Preconference Skills Course
Psychiatrists routinely prescribe psychotropic drugs that may prolong cardiac repolarization, thereby increasing the risk for Torsades de Pointes (TdP), a potentially fatal cardiac arrythmia. The corrected QT interval (QTc) on the 12-lead electrocardiogram (ECG) is the most widely accepted benchmark of TdP risk and has drawn significant attention amongst prescribers of psychotropic medications. Over the past decade, psychiatrists have witnessed the swinging-pendulum-effect of approaches to QTc prolongation and psychopharmacology, from unwitting disregard to marked hypervigilance.
The APA Council on Consultation Liaison Psychiatry, in collaboration with the American College of Cardiology, convened a workgroup of experts, including all three speakers, to create a set of clinical considerations for the practicing psychiatrist. Questions addressed by the workgroup included: What are the medications that confer risk of TdP? When is it important to monitor the QTc? How do you balance the potential risk of arrythmia with the potential risk of failure to control high-risk psychopathology? Central to these considerations is the expectation that basic ECG interpretation is within the scope of a psychiatrist, who is ultimately “physician first."
In this experiential Master Course, we will lead participants through an in-depth evidence-based understanding of QTc prolongation, Psychotropic Medications and ECG interpretation. A primer on electrocardiogram (ECG) interpretation will be presented, followed by hands-on practice with measurement of the QTc, appropriate applications for different QTc correction formulae, and an approach to more complex patients including those with pacemakers and implantable cardioverter defibrillators. A general approach to TdP risk stratification and risk mitigation will be presented followed by a broad set of interactive clinical cases, which will become increasingly complex as the learner becomes more confident. We will discuss high-yield strategies for various practice settings and populations, including: outpatient public and community psychiatry settings, resource-poor clinics, patients with substance-use disorders, patients with complex cardiac disease, and the general hospital and intensive care unit setting.
The panel will present a series of challenging clinical cases, using an audience response system and open forum discussion. Our team has presented symposia on this topic for the past 6 years, and these sessions have always been widely attended and well-reviewed. We will also be presenting a 4-hour workshop at APA this year, and will base our proposed ACLP Pre-conference Course on the model of that workshop, though with much more specific targeting to the advanced knowledge of CL psychiatrists.