Abstract Appendix

Abstract

Medical Cannabinoids and their Relevance to Psychiatrists

N Lintzeris^1,2

¹Drug and Alcohol Services, South East Sydney Local Health District

²Division Addiction Medicine, University of Sydney

Abstract: There is increasing interest in the general community in the use of cannabinoids for therapeutic purposes. Australian data suggests that many people in the community are using illicit cannabis products to try to manage a range of health conditions, including mental health conditions such as depression, generalized anxiety, PTSD, and sleep problems. However the evidence base supporting the use of cannabinoids for these indications remains limited, and there legitimate concerns regarding adverse events associated with cannabinoids. Surveys of psychiatrists and trainees indicates professional concerns regarding their widespread use, and the need for increased education of health providers and consumers.

The presentation will

provide an overview of cannabinoid pharmacology and regulations regarding cannabinoid prescribing in Australia

provide an overview of the consumer and practitioner perspectives regarding medical cannabis use for mental health conditions

summarize existing evidence regarding cannabinoids (including THC, cannabidiol) for mental health conditions

identify potential areas of future research and practice in this area.

Editors Round Table: How to Write a Paper and Get it Accepted

G Malhi¹, K Bhui², V Brakoulias³, Sara Purdy⁴, G Newton-Howes⁵

¹University of Sydney, Sydney, Australia

²Queen Mary University, London, UK

³University of Sydney, Sydney, Australia

⁴Sage Publishing

⁵University of Otago, Wellington, New Zealand

Overview: This editor’s round table brings together the editors on chief of BJPsych, ANZJP and Australasian Psychiatry, along with the expertise of Sage publishing. The purpose of this session is to assist psychiatric registrars and fellows embarking on preparing academic work for publication in high ranking journals. Questions from the development of creative ideas into viable research questions to the nitty gritty of choosing a journal and preparing a paper will be discussed. A series of prompts and starter questions have been collected and considered by the panel, however attendees are welcome to bring their own questions along. This is a unique opportunity to gain insights from the editors of leading Australasian and International journals, to sharpen your academic writing and contribute to the discussion of publishing in psychiatric practice.

Social Media: Risks, Rewards and Opportunities for RANZCP

A Amos¹, C Arrow², CS Yong¹

¹RANZCP – Membership Engagement Committee

²PR Knowledge Hub, New Zealand

Background: Social media platforms like Facebook and LinkedIn increasingly dominate the networks that initiate and maintain personal and professional relationships, validate or condemn commonly held values and beliefs, and rapidly disseminate precisely targeted information of wildly variable accuracy. Based on their own experiences with Facebook, many doctors view professional use of social media as unacceptably blurring boundaries, tantamount to enticing patients into a personal correspondence, or exposing family and friends to unsolicited professional advice. Many are also concerned at the potential for unprovoked attacks, or for unwanted public exposure of private or professional views. While these concerns are understandable, they may be exaggerated by lack of familiarity with social media platforms and the tools available to control exposure and maintain boundaries.

Objectives: The symposium will outline the current features and future promise of social media for psychiatrists and psychiatric organisations in building professional networks, communicating with the public, and streamlining continuing professional development. The power and security features of different platforms will be discussed, with a focus on specific techniques for managing risk such as open and closed groups, blocking, and approaches to managing separate personal and professional online identities. Attendees will learn how they can benefit from social media, a realistic appraisal of the risks specific to doctors and psychiatrists, and how those risks can be managed by selecting appropriate platforms and using the built-in features.

Member Welfare Symposium

T Cookson, S Kumar, S Rotstein, S Romans

Background: This symposium is an official presentation of the RANZCP Member Welfare Committee.

Objectives: The symposium will provide an opportunity for attendees to discuss a range of issues such as burnout, resilience, wellbeing, stigma and self-care.

Methods: Presenters will provide an update of the current literature, share experiences and identify resources and strategies that may be helpful for RANZCP trainees and members.

Findings: There is a growing body of evidence (both published and anecdotal) outlining the increased prevalence of mental ill health amongst doctors and specifically those working in psychiatry. Numerous potential risk factors have been considered (to varying degrees of scrutiny). There is a general paucity of studies considering possible interventions.

Conclusions: Our focus, both as clinicians and researchers, must now turn to determining modifiable contributors and effective interventions.

Presenter 1

What is Burnout? Signs, Symptoms and Risk Factors for Psychiatrists with an Overview of Preventative/Management Strategies

S Kumar

Consultant Psychiatrist, Department of Forensic Psychiatry

Honorary Clinical Associate Professor, Waikato Clinical Campus, University of Auckland

Graduated from Calcutta Medical College in India (and after completing postgraduate training in India and the UK migrated to New Zealand in 1997. Served as Clinical Director of Mental Health Services in Rotorua till 2006. Additional positions held were Director of Clinical Training, Director of Postgraduate Education in Psychiatry, Intern Supervisor and Director of Area Mental Health Services. Moved to Waikato District Health Board as Forensic Consultant Psychiatrist in 2006. Attached to University of Auckland and Waikato Clinical School as an Honorary Clinical Associate Professor. Several publications in peer reviewed journals and have written chapters in text books many of which have been on burnout.

The term burnout was first introduced in the 70s. Since then scientific publications on this topic have proliferated. Psychiatrists have been identified as a group vulnerable to developing burnout due to significant degree of interpersonal contact with troubled client population. Burnout has significant impact on the delivery of service, the quality of service, the emotional and physical health of the person experiencing it and their interpersonal/social functioning. There is also some evidence to suggest burnout may have protective effects on the psyche of the person experiencing it. Burnout serves as an emotional brake by slowing down the working and thus scope of further strain on the person. Distancing oneself from demanding work situations may also be protective against emotional drain and depletion of empathy. Key lessons from opinions and research studies on the prevention and management of burnout are reviewed. Active screening of burnout, developing resilience and a strong organizational culture of tackling burnout early can help prevent burnout. A combination of intensive individual or group therapy sessions based on cognitive behavioural principles along with booster sessions appears to be most effective in managing burnout once it has developed. Specific treatment interventions against stress may reduce scores on the three dimensions of burnout.

Presenter 2

Update on the Current Literature on Psychiatrist Welfare, Including Data from the Member Engagement Committee (MEC) Member Welfare Study. Identification of Factors Obstructing Trainees and Fellows Seeking Support, and an Overview of the Evidence to Date in Regards to Effective Interventions

S Rotstein

Current advanced trainee in psychiatry with a particular interest in medical education and well being of doctors and medical students. Sarah took a ‘break in training’ last year and completed a graduate certificate of clinical education and a graduate certificate of Arts. Over recent years she has been completing a systematic literature review pertaining specifically to the mental health and job satisfaction of doctors working in psychiatry.

Presenter 3

Stage Specific Stressors and Interventions and the Role of Supervision. A Summary of Findings from Trainee Welfare: a New Zealand Perspective

S Romans

Currently HOD in the Department of Psychological Medicine University of Otago Wellington (UOW). Worked in Dunedin at the university (UOD) for 30 years, then in Toronto in a research professorship for 8 years before returning to NZ in Wellington in 2009. She led a group of senior psychiatric registrars to undertake some qualitative research into stress during registrar training, which is being presented

New Zealand Inquiry into Mental Health and Addiction

R Paterson¹, D Codyre^2,3

¹Member of the Inquiry Panel, New Zealand

²East Tamaki Healthcare, Auckland, New Zealand

³Nirvana Health Group, Auckland, New Zealand

Background: The New Zealand Government announced an Inquiry into Mental Health and Addiction in late January. The scope of the Inquiry is very broad, covering promotion of mental health and wellbeing, prevention of mental health challenges, and improved responses to mental health and addiction problems. The Inquiry is to examine societal causes across multiple sectors and the community, as the basis for a strong focus on solutions. It is to report to Government by the end of October 2018. More information about the Inquiry may be found at: https://www.dia.govt.nz/Government-Inquiry-into-Mental-Health-and-Addiction

Objectives:

To inform Congress attendees about the scope of the inquiry, the processes of the inquiry and observations of the panel to date.

To hear the views of Auckland region psychiatrists leaders about issues they consider of relevance for the Inquiry.

To hear from Congress attendees issues they believe are useful for the Panel to consider.

Method: Presentations will be made by the Panel then by a representative of local psychiatrists. This will be followed by invitation for comments from the floor.

Kava for the Treatment of Generalized Anxiety Disorder RCT: Analysis of Adverse Reactions, Liver Function, Addiction, and Sexual Effects

J Sarris^1,2,3, C Stough^2,3, R Teschke⁴, ZT Wahid^2,3, CA Bousman^1,2,5,6, G Murray⁷, KM Savage^2,3, P Mouatt⁸, C Ng¹, I Schweitzer¹

¹Department of Psychiatry, The University of Melbourne, Victoria, Australia

²Swinburne University of Technology, Centre for Human Psychopharmacology, Victoria, Australia

³NICM Collaborative Centre for Neurocognition, Victoria, Australia

⁴Goethe University of Frankfurt, Teaching Hospital Hanau, Department of Internal Medicine II5Frankfurt au Main, Germany

⁶Florey Institute of Neuroscience and Mental Health, Victoria, Australia

⁷Department of General Practice, The University of Melbourne, Australia

⁸Brain and Psychological Science Research Centre, Swinburne University of Technology, Victoria, Australia

⁹Southern Cross University, Southern Cross Plant Science, New South Wales, Australia

Abstract: Presently, little is known about a number issues concerning kava (Piper methysticum), including (i) whether kava has any withdrawal or addictive effects; (ii) if genetic polymorphisms of the cytochrome (CYP) P450 2D6 liver enzyme moderates any potential adverse effects; and (iii) if medicinal application of kava has any negative or beneficial effect on sexual function and experience. The study design was a 6-week, double-blind, randomized controlled trial (n = 75) involving chronic administration of kava (one tablet of kava twice per day; 120 mg of kavalactones per day, titrated in non-response to two tablets of kava twice per day; 240mg of kavalactones) or placebo for participants with generalized anxiety disorder. Results showed no significant differences across groups for liver function tests, nor were there any significant adverse reactions that could be attributed to kava. No differences in withdrawal or addiction were found between groups. Interesting, kava significantly increased female’s sexual drive compared to placebo (p = 0.040) on a sub-domain of the Arizona Sexual Experience Scale (ASEX), with no negative effects seen in males. Further, it was found that there was a highly significant correlation between ASEX reduction (improved sexual function and performance) and anxiety reduction in the whole sample.

Reference:

Phytother. Res. 27: 1723–1728 (2013)

Kava in the Treatment of Generalized Anxiety Disorder - A Double-Blind, Randomized, Placebo-Controlled Study

J Sarris^1,2,3, C Stough^2,3, CA Bousman^1,2,5,6, ZT Wahid^2,3, G Murray⁷, R Teschke⁴, KM Savage^2,3, A Dowell¹, C Ng¹, I Schweitzer¹

¹Department of Psychiatry, The University of Melbourne, Victoria, Australia

²Swinburne University of Technology, Centre for Human Psychopharmacology, Victoria, Australia

³NICM Collaborative Centre for Neurocognition, Victoria, Australia

⁴Goethe University of Frankfurt, Teaching Hospital Hanau, Department of Internal Medicine II⁵Frankfurt au Main, Germany

⁶Florey Institute of Neuroscience and Mental Health, Victoria, Australia

⁷Department of General Practice, The University of Melbourne, Australia

Abstract: Kava (Piper methysticum) is a plant-based medicine, which has been previously shown to reduce anxiety. To date, however, no placebo controlled trial assessing kava in the treatment of generalized anxiety disorder (GAD) has been completed.

A total of 75 participants with GAD with no comorbid mood disorder were enrolled in a 6-week double-blind trial of kava (120/240 mg of kavalactones per day depending on response) versus placebo. F-Aminobutyric acid (GABA) and noradrenalin transporter polymorphisms were also analyzed as potential pharmacogenetic markers of response.

Reduction in anxiety was measured using the Hamilton Anxiety Rating Scale (HAMA) as the primary outcome. Intention-to-treat analysis was performed on 58 participants who met inclusion criteria after an initial 1 week placebo run-in phase. Results revealed a significant reduction in anxiety for the kava group compared with the placebo group with a moderate effect size (P = 0.046, Cohen d = 0.62). Among participants with moderate to severe Diagnostic and Statistical Manual of Mental Disorders- diagnosed GAD, this effect was larger (P = 0.02; d = 0.82).

Conclusion: At conclusion of the controlled phase, 26% of the kava group were classified as remitted (HAMA e 7) compared with 6% of the placebo group (P = 0.04). Within the kava group, GABA transporter polymorphisms rs2601126 (P = 0.046) and rs2697153 (P = 0.02) were associated with HAMA reduction. Kava was well tolerated, and aside from more headaches reported in the kava group (P = 0.05), no other significant differences between groups occurred for any other adverse effects, nor for liver function tests. Standardized kava may be a moderately effective short-term option for the treatment of GAD. Furthermore, specific GABA transporter polymorphisms appear to potentially modify the anxiolytic response to kava.

Reference:

J Clin Psychopharmacol 2013;33: 00Y00