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The Royal College of Psychiatrists recommends that all psychiatrists undertake continuing professional development (CPD) as part of their personal development plan (PDP) and that, for quality assurance, all CPD activity is approved by their peer groups. We conducted a regional survey (Survey I) of consultant psychiatrists attending a regional conference of the College to assess their current CPD practice, and a more detailed national survey (Survey II) into sessional time for CPD and peer group activity of all consultant psychiatrists and staff grade, associate specialist and specialty (SASS) doctors.
The surveys showed some similarities. Survey I (n = 36) showed that 83% of consultants had a current CPD certificate and that consultants experienced significantly more difficulty in achieving their ‘internal’ compared with ‘external’ CPD requirements (39% v. 20%). Survey II (n = 2632) showed that 98% of our sample thought CPD was important for revalidation. Despite this, over 50% had difficulty accessing CPD time regularly in their timetable. In total, 97.4% of consultants and 85.7% of SASS doctors were in peer groups.
A revised CPD policy must give credit to peer group meetings and set out more clearly the distinction between the types of CPD activity psychiatrists undertake. We recommend more robust job planning to enable psychiatrists to fulfil their CPD requirements in the face of competing demands on their clinical time and reducing resource.
Depression increases the risk of subsequent vascular events in both cardiac and non-cardiac patients. Atherosclerosis, the underlying process leading to vascular events, has been associated with depression. This association, however, may be confounded by the somatic-affective symptoms being a consequence of cardiovascular disease. While taking into account the differentiation between somatic-affective and cognitive-affective symptoms of depression, we examined the association between depression and atherosclerosis in a community-based sample.
In 1261 participants of the Nijmegen Biomedical Study (NBS), aged 50–70 years and free of stroke and dementia, we measured the intima–media thickness (IMT) of the carotid artery as a measure of atherosclerosis and we assessed depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis (PCA) of the BDI items yielded two factors, representing a cognitive-affective and a somatic-affective symptom cluster. While correcting for confounders, we used separate multiple regression analyses to test the BDI sum score and both depression symptom clusters.
We found a significant correlation between the BDI sum score and the IMT. Cognitive-affective, but not somatic-affective, symptoms were also associated with the IMT. When we stratified for coronary artery disease (CAD), the somatic-affective symptom cluster correlated significantly with depression in both patients with and patients without CAD.
The association between depressive symptoms and atherosclerosis is explained by the somatic-affective symptom cluster of depression. Subclinical vascular disease thus may inflate depressive symptom scores and may explain why treatment of depression in cardiac patients hardly affects vascular outcome.
To identify and reduce the number of patients receiving depot neuroleptics above the British National Formulary maximum. The medical records were scrutinised and individual consultants were informed of the results.
For the team involved in this audit there was a significant reduction in the prescription of high-dose depot medication, but this did not generalise to other teams.
Different teams should repeat the audit and a new depot card has been developed.