trust) and Janet Howell (Herts Parts)

Louisa Rowlands, Vanessa Lawrence and Vanessa Bate

The ceilidh to the Woodpeckers was lively as usual, although rumours have started with less than the above action pose...

The place to be after the ceilidh was the IVAX-Genthon stand

In a spirit of co-operation, Simon Collis joins Ivax and is too far gone to realise it's a Zaponex pack not a Denzapine pack he's holding

Sunday 3rd October

Bristol Myers Squibb & Otsuka sponsored Breakfast Satellite Symposium with Dr David Taylor

Morning worship led by Alan Pollard

The challenge of treating Child and Adolescents. Chair Tony Nunn, Liverpool Children's Trust

  • Overview of child and adolescent services, Dr Helen Holmes, Cardiff
  • Treatment options in ADHD, Dr Gordon Bates, Birmingham
  • CBT for teenagers, Dr. Steve Killick, Cardiff
  • Giving Consent, Dr Don Batten, Swindon

Tony Nunn

Helen Holmes

Steve Killick

Don Batten

Gordon Bates

General view of the medical exhibition

General view of the street

Cheer up Helen, it might never happen.

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Conference and organising committee:


  • Celia Feetam - Conference co-ordination and sponsorship
  • Denny Humphries - Administration, advertising, bookings, delegates
  • Ian Maidment - Friday afternoon
  • Graham Parton - Posters, oral presentations, Saturday morning
  • Fiona Couper - workshops
  • Robert Goff - Medical Exhibition and IT
  • Alan Pollard - Morning worship
  • Wendy Davies - Sunday morning
  • Andy Nunney - photographs

Graham Parton

Andy Nunney

Denny Humphries and Celia Feetam, the hardest workers at the conference

Conference report, by Celia Feetam

Mental Health Pharmacists and the National Patient Safety Agency

Patient safety in mental health was the subject of the keynote address by Professor David Cousins at the 29th Annual (11th International) United Kingdom Psychiatric Pharmacy (UKPPG) Conference held from 1st to 3rd October in Reading. Professor Cousins, Head of Safe Medication Practice at the National Patient Safety Agency described how the NPSA and mental health pharmacists could work together to improve the safety surrounding medicines management in mental health. Lessons learned from safety critical industries elsewhere clearly indicate that underlying systems are often the root cause of problems in this area. The National Reporting and Learning System (NRLS) will be launched in 2005, as a reporting system for medication errors as well as near misses across primary and secondary care in England and Wales. Mental health pharmacists working closely as integral members of the multidisciplinary team as well as with patients and carers are well placed to prevent untoward events occurring promote the safe use of medicines and ensure that risk reduction systems are in place.

Bipolar Disorder During the opening session of the Conference, devoted to bipolar disorder, delegates from New Zealand, Holland and the UK heard from Stephen Bazire, Chief Pharmacist, Norfolk and Waveney Mental Health Partnership NHS Trust. about the importance of an early and accurate diagnosis. He suggested prevalence rates for this potentially life-long, disabling disorder may underestimate the true situation. Biploar disorder is thought to be significantly under-diagnosed, is associated with considerable co-morbidity, as well as substance misuse and a high suicide rate.

Professor Tony Hale, Professor of Psychiatry, University of Kent then went on to describe the latest treatments for bipolar disorder. He told the Conference that between 1993 and 2000 nine new mood stabilisers had been approved by the FDA. There was good date for seven of these for the treatment of bipolar disorder, however with the exception of oxcarbazine, they were generally ineffective in mania. Some efficacy, however had been demonstrated for bipolar depression and associated co morbidities. Lamotrigine in particular, is effective as a prophylaxis against bipolar depression and although not licensed for this indication in the UK it is licensed and extensively used elsewhere in Europe. He concluded by reviewing atypical antipsychotic as treatments for bipolar mania. Olanzapine, quetiapine and risperidone are all licensed for this indication and the evidence to date suggests that the prescription of a mood stabiliser as monotherapy is inferior to the combined use of an atypical antipsychotic with a mood stabiliser.

Patients and carers viewpoints were then presented by Vicky Lawson, Self-training Training Manager of the Manic depression Fellowship. She talked about the work of the MDF and how people affected by the disorder can be assisted to manage their mood swings. She also presented some results of the "Our Points of View Survey" a joint venture between the MDF, Rethink and Mind. General concerns focused around lack of choice, side effects, attitudes of professionals, including pharmacists to service users and poor follow up. Pharmacists have an important role to play here in addressing some of these issues which clearly cause patients and their carers considerable distress. The final presentation in this session was from Dr Peter Kinderman, Reader in Clinical Psychology, University of Liverpool. He addressed the psychological treatment of bipolar disorder and talked about holistic and integrative care. We need to know how medicines impact on the psychological processes involved in the disorder. He spoke in some detail about cognitive behavioural therapy and relapse prevention. Sufferers are often able to recognise prodromal signs of both depressive and manic relapse. They should then be encouraged to seek help. He concluded that psychological therapies are effective and must be made available together with medication to those suffering from this distressing but manageable condition.

The Conference throughout was punctuated by industry supported satellite symposia, Topics covered included evidence-based medicine and psychiatry, the pharmacological rationale of the escitalopram enantiomer, bipolar depression and the use of the partial D2 agonist, aripiprazole in the treatment of schizophrenia.

The Pharmacy practice sessions provided a forum for mental health pharmacists to present their work. This was in addition to the well supported poster sessions. Joan Miller from Manchester presented her work on how to respond to a red clozapine alert, Peter Pratt, described the introduction of electronic prescribing in mental health in Sheffield. Karen Allison, also of Sheffield presented an audit of prolactin and Ian Maidment from Kent shared his initial twelve month experience of a local medication error reporting system.. The AstraZeneca Travel Award 2004 was won by Stephen Bazire and Bren Holmes from Norwich for their pioneering lithium data base which holds data for patients in Norwich and the surrounding areas. The database is managed within the pharmacy department and provides a register and recall service for the monitoring of lithium levels across the primary and secondary care interface.

In common with previous years and in tribute to a mental health pharmacist who pioneered the involvement of patients and carers, but whose untimely death in sadly ended his work in this area, the Brett Hill Memorial Lecture addressed the "patient experience". It was delivered by Jim Philips, Senior Trainer in the Expert Patient Programme who movingly spoke about his own experiences and the role of the Expert Patient Programme in mental health.

The Challenge of Treating Children and Adolescents

The final conference session addressed the challenge of treating children and adolescents. An overview of CAMHS services was provided by Dr Helen Holmes, consultant child psychiatrist, Cardiff. She described the multidisciplinary nature of such services but added that service provision remains patchy despite the Health Advisory Service review document which introduced the concept of four tiers. The Audit Commission report in 1999 first recognised the importance of the correct diagnosis and treatment of mental disorders in young people who may previously have been described as suffering from "growing pains" and left to the parents to deal with. Extra resources have since been made available to help authorities and trusts to tackle this agenda and improve the lives of the many children and young people who are among some of the most disadvantaged in our society. More recently the Children's National Service Framework has as Standard 9. the mental health and psychological well being of children and young people. It also endorses and encourages multi-disciplinary working.

Dr Gordan Bates, from Birmingham, then gave and inspiring over view of ADHD and its treatment including the use of ritalin as well as the newer agent atomoxetine. He runs a second opinion clinic and deals with the most difficult of cases. He gave practical advice about the management and treatment of this condition. Examples include the need to add immediate release Ritalin to the modified release formulation in the afternoon to facilitate homework sessions, the value of the MR formulation in reducing the stigma attached, in some schools, to having to go to the school nurse for a dose of medication, the use of high doses when lower dose fail. He ended by reminding his audience of the difference between a naturally exuberant child and one with a pathological condition., especially after a birthday party!

Following the recurrent theme of looking at psychological as well as pharmacological interventions, the next speaker, Dr Steve Killick showed that you can actually talk to teenagers Cognitive behavioural therapy (CBT) is increasingly used with children, young people, their parents and families. Treatments have been developed for a whole range of disorders in this group including anxiety, depression, eating disorders, anger management and behaviour change. CBT is essentially a mix of behavioural theory. cognitive science and humanistic therapy with the aim of producing a collaborative, problem solving and psycho-educational approach. Perhaps as many as 20% young people experience mental health problems, there has been a 70% increase in depression and anxiety in young people aged 15 since 1986, 50,000 children and young people in the UK were on antidepressants in 2003. Following the recent MHRA warnings about the use of antidepressants in children and adolescents, CBT for this population should more available and utilised.

Legal issues surrounding the use of medicines in young people were alluded to by the Chairman of this session Tony Nunn, Clinical director of Pharmacy, Royal Liverpool Children's NHS Trust, who, in his introduction commented upon the lack of licensed indications and the regulatory status of the SSRIs. Further legal issues around informed consent and confidentiality were covered by the final speaker Dr Don Batton, a consultant child psychiatrist from Swindon. He emphasised the fact that children need to be given information in an understandable form and that their ability to understand will change with time as they are constantly developing. He confirmed that parents are usually the best judges of what is in a child's best interest and reminded the audience that refusal is complex and not absolute and that treatment should only be enforced if absolutely necessary.

And finally, it's the

Annual caption contest

In the tram in the early hours of Sunday morning, Pat Morgan's legs have the undivided attention of two admiring delegates, but who is saying what to who(m)?

E-mail your entries to sbazire@ukppg.org.uk.