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OBJECTIVE: The OSCE has been demonstrated to be a reliable and valid method by which to assess students' clinical skills. An OSCE station was used to determine whether or not students who had completed a core psychiatry clerkship demonstrated skills that were superior to those who had not taken the clerkship and which areas discriminated between clerkship completers and noncompleters. METHODS: One hundred thirty-six students took a 48-item, fourth-year OSCE with one psychiatry station. Sixty-three (46%) had already completed psychiatry, and 70 (51%) had not, with three unknown. Students were to take histories, perform mental status examinations, assess dangerousness, and propose the differential diagnosis and treatment plans. RESULTS: Nine items differed significantly between completers and noncompleters, six concerning phenomenology and mental status and three concerning differential diagnosis. There were no differences regarding history, communication skills, or recommended interventions. CONCLUSION: Students may learn history taking, communication, and treatment planning in many settings. However, for the mental status examination, phenomenology, and differential diagnosis, completing a psychiatry clerkship was associated with better OSCE performance.

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Research has shown that cognitive-behavioral therapy (CBT) is effective in the treatment of schizophrenia (Wykes et al. in Schizophr Bull 34(3):523-537, 2008). The majority of this research has been conducted in the United Kingdom (Beck and Rector in Am J Psychother 54:291-300, 2000) where the National Health Service recommends that CBT be delivered to all people with schizophrenia (NICE in Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care (update). http://www.nice.org.uk/Guidance/CG82/NiceGuidance/pdf/English , 2009). In contrast, the corresponding American Psychiatric Association guidelines describe CBT as an adjunctive technique that "may benefit" patients (Lehman et al. in Am J Psychiatry 161:1-56, 2004, p. 35). Anecdotal evidence also suggests a difference between UK and US clinicians' use of and views on CBT with schizophrenia (Tarrier in Clinical handbook of psychological disorders: a step-by-step treatment manual. Guilford, New York, 2008). In the present study 214 clinicians in the UK and US completed an internet survey examining this apparent discrepancy. UK and US participants were equally aware that empirical research supports the efficacy of CBT with schizophrenia. However, UK participants were more likely to practice CBT, rated CBT effectiveness more highly, and were more optimistic about the chances of recovery. These findings suggest fundamental differences in the attitudes and practices of UK and US clinicians.

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The past decade has brought major new developments in the psychopharmacologic management of generalized anxiety disorder and social phobia. We examined medication-prescribing patterns for the treatment of these anxiety disorders for 12 years to assess changes in patients' anti-anxiety psychotropic medication usage during that period of evolving practice guidelines. We examined psychotropic medication use in 305 patients with generalized anxiety disorder and 232 with social phobia enrolled in the Harvard/Brown Anxiety Disorders Research Project (HARP), a prospective, longitudinal study of anxiety disorders. Psychotropic treatment patterns seem to have remained relatively stable over 12 years with benzodiazepines the medications most commonly used for both generalized anxiety disorder and social phobia. Comparatively, selective serotonin reuptake inhibitor (SSRI) and venlafaxine usage as stand-alone medications for these disorders remained low throughout the follow-up period. At the 12-year follow-up, 24% of patients with generalized anxiety disorder and 30% of patients with social phobia were utilizing neither an SSRI/selective norepinephrine reuptake inhibitor (SNRI) nor a benzodiazepine. Treatment recommendations for use of SSRIs and venlafaxine in the management of generalized anxiety disorder and social phobia initially promulgated in 1998 had a modest impact on changes in psychopharmacologic practice 4-5 years later. Difficulties in the implementation of treatment guidelines are discussed.

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OBJECTIVE: Recently, pharmacological treatment guidelines for panic disorder have changed as newer treatment options have become available. The authors examined how the use of psychotropic drugs has shifted over the course of 10 years to determine if prescribing patterns have changed to reflect these revised treatment guidelines. METHOD: A total of 443 patients with panic disorder were enrolled in the Harvard/Brown Anxiety Research Project, a prospective longitudinal study of anxiety disorders. These patients were interviewed over the course of 10 years to examine their use of psychotropic medications. RESULTS: Despite efforts aimed at increasing the use of selective serotonin reuptake inhibitors (SSRIs) in patients with panic disorder (e.g., APA's practice guideline for panic disorder, Food and Drug Administration approval of particular SSRIs for the treatment of panic disorder), only a modest increase in their use was found. Treatment patterns for psychotropic drugs appear to have remained stable over the past decade, with benzodiazepines being the most commonly used medication for panic disorder. In comparison, SSRI use throughout the follow-up period has remained low. Patients using an SSRI did not have a more favorable clinical course than those using a benzodiazepine, nor were there significantly better rates of remission in patients using SSRIs and benzodiazepines concomitantly. CONCLUSIONS: These results highlight a gap between pharmacological treatment guidelines and actual delivery of care in that recommendations to use SSRIs to treat panic disorder are not being followed. Factors potentially associated with promoting and ignoring treatment recommendations are discussed.

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