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Report by Dr Lee Cheng for the American Psychiatric Association (APA) Meeting held at New York, USA from 05 to 09 May 2018.

Posted on 16 May, 2018 by admin

The American Psychiatric Association Annual Meeting is one of the largest psychiatric meeting in the world whereby attendees benefit not only from the scientific programs but also the global networking.

This year, the meeting was held in New York from 5 to 9 May 2018 and the theme of the meeting is ‘Building Well-being through innovation”. The Special Lecture this year was by Lt Gen Mark Hertling (Ret) who is now leading programmes for Global Partnering Leadership Development and Health Performance Strategies at the innovative Florida Hospital in Florida. His talk was mainly on the today’s and tomorrow’s attributes and competencies required of a good leader. He emphasized the importance of a good leader to know oneself, exhibit strong values, understand the environment, find ways to build trust, understand other’s motivations and how to influence but continue to remain humble, serve others and their profession.

I attended a number of sessions related to forensic psychiatry. One of the sessions was on the psychiatric impact of insanity acquittees. Acquittees are usually people with severe psychiatric disabilities and the insanity acquittal is premised on lack of moral blameworthiness and punishment is illegitimate in insanity acquittal. After the initial stabilization, symptom reduction and functional improvement, these individuals would need to acknowledge and cope with their illness and knowledge of their past violence. Multiple court hearings and repeated media attention would increase the stigma directed toward them and stimulate negative public affect against these patients. At the same time, there is a need to continue to provide care for the victims who may require professional psychiatric care and community and societal supports. The other session was on violence and mental illness which highlighted that although 3% of violent crimes are committed by people with mental illness (PMIs) but PMIs are 23 times more likely to be victims than individuals without mental illness. Beyond the mental illness, other factors that come into play in aggression include: lack of social support, substance abuse, poor access to treatment and medical conditions.

I also attended a number of pharmacological update sessions such as the role of endogenous opioid system in mood disorders, the treatment of tardive dyskinesia and  the medical indications of cannabinoids e.g. for chronic pain, neuropathic pain, pediatric seizure disorders and chemotherapy-induced nausea and vomiting. At present, evidence appears to illustrate that cannabis use is associated with increase in depression, anxiety, cognitive changes and abuse/dependence.

Some of the other sessions which I attended included those related to improvement in access to psychiatric care (‘queuing theory’ whereby splitting of responsibilities and duties result in better workload distribution) and the community services and bed situations in US, Europe and Australia, While recognizing non-bedded services can reduce the need for beds but the goal should be to improve health and not merely to reduce beds. Different approaches can be adopted although the observed outcomes approach looking into out of areas placements, boarding in emergency rooms, involuntary admission, occupancy rates in psychiatric units, ALOS, readmission rates and homelessness should all be taken into consideration.

I also attended a number of sessions related to terrorism and radicalization. Most of these terrorist attacks were committed by individuals with no mental illness. Some of the acts were secondary to anger against government policies; committed by individuals with extreme ideology and in some poor countries, an escape from poverty and a promise of heaven. To them, violence is the only option to eliminate injustice. As radicalized groups are very diverse, agencies should adopt a person-oriented and integrated approach in the rehabilitation. Mental health professionals, policy makers, police and other stakeholders each have specific competencies and complementary roles.

Lastly, I would like to thank APA Organising Committee for inviting the presidents of international psychiatric associations and societies to the APA annual meeting. This year is especially memorable to me as it would be the last year I attended as the President of Singapore Psychiatric Association (SPA).

 

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Photos: With some Singaporean psychiatrists at APA NYC (above) and with Prof Jun Soo Kwon, President of the Korean Neuropsychiatric Association (below)
 

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Report by Dr Lee Cheng for the World Psychiatric Association (WPA) World Congress of Psychiatry held at Berlin, Germany from 08 to 12 Oct 2017

Posted on 29 March, 2018 by admin

The World Psychiatric Association (WPA) World Congress of Psychiatry is one of the largest psychiatric meeting in the world whereby attendees benefit not only from the scientific programs but also the global networking. As President of Singapore Psychiatric Association (SPA), I was honored and privileged to attend the congress held in Berlin, Germany from 8 to 12 October 2017 as well as the WPA General Assembly and the Asian Federation Psychiatric Associations meetings. WPA has issued a number of position statements that are of relevance to psychiatric practice and training; these include that of Mental health in the workplace, Rights for Persons with Mental Illness, Suicide Prevention, Roles and Responsibilities of the Psychiatrist in the 21st Century and Promoting Psychiatry as a promising medical specialty for medical students.

I have enjoyed the plenaries and keynote speeches at the congress. An example was the notion of the subsequent reduction of lifestyle habits (such as smoking), binge drinking, use of drugs (such as cannabis and heroin) and violence victimization and violence perpetuation by the prevention of adverse childhood experiences (ACE) in future generation. There was also the emphasis on social justice whereby the society should treat all equally well by Prof Dinesh Bhugra, the outgoing WPA President and an interesting talk on ‘Shell Shock – the British Experience ’ by Sir Simon Wessely which also highlighted the controversy behind Post Traumatic Stress Disorder.

The other sessions were as interesting and educational. There was a talk on ‘Aggressive obsessions i.e. Harm OCD’ – the model behind the condition – ‘autogenous’ without any identifiable trigger and ‘reactive’ which is triggered by environmental factors and its treatment including mindfulness. Another topic that was especially relevant to our local context since Singapore is currently embarking on training and certification of peer support specialists was the session on ‘Peer support: foundation of experiential knowledge’ which touched on the differences in its intervention work and sharing experiences. It also emphasized on the need to embark on research methods to allow peer specialists to capture collective benefits and social change.

The poster sessions have been useful as there were a number of posters on addiction psychiatry such as the use of Varenicline and Combination Nicotine Replacement therapy in a smoking cessation clinic in Taiwan and the use of a bed occupancy management in an addiction unit in a German psychiatric hospital. I presented the findings of the Home Treatment Team (HTT) pilot programme of the Institute of Mental Health and there was wide interest and discussion amongst the attendees especially from the European countries. There was also a poster on HTT in a Swiss population looking at the differential characteristics of patients treated under the programme.

Finally, I would like to congratulate the newly elected members of the WPA Executive Committee and the Zonal Representatives.

 

SPA in Berlin Dr Lee Cheng in Berlin(1)

Report by Dr Lee Cheng at the American Psychiatric Association held at San Diego from 20-24 May 2017.

Posted on 12 June, 2017 by admin

I have always found the APA Annual Meeting to be of high standards and offered a variety of topics ranging from clinical, education, research and even technological advances in the delivery of healthcare services. The theme for this year meeting was ‘Prevention Through Partnerships’ which is timely as we are also looking at prevention and early detection of psychiatric conditions and developing a relationship based healthcare system in Singapore. Working together with different parties is crucial to the success of clinical programmes and clinicians need to be mindful of the integration of care of psychiatric and medical conditions. After the Opening Session by APA President, Prof Maria A Oquendo, there was a special lecture by Susannah Cahalan, a New York Times bestselling author of ‘Brain on Fire: My Month of Madness. She shared her experience as a psychiatric patient when she was misdiagnosed to suffer from Schizoaffective Disorder and Bipolar Disorder when she presented with paranoia and erratic behavior. Her actual diagnosis was Anti-NMDA Receptor Autoimmune Encephalitis. It was a powerful speech and it highlighted the need for treating psychiatrist to stay abreast of current medical knowledge and to have a high level of suspicion especially when encountering atypical clinical presentations.

At the conference, I have deliberately chosen a few topics of special interests especially with my current role in National Addictions Management Service in the Institute of Mental Health. The sessions on addictions and alcoholism which were co-organized by the National Institute on Alcohol Abuse and Alcoholism renewed my understanding of these disorders especially the sessions on alcohol screening and brief intervention for youths as well as the use of mobile phone- and web-based technology to enhance treatment and support recovery for patients with addiction problems. There were also presentations on the use of wearable alcohol biosensor which would provide feedback to the wearer to keep him/her honest and motivated. Other sessions that interested me included that of promoting physician competence across the lifespan by identifying the learning gaps and through a targeted lifelong learning and continuous practice assessment and improvement method. As clinicians we need to provide the best clinical care to our patients – not just knowing recent findings from the literature but to implement good practices from evidence-based medicine. Another topic that I found useful was on attaining leadership and mentorship roles while being a clinician – readiness to serve, deep determination, ‘recalcitrant’ persistence, commitment to quality, openness to feedback, devotion to developing people and unfailing honesty.

Other clinical sessions that I have attended included that on the role of psychiatrists on end of life option (e.g. physician assisted suicides versus euthanasia), assessment of malingering using tools like Rey I, Rey II, B test, coin-in the-hand and Miller forensic assessment of symptoms test (M-FAST) and antidepressant treatment for pregnant women etc. Beyond the clinical updates, I was honored to be invited to the Presidential Reception hosted by Prof Maria A Oquendo. It was a memorable night as I made new friends and also re-established the relationship with the existing ones.

Dr Lee Cheng
SPA President
With Ms Susannah Cahalan, author of 'Brain on Fire: My Month of Madness'

With Ms Susannah Cahalan, author of ‘Brain on Fire: My Month of Madness’

With Prof Maria Oquendo, President of American Psychiatric Association

With Prof Maria Oquendo, President of American Psychiatric Association’

Report by Dr Robin Goh at the VIII National Congress of Indonesian Psychiatric Association and the 15th ASEAN Federation of Psychiatry and Mental Health Congress.

Posted on 28 April, 2017 by admin

The VIII National Congress of Indonesian Psychiatric Association and the 15th ASEAN Federation of Psychiatry and Mental Health Congress was held from the 25th to 27th August 2016 at Semarang, Indonesia and I was privileged to attend the meeting in the capacity of the Vice President of the Singapore Psychiatric Association. The meeting was organized by PERHIMPUNAN DOKTER SPESIALIS KEDOKTERAN JIWA INDONESIA and ASEAN Federation for Psychiatry and Mental Health (AFPMH). The theme for the meeting was “New Challenges in Psychiatric Care in ASEAN Economic Community” and was chosen to meet the learning, networking and latest needs of regional psychiatric services.

Dr. DanardiSosrosumihardjo, Sp.KJ(K), the President of Indonesian Psychiatric Association and the President of AFMPH welcomed the delegates from ASEAN countries to the meeting on the first day with an elaborate ceremony consisting of Indonesian dance and music.There were different tracks in the program to meet the needs of the participants. Examples of the tracks included Alcohol and Substance Abuse Disorder, Biological Psychiatry, Community Psychiatry, Consultation Liaison Psychiatry and Forensic Psychiatry etc.

I was invited to give a sharing on Singapore’s approach in reducing the treatment gap of mental disorders. Delegates from Indonesia, Philippines, Vietnam and Malaysia also share their countries’ endeavors in addressing this issue. Some of the common themes echoed from them werethe difficulties in translating a lot of their governments’ healthcare policies due to the size of their country, the geographical barriers and the level of literacy. Singapore was privileged in comparison as we do not face such difficulties but there was still more work to be done to improve mental health awareness.

The meeting provided an excellent platform in getting to know the leaders in the ASEAN Psychiatric community as well as create more awareness for the need to do more for mental health. The meeting ended with the formal passing of the host country from Indonesia to the Philippines for the 16th ASEAN Federation of Psychiatry and Mental Health Congress.

SPA Vice President and country delegates during session discussion

SPA Vice President and country delegates during session discussion

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