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iCAAD London 2019 - Dr Mike McPhillips -

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In this presentation, Consultant Psychiatrist and international addictions specialist, Dr McPhillips, will provide an overview of emerging medical treatments for addiction.

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iCAAD London 2019 - Dr Mike McPhillips -

  1. 1. What does the future hold for addictions medicine? Dr Mike McPhillips Consultant Psychiatrist Nightingale Hospital, London
  2. 2. Medical practice in which the treatment decisions are based, where possible, on the results of well-conducted clinical research. Research is well-conducted if it obeys certain criteria aimed at reducing subjectivity (that which we want to be true) and increasing objectivity (that which we can reliably demonstrate to be true). Some types of research are inherently more reliable than others, i.e. Meta-analysis and systematic reviews (studies that analyse all of the published scientific evidence rather than only part on none of of it), and above all, the evidence from randomised, controlled clinical trials. Evidence-based medicine
  3. 3. Comparison of study designs Randomised controlled trial (RCT) Cohort study Case-control study Time series Case studies, expert opinion Strong design Weak design
  4. 4. Randomised control trial
  5. 5. Performance enhancement in the NHS 2001
  6. 6. Randomised control trial Ideally also has • Independent “blind” observers • Intention to treat analysis • Adequate numbers (n = ‘00’s) • Valid outcome measures • LTFU accounted for
  7. 7. Case studies and expert opinion “In my clinical experience……” “Time after time, we see…..” “In case after case after case…..”
  8. 8. Expert opinion “There are as many opinions as there are experts”
  9. 9. Case studies and expert opinion “In my clinical experience……” “Time after time, we see…..” “In case after case after case…..”
  10. 10. RTMS “In my clinical experience……” “Time after time, we see…..” “In case after case after case…..”
  11. 11. RTMS: A pulsed magnetic field induces electrical stimulation in the brain • Medication free treatment • No anaesthetic required • Minimal discomfort • Numerous RCT’s and meta- analyses demonstrate effectiveness for depression, OCD, bipolar depression • Approved by FDA for depression, OCD, and NICE for depression in 2015, but not widely available in NHS • 20-30 x 20 minute applications, outpatient treatment • Becoming less expensive , technology improving Evidence-based medicine RTMS
  12. 12. • Medication-free treatment for comorbid depression/OCD • Reduces craving for nicotine, alcohol, cocaine • Current trials on food, methamphetamine, opiates, gambling • Increases dopaminergic activity in limbic structures governing mood, sense of well-being, may be useful in rehabilitation RTMS in addictions
  13. 13. • EC’s are a popular option among people trying to reduce or quit tobacco smoking • They indisputably produce fewer carcinogens than tobacco smoke • They are not known to be free of adverse health effects, because they produce nicotine, formaldehyde and other potentially harmful chemicals • A recent NEJM trial showed 18% 1y quit rate vs 9% for NRT’s, N= 900 Electronic cigarettes in smoking cessation
  14. 14. There is especial concern about young people experimenting with them, and possible “gateway” effects Electronic cigarettes Controversies
  15. 15. Electronic cigarettes in smoking cessation
  16. 16. • Baclofen is a muscle relaxant that has significant effects in making the brain less excitable. • Dr Beaurepaire is a French psychiatrist who treated his own alcohol dependence with baclofen. He went on to treat another 400 of his patients and to write a book about it, plus assorted blogs, websites, videos and interviews. He claimed over a 60% success rate in keeping people sober. • There have been 12 RCT’s of baclofen for alcohol, with over 1200 participants in 8 different countries. • None of the primary or secondary outcomes of the review showed evidence of a difference between baclofen and placebo. Cautionary tales Baclofen for alcohol and gambling disorder?
  17. 17. Contact details Outpatients Inpatients Dr Mike McPhillips Chelsea Consulting Rooms 2 Lower Sloane Street London SW1W 8BJ T. 020 7245 1199 F. 020 7245 1221 E. info@drmikemcphillips.com www.drmikemcphillips.com Nightingale Hospital 11-19 Lisson Grove Marylebone, London NW1SH T. 020 7535 7700 F. 020 7724 5976 E. patientservices@nightingalehospital.co.uk www.nightingalehospital.co.uk

In this presentation, Consultant Psychiatrist and international addictions specialist, Dr McPhillips, will provide an overview of emerging medical treatments for addiction.

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