Competent psychopharmacology.

David M Gardner

doi:10.1177/070674371405900802

Abstract

There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care.

Highlights

There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses
Prior to the introduction of fluoxetine in 1989, depressed patients typically were prescribed a TCA, with an initial prescription for 7 or 14 days to allow for assessing adverse effects and responses, to limit the risk for self-harm in the event of an overdose, and to limit waste owing to poorly tolerated treatments
Specialty involves learning about psychotropics, first as an undergraduate medical student during introductory courses on neuroscience, pharmacology, and the brain and behaviour, and a typically brief clinical psychiatric clerkship. These rudimentary components of medical training apply to all future physicians, who will regularly encounter the 4% or so of the general population with a serious mental illness, whose treatment almost always involves 1 or more psychotropics.[6]