Adverse medication events in a psychiatric practice: a naturalistic study

Aims and methodTo document the number and type of adverse medication events in a psychiatric sector service. Significant new adverse events were collated by the author and team over 30 months. Intervention to prevent any adverse event was enacted as soon as any were noticed or anticipated.ResultsThirty-six significant events occurred including three deaths and nine near misses. Corrective action was taken immediately any adverse event occurred. Inadequate communication between various hospital clinics, general practitioner practices, psychiatric clinics and pharmacies was the biggest avoidable cause of adverse events.Clinical implicationsAwareness of adverse drug events is essential in psychiatry. Clear, transparent pathways of prescribing are a key requirement to reduce avoidable adverse medication events. Psychopharmacology is a core module for psychiatric training.

Diagnosis and treatment of Wernicke's encephalopathy in an in-patient alcohol detoxification unit: a completed audit cycle

Aims and methodA baseline audit of trainees' ability to recognise Wernicke's encephalopathy and initiate appropriate thiamine regimes in an in-patient alcohol detoxification unit was carried out. Based on the findings, gaps were addressed using targeted education and training, and their impact on improving standards of managing Wernicke's encephalopathy was re-audited.ResultsThe initial audit revealed that trainees' ability to recognise Wernicke's encephalopathy and initiate thiamine was inadequate. Significant improvement in appropriate use of treatment regime (P < 0.05) of thiamine and the monitoring of clinical response was observed after addressing the initial gaps through education.Clinical implicationsTreatment of Wernicke's encephalopathy can be inadequate, given a lack of awareness of clinical presentation and appropriate management. This can be addressed through education and training.

Screening for psychiatric morbidity in police custody: results from the HELP-PC project

Aims and methodTo ascertain the efficacy of custody health screening for mental disorders. We assessed a sample of detainees for the presence of mental disorders and the need for an appropriate adult. The assessments were carried out using pragmatic interviews and examinations supported by structured tools. Where possible, we attributed a probable clinical diagnosis based on the information available to us. The need for an appropriate adult was judged based on this information and capacity assessments.ResultsExisting screening procedures missed a quarter of cases of severe mental illness and moderate depression; they also failed to detect about a half of those at risk of alcohol withdrawal and 70% of those at risk of withdrawal from crack cocaine. The need for an appropriate adult was not recognised in more than half of cases.Clinical implicationsConsideration should be given to modifying police screening procedures for mental and associated disorders so that detainees receive the appropriate attention.

Academic training in psychiatry

Aims and methodThe structure of academic training in psychiatry has changed in recent years and little is known about the trainees currently pursuing this career path. Two surveys were conducted of academic trainees in psychiatry and the heads of departments of psychiatry. These surveys aimed to identify the number of trainees currently in academic training, the nature of their positions and opinions about the current system of training in academic psychiatry.ResultsThere were 165 academic trainees identified, of whom 101 were not currently in academic clinical fellow (ACF) or academic clinical lecturer (ACL) posts. Academic trainees are located in a relatively small number of universities, with a quarter being based at one institution. In total, 60% of the trainees were in general adult psychiatry. Only 4.6% of respondents rated their academic training as excellent and just over half were certain that they wished to pursue an academic career in the future. Various challenges to academic training in psychiatry were identified by both the heads of departments and trainees.Clinical implicationsCurrent difficulties in academic training in psychiatry, such as lack of flexibility of the training pathway, need addressing to ensure the provision of high-quality research and teaching in psychiatry in the future.