M. Wise, United Kingdom

Brent CMHT Psychiatry
I am NHS Consultant in General Adult Psychiatry, with higher training in Liaison Psychiatry, working in a busy inner city area, responsible for the provision of long term care for over 200 patients with severe and enduring mental illnesses. I supervise 400 assessments per year. Multiple diagnoses are common. In my independent practice I see over 60 new patients a year and coordinate the care of over 150 patients, many employed by City of London businesses. Between 2003 – 2010 I worked with the Irish Redress Board Scheme and Australian Claimants, providing reports for victims of institutional physical, emotional and sexual abuse. I have been involved in Class actions involving defective products (pharmaceutical) and civil rights violations (HMG). During the 2020 CoVID Pandemic I was a member of the CNWL NHS Trust ‘3 wise men’ ethics panel. I am a Fellow of the Royal College of Psychiatrists and an International Distinguished Fellow of the American Psychiatric Association. I was awarded the distinction of Honorary Member of the World Psychiatric Association in 2017. I was elected to the board of the EPA in 2019, and awarded the Association Medal of the BMA for sustained and meritorious service As Chair of the British Medical Associations Medico-Legal Committee, I regularly liaise with the Ministries of Health & Justice, the CPS and Medical Defence Organisations. I sat on the BMA’s Medical Ethics Committee, and continue on that of the European Psychiatric Association, and previously the World Psychiatric Association. I investigated complaints for the NHS Ombudsman & the Healthcare Commission (as of 1st April 2009 the Care Quality Commission). I write over 80 reports a year for the UK and Eire Courts; claims have involved NHS Resolve; maritime work; government agencies, including the Ministry of Defence, Police forces, and Local Authorities; and multinational corporations. My research is forensically based, the interface of law with psychiatric practice and medically unexplained symptoms. Since 2001 I have lectured, and ran Workshops at National/International Conferences. I am author of 5 textbooks and monographs, and over 100 articles, letters, abstracts, and web-based learning resources. I am a reviewer for the RCPsych journal of continuing medical education, Advances in Psychiatric Treatment, European Psychiatry and the British Medical Journal

Moderator Of 4 Sessions

EPA Course
Date
Sun, 11.04.2021
Session Time
15:00 - 17:00
Room
Courses Hall A
Session Description
Ethics (from the Greek ‘εiks: the best way to behave”) is, according to the Oxford dictionary “the branch of knowledge that deals with moral principals”. Moral principles govern a person’s behaviour. Aristotle held “virtues” as the guiding principal, Kant “duty”, whereas utilitarianism stipulates that the “guiding principal” should be “the greatest happiness or benefit of the greatest number”. In medicine ethics are based on the Hippocratic oath, nowadays expressed in the “Declaration of Geneva” (2017). Two moral principles in this medical oath are crucial: - respect for the autonomy of the patient and their safety (in a broad sense: both physical and intellectual (privacy). In clinical practice, medical doctors struggle, on daily basis, with dilemmas around these themes. What to do, if there are appropriate treatments but the patient declines them or cannot express his will? When a patient expresses a wish to die or asks their doctor to refrain from treatment this is particularly challenging. In cases of cancer, few will doubt that the doctor should abide by the patient’s wishes. In psychiatry the doctor will struggle with the dilemma of whether the patient understands what they ask for and its consequences, particularly if it appears to be suicidal ideation? In other words, does the patient have capacity to oversee the consequences of his ideas, are they an autonomous agent? These themes will be explored and discussed in the groups or subgroups, using case vignettes.
Session Icon
Live, Ticket Required
Date
Mon, 12.04.2021
Session Time
19:30 - 21:00
Room
Channel 2
Session Description
In this session we will explore the latest findings in epigenetics in several mental disorders, with a special focus on schizophrenia, ADHD and trauma. The session will also look at recent findings on epigenetic changes following treatment. Finally we will also explore how some known environmental factors, e.g. cannabis and childhood trauma, are affecting epigenetic markers.
Session Icon
Live
Clinical/Therapeutic
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 2
Session Description
This symposium is a new, dynamic format based on the concept of Pecha Kucha. Focusing on the essentials of last year’s advances in their respective fields, 3 internationally-recognised experts will explain which 5 papers changed their practice. With 3 slides per paper to explain why and what they changed, we hope delegates will leave with practical and pragmatic tips that will change their own practices!
Session Icon
Live
Mental Health Policy
Date
Sun, 11.04.2021
Session Time
17:30 - 19:00
Room
Channel 6
Session Description
The Live Q&A of this session will take place in the Live Sessions auditorium. Please refer to the interactive programme for the exact time and channel.

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.

Session Icon
Pre-Recorded with Live Q&A

Presenter Of 7 Presentations

Symposium: On a Level Playing Field with Forensic Patients? (ID 208) No Topic Needed

Live Q&A

Session Icon
Pre-Recorded with Live Q&A
Date
Sun, 11.04.2021
Session Time
17:30 - 19:00
Room
Channel 6
Lecture Time
18:38 - 18:58
LIVE - Workshop: Diagnosing Borderline Personality Disorder: A Masterclass (ID 244) No Topic Needed

Live Q&A

Session Icon
Live
Date
Mon, 12.04.2021
Session Time
17:30 - 19:00
Room
Channel 3
Lecture Time
18:40 - 19:00
LIVE - Best of 2020 : Research that Advanced Psychiatry and Changed our Practice (ID 778) No Topic Needed

Live Q&A

Session Icon
Live
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 2
Lecture Time
16:39 - 16:59
LIVE - Symposium: Epigenetics in Mental Disorders (ID 636) No Topic Needed

Live Q&A

Course 11: Medical Ethics in Psychiatry (ID 216) No Topic Needed

Medical Ethics in Psychiatry

Session Icon
Live, Ticket Required
Date
Sun, 11.04.2021
Session Time
15:00 - 17:00
Room
Courses Hall A
Lecture Time
15:00 - 17:00
Symposium: On a Level Playing Field with Forensic Patients? (ID 208) No Topic Needed

S0067 - Oh What a Tangled Web we Weave When First we Practice to Deceive...

Session Icon
Pre-Recorded with Live Q&A
Date
Sun, 11.04.2021
Session Time
17:30 - 19:00
Room
Channel 6
Lecture Time
18:04 - 18:21

ABSTRACT

Abstract Body

'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.

Hide
LIVE - Workshop: Diagnosing Borderline Personality Disorder: A Masterclass (ID 244) No Topic Needed

W0048 - Diagnostic Dilemma's in the New World of ICD-11 Personality Disorders

Session Icon
Live
Date
Mon, 12.04.2021
Session Time
17:30 - 19:00
Room
Channel 3
Lecture Time
18:26 - 18:40

ABSTRACT

Abstract Body

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’!

Hide