CACLP Annual Meeting – Wednesday, October 26, 2022

Overall Learning Objectives:

1. Describe the process and outcome of developing an inpatient medical psychiatry unit.

2. Appraise new research in the field of CL Psychiatry.

3. Compare and contrast the past, present, and future of Canadian CL Psychiatry, in terms of clinical practice, research, and education.

 

This event is an accredited group learning activity (section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Canadian Psychiatric Association (CPA).

The specific opinions and content of this event are not necessarily those of the CPA, and are the responsibility of the organizer(s) alone.

La présente activité est une activité d'apprentissage collectif agréée (section 1), au sens que lui donne le programme du Maintien du certificat du Collège royal des médecins et chirurgiens du Canada; elle a été approuvée par l'Association des psychiatres du Canada. 

Les opinions et le contenu spécifiques de cette activité ne sont pas nécessairement ceux de l'APC, et sont la responsabilité exclusive de l'organisateur ou des organisateurs.​​ 

8:00 – 8:45

Registration and Continental Breakfast​​ service​​ in meeting room​​ for all attendees

8:45 – 9:00

Opening Remarks

Dr. Raed Hawa​​ - CACLP President

Dr. Kathleen Sheehan​​ -CACLP CPD Chair & Vice President

9:00 – 10:30

Plenary

Dr. Rupang Pandya

The Calgary Medical Psychiatry Unit (MPU) Experience - How to Formulate the ‘Secret Sauce’ of a Successful MPU

Dr. Rupang Pandya

Abstract:

The Calgary Medical-Psychiatry Unit (MPU) is a six-bed unit located on a general medical ward at the Peter Lougheed Centre. The focus is to treat patients with highly acute medical and psychiatric illnesses which could benefit from co-managed care.

 

Our co-attending physician model includes a Psychiatrist along with a variety of Internal Medicine and Hospitalist Physicians. The team is composed of many allied health professionals including a clinical nurse specialist, social worker, dietician, clinical ethics, spiritual care​​ practitioner, pharmacist, occupational and physical therapists, transition services​​ worker​​ and others. Our nursing staff have a medical background​​ with​​ cross-training in psychiatric nursing.

 

The MPU is complementary to our Psychiatry Consultation-Liaison Service. The foundations of the establishment of the unit along with lessons learned will be reviewed. A discussion on the benefits of the MPU on clinical care, education of trainees,​​ and potential research opportunities will be explored. 

25% of this session will be dedicated to interactive learning through questions and case discussion with the audience.

 

Learning Objectives:

  • Describe the origin and admission criteria of the Medical Psychiatry Unit at the Peter Lougheed Hospital in Calgary.

  • Apply the experiences of the Medical Psychiatry Unit at the Peter Lougheed Hospital in Calgary to improve care and collaboration of patients at your unit.

  • Appraise the impact of the Medical Psychiatry Unit on clinical care, education, and research.

CanMEDS Roles: Collaborator, Health Advocate, Communicator

10:30 – 10:45

Refreshment Break –​​ Coffee, Tea, Water service in meeting room

10:45 – 11:05

Oral Presentation

Dr. Peter Chan

Project in Progress​​ 

Oral Presentation​​ – Project in Progress (a research project with preliminary results orprogram evaluation)

The PAWSS Before the CIWA: Implementing a New Protocol to Manage Alcohol Withdrawal Syndrome in​​ Medically Ill​​ Inpatients

Dr. Peter Chan

Abstract:

Introduction:​​ The Prediction of Alcohol Withdrawal Severity Scale (PAWSS) is a validated tool for prediction of risk of moderate to

severe alcohol withdrawal in​​ medically ill, hospitalized patients. A combined PAWSS/CIWA protocol was initiated at the

Vancouver General Hospital (VGH) in February 2021 with the goal of reducing benzodiazepine usage and potential

harms. This new protocol is a refinement of the currently existing CIWA protocols that have been implemented since

2007 at VGH. To date there is limited research available on the impact of a combined PAWSS/CIWA protocol on

managing alcohol withdrawal syndrome (AWS).

 

Methods:​​ Chart review of patients admitted to internal medicine receiving benzodiazepines under the PAWSS protocol

(September 2021-November 2021). Data collected included benzodiazepine doses, completeness of PAWSS score,

accuracy of CIWA administration and adverse events. This phase addressed the primary question of the fidelity of the

protocol in practice.

 

Results:​​ A total of 70 patient visits met the inclusion criteria. Accessible data were available for 65 charts. The average patient age was 49.6 (min: 22, max: 83). 16 patients were >59 years (24.6%). Errors were identified in 33 of the PAWSS scores reviewed (50.7%). Errors in the administration of CIWA were identified in 48 charts (73.8%). CAM scores were completed in 6 of 65 charts (9.2%). There was a higher degree of error in implementation for adults >59, for both the PAWSS and CIWA elements of the order set. Benzodiazepine usage will be further analyzed and presented.

 

Conclusions:

Review of the implementation of the combined PAWSS/CIWA protocol has identified limitations with regards to the fidelity of the intervention. A potential variance in the quality of care received by older adults compared to younger adults was also identified. Areas for improvement include streamlining the order set and further tailored education for healthcare providers.

25% of this session will be dedicated to interactive learning through questions and discussion with the audience.

 

Learning Objectives:

  • Describe the manifestations of AWS in a​​ medically ill​​ inpatient population.

  • Explain​​ the rationale for implementing the PAWSS in managing AWS.

  • Identify the barriers to administering the PAWSS and CIWA accurately.

11:05 – 11:25

Oral Presentation

Dr.​​ Sylvain Iceta

New Research Papers

 

Oral Presentation – New Research Papers

Loss to follow-up after bariatric surgery: potential influence of psychological and psychiatric factors on short (2-year) and medium term (5-year).

Dr. Sylvain Iceta

Abstract:

Introduction:​​ Improving adherence to follow-up has become a major challenge regarding longer-term complications of bariatric surgery and/or weight regain. Data on psychiatric or psychological risk factors for loss to follow-up are scarce.

 

Objective:​​ To assess the psychiatric and psychological risk factors for the discontinuation of the follow-up at 2 and 5 years after bariatric surgery.

 

Methods:​​ This study retrospectively collected the medical records of patients who underwent a sleeve gastrectomy (SG) or a Roux-en-Y gastric bypass (RYGB) from January 2012 to August 2016. BMI, sex, age, home-hospital distance were collected. Current and past psychiatric or psychological characteristics were determined from reports of pre-surgical psychiatric or psychological interviews and coded according to a predetermined procedure.

 

Results: Of the 346 patients in the 2-year cohort, 81.5 % were​​ adherent to follow-up; and of the 297 patients in the 5-year cohort, 40.4 % were​​ adherent. No significant differences were found between SG and RYGB in either the 2-year or 5-year cohort. Lost to follow-up participants had a higher home-hospital distance in the 2-year cohort (49.4 km ±66.4 vs 68.9 km ±63.6; p=0.04) and a younger age in the 5-year cohort (46.6 ±11.5 vs 43.5 ±10.9; p=0.02). A higher prevalence of a history of food addiction (2-year cohort) (4.3% vs. 10.9%; p=0.03) and a lower presence of emotional eating (5-year cohort; 31.7% vs 21.5%; p=0.05) were found in participants lost to follow-up.

 

Conclusion:​​ The number of participants lost to follow-up remained low 2 years after bariatric surgery but dramatically increased at 5 years. In addition to age and distance, mental health factors related to eating behaviors and addictions may influence the rate of loss to follow-up, whereas no such association was found with anxiety or depression.

25% of this session will be dedicated to interactive learning through questions and discussion with the audience.

 

Learning Objectives:

  • Describe the​​ loss to follow-up​​ care, which​​ increases​​ dramatically five years after bariatric surgery.

  • Identify that loss to follow-up rate was not different according to the type of surgery performed.

  • Distinguish​​ the psychological​​ or psychiatric factors related to addiction (to food but not only) or emotional eating​​ that​​ may influence​​ adherence​​ in the short and medium term.

11:25 – 11:45

Oral Presentation

Dr. Rosalie Steinberg

New Research Papers

Oral Presentation – New Research Papers

Implementation of a psychiatry consult liaison service at an inpatient rehabilitation hospital: An observational study

Dr. Rosalie Steinberg

Abstract:

Introduction:

Psychiatric illness is common among patients admitted to inpatient rehabilitation hospitals and can contribute to poor rehabilitation participation, decreased coping, and increased length of stay.

 

Objective:​​ To identify which rehabilitation patient populations most frequently received psychiatric consultation and recognize the most common psychiatric comorbidities at a​​ 178-bed​​ rehabilitation hospital after the implementation of an embedded Psychiatry Consult Liaison (PCL) Service.

 

Design:​​ A chart review of consultations completed by the PCL service was performed to extract patient demographics (age and sex), rehabilitation diagnosis, cause of rehabilitation diagnosis (intentional, accident, self-inflicted, or disease), reason for referral to psychiatry, and psychiatric diagnosis on initial consultation. SPSS was used for statistical analysis to answer the pre-specified research questions.

 

Results:​​ N=1016 charts were reviewed in the initial chart review. Most common rehabilitation diagnoses that were associated with a psychiatric consult were (% admissions receiving consultation): amputations (38%); burns (35%), neurologic disorder (28%), debility/deconditioning (14%), and musculoskeletal injury (7%). While 20% of patients did not meet criteria for a psychiatric diagnosis, most common psychiatric diagnoses included mood disorder, adjustment disorder, neurocognitive disorder and delirium.

 

Conclusion:​​ There are significant perceived needs for psychiatric services in an inpatient rehabilitation setting. While some patient groups such as amputees, burn and trauma patients exhibit the highest utilization, the service supports mental health needs from many patient groups and may best be supported by targeted screening and more tailored interventions.

 

Rehabilitation populations with the highest rate of referral for psychiatric consultation included patients with amputation, burns, neurologic disorders, polytrauma and debility/deconditioning. In the rehabilitation population, mood disorders, adjustment disorders, neurocognitive disorders and delirium were the most common diagnoses. Screening tools and group-based interventions implemented for these high-risk populations, focused specifically on these common diagnoses, may be helpful in both the early identification and treatment of psychiatric illness among rehabilitation populations.

25% of this session will be dedicated to interactive learning through questions and discussion with the audience.

 

Learning Objectives:

  • Recognize the burden of psychiatric illness in a rehabilitation setting.

  • Identify which rehabilitation sub-populations most frequently received psychiatric consultation.

  • Discuss methods to improve early identification and treatment for high-risk populations in rehab settings.

11:45 – 1:00

CACLP AGM​​ &​​ Lunch

CACLP Annual General Meeting and Lunch​​ –​​ Lunch service in meeting room​​ for all attendees

Dr. Raed Hawa, President​​ of​​ CACLP​​ will Chair the CACLP Annual General Meeting of Members

1:00 – 1:30

Posters

Posters,​​ Q​​ & A,​​ and Judging

  • Efficacy of a virtual Cognitive Behavioral Therapy for Insomnia "book club" group intervention for insomnia with comorbid conditions​​ ​​ Dr. Christopher Earle

  • Examining the neuropsychiatric sequelae of multiple sclerosis over time​​ ​​ Dr.​​ David Freedman​​ and Dr. Anthony Feinstein

  • Efficacy of an Eight-Session Stress-Reduction Pilot Program for Primary Healthcare Providers Delivered Virtually, Once a Month, in 2021​​ ​​ Dr. Kathy Margittai

  • A Scoping Review of Dementia and NAFLD- Does an association exist?​​ ​​ Dr. Kerstina Boctor

25% of this session will be dedicated to interactive learning through questions and discussion with the audience.

1:30​​ ​​ 3:30

Workshop​​ 

Workshop​​ 

The​​ Past, Present,​​ and​​ Future of Consultation-Liaison Psychiatry in Canada.

Dr. Kathleen Sheehan, Dr. Leon Tourian, Dr. Adrienne Tan

Abstract:

In this workshop, participants will have the opportunity to better understand and explore the past and present of Consultation-Liaison Psychiatry in Canada and contribute to its future.​​ 

 

Dr. Kathleen Sheehan will provide an overview of CL Psychiatry in Canada dating back to the 1950s. This will include insights into clinical work, research, and education. Participants will have the opportunity to ask questions and consider how the past impacts CL Psychiatry’s current and future state.​​ 

 

Dr. Leon Tourian will lead a highly interactive session on the current state of CL Psychiatry in Canada. Its aim will be to build on the most recent survey of Canadian CL Psychiatrists, published in 1993. Participants will divide into smaller groups (clinical practice in academic and community settings, research, education, and government/policy) to discuss what information is needed to understand the current breadth and depth of this field. The small groups will each report back to the larger group and the information will be used to inform a survey of CL Psychiatrists to be conducted by CACLP in 2023.​​ 

 

Dr. Adrienne Tan will wrap up the workshop by discussing the future of CL Psychiatry in Canada. She will facilitate a discussion of the recently approved Royal College Area of Focused Competence in CL Psychiatry and participants will have the opportunity to speak about how this will impact CL Psychiatry.

25% of this session will be dedicated to interactive learning through questions and discussion with the audience.

 

Learning Objectives:

  • Compare historical elements of CL Psychiatry in Canada with its current state.

  • Formulate questions for a future survey of Canadian CL Psychiatrists to explore the breadth and depth of the field.

  • Describe the new area of focused competence in CL Psychiatry and its potential impact on practice and education.

 

CanMEDS Roles:​​ Collaborator, Leader, Scholar

3:30 – 4:30

Awards & Social

CACLP​​ Award for Distinguished Contribution to Consultation-Liaison Psychiatry in Canada

CACLP​​ Best Trainee Presentation Award