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.
TaylorMA. Hippocrates cried: The decline of American psychiatry. Oxford (GB): Oxford University Press; 2013.
3.
StettinGDYaoJVerbruggeRR, Frequency of follow-up care for adult and pediatric patients during initiation of antidepressant therapy. Am J Manag Care. 2006;12(8):453–461.
4.
ChenSYHansenRAFarleyJF, Follow-up visits by provider specialty for patients with major depressive disorder initiating antidepressant treatment. Psychiatr Serv. 2010;61(1):81–85.
5.
OlfsonMMarcusSCWeissmanMM, National trends in the use of psychotropic medications by children. J Am Acad Child Adolesc Psychiatry. 2002;41(5):514–521.
6.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2012 National Survey on Drug Use and Health: Mental health findings, NSDUH series H-47, HHS publication no (SMA) 13–4805.Rockville (MD): SAMHSA; 2013.
7.
BaldessariniRJ. Chemotherapy in psychiatry: Pharmacologic basis of treatments for major mental illness. 3rd ed.New York (NY): Springer; 2013.
8.
GardnerDMTeehanMD. Antipsychotics and their side effects. Cambridge (GB): Cambridge University Press; 2010.
9.
BarkerWAScottJEcclestonD.The Newcastle chronic depression study: Results of a treatment regime. Int Clin Psychopharmacol. 1987;2(3):261–272.
10.
SadockBJSadockVARuizP, Kaplan and Sadock's comprehensive textbook of psychiatry. 9th ed.Philadelphia (PA): Lippincott Williams & Wilkins; 2009.
11.
MichieSvan StralenMMWestR.The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
12.
OlfsonMBlancoCWangS, National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry. 2014;71(1):81–90.
13.
OlfsonMKroenkeKWangS, Trends in office-based mental health care provided by psychiatrists and primary care physicians. J Clin Psychiatry. 2014;75(3):247–253.
14.
MidlovPBondessonAErikssonT, Effects of educational outreach visits on prescribing of benzodiazepines and antipsychotic drugs to elderly patients in primary health care in southern Sweden. Fam Pract. 2006;23(1):60–64.
15.
KeijsersCJVan HensbergenLJacobsL, Geriatric pharmacology and pharmacotherapy education for health professionals and students: A systematic review. Br J Clin Pharmacol. 2012;74(5):762–773.
16.
KamarudinGPenmJChaarB, Educational interventions to improve prescribing competency: A systematic review. BMJ Open. 2013;3(8):e003291.
17.
DriesenAVerbekeKSimoensS, International trends in lifelong learning for pharmacists. Am J Pharm Educ. 2007;71(3):52.
18.
FleuryMJImbouaAAubeD, General practitioners' management of mental disorders: A rewarding practice with considerable obstacles. BMC Fam Pract. 2012;13(1):19.
19.
ForsetlundLBjorndalARashidianA, Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;(2):CD003030.
20.
DavisDDavisN.Selecting educational interventions for knowledge translation. CMAJ. 2010;182(2):E89–E93.
21.
DavisDAPrescottJFordisCMJrRethinking CME: An imperative for academic medicine and faculty development. Acad Med. 2011;86(4):468–473.
22.
MerkurSMossialosELongM, Physician revalidation in Europe. Clin Med. 2008;8(4):371–376.
23.
AhmedKWangTTAshrafianH, The effectiveness of continuing medical education for specialist recertification. Can Urol Assoc J. 2013;7(7–8):266–272.
24.
KnoppRKWyerPC. Maintenance of certification: A work in progress. Ann Emerg Med. 2014;63(4):471–473.e2.
25.
VázquezGH. The impact of psychopharmacology on contemporary clinical psychiarty. Can J Psychiatry. 2014;59(8):412–416.
26.
BaldessariniRJ. The impact of psychopharmacology on contemporary psychiatry. Can J Psychiatry. 2014;59(8):401–405.
27.
MarcusSCOlfsonM.National trends in the treatment for depression from 1998 to 2007. Arch Gen Psychiatry. 2010;67(12):1265–1273.
28.
ShrankWHPolinskiJMAvornJ.Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc. 2007;55(Suppl 2):S373–S382.
29.
SultzerDLDavisSMTariotPN, Clinical symptom responses to atypical antipsychotic medications in Alzheimer's disease: Phase 1 outcomes from the CATIE-AD effectiveness trial. Am J Psychiatry. 2008;165(7):844–854.
30.
BarbuiCSignorettiAMuleS, Does the addition of a second antipsychotic drug improve clozapine treatment?Schizophr Bull. 2009;35(2):458–468.
31.
CorrellCURummel-KlugeCCorvesC, Antipsychotic combinations vs monotherapy in schizophrenia: A meta-analysis of randomized controlled trials. Schizophr Bull. 2009;35(2):443–457.
32.
MorrowRLGarlandEJWrightJM, Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children. CMAJ. 2012;184(7):755–762.
33.
CorrellCUManuPOlshanskiyV, Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA. 2009;302(16):1765–1773.
34.
Medicaid Medical Directors Learning Network (MMDLN) and Rutgers Center for Education and Research on Mental Health Therapeutics (CERTS). Antipsychotic medication use in Medicaid children and adolescents: Report and resource guide from a 16-state study. MMDLN–Rutgers CERTs publication no 1 [Internet].New Brunswick (NJ): Distributed by Rutgers CERTs; 2010 Jul [cited 2014 Apr 14]. Available from: http://rci.rutgers.edu/∼cseap/MMDLNAPKIDS.html. Further details can be found at: http://chsr.rutgers.edu/MMDLNAPKIDS.html.
35.
PattenSBWaheedWBreseeL.A review of pharmacoepidemiologic studies of antipsychotic use in children and adolescents. Can J Psychiatry. 2012;57(12):717–721.
36.
OlfsonMBlancoCLiuSM, National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry. 2012;69(12):1247–1256.
37.
BirnbaumMLSaitoEGerhardT, Pharmacoepidemiology of antipsychotic use in youth with ADHD: Trends and clinical implications. Curr Psychiatry Rep. 2013;15(8):382.
38.
BoboWVCooperWOSteinCM, Antipsychotics and the risk of type 2 diabetes mellitus in children and youth. JAMA Psychiatry. 2013;70(10):1067–1075.
39.
MurphyALGardnerDMCookeC, Prescribing trends of antipsychotics in youth receiving income assistance: Results from a retrospective population database study. BMC Psychiatry. 2013;13(1):198.
40.
ParryPILevinEC. Pediatric bipolar disorder in an era of “mindless psychiatry”. J Trauma Dissociation. 2012;13(1):51–68.
41.
PringsheimTGardnerDM. Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: A descriptive study. CMAJ Open. Forthcoming 2014.
42.
Klein-SchwartzWSchwartzEKAndersonBD. Evaluation of quetiapine abuse and misuse reported to poison centers. J Addict Med. 2014;8(3)195–198. Epub ahead of print.
BoboWVEpsteinRAJrHayesRM, The effect of regulatory advisories on maternal antidepressant prescribing, 1995–2007: An interrupted time series study of 228,876 pregnancies. Arch Womens Ment Health. 2014;17(1):17–26.
45.
EpsteinRABoboW VSheltonRC, Increasing use of atypical antipsychotics and anticonvulsants during pregnancy. Pharmacoepidemiol Drug Saf. 2013;22(7):794–801.
46.
BenkertOGraf-MorgensternMHillertA, Public opinion on psychotropic drugs: An analysis of the factors influencing acceptance or rejection. J Nerv Ment Dis. 1997;185(3):151–158.
47.
Van SchaikDJKlijnAFVan HoutHP, Patients' preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry. 2004;26(3):184–189.
48.
AppelbaumPSGoldA.Psychiatrists' relationships with industry: The principal-agent problem. Harv Rev Psychiatry. 2010;18(5):255–265.
49.
CosgroveLKrimskyS.A comparison of DSM-IV and DSM-5 panel members' financial associations with industry: A pernicious problem persists. PLOS Med. 2012;9(3):e1001190.
50.
GardnerDMMurphyALWoodmanA, Community pharmacy services for antidepressant users. Int J Pharm Pract. 2001;9:217–224.
51.
DemyttenaereK.Risk factors and predictors of compliance in depression. Eur Neuropsychopharmacol. 2003;13(Suppl 3):S69–S75.
52.
MaddoxJCLeviMThompsonC.The compliance with antidepressants in general practice. J Psychopharmacol. 1994;8(1):48–52.
53.
BullSAHuXHHunkelerEM, Discontinuation of use and switching of antidepressants: Influence of patient–physician communication. JAMA. 2002;288(11):1403–1409.
54.
MurphyAGardnerDKutcherS, Collaborating with youth to inform and develop tools for psychotropic decision making. J Can Acad Child Adolesc Psychiatry. 2010;19(4):256–263.
