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GERIATRIC PSYCHIATRY PROGRAM

ANNUAL REPORT

July 1st, 2007 to June 30th, 2008

GERIATRIC PSYCHIATRY PROGRAM

ANNUAL REPORT

July 1st, 2007 to June 30th, 2008

OVERVIEW

The Program had 34 members during this year working in a variety of settings, including VGH, Providence, VCMHS, Geriatric Mental Health North Shore, Delta, Burnaby, Royal Columbian Hospital in New Westminster, White Rock, Riverview, Royal Jubilee in Victoria, Prince George and Kamloops.

Approximately ½ of the members sent information for the Annual Report. This information is amalgamated from this below.

EDUCATION

Undergraduate Education:

First Year Medicine: Dr. Martha Donnelly: August 29th, 2007, Medical Student Seminar (8 students), “Breaking Bad News and Dealing with Angry Patients;” December 18th, 2007, Medical Students PMP Lecture, “Assessment of Capacity and Decision Making for Chronic Care;” February 26th & 28th, 2008 Family Practice 401 Lecture, “Introduction to Geriatrics.”

Second Year Clinical Skills: Dr. Elisabeth Drance, Dr. Candida Graham, Dr. Nirmal Kang, Dr. Atul Mehra, Dr. Stephen Kiraly.

Second Year Medicine: Dr Candida Graham Brain & Behaviour Lecture “Psychiatric Classification” March 25th 2008

3rd Year Medical Student Seminar: Introduction to Geriatric Psychiatry: Dr. Femi Agbayewa, Dr. Elisabeth Drance, Dr. Stephen Kiraly. Dr Candida Graham Anxiety Disorders March 4th 2008, Dr. Nirmal Kang, Dr. Stephen Kiraly: author and coordinator the Third Year Med students’ (Phase-IV) Introduction to Geriatric Psychiatry lecture program that includes a patient interview.

Supervision of Undergraduates: Dr. Peter Chan, Dr. Michael Cooper, Dr. Martha Donnelly, Dr. Arvind Kang, Dr. Nirmal Kang, Dr. Stephen Kiraly, Dr. Atul Mehra, Dr. Akber Mithani, Dr. Mafalda Musacchio, Dr. Ranier Persuad and Dr. Carol Ward,Dr. Michael Wilkins-Ho

Supervision of Residents: Dr. Peter Chan, Dr. Elisabeth Drance, Dr. Martha Donnelly, Dr. Caroline Gosselin, Dr. Candida Graham, Dr. Arvind Kang, Dr. Nirmal Kang, Dr. Michael Passmore, Dr. Bruce Patterson, Dr. Rainer Persaud and Dr. Les Sheldon, Dr. Michael Wilkins-Ho

Education of UBC Students Outside of Medicine:

Family Practice Residents Supervision: Dr. M. Donnelly Dr Candida Graham

IMG Supervision: Dr. Arvind Kang, Dr. Nirmal Kang

Nursing Students Supervision: Dr. Mafalda Musacchio

IHHS 401: Dr. Martha Donnelly, Evening seminar for 30 students “Informed Consent.”

Interprofessional Education in the Care of Elders: Dr. E. Drance, Providence Health Care - Pilot Project 2008

OTHER UNIVERSITY RELATED ACTIVITIES

UBC Committees:

  • Dr. Peter Chan: Undergraduate Education Department of Psychiatry Year 4
  • Dr. Caroline Gosselin: UBC Department of Psychiatry Program Committee, UBC Department of Psychiatry Undergraduate Committee, UBC Department of Psychiatry Faculty Advisory Committee, UBC Department of Psychiatry Clinical Faculty Committee, UBC Department of Psychiatry Post Graduate Education Executive Committee, UBC Department of Psychiatry Clinical Faculty Appointment, Re-appointment and Promotions Committee, UBC Department of Psychiatry, COPCE in Ottawa, Institute of Mental Health Advisory Board
  • Dr. Martha Donnelly: UBC Department of Psychiatry Advisory Committee, UBC Department of Psychiatry Executive Committee.
  • Dr. Elisabeth Drance: UBC Department of Psychiatry Selection Committee
  • Dr Candida Graham Psychiatry Resident Program Director Prince George, Educational Advisory Committee NMP
  • Dr. Michael Wilkins-Ho: UBC Department of Psychiatry Post-Graduate Selection Committee

Mock Orals: Dr. Rainer Persaud

2nd Annual PDM Course: Dr. Carol Ward February 29th to March 2nd, 2008

RCPSC: Examiner: Dr. Caroline Gosselin

Preparation Administration or Marking of Exams: Dr. Arvind Kang, Dr. Nirmal Kang, Dr. Carol Ward.

LECTURES SEMINARS AND WORKSHOPS

Dr. Peter Chan:

  • “Management of Geriatric Delirium: Putting National Based Guidelines into Practice,” Victoria General Hospital Grand Rounds, May 20th, 2008
  • “Brain Stimulation for the Treatment of Psychiatric Patients,” Richmond Department of Psychiatry Clinical Day, April 4th, 2008
  • “rTMS in Treating Auditory Hallucinations in Schizophrenia,” Neurobiology of Psychosis Journal Club, April 15th, 2008
  • “Lethal Catatonia,” VGH Geriatric Psychiatry Case Rounds, February 11th, 2008
  • FHA Physicians Psychiatry Update ECT Workshop January 19th, 2008
  • UBC Neuropsychiatry Grand Rounds, “RTMS in Treating Depression,” October 3rd, 2007
  • 5th Annual Canadian Hospitalists Conference, “Assessing Competency,” Vancouver B.C., September 29th, 2007
  • “ECT Indications in Cognition,” presenter and ECT devices seminar leader at CPA, full-day course on ECT, 2008, Vancouver
  • UBC, Department of Psychiatry Clinic Day, “To Use or Not to Use. That is the Question. The Role of Atypical Antipsychotics in Treating Agitation and Aggression in Dementia,” Vancouver, May 30th, 2008.
  • CPA, “Relieving Suffering in Oncology in Palliative Care Settings,” Moderator, Montreal, November 2007
  • CPA, ECT Therapy Course, “Indications and Cognition,” presenter ECT Devices Seminar leader, Montreal, 2007.
  • International Congress of Psychosomatic Medicine Scientific Meeting, paper presentation, “Loxapine and the Management of Post-Operative Delirium,” Quebec City, August 2007

Dr. Martha Donnelly:

  • September 16th, 2007, “Why and How - Capacity Assessment and Ethical Issues in the Elderly,” Symposium at the CPA, Montreal
  • September 24th, 2007, Care for Elders Case-Based Modular “Interdisciplinary Curriculum in Geriatric Care: Implementation and Evaluation,” paper at the CCSMH 2nd National Conference
  • September 24th, 2007, “Collaborative Mental Health Care: Meeting the Accessibility Needs of Older Adults with Concurrent Chronic Disorders,” CCSMH 2nd National Conference
  • September 25th, 2007, “B.C. Dementia Service Framework and Physician Guidelines to Care” workshop, CCSMH 2nd National Conference
  • September 25th, 2007, “The CCSMH Suicide Guidelines,” workshop with Dr. Heisel and Dr. Moore, CCSMH 2nd National Conference
  • October 11th, 2007, “B.C. Cognitive Impairment Guidelines and Alzheimer’s Disease Therapeutic Initiative” for Vancouver Coastal Continuing Care Staff
  • October 15th, 2007, “The Use of the Cholinesterase Inhibitors,” DIC Rounds, GPOT
  • October 20th, 2007, “Shared Care In Dementia” workshop 4th Canadian Colloquium on Dementia, Vancouver
  • January 25th, 2008, “Cholinesterase Inhibitor Use in Dementia,” Hot Topics in Psychiatry for Primary Care Conference, Vancouver
  • February 22nd, 2008, “Cholinesterase Inhibitors for Alzheimer’s Disease - Dementia Update” UBC CPD-KT, Victoria
  • April 11th, 2008, “Understanding Behaviours Associated with Dementia,” Pacific Society of Nutrition Management, Richmond
  • April 12th, 2008, “B.C. Dementia Guidelines: Focus on Management,” UBC Continuing Professional Development and Knowledge Translation, 3rd Annual Women’s Health Conference, BCIT, Vancouver
  • April 16th, 2008, “The Tertiary Client and the Law: Seniors: Not in one place, but everywhere” 2nd Annual BC Tertiary Mental Health Conference - Vancouver Island Health Authority
  • April 16th, 2008, ‘Beyond Beds” in the Provision of Tertiary Mental Health Care for Adults and Older Adult in B.C., 2nd Annual BC Tertiary Mental Health Conference - Vancouver Island Health Authority
  • April 25th, 2008, “Managing Agitation; Why does everything I do worsen matters?” CME on the Run – UBC Division of CPD-KT, Petzold Theatre, VGH
  • May 1st - 3rd, 2008, Work shop: “Psychoactive Medication for Seniors: Sharing Our Experience and Panel Discussion: “Bringing it together. Take Home Messages,” moderator BCPGA 11th Annual Conference, Cranbrook, B.C.
  • May 24th, 2008, “Aging – An Interdisciplinary Team Approach for Health Professionals,” and “Seniors & Health,” Panel discussion: Panel facilitator, Continuing Dental Education, Faculty of Dentistry, UBC, Vancouver

Dr. Elisabeth Drance

  • February 21 2008– Need-Driven Dementia Compromised Behaviour Model of Challenging Behaviour in Dementia – Nursing Skills Immersion Program
  • February 22 2008 – Behaviour that Challenges Us – Resetting our Sails Geriatric Services Conference – Tapestry Health Care Foundation
  • April 4, 2008 – Putting the Heart Back into the Nursing Home – Richmond Hospital Education Day
  • May 1, 2008, Work shop: Person-Centered Dementia Care/Nonpharmacological interventions for BPSD – Alzheimer Drug Therapeutics Initiative for Physicians – Cranbrook BC
  • May 2, 2008 Elder Friendly Acute Care – What does it look like – BCPGA – Cranbrook BC
  • May 5, 2008, Implementing the Eden Alternative Philosophy in a Large Organization – the Providence Health Care Experience – BCHCLA annual meeting Whistler BC
  • May 12,2008 To Use or Not to Use – Antipsychotics in the Care of People with Behavioural and Psychological Symptoms of Dementia – Difficult and Interesting Case Rounds Vancouver General Hospital,
  • May 30, 2008, UBC, Department of Psychiatry Clinic Day, “To Use or Not to Use. That is the Question. The Role of Atypical Antipsychotics in Treating Agitation and Aggression in Dementia,”
  • May 16, 2008 Communicating Effectively with People who have Dementia – Nurses’ Week Fairhaven Care Home – Burnaby BC
  • June 6, 2008 – Caring for the Person with Mild Dementia - Alzheimer Drug Therapy Initiative – Riverview Hospital CME Course

Dr. Caroline Gosselin

  • November 16th, 2007, all day ECT Course delivered at 57th Annual Conference of CPA in Montreal, December 4th, 2007
  • “ECT for Community Clinicians,” Grand Rounds, Mount St. Joseph’s Hospital, January 25th, 2008.
  • “Hot Topics in Psychiatry: Making a Sound Decision: Competency Assessments and a review of BC Law,” January 25th, 2008

Dr Candida Graham

  • Presenter “The Genetics of Post Operative Cognitive Decline” selected audience King’s College, London June 2008
  • Presenter “Mental Health in Old Age” Seniors Dialogue on Health, Prince George 30th November 2007
  • Presenter Seminars for Community Mental Health Team for Older Adults “Obsessive Compulsive Disorders in Older Adults 2nd April 2008, Psychosis in Older Adults 11th February 2008
  • Presenter Seminar for Medical Nursing Staff “Behaviour Management of the behavioural & psychological symptoms of dementia (BPSD)” 21st November 2007

Dr. Arvind Kang:

  • “Tertiary Geriatric Psychiatry Services,” Riverview Hospital Conference
  • “Moderate to Severe Dementia,” Practice Management with a case discussion, Dementia Update 2008

Dr. Stephen Kiraly:

  • Dementia Subtypes: Prevalence and Management, In-service Seminar, Hilltop, Squamish General Hospital, Squamish, B.C. January 15, 2008. 1300-1400, 1500-1600
  • Probe the Lobes: Screening and Diagnosis. A Practical Strategy for Care Planning for Dementia. Older Adult Outreach Program, Sea to Sky Mental Health and Addictions. Squamish, B.C. February 19, 2008.
  • Traumatic Brain Injury (TBI): Simple Concussion, Complex Concussion and Delayed Sequelae: Recent Reviews. Insight: Disability Claims Management and Litigation, The Metropolitan Hotel, Vancouver, May 22-23, 2008.
  • North Shore Psychiatric Association: Journal Club, Your Brain in Health and Sickness. Beach House Restaurant, West Vancouver, May 29, 2008.
  • Twelve Ways to Save Your Brain: Timely Diagnosis of Risk Factors for the Prevention of Early Onset Brain Disease. Kay Meek Centre, West Vancouver, B.C. June 26, 2008.
  • Your Brain Health and Sickness – North Shore Psychiatric Association Journal Club, May 29, 2008.

Dr. Atul Mehra:

  • Co-morbidity Case Studies: Medical Co-Morbidity Conference, Vancouver General Hospital September 28th, 2007
  • “What to do When We’re Stuck,” A Community Perspective, Geriatric Psychiatry Conference Riverview Hospital, November 23rd, 2007
  • “Treatment of Medical Co-Morbidity in Mentally Ill Patients,” A Medical/Legal Perspective, Geriatric Psychiatry Conference, Riverview Hospital, November 23rd, 2007

Dr. Mafalda Musacchio:

  • “Dementia Update,” UBC CME 2008, two small groups

Dr. Michael Passmore:

  • “Agitation in Dementia and Delirium,” for a post graduate education seminar

Dr. Rainer Persaud:

  • “Management of Behavioural Problems in Dementia,” Hospital Conference, September 25th, 2007
  • “Management of Behavioural Problems in Dementia,” VGH Grand Rounds, November 2007
  • Note also Visiting Professor at St. George’s University, Grenada, WI, 10 hours of lectures to medical students

Dr. Les Sheldon:

  • Geriatric Psychopharmacology
  • CME on the Run for Family Practice

Dr. Carol Ward:

  • October 24th, 2007, presenter CME event for Gerontological Nurses Association, “Geriatric Psychiatry Assessment,” Kamloops, B.C.
  • April 17th, 2008, presenter VIHA 2nd Annual Tertiary Mental Health Conference, “Beyond Beds” Acute Tertiary Mental Health, IHA Victoria B.C.

Dr. Michael Wilkins-Ho:

  • UBC Neuropsychiatry Grand Rounds, “RTMS in Treating Depression,” October 3rd, 2007
  • April 12th, 2008, “Treatment of Depression,” UBC Continuing Professional Development and Knowledge Translation, 3rd Annual Women’s Health Conference, BCIT, Vancouver
  • February 22, 2008, “Certifying the Demented Patient,” Geriatric Services Annual Conference, Tapestry Foundation, Vancouver, B.C.
  • February 19, 2008,” The Aging Patient with Mental Illness, “ Skills Immersion Program, Providence Health Care, Vancouver, B.C.
  • April 29, 2008, “Root Cause Analysis,” Quality Improvement Workshop, Providence Health Care, Vancouver, B.C.

INVOLVEMENT IN RESEARCH PRESENTATIONS AND PUBLICATIONS

Dr. Peter Chan

  • Delva, N. and the Canadian ECT Survey Associates: “The Geographic Distribution of ECT Services in Canada,” poster presentation CPA, Montreal 2007
  • Lam, R., Chan, P., Wilkins-Ho, M. and Yatham, L. “A Systematic Review of Transcranial Magnetic Stimulation in Patients with Treatment-Resistant Depression,” Paper presentation, CPA Annual Meeting, Montreal November 2007
  • A chapter - Lam, R., Chan, P., Howard, A., “Somatic Treatments for Bipolar Disorders” (ECT Section) in “Bipolar Disorders: A Clinicians Guide to Biological Treatments, Yatham, L.N. and Kusakumar, V., 2nd Edition, 2008
  • On line E-learning module on “Geriatric Delirium Management for Nursing Staff,” 2008, co-producer Maurine Shaw, Gerontology RN at VCH
Work in Progress
  • Loxapine in Managing Delirium, an open label trial
  • Canadian Survey of ECT Practice, national survey
  • A prospective study of “Efficacy and Tolerability of Bifrontal and Bitemporal and Right Unilateral ECT in the Elderly,” multi site trial
  • “Utilization and cost benefit analysis of a novel Canadian public-private partnership to establish an outpatient ECT Clinic,” Drs’ Chan and Isomura - to be submitted.

Dr. Martha Donnelly

  • Dunne J, Donnelly M, Nesbitt K, Lee D, Bradley C, Roodenburg K. Understanding

Quality of Life of Ventilator-Dependent Individuals Living in a Long-Term Care Unit: Part I. Canadian Journal of Geriatrics. 2007;10(2):64-67

  • Donnelly M, Nesbitt K, Dunne J, Lee D, Bradley C,. Roodenburg K. Understanding Quality of Life of Ventilator-Dependent Residents on a Long-Term Care Unit: Part II. Canadian Journal of Geriatrics. 2007;10(2):68-71.
  • O’Connor D, Phinney A, Smith A, Small J, Purves B, Perry J, Drance E, Donnelly M, Chaudhury H, Beattie L. Personhood in Dementia Care: Developing a research agenda for broadening the vision. Dementia. 2007;6(1):121-142.
  • Fisk JD, Beattie BL, Donnelly M, Byszewski A, Molnar FJ. Disclosure of the diagnosis of dementia. Alzheimer’s & Dementia. 2007;3:404-410
  • Fisk JD, Beattie BL, Donnelly M. Ethical Considerations for Decision Making for Treatment and Research Participation. Alzheimer’s & Dementia. 2007;3:411-417.
  • O’Connor D, Hall MI, Donnelly M. Assessing Capacity within a Context of Abuse or Neglect. Accepted for Press 2008, Journal of Elder Abuse & Neglect
  • O’Connor D, Donnelly M. Confronting the Challenges of Assessing Capacity: Dementia in the Context of Abuse in: O’Connor D, Purves, B, editors. “Decision Making Personhood and Dementia Exploring the Interface.” London: Jean Kingsley Press for publication spring 2009.

Abstracts:

  • Shared/Collaborative Care for Patients/Families with Dementia. Canadian Journal of Geriatrics. 2007;10:3:100.

Dr. Caroline Gosselin

  • Principle investigator: “Bifrontal, Bitemporal and Right Unilateral ECT in the Elderly: A Prospective, Double Blind Study” CREB approval February 9th, 2006 - continued.
  • CANECTS: The Canadian ECT Survey: Co-Founder underway since 2004.

Dr. Candida Graham

  • Investigator “Post Operative Cognitive Decline”
  • Investigator “Aromatherapy for Agitation in Dementia Sufferers”
  • Investigator “Memantine and Brain Atrophy in Alzheimer’s Disease”
  • High Frequency of Persistent Post Operative Cognitive Decline in Older People After Elective Orthopedic Surgery David Lowery (1), Clive Ballard (2), Katja Kossakowski (2), Timothy Smith (2), Brian Saxby (2,3), Keith Wesnes (3,4) Candida Graham (2)*
  • Graham C, Banerjee S & Gill R [in press]. Postal Questionnaire to Identify Carer Depression Prior to Initial Patient Contact. Psychiatric Bulletin.
  • Lowery D, Ballard C, Kossakowski K, Smith T, Saxby B, Wesnes K & Graham C [2007] High Frequency of Persistent Post Operative Cognitive Decline in Older People After Elective Orthopedic Surgery.
  • Rowan E, Graham C, Ballard C, O’Brien J, Kalaria R [2007] Association of Cognitive Impairment following stroke with depression and activities of daily living [in press] Presentation to the 3rd International Vas-Cog Congress, July 2007.
  • “Professionalism, Curriculum and Student Life Histories: A study to explore medical students’ views on professionalism across the span of the medical program exploring the contribution of student life histories and the curriculum to their views” grant award of $36,000, February 2008.

Dr. Arvind Kang

  • Tertiary Care Geriatric Psychiatry Patients: Clinical and Diagnostic characteristics Barbara Buree Ph.D., Rhonda Malyuk Pharm.D., Carol Wong MA, Arvind Kang MBBS FRCPC, Kiran Rabheru MD CCFP FRCP ABPN, Marilynn MacDougall, poster, AAGP, March 2008Dr. Nirmal Kang
  • “Measuring Outcome Effects of Medication Changes in Tertiary Geriatric Psychiatry Patients,” Rhonda Malyuk, Barbara Buree, Carol Wong, Arvind Kang, Nirmal Kang, Kiran Rabheru, Marilynn MacDougall
  • Malyuk, R., Wong, C., Buree, B., Kang, A. “Bugs Need Drugs: Impact of Early Identification and Treatment of Infections in Tertiary Geriatric Psychiatry Patients with Dementia,” poster presentation 4th Dementia Colloquium, Vancouver, Oct. 18-20, 2007
  • Malyuk, R, Wong, C., Buree, B., Kang, A. “Benzodiazepines in Tertiary Geriatric Psychiatry Patients with a High Prevalence of Dementia: Can reducing use have measurable outcome effects?” New scientific research presentation. 4th Dementia Colloquium, Vancouver, Oct. 18-20, 2007
  • Malyuk, R., Buree, B., Wong, C., Kang, A., Kang, N., Rabheru, K., MacDougall, M. “Measuring Outcome Effects of Medication Changes in Tertiary Geriatric Psychiatry Patients,” poster, AAGP March 14-17, 2008

Dr. Nirmal Kang

  • “Measuring Outcome Effects of Medication Changes in Tertiary Geriatric Psychiatry Patients,” Rhonda Malyuk, Barbara Buree, Carol Wong, Arvind Kang, Nirmal Kang, Kiran Rabheru, Marilynn MacDougall
  • “ECT Clinical Database: A Standardized Approach in Tertiary Care Psychiatry,” Poster AAGP 2008
  • “Efficacy of ECT in Geriatric Tertiary Psychiatry Patients: 6 Year Retrospective Analysis,” CAGP 2008 with Susan Rai, Trisha Kivisalu, Kiran Rabheru and Nirmal Kang
Dr. Stephen Kiraly
  • Kiraly MA, Kiraly SJ. Traumatic Brain Injury and Delayed Sequelae: A Review - Traumatic Brain Injury and Mild Traumatic Brain Injury (concussion) are Precursors to Later Onset Brain Disorders Including Early Onset Dementia. The Scientific World Journal. In Press: Accepted for publication: September 13, 2007.
  • Kiraly SJ. “Your Healthy Brain: A Personal and Family Guide to Staying Healthy and Living Longer.” March 2008. Westcoast Reproductions, Vancouver. ISBN 978-0-9808814-0-0. Work In Progress
  • A manualized version of the above book to be used by facilitators of support groups.

Dr. Michael Passmore

  • Passmore, MJ, Sheldon, L, Lax, S. et al. Oral midazolam for the management of refractory dementia-related agitation. September 2008: Poster – Canadian Association of Geriatric Psychiatry Annual Meeting, Vancouver, BC.
  • Passmore MJ, Gardner DM, Polak Y, Rabheru, K: Alternatives to atypical antipsychotics for the management of dementia-related agitation. Drugs & Aging. 25(5):381-98. 2008.
  • Passmore MJ: The cannabinoid receptor agonist Nabilone for the treatment of dementia-related agitation. International Journal of Geriatric Psychiatry. 23: 116-117. 2008.
  • Hickey C, Chisholm T, Passmore M, O’Brien D: Differentiating the dementias: Revisiting the synucleopathies and tauopathies. Current Alzheimer Research. 5(1):52-60. 2008.
  • Garnham J, Munro A, Slaney C, MacDougall M, Passmore M, Duffy A, Teehan A, Alda M: Prophylactic treatment response in bipolar disorder: results of a naturalistic observation study. Journal of Affective Disorders. 104 (1-3): 185-90. 2007.
  • Ingles J, Fisk J, Passmore M, Darvesh S: Progressive anomia without semantic or phonological impairment. Cortex 43:558-564. 2007.

Dr. Carol Ward