M. Wise, United Kingdom
Brent CMHT PsychiatryModerator of 4 Sessions
Psychiatry relies upon self-reports to access the patient's inner world, more than most specialties. In forensic psychiatry the risk of secondary gain distorting events is substantially higher than elsewhere. With estimates of exaggeration being between 15%-40% we need better tools than 'clinical impression' to assess the validity of claims and reports. Dr Torenc (Portugal) will take us through the twists and turns that prisoners take to persuade us of their illnesses, of why they may feign for benefit and how to manage them. Dr Wise (UK) will discuss some of the issues that medical personnel face when using these tests, including attacks on their credibility; examples from court cases will demonstrate possible solutions. On the other hand in recent years the introduction of peer support workers (PSW), individuals with personal experience of mental health problems who have recovered and support those with current mental health difficulties, has been recommended. Evidence suggests gains of such interventions, particularly in psychosocial outcomes. The introduction of PSW in mental health settings poses particular challenges. Dr. Drennan will talk about developments in governance for lived experience roles in forensic in-patient treatment programmes. Ms Walde will add a German perspective about the preparation and implementation of a peer support worker in a forensic hospital for offenders with substance use disorders.
Presenter of 7 Presentations
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Medical Ethics in Psychiatry
S0067 - Oh What a Tangled Web we Weave When First we Practice to Deceive...
ABSTRACT
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'Oh what a tangled web we weave when first we practice to deceive'. Marmion, Sir Walter Scott 1808.
Conflict is unpleasant, it is aversive, we tend to avoid it. Yet inevitably tension between individuals or between individuals and society is inevitable as the wants of one collide with the purpose of the other.
Most of these tensions resolved peacefully but a societal level aggression can sometimes spill out. In the hinterlands between individuals and larger groups these can play out more safely through the courts or sometimes the avoidance of conflict can be the only tactic that the individual can use.
As doctors we are used to sing medical problems with patients have true disease believe they have two disease and want to get well-the standard social model of medicine. But sometimes this plays out differently there are those who may fabricate symptoms to avoid punishment or for reward: malingering. There are those who believe they have a disease but the distress is disproportionate to any possible recognised component; somatic symptom disorder. There are those whose anxiety about whether they have a disease or not is paralysing and perhaps most distressing for all of the groups who self-harm or malinger with authentic illness or disease.
In this talk Dr Wise will, using case examples, look at a couple of the tools that exist to assist psychiatrists in piloting a pathway through the stormy waters of abnormal illness in litigation.
W0048 - Diagnostic Dilemma's in the New World of ICD-11 Personality Disorders
ABSTRACT
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Personality disorders have ever been a troublesome group. From the early 90’s ICD 10 tidied up the group. DSM-IV, IV-TR, aand then DSM 5, changed the style but not substance, leaving clinicians to grapple with thorny questions of multiple diagnoses, treatment and prognosis.
International views on the utility of the diagnosis often depended upon the institution or the funding mechanism. Were fears of exclusion and stigma dominated or where there was no treatment, there was under-diagnosis, such as in the United Kingdom and the Republic of Ireland. Where a label was a ticket of entry to treatment and funding, diagnostic generosity prevailed, such as in Australia, New Zealand and the United States. Gender discrepancies disappeared with structured interviews, and interest grew in the category which seem to only include the most severe forms.
For many years the DSM taskforce tried to shift the construct but shied away from the cliff edge; a bold new initiative did not materialise. It was left to the ICD-11 to generate a much more adventurous and positive view of how characterological traits shift under pressure, moving from something that may at first have helped patients to ‘survive’ to something that became maladaptive and harmful.
With a court tested case Dr Wise will demonstrate the differences between ICD-10 and ICD-11 highlighting the more important differences: onset, course and severity descriptors. PD’s are no longer lifelong impairments. Prepare for ‘The shock of the new’!