Characteristics and consequences of antenatal exposure to selective serotonin reuptake inhibitors

Depression is a common condition, affecting around one in 20 people worldwide. It is challenging conceptually and clinically, with treatment being ineffective for many, and significant consequences for individuals and societies alike. Depression is particularly problematic during pregnancy, where it is no less common, but poses additional difficulties. Both depression and its pharmacological treatments are associated with a range of short- and longer- term sequelae for offspring, and current data is insufficient to allow fully informed decisions to be made by mothers, midwives, or doctors. Research is affected by practical, ethical, and methodological issues, and a myriad of confounding factors, which combine to increase uncertainties over the risks and benefits of prescribing (or not). Retrospective and prospective observational studies accompany epidemiological data linkage and meta- analyses involving millions of subjects, in contributing to both current knowledge and testable hypotheses to inform future directions for research, while clinical and preclinical studies with smaller sample sizes provide invaluable and complementary details. However, significant gaps remain, not least in delivering optimal care to each individual mother and baby. While the overall emerging picture appears reassuring to some, others acknowledge that we do not even possess all the pieces of the puzzle yet. There remains an urgent need for more comprehensive and relevant data. This thesis presents the findings from a series of pilot studies on evaluating the characteristics and consequences of antenatal exposure to selective serotonin reuptake inhibitors. Up to one in 10 women in the general Scottish population may be exposed to an antidepressant at some point during pregnancy, but adverse outcomes may be related more to underlying maternal depression, rather than its pharmacological treatment. We highlight areas of both intelligence and ignorance, and make proposals for future research

Educational supervision and the impact of workplace-based assessments: a survey of psychiatry trainees and their supervisors

<p>Abstract</p> <p>Background</p> <p>Educational supervision (ES) is considered to be an essential component of basic specialist training in psychiatry in the UK. However, previous studies have indicated variation in its provision, and uncertainty about structure and content. Workplace-based assessments (WPBAs) were introduced in 2007 as part of major postgraduate medical training reform. Placing considerable time demands on trainees and supervisors alike, the extent to which WPBAs should utilise ES time has not been specified. As ES and WPBAs have discrete (although complementary) functions, there is the potential for this increased emphasis on assessment to displace other educational needs.</p> <p>Methods</p> <p>All junior doctors and their educational supervisors in one UK psychiatry training scheme were surveyed both before and after the introduction of WPBAs. Frequency and duration of ES were established, and structure, content and process were ascertained. Opinions on usefulness and responsibility were sought. The usage of ES for WPBAs was also assessed.</p> <p>Results</p> <p>The response rate of 70% showed general agreement between trainees and supervisors, but some significant discrepancies. Around 60% reported 1 hour of ES taking place weekly or 3 times per month. Most agreed that responsibility for ES should be shared equally between trainees and supervisors, and ES was largely seen as useful. Around 50% of trainees and supervisors used 25–50% of ES time for WPBAs, and this did not appear to affect the usefulness of ES or the range of issues covered.</p> <p>Conclusion</p> <p>ES continues to be an important component of psychiatric training. However, using ES for WPBAs introduces the potential for tension between trainees' education and their assessment by emphasising certain training issues at the expense of others. The impact of reduced training time, WPBAs and uncertainties over ES structure and content should be monitored to ensure that its benefits are maximised by remaining tailored to individual trainees' needs.</p