CLINICAL PSYCHOPHARMACOLOGY   

The trainee will demonstrate knowledge of psychopharmacology. This knowledge will include pharmacological action, clinical indications, side effects, drug interactions, toxicity and appropriate prescribing practice. Trainees will be able to demonstrate knowledge of:   

  General Principles   

 A brief historical overview of the development of psychotropic drugs. Their classification. Optimizing patient compliance. Knowledge of the placebo effect and the importance of controlling for it. The principles of rational prescribing of psychoactive drugs.    

Pharmacokinetics   

General principles of absorption, distribution, metabolism, and elimination. Drug interactions.  Reference to a comparison of oral, intramuscular, and intravenous routes of administration as they affect drug availability, elimination as it affects the life of the drug in the body and access to the brain through the ‘blood-brain barrier’. Applications of these to choose of administrative route and timing of doses. The relationship of aging, culture, ethnicity to pharmacokinetics.  Relationships between plasma drug level and therapeutic response:  the possibilities and limitations of this concept with specific examples such as lithium, antidepressants, and anticonvulsants.   

  Pharmacodynamics   

 Synaptic receptor complexity, main receptor sub-types, phenomena of receptor up-, and down-regulation. Pharmacogenetics. The principal CNS pharmacology of the main groups of drugs used in psychiatry with particular attention to their postulated modes of action in achieving therapeutic effect: at both molecular/synaptic and systems levels. These groups would include ‘anti-psychotic’ agents, drugs used in the treatment of the affective disorder (both mood-altering and stabilizing), anxiolytics, hypnotics, and anti-epileptic agents. The relationship of culture, race, and ethnicity to pharmacodynamics.   

Neurochemical effects of ECT.   

 Adverse Drug Reactions (ADRs)   

Understanding of dose-related as distinct from ‘idiosyncratic’ ADRs.  The major categories of ADRs associated with the main groups of drugs used in psychiatry and those associated with appropriate corrective action.   The importance of assessing risks and benefits for every individual patient in relation to his medication. Risks and benefits of psychotropic drugs in acute, short- and long-term use including effects of withdrawal. Where appropriate, knowledge of official guidance on the use of drugs (e.g., the Royal College Guidelines on the use of Benzodiazepines, NICE guidance).  The information database for adverse drug reactions and how to report them.   

Prescribing of controlled drugs.