The psychodynamic action of psychopharmacologic drugs and the target symptom versus the anti-psychotic approach to psychopharmacologic therapy: thirty years later.
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Antipsychotic Agents↗
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[Therapy with psychopharmacological drugs in psychoses. Psychopathological criteria for the ambulatory treatment with psychopharmacological drugs--2].
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Affective Symptoms↗
[Use and abuse of psychopharmacological agents. Need for psychopharmacological agents in general practice].
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Humans↗
On placebos, placebo responses and placebo responders. A review of psychological, psychopharmacological and psychophysiological factors. II. Psychopharmacological and psychophysiological factors.
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Animals↗
The limited role of expert guidelines in teaching psychopharmacology.
OBJECTIVE: To consider the limited usefulness of expert guidelines for teaching psychopharmacology. METHOD: Potential problems using expert guidelines for teaching psychopharmacology are reviewed. RESULTS: Expert guidelines are an important contribution to the growth of evidence-based psychiatry. As such, they may also be used to teach fundamentals of psychopharmacology. Their use as teaching materials may be limited by their reliance on Diagnostic and Statistical manual of Mental Disorders (DSM) diagnoses, especially for patients with unclear or complicated diagnosing pictures. Biases may also exist in their construction and the data from which they are derived. Other problems include overemphasis on newly released medications and the potential for teaching a "cookbook" approach to psychopharmacology treatment, limiting the development of the "art" of psychopharmacology practice. CONCLUSION: Although expert guidelines may be a useful tool for teaching psychopharmacology, they also may limit the teaching of psychopharmacology. Comprehensive psychopharmacology training programs that use expert guidelines as teaching tools should emphasize critical reading of clinical trials literature and teaching the use of all psychotropic drugs. Training in the art of psychopharmacology including, nonpharmacological aspects of drug treatment, should also be included.
Algorithms↗
Psychopharmacological drugs as represented in the press: results of systematic analysis of newspapers and popular magazines.
The representation of mental diseases and psychopharmacological drugs in the media, especially in the press, is thought to be of great impact on people's opinions on the subject. During the course of one year, all articles about psychopharmacological drugs and cardiac drugs published in nineteen German newspapers were collected. All statements, together with related aspects, reasons for prescription, individual details of the patient, effects and side-effects, were registered and classified according to a key. The results show that, in contrast to 13% of the articles about cardiac drugs, half of the reports about psychopharmacological drugs deal primarily with the problems of side-effects and dependence the drugs may produce. There was much more critical comment and emotional emphasis used to characterize the psychopharmacological drugs. Only in 9% of articles was their therapeutic efficacy mentioned. Cardiac drugs are generally discussed objectively in a medical context and in 53% efficacy is emphasized. Psychopharmacological drugs are often mentioned in stories about prominent persons having a life crisis, taking drugs, turning to alcoholism, or in the context of social decline. Only in 3% of all articles about psychopharmacological drugs was it possible to identify a serious mental disease as the reason for prescription. The reasons for and implications of these findings, which mainly reflect the negatively biased image of psychopharmacological drugs in women's magazines (while they are treated relatively fairly in general newspapers) are discussed.
Cardiovascular Agents↗
The challenge of teaching psychopharmacology in the new millennium: the role of curricula.
OBJECTIVE: For a variety of pedagogical, political and financial reasons, there are major problems in achieving effective teaching of cutting-edge psychopharmacology for psychiatric residents. This article focuses on ways to improve the teaching/learning process, in part through the use of structured curricula. The authors review 1) attempted solutions to the educational problems, including use of the 1980s American College of Neuropsychopharmacology (ACNP) and 1990s American Society of Clinical Psychopharmacology (ASCP) model curriculums; 2) evaluation of and obstacles to change; and 3) suggestions of what to do now. METHOD: A psychopharmacology curriculum was prepared in the early 1980s under the auspices of the ACNP and in the 1990s and early 2000s by the ASCP in three editions. Three separate surveys of training directors and Chairs of departments using the curriculum, informal feedback from a variety of psychopharmacology experts, interactive presentations at national meetings (e.g., ACNP and AADPRT) served to guide development and revisions of the curriculum. RESULTS: Three formal follow up evaluations over two decades of users of the curriculum have suggested that it is not enough to have a strong content of what needs to be taught. In addition, a successful psychopharmacology curriculum must have 1) the pedagogy, (i.e., features like pre-post questions, teaching points, etc.) to facilitate use of the many facets and considerable amounts of information; 2) advanced technology to make the content current, adaptable, and both teacher- and student-friendly; 3) accompanying strategies to allow buy-in from training directors and teachers who have had no role in development; 4) reasonable cost to allow wide-spread dissemination while covering preparation expense (preferably without industry support); and, finally 5) evaluation of competence both at the end of training and post-residency in actual practice. CONCLUSION: The long-term objective of improving the teaching/learning process is to improve the clinical practice of psychopharmacology.
Curriculum↗
Cosmetic psychopharmacology and the President's Council on Bioethics.
Advances in neuroscience and biotechnology have heightened the urgency of the debate over "cosmetic psychopharmacology," the use of drugs to enhance mood and temperament in the absence of illness. Beyond Therapy: Biotechnology and the Pursuit of Happiness (2003), the report of the President's Council on Bioethics, has criticized the use of cosmetic psychopharmacology. The Council claimed that cosmetic psychopharmacology will necessarily lead to "severing the link between feelings of happiness and our actions and experiences in the world," but it provided no satisfactory arguments to support this claim and ignored the possibility that cosmetic psychopharmacology might actually enhance the link between happiness and experience. The Council's arguments against cosmetic psychopharmacology depend heavily on the mistaken belief that Prozac and similar antidepressants are mood brighteners in healthy subjects. The empirical evidence, however, clearly indicates that these drugs are not forms of cosmetic psychopharmacology, thus negating much of the Council's arguments. The use of pharmaceutical agents to enhance mood or personality in normal individuals should not be rejected a priori. Instead, the effects of each agent on the individual and on society must be weighed using sound ethical reasoning and the best evidence available.
Advisory Committees↗
[The development of modern psychopharmacology. Historical aspects of therapeutic claims and capabilities].
Even though psychopharmacology is an integral part of modern psychiatric treatment, it remains a controversial topic in public discourse. Historical analysis is an important tool, which gives us a more realistic view of the theoretical underpinnings and therapeutic potential of psychopharmacological treatments. Not surprisingly, a historical survey of claims and treatments shows that psychopharmacological developments are closely connected to the intellectual framework of the period. While drugs have been used to treat psychopathological disorders since ancient times, post-19th century modern psychopharmacology has been characterized by its reliance on science. This study examines this reliance on scientific disciplines, such as chemistry and anesthesiology, by examining case studies such as the introduction of new psychopharmacological techniques. For instance, the introduction in 1869 of the first synthetic sedative, chloral hydrate, clearly illustrates several trends in modern psychopharmacology. The successful introductions of antipsychotic and antidepressant drugs in the late 1950s have also been important milestones, which were instrumental in breaking down the skepticism of clinical psychiatrists.
History, 19th Century↗
Prescribing non-psychopharmacological agents: a new potential role for psychologists in primary care settings and specialty clinics.
At least 10 years have passed since the Department of Defense Psychopharmacology Demonstration Project graduated its first class of psychologists. All graduates of that program were credentialed to prescribe and the program received promising external reviews and audits. The profession has since moved well beyond the initial question, "Can and should psychologists prescribe?" posed over two decades ago. A number of professional schools and training institutions have implemented postdoctoral psychopharmacology training programs and over 20 states are actively pursuing legislative agendas. Given recent initiatives to provide health psychology services within the primary care arena, the authors introduce a new role in the scope of psychology's prescribing activities. They propose that psychopharmacological agents are not the only medications psychologists should be trained to prescribe and psychopharmacology training should include course work and supervision related to treatment within a primary care patient setting in addition to a traditional psychiatric one. The authors provide the rationale for primary care clinical health psychology training as the appropriate mechanism for psychopharmacology education and practice. Public health needs and epidemiological data provide the rationale for health psychologists additionally prescribing non-psychopharmacological agents.
Ambulatory Care↗
Psychopharmacology in pediatric critical care.
Psychopharmacologic treatment in pediatric critical care requires a careful child or adolescent psychiatric evaluation, including a thorough review of the history of present illness or injury, any current or pre-existing psychiatric disorder, past history, and laboratory studies. Although there is limited evidence to guide psychopharmacologic practice in this setting, psychopharmacologic treatment is increasing in critical care, with known indications for treatment, benefits, and risks; initial dosing guidelines; and best practices. Treatment is guided by the knowledge bases in pediatric physiology, psycho-pharmacology, and treatment of critically ill adults. Pharmacologic considerations include pharmacokinetic and pharmcodynamic aspects of specific drugs and drug classes, in particular elimination half-life, developmental considerations, drug interactions, and adverse effects. Evaluation and management of pain is a key initial step, as pain may mimic psychiatric symptoms and its effective treatment can ameliorate them. Patient comfort and safety are primary objectives for children who are acutely ill and who will survive and for those who will not. Judicious use of psychopharmacolgic agents in pediatric critical care using the limited but growing evidence base and a clinical best practices collaborative approach can reduce anxiety,sadness, disorientation, and agitation; improve analgesia; and save lives of children who are suicidal or delirious. In addition to pain, other disorders or indications for psychopharmacologic treatment are affective disorders;PTSD; post-suicide attempt patients; disruptive behavior disorders (especially ADHD); and adjustment, developmental, and substance use disorders. Treating children who are critically ill with psychotropic drugs is an integral component of comprehensive pediatric critical care in relieving pain and delirium; reducing inattention or agitation or aggressive behavior;relieving acute stress, anxiety, or depression; and improving sleep and nutrition. In palliative care, psychopharmacology is integrated with psychologicapproaches to enhance children's comfort at the end of life. Defining how best to prevent the adverse consequences of suffering and stress in pediatric critical care is a goal for protocols and for new psychopharmacologic research [23,153].
Biotransformation↗
Use of psychopharmacologic agents in the elderly.
Most psychiatric disorders in elderly patients are amenable to treatment, provided that intervention is thorough and intensive. Appropriate and judicious use of psychopharmacologic agents has a potential for dramatically improving the quality of life and functional status of many elderly patients with psychiatric disorders. The decision to prescribe a psychopharmacologic agent in elderly patients is a serious and complex issue. Several basic principles need to be followed (Table 6). Although some strides have been made in the last decade regarding safety and efficacy of many psychopharmacologic agents in elderly [table: see text] patients, for many psychopharmacologic agents, large randomized controlled studies to evaluate efficacy and safety in elderly patients are lacking. Sparse data are available regarding the long-term effects of psychopharmacologic agents in elderly patients. Important gaps remain in our knowledge concerning the optimal duration of treatment for most psychiatric disorders in elderly patients. The treatment data deficiency is most striking among the oldest old (patients aged 85 and older), frail medically ill elderly patients (such as nursing home residents), and ethnic minority groups. Future research should focus on these and other relevant issues related to the use of psychopharmacologic agents in elderly patients.
Aged↗
[Attitude of ambulatory psychiatric patients to psychopharmacologic treatment].
By means of a semistructured interview 51 nonpsychotic new outpatients of the Psychiatric University Outpatient Clinic, Basle, Switzerland, were asked about their expectation of being treated with a psychotropic medication during the ensuing therapy. Their conceptualizations about the modes of action of psychopharmacological drugs were also studied. In addition, their emotionally connoted attitudes towards these modes of action were elucidated. 2/3 of those patients who have been treated with a psychopharmacological medication by their family doctor expected that also their psychiatrist at the outpatient clinic prescribed a psychotropic medication, whereas only 1/6 of those patients without a corresponding experience stated to expect a psychopharmacological treatment. Patients who have previously been treated psychopharmacologically stated significantly more often that psychotropic drugs had an effect on emotional processes and compared them significantly less often to alcohol or addictive drugs of the drug subculture than patients without the experience of previous psychotropic medication. Patients expecting to receive psychotropic drug gave significantly more often positive emotional connotations about the presumed modes of action of these drugs than patients without such an expectation. It can be concluded that previous experiences with psychotropic medication evokes the expectancy of also receiving a psychopharmacological treatment during an ensuing therapy at the Psychiatric Outpatient Clinic. Furthermore the experience of a psychopharmacological treatment induces mainly emotionally positive connotated conceptualizations about the modes of action of psychotropic medication.
Adult↗
Teaching psychopharmacology: two trainees' perspectives.
OBJECTIVE: To describe our experience of learning clinical psychopharmacology during residency, in order to assist educators planning psychopharmacology curricula. METHODS: We describe how psychopharmacology teaching was structured in our program, dividing our experience into two phases, early residency (PGY-I and PGY-II) and late residency (PGY-III and PGY-IV). We discuss the advantages and disadvantages of various teaching strategies, and make recommendations for improvement. RESULTS: Our educational needs differed substantially in early and late phases of training. We identified areas deserving additional focus, including dealing with special populations, practical treatment dilemmas, systems issues, and ethics. Learning to manage both patient-psychopharmacologist and mentor-trainee relationships was crucial to our growth as psychopharmacologists. CONCLUSIONS: A developmental approach that takes into account residents' skill levels and prior experiences is important in implementing psychopharmacology didactics, patient assignments, and supervision. We recommend presenting principles of clinical psychopharmacology in practical, appropriately contextualized formats, and with gradually increasing complexity.
Curriculum↗
Assessment of psychopharmacology on the American Board of Psychiatry and Neurology examinations.
OBJECTIVE: To report the assessment of psychopharmacology on the certification and recertification exams in general psychiatry and in the subspecialties administered by the American Board of Psychiatry and Neurology (ABPN). METHODS: The ABPN's core competencies for psychiatrists were reviewed. The number of items addressing psychopharmacology or neuropharmacology was determined for each examination. For the multiple-choice certification exams, item performance was reviewed. The grade cards of failing candidates were reviewed for the oral certification exam. RESULTS: A significant number of the core competencies involved psychopharmacology. The percent of items addressing the topic varied by examination but was substantial in general. Performance on these items on the multiple-choice certification exam was similar to performance in other areas. However, a majority of those who failed the patient section of the oral examination had inadequate performance in the area of drug treatment, indicating that trainees may need additional experience with applying psychopharmacological knowledge in the context of patient cases. CONCLUSION: This review indicated that knowledge of psychopharmacology was a significant component of the ABPN's core competencies and of its certification and recertification exams.
Certification↗
British Association for Psychopharmacology Summer Meeting: 23-26 July 2006, Oxford, United Kingdom.
The 2006 British Association for Psychopharmacology Summer Meeting was held in Oxford, UK. The British Association for Psychopharmacology is now one of the largest national psychopharmacology associations in the world with over 1000 members, and 550 national and international delegates attended the summer meeting. This meeting provides an annual forum for scientists and clinical investigators from academia and the pharmaceutical industry to share information on many aspects of the psychopharmacology of psychiatric illness. In total, 292 abstracts were accepted for presentation at the meeting. These were divided into 57 oral and 235 poster presentations. Research areas covered all aspects of psychopharmacology from basic research to pharmaceutical development and clinical application. This report highlights selected presentations from the meeting, focusing on rapid tryptophan depletion, which is a dietary manipulation that is used to study central serotonin function and putative animal models of depression and schizophrenia.
Animals↗
The psychobiology and psychopharmacology of PTSD.
This paper reviews the currently available knowledge about the psychobiology and psychopharmacology of post-traumatic stress disorder (PTSD). It also reviews the various studies that have elucidated changes in brain function and structure in PTSD populations, including position emission tomography (PET), single photon emission computed tomography (SPECT), and event-related potential (ERP) studies. It then reviews the literature on catecholamine and hypothalamic-pituitary-adrenal (HPA) axis abnormalities in PTSD, and finally reviews the literature available on the psychopharmacology of PTSD. It discusses how the pathophysiology of PTSD determines the nature of psychopharmacological interventions. Psychopharmacological interventions in PTSD are largely limited to good studies on the effects of the selective serotonin reuptake inhibitors (SSRIs). In order to effectively intervene in PTSD, studies of other psychopharmacological agents are necessary, specifically of agents which affect limbic activation, decreased frontal lobe functioning, altered HPA activity, and other biological features of PTSD. Copyright 2001 John Wiley & Sons, Ltd.
Journal Article↗
Appraisal of the quality of assessment of memory in anesthesia and psychopharmacology literature.
To test the hypothesis that there are important differences between studies on memory published in anesthesia literature and those published in the psychopharmacology literature, we compared the two from the period January 1978 through May 1988 to identify deficiencies in the design and methodologies used and to provide guidelines for future experiments. Eight-eight articles in each discipline were reviewed. The sample sizes were larger in the articles in anesthesia journals than in those in psychopharmacology journals (medians 52.5 vs. 18 subjects, respectively). Most (85%) of the studies in the anesthesia literature used patients, who had a median age of 38.9 yr and included a median of 28 women among the subjects per study. In contrast, the majority (60%) of the studies in the psychopharmacology literature used healthy volunteers, who had a median age of 23.6 yr and included a median of only 3.5 females among the subjects per study. Characteristics more common in the psychopharmacology than in the anesthesia literature, respectively, were use of a control or placebo group (90% vs. 42%), double-blind design (80% vs. 47%), use of pre- and posttreatment memory measurements (64% vs. 23%), use of multiple memory tests with distinct equated stimuli (83% vs. 8%), relation of methodology to some theoretical model of memory (72% vs. 17%), and use of other behavioral tests (68% vs. 48%). Relative to the psychopharmacology literature, the anesthesia literature used pictures as stimuli for the memory tests more often (44% vs. 14%, respectively) and words less often (11% vs. 67%) and relied heavily on questions about recall of perioperative events (41% vs. 0%). There is room for improvement in both types of literature, and more so in the anesthesia literature.
Anesthesia↗