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. 2008 Jul 1;5(3):76–77.

CORRESPONDENCE

PMCID: PMC6734835  PMID: 31507953
Int Psychiatry. 2008 Jul 1;5(3):76.

Ethno-psychopharmacology

Sir: We read the article by Pi & Zhu (2007) with interest, as this topic is particularly important to psychiatrists practising in countries like Sri Lanka, where, because of the lack of local prescribing guidelines, the dosing of medication is generally determined by guidelines developed for patients in the West, such as those from the National Institute for Health and Clinical Excellence (NICE) and the British National Formulary.

There are reports that Asian people generally require lower doses of psychotropic medications than White people and also that they have a lower threshold for extrapyramidal side-effects (Lin & Finder, 1983). This may be because of genetic and biological variations in pharmacokinetics and pharmacodynamics. Therefore it seems prudent to observe the rule of thumb ‘start low and go slow’ when prescribing psychotropics, in order to achieve a clinical improvement while avoiding adverse effects.

Self-adjustment of doses of medications is commonly seen among our patients, and that can lead to suboptimal therapeutic responses and more side-effects. Hence it is important to explain treatment decisions and the adjustment of doses.

Another factor which has to be kept in mind is that these patients may also be on concomitant herbal medication. There have been reports that some herbal medications (particularly Asian herbal mixtures) are contaminated with heavy metals (Ernst & Thompson Coon, 2001). Herbal medications may also be adulterated with prescription drugs or contain misidentified herbal ingredients. The presence of these constituents may alter the pharmacokinetic and pharmacodynamics of psychotropics, leading to toxic effects as well as suboptimal clinical improvement. Patients should be asked about the use of herbal medications, and be educated and cautioned with regard to the possible interactions between herbs and psychotropics.

Therefore, it is important to consider the inter-racial pharmacokinetic and pharmacodynamic differences as well as environmental and cultural factors when determining the dosage of psychotropics for our patients.

A. Hapangama1 and K. A. L. A. Kuruppuarachchi2
1Lecturer in Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
2Professor of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, email lalithkuruppu@lycos.com

References

  1. Ernst, E. & Thompson Coon, J. (2001) Heavy metals in traditional Chinese medicines: a systematic review. Clinical Pharmacology and Therapeutics, 70, 497–504. [DOI] [PubMed] [Google Scholar]
  2. Lin, K. M. & Finder, E. (1983) Neuroleptic dosage for Asians. American Journal of Psychiatry, 140, 490–491. [DOI] [PubMed] [Google Scholar]
  3. Pi, E. H. & Zhu, W. (2007) New research advances in ethno-psychopharmacology: an Asian perspective. International Psychiatry, 4, 57–58. [PMC free article] [PubMed] [Google Scholar]
Int Psychiatry. 2008 Jul 1;5(3):77.

Psychiatry for the person – the view from Asia

Sir: The editorial by George Christodoulou et al (2008) on ‘Psychiatry for the person’ and the response by Jeremy Holmes (2008) have been read with avid interest on this side of the globe. Listening to previous presentations on this topic at Asian meetings of the World Psychiatric Association (WPA), we were often left with a sinking feeling that they resonate well with our work but could be better. For the Institutional Programme on Psychiatry for the Person (IPPP) to succeed, there should be more participation from developing countries. The marketplace of ideas should not be confined to academics in Europe and North America and ignoring the rich experience of clinicians in Chennai, Singapore or Batu Pahat.

Professor Holmes understands that the practice of psychological therapy is different in Asia – the philosophies of Confucius and Lao Tze have immense influence on East Asian psychological therapy. The challenge is how to translate an erudite document in the IPPP into clinical practice, not just for psychiatrists but also for other doctors and medical students. Psychiatry for the person should also be practised at the primary care level; in Singapore two family physicians have crafted an innovative narrative approach in psychological therapy for primary care doctors, focusing on the centrality of personhood (Cheong & Goh, 2008). Psychiatry for the person should not be a hollow catchword and future psychiatrists should not merely be pharmacotherapists, with psychological therapy outsourced to social workers, counsellors and psychologists.

Fortuitously, some of these issues will be discussed in a forthcoming meeting in Singapore on 23–24 February 2009. The TOP (Teachers Of Psychiatry) Conference has the support of the Royal College of Psychiatrists (UK, Western Pacific Division), Pacific Rim College of Psychiatrists and Asian Federation of Psychiatric Associations. This is an open letter to welcome the WPA to participate. Further information on this conference can be obtained from pcmkeh@nus.edu.sg.

Professor Kua Ee Heok
Head, Department of Psychological Medicine, National University of Singapore, email pcmkeh@nus.edu.sg

References

  1. Cheong, P. Y. & Goh, L. G. (2008) The Singapore Family Physician. College of Family Physicians, Singapore: (in press). [Google Scholar]
  2. Christodoulou, G., Fulford, B. & Mezzich, J. E. (2008) Psychiatry for the person and its conceptual bases. International Psychiatry, 5, 1–3. [PMC free article] [PubMed] [Google Scholar]
  3. Holmes, J. (2008) Psychiatry for the person. International Psychiatry, 5, 50. [PMC free article] [PubMed] [Google Scholar]
Int Psychiatry. 2008 Jul 1;5(3):77.

Competency-based training schemes in psychiatry

Sir: At its 2006 annual forum in Riga, the European Federation for Psychiatric Trainees (EFPT) issued its first statement on competency-based training and assessment in psychiatry. The EFPT, which represents national associations of psychiatric trainees from across Europe, is broadly in favour of competency-based training if it improves the standard of psychiatric education and is not overly bureaucratic.

Competency-based training schemes in psychiatry are currently being introduced in Denmark, the Netherlands, Sweden and the UK, and there are plans for similar changes to training in a number of other European countries. The EFPT believes there are significant opportunities for cross-European collaboration and mutual learning between the countries introducing these changes. The EFPT also very warmly welcomes the decision of the Board of Psychiatry of the Union Européenne des Médicines Spécialistes (UEMS) to set up a working group to look at common competencies in psychiatry required for all specialists working within the European Union (EU), based on the UEMS document ‘A profile of a psychiatrist’.

We, as European trainees, believe that well designed, properly funded and wisely implemented reforms that have the potential to improve training will also improve the mental health of Europe. The fact that many EU countries are taking a similar approach and implementing similar changes at the same time also provides a unique opportunity to agree some common standards, to share and develop common assessment tools, and to strengthen the specialty. The adoption of more similar approaches in training and assessment may also facilitate greater cross-EU collaboration and exchange, for example making it far easier for a trainee from one country to spend a period of training in another country if the competencies and means of assessing them are similar.

Ian Soosay
Chairperson, Working Group on Competency-Based Training, European Federation of Psychiatric Trainees, email r.soosay@ucl.ac.uk

Int Psychiatry. 2008 Jul 1;5(3):77.

Association of European Psychiatrists (AEP)

Sir: Your readers may be interested to know that the Association of European Psychiatrists (AEP) held its 16th Annual Congress in Nice, France, 5–9 April 2008. There were almost 3000 delegates from 57 countries. The theme was ‘Pathways to Integrative Care.’

The AEP Young Psychiatrists Committee also organised a parallel series of high-quality lectures and informal sessions aimed specifically at trainees and young psychiatrists. Among these, Povl Munk-Jørgensen, editor of Acta Psychiatrica Scandinavica, provided an informative lecture on getting research published. There were also informal discussions with Professor Wolfgang Fleischhacker on how to embark upon a career in research and Professor Norman Sartorius on mental health issues across Europe. The Committee awarded 15 scholarships to trainees and young psychiatrists from across Europe. These awards enabled enthusiastic trainees and young psychiatrists to attend the conference by providing financial assistance with travel and accommodation. Scholarship winners also received 1 year’s free AEP membership and admission to a course for continuing medical education at the Congress.

We look forward to the 17th AEP European Congress of Psychiatry, entitled ‘New Diagnostic Approaches in Psychiatry: Relevance for Research and Practice in Europe’, which will take place in Lisbon, Portugal, 24–28 January 2009 (see http://www.kenes.com/aep2009).

Iris Calliess,1 Kai Treichel1 and Alexis Bowers2
1Young Psychiatrists Committee; 2AEP scholarship winner, email dralexisbowers@hotmail.com

Articles from International Psychiatry are provided here courtesy of Royal College of Psychiatrists

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