Webinar DATE: Collaborating to recognise and address November 12, 2008 depression in cannabis users Wednesday 17 July 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 Paul Grinzi Lee Brient Monica Lord Dr Shalini Arunogiri Prof. Stephen Trumble General Psychologist, Tas Accredited Psychiatrist, Vic General Practitioner, Vic Practitioner, Vic Mental Health Social Worker, Qld Like to read more about tonight’s panellists? Click the resources icon at the top 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 by clicking the icon at the top right of your screen. 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 Help icon at the top right 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, Audio issues? you will be alerted via an announcement. Listen on your phone by dialling this phone number 1800 896 323 Passcode: 126 472 5328# PAGE 4 Learning outcomes Through an exploration of depression in cannabis users, the webinar will provide participants with the opportunity to: • describe the factors associated with depression in cannabis users • identify the challenges, merits and opportunities in evidence-based approaches deemed most effective in treating and supporting people experiencing depression from cannabis use • implement a referral pathway to support cannabis users with depression. Click the Chat icon at the top right of your screen to chat with other participants. 2
PAGE 5 GP’s perspective Dr Paul Grinzi PAGE 6 GP’s perspective Dr Paul Grinzi 3
PAGE 7 GP’s perspective Dr Paul Grinzi PAGE 8 GP’s perspective Dr Paul Grinzi 4
PAGE 9 GP’s perspective Dr Paul Grinzi PAGE 10 GP’s perspective Dr Paul Grinzi 5
PAGE 11 Psychologist’s perspective Expected referral pathway – GP referral to private psychologist through Mental Health Plan • Voluntary referral by self, GP or family member to a drug and alcohol service • Police may mandate attendance as part of a caution process Lee Brient PAGE 12 Psychologist’s perspective Comprehensive biopsychosocial assessment to determine the range of factors potentially contributing to Kyle’s presentation • Genetic and/or physical • Psychological • Social Lee Brient 6
PAGE 13 Psychologist’s perspective Depression • Assess level of depression symptoms – DASS21: also provides measures of anxiety and stress symptoms • Results guide indicated treatment efficacy • Interactions between mood and biopsychosocial factors Lee Brient PAGE 14 Psychologist’s perspective Substance use • Assess level of use – cannabis and alcohol • Motivation to reduce/cease/abstain • Interactions between mood and biopsychosocial factors Lee Brient 7
PAGE 15 Psychologist’s perspective Collaborative treatment plan likely to include • Psychoeducation to equip client with evidence-based info around his issues • Cognitive strategies • Behavioural strategies • Motivational interviewing • Explore suitability of medication – possible recommendation of referral to psychiatrist, in consultation with GP Lee Brient PAGE 16 Social worker’s perspective Assessment Comprehensive biopsychosocial assessment • • Home and environment Appetite • • Education/Employment Sleep • • Social Risk – suicide, self-harm, homicide • Relationships and sexuality • Mental health history • Drug and alcohol use (past and • present) Psychosis symptoms • • Mood/Depression symptoms Other health conditions • Stress/Anxiety symptoms Monica Lord 8
PAGE 17 Social worker’s perspective Assessment of cannabis use and substance use more broadly Monica Lord PAGE 18 Social worker’s perspective Assessing needs and determining motivation to change • What does the client want to achieve? What are their priorities? • Does the client have any long-term goals/plans? • How does substance use fit in with any long-term plans? • Assess motivation to change using ‘Stages of Change’ model • Working with resistance to change behaviours • Accepting and validating pre-contemplative motivation and working on other goals to create a sense of achievement Monica Lord 9
PAGE 19 Social worker’s perspective Intervention - An Accredited Mental Health Social Worker approach Address low mood (CBT, MI, DBT, ACT) • Addressing cognitive distortions/automatic negative thoughts o “I’m so useless,” “I’m a failure,” “I don’t know what I want to do with my life” • Goal setting (work, study, social, independence, intimate relationships) • Activity scheduling • Sensory modulation to regulate mood • Relaxation strategies (and address underlying anxiety symptoms if evident) • Sleep hygiene Monica Lord PAGE 20 Social worker’s perspective Intervention - An Accredited Mental Health Social Worker approach Address substance use (CBT, MI) FIRST: • Address underlying causes for substance use (depression, anxiety, trauma . . . ) THEN: • Psychoeducation re: substance use; harm minimisation; options for the future if not wanting to address use now • If wanting to quit now - Develop a comprehensive written plan for cutting down /quitting – i.e. high-risk situations, managing urges and cravings, managing withdrawals • Assess concurrent substance use – alcohol, nicotine – do these require intervention (e.g. Nicotine Replacement Therapy, additional quitting plan for nicotine)? • Address and plan for lapses/relapses • Family support – psychoeducation about substance use and mental health, strategies to improve communication, strategies to support young person Monica Lord 10
PAGE 21 Psychiatrist’s perspective Diagnostic Assessment • Kyle’s identified concerns; his treating professionals (GP, psychologist etc.) and his parents identify as their concerns and needs • How does Kyle’s mental health and his function relate to and interact with his cannabis use • Rating scales e.g. depression and anxiety instruments, sleep, mood, exercise and cannabis use diaries Dr Shalini National Comorbidity Guidelines Arunogiri PAGE 22 Psychiatrist’s perspective Any cannabis use 'Heavy’ cannabis use Dr Shalini Arunogiri 11
PAGE 23 Psychiatrist’s perspective Formulation • Systems perspective and relationship dynamics • How does Kyle fit into his (i) family, (ii) his peer group, (iii) his community • What are the dynamics between Kyle and his parents, and/or Kyle and his treating team, and how does this impact on his recovery? • Tying things together in a way that makes sense for Kyle – why are things the way they are for him right now? • Kyle’s low sense of self-efficacy ; • disempowerment in current situation; • social isolation and disengagement from peer group etc. Dr Shalini Arunogiri PAGE 24 Psychiatrist’s perspective Risk Assessment • Informed by GP, other treating professionals, parents and Kyle • Mental health risks incl. psychosis • Risks to self/other • Risks relating to driving and motor impairment • Risks in terms of deterioration/recovery Dr Shalini Arunogiri 12
PAGE 25 Psychiatrist’s perspective Recovery Plan • Recovery – needs, social recovery, self-efficacy, identified goals • The role of medication • Are they necessary? What is Kyle’s choice? • Weighing up risk/benefits of medication • Antidepressant choice • Guided by symptom profile • Support and education for family • Potentially seeing Kyle with family if this is his choice as this can support Kyle, dispel some myths the family might have, and get everyone on the same page re: shared goals Dr Shalini Arunogiri PAGE 26 Q&A session Dr Paul Grinzi Lee Brient Monica Lord Dr Shalini Arunogiri Facilitator: General Psychologist, Tas Accredited Psychiatrist, Vic Prof. Stephen Trumble Practitioner, Vic General Practitioner, Vic Mental Health Social Worker, Qld Audience tip: Click the ‘Ask a question’ icon at the top right of your screen to post a question to the panel. 13
PAGE 27 Thank you! Don’t forget to complete the feedback survey Click the survey icon at the top right of your screen to open the survey. 14
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