Tonights panel Dr Helen Stanley Dr Phillip Tully Associate - PDF document

Webinar DATE: Working together to prevent November 12, 2008 heart disease for people living with psychiatric illness Tuesday 25 June 2019 Supported by The Royal Australian College of General Practitioners, the Australian Psychological Society, the Australian College of Mental Health Nurses and The Royal Australian and New Zealand College of Psychiatrists PAGE 2 Tonight’s panel Dr Helen Stanley Dr Phillip Tully Associate Professor Ms Nicola Palfrey David Colquhoun General Practitioner, Vic Psychologist, SA Psychologist, ACT Cardiologist, Qld Like to read more about tonight’s panellists? Click supporting resources in the library tab at the bottom right of your screen for panel bios and more! 1

PAGE 3 Ground Rules To ensure everyone has the opportunity to gain the most from this live event please: • Be respectful of other participants and panellists: behave as you would in a face-to-face activity. • Interact with each other via the chat box . As a courtesy to other participants and the panel, please keep your comments on topic. Please note that if you post your technical issues in the participant chat box you may not be responded to. • Need help? Click the technical support FAQ tab at the top of your screen. If you still require support, call the Redback Help Desk on 1800 291 863. • If there is a significant issue affecting all participants, you will be alerted via an announcement. Audio issues? Listen on your phone by dialling this phone number 1800 896 323 Passcode: 1264725328# PAGE 4 Learning outcomes At the completion of the webinar participants will be able to: • describe the complex bidirectional relationship between heart disease and mental health, as well as the risk factors for and warning signs of heart disease in persons with psychiatric illness • describe the challenges, merits and opportunities in evidence-based approaches deemed most effective in treating and supporting people experiencing heart disease related to mental health issues • better target referrals for people experiencing mental health issues who are at risk of heart disease as a result of an improved understanding of the role of different disciplines. Click OPEN CHAT at the bottom right of your screen to chat with other participants. NB: chat will open in a new browser window. 2

PAGE 5 GP’s perspective The encouraging for Michael • Employed part-time as a shelf-stacker • Connected to family who provide housing • Very stable for 10 years • Ongoing relationship with his GP and psychiatrist BUT • Slow time bomb for CV disease • Absolute CVS risk 24% i.e., 1 in 4 chance of CV event in the next five years. Could be sudden death. • 699 Medicare Heart Health Check Dr Helen Stanley PAGE 6 GP’s perspective GP agenda Work with Michael to improve his life-style, long-term therapeutic relationship: • Quit smoking • Encourage him to reshape his body by eating less energy (less sugar, less fat, less alcohol) • Encourage him to be more active, less sitting and more movement. 30 min of exercise 5 days per week. • Drink more water, avoid salt. • Eat more fruit and vegetables, nuts, fish and olive oil. Treat his risk factors: consider medications for his cholesterol, hypertension and his diabetes and quitting smoking. Dr Helen Stanley 3

PAGE 7 GP’s perspective Write to Michael’s psychiatrist: - 21% CV risk - Newly diagnosed diabetes - Smoker Team approach - Metabolic syndrome - BMI 34.6 - Can Michael stop the Olanzapine and Valproate and have a mood stabiliser that is better metabolically? Go slow GPMP and TCA 5 Medicare rebates p/a, Refer according to 3 diabetic educator and 2 Work with his podiatrist Michael’s interest psychologist: Optometry check for diabetic - sleep hygiene retinopathy - activity activation Monthly GP review Urine MCR for diabetic nephropathy - tolerance of unpleasant emotion to journey with him Hospital or Community Centre, and finding his healthy life style group, on lifestyle change values exercise physiologist, dietician, community garden project, men's shed, motor car museum /club Dr Helen Stanley PAGE 8 GP’s perspective Michael’s agenda • What does a rich, full life look like for Michael? • What does he value? Working, family, cars, racing, repairing cars? • How does he view his smoking? Stage of change • He wants to quit for his health and save money? Spends $100 per week, could this money help restore his car? The barriers to quitting. • If he is ready to quit? Prescribe nicotine patches 21mg, 4 d’s, it is just an urge and will pass, NOTICE the now, keep busy polish his cars. Dr Helen Stanley 4

PAGE 9 GP’s perspective Lifestyle journey with Michael • View that Michael is stuck not diseased and can become unstuck and lead a rich, meaning full life. He has potential.? senator, TAFE, mechanic etc. • His CV risk can be reduced eg quit smoking 24% to 12% • Reinforce his healthy behaviour and do not reinforce his unhealthy behaviour. E.g., praise for him being more active, don ’ t prescribe valium to allow him to avoid life. • Create experiences in the consult that he can learn from e.g., both of us standing and walking on the spot in the consultation, to be active and encourage him to do this at home e.g., while he watches motor sport. • Notice three things with eyes, ears and three body sensations i.e., experience of mindfulness. • Work with the team but still regularly review him for a long-term therapeutic relationship. Be non-judgemental, accepting him as he is and Dr Helen Stanley encouraging him. PAGE 10 Psychologist’s perspective What does a Psychologist need to know about Michael’s care? • Information required from Psychiatrist – potential mood stabilizer & anti- psychotic medication change was flagged (risk for deterioration in mood, mania and/or suicide risk) • Are early warning signs monitoring in place? Over what timeframe will med. switch occur? • Information required from GP – are there new or existing medications for hypertension, hypercholesterolemia, or diabetes (given severity of individual CVD risk factors) • Are lifestyle modifications being recommended? How is Michael supported to do these? • Information required from Cardiologist – cardiac functioning (e.g. coronary atherosclerosis, cardiomyopathy, echocardiography & ECG findings) • Will he experience somatic symptoms overlapping with MDD? How urgent is CVD risk reduction? Dr Phillip Tully Goldstein et al., Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: A Scientific Statement From the American Heart Association. Circulation 2015;132:965-986 5

PAGE 11 Psychologist’s perspective Collaborative care approaches • Historically the treatment of mental health in CVDs is independent of the cardiology and the primary care sectors, without considering; • The complexity of patient’s mental health & cardiovascular needs • The impact of severe mental illness on CVD risk factors (& vice versa), difficulties in dual management • Shift from unitary/singular interventions (e.g. CBT alone), in favour of coordinated approaches between cardiologist, GP, psychiatrist & psychologist/MHP Dr Phillip Tully eg. In Bipolar – van der Voort et al., Collaborative care for patients with bipolar disorder: randomised controlled trial. Br J Psychiatry 2015;206(5):393-400 PAGE 12 Psychologist’s perspective Michael’s first consultation & assessment Ψ CVD • Michael’s psychosocial, medical & factors risk family history • Assess mood, irritability, & what Physical strategies are in place Mania activity • Sleep monitoring, early warning Alcohol, signs Mood smoking • Consider under-reporting of alcohol/illicit substance use Cardio- Sleep metabolic • Agreed upon treatment goals (more likely related to CVD & behaviours) Goodrich et al., Design and rationale of a randomized controlled trial to reduce cardiovascular disease risk for patients with Dr Phillip Tully bipolar disorder. Contemp Clin Trials 2012;33(4):666-78 6

PAGE 13 Psychologist’s perspective Evidence-based approaches for bipolar • Sufficient evidence for bipolar disorder - collaborative care, CBT, integrated C-IPT, family-focused, IP-social rhythm therapy, DBT and MBCT (in euthymic patients) • Irrespective of approach - ensure that sleep, activity, self- harm/suicide risk, and early warning sign monitoring is in place Oud et al., Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. Br J Psychiatry 2016;208(3):213-22; Dr Phillip Tully Salcedo et al., Empirically supported psychosocial interventions for bipolar disorder: Current state of the research. J Affect Disord 2016;201:203- 14; Haynes et al., Social rhythm therapies for mood disorders: an Update. Curr Psychiatry Rep 2016;18(8):75. PAGE 14 Psychologist’s perspective Possible directions with Michael Interpersonal- Motivational Social CBT/other Interviewing Rhythm Barriers & Distress Transition self-efficacy tolerance Behaviour Coping Routine change strategies Cognitions Monitoring Adherence about disease Dr Phillip Tully 7