Speakers - 2025

Abstract

Statement of the Problem:
Psychiatrists increasingly care for individuals with overlapping psychiatric disorders, physical comorbidities, and social vulnerability — including those with addiction histories. Yet training remains siloed, with limited preparation for managing the complexity, risk, and ethical tension these patients often present. This case-based reflection explores how gaps in psychiatric training undermine recovery and continuity of care, especially for patients with high-risk multimorbidity and treatment resistance.

Methodology & Theoretical Orientation:
The case involves a 69-year-old woman detained under the Mental Health Act with treatment-resistant schizophrenia, diabetes, chronic kidney disease, and vascular disease. Her psychiatric admission was marked by treatment refusal, fluctuating capacity, and delayed medical escalation. Despite involvement from multiple specialties, her physical condition deteriorated on the ward and she later died following emergency transfer. Her trajectory exemplifies the gaps between mental and physical health services, and the limitations of training when faced with complex comorbidity.

Findings:
Surveys show only 34% of psychiatry trainees feel confident managing physical health, and fewer than 30% feel prepared for end-of-life care. These deficits are especially critical for clinicians treating patients with addiction or high medical risk, where timely, coordinated action is essential. Current training fails to prepare psychiatrists to manage frailty, navigate best interest decisions, or lead integrated multidisciplinary teams.

Conclusion & Significance:
As addiction and psychiatric complexity increase, training must evolve. This case calls for psychiatric education that prepares clinicians to manage comorbidities, ethical conflict, and risk with confidence. A recovery-oriented model must embed trauma-informed care, physical health literacy, and cross-sector collaboration — core competencies for the future of psychiatry and addiction medicine.