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Articles: Nasser Abdelmawla and Alex J. Mitchell Sudden cardiac death and antipsychotics. Part 2: Monitoring and prevention Adv Psychiatr Treat 2006; 12: 100-109 [Abstract] [Full text] [PDF]

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Training Needs – For trainees or Consultants?

SIRAJ SALAHUDEEN   (9 April 2006)

Training Needs – For trainees or Consultants? 9 April 2006
SIRAJ SALAHUDEEN, SENIOR HOUSE OFFICER, CAMHS, TELFORD SHROPSHIRE PRIMARY CARE NHS TRUST Send letter to journal: Re: Training Needs – For trainees or Consultants? drsirajs{at}hotmail.com SIRAJ SALAHUDEEN	I read with interest the article by Abdelmawla and Mitchell (APT March 2006) relating to antipsychotics and cardiac monitoring. As discussed by the authors it is important to monitor the cardiac function of patients taking antipsychotics which have cardiac adverse effects as this factor may play a major part in the decreased life expectancy of patients with schizophrenia (Osby et al, 2000). However, the disease itself, or confounding factors such as smoking or diabetes could also contribute to reduced life expectancy. (Hennessy et al, 2002) One of the methods of assessment and monitoring of cardiac function is by an electrocardiogram (ECG) performed by the clinician prescribing the medication. I agree that if an ECG is difficult to interpret then the clinician should consider seeking a cardiologist’s opinion. One of the main conclusions in the article is the highlighting of the training needs of doctors regarding ECG interpretation. The study conducted by Warner et al, in 1996 is still relevant as it was carried out before 1996 so that many of the junior doctors at that time would now be Consultants. Moreover there are more Consultants than junior doctors in Psychiatry in the UK. (RCPsych 2004). It would be interesting to perform a similar study regarding ECG interpretation involving Consultants and other senior doctors working in psychiatry in the UK. Nonetheless, training in calculating the QTc interval alone has potential medico-legal pitfalls, as clinicians could miss some other important features of the ECG if they are not fully competent in interpreting them. So it would be prudent to send a copy of the ECG to the patient’s general practitioner. Declaration of interest: Junior Doctor References: Osby U, Correia N, Brandt L, Ekbom A, Sparen P. (2000) Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. British Medical Journal, 321, 483-484 Hennessy S, Bilker WB, Knauss JS, Margolis DJ, Kimmel SE, Reynolds RF, Glasser DB, Morrison MF, Strom BL. (2002) Cardiac arrest and ventricular arrhythmia in patients taking antipsychotic drugs: cohort study using administrative data. British Medical Journal, 325:1070 Warner, J. P., Gledhill, J. A., Connell, F., et al (1996) How well do psychiatric trainees interpret electrocardiographs. A cross-sectional survey. Psychiatric Bulletin, 20, 651–652. Royal College of Psychiatrists (2004) 12th annual census of psychiatric staffing, http://www.rcpsych.ac.uk