Psychopharmacology

Two problems persist in the treatment of severe mental illness that constitute a barrier to effective patient-centered care: excessive reliance on a limited number of antipsychotic medications at the expense of other effective treatments, and the underutilization of other evidence-based treatment options.

Quick . . . name a class of prescription medications that, by most evidence, appears to be overprescribed and abused and the use of which has resulted in an increasing number of emergency department visits. If you said "opioids," you would be right.

Engaging in mindfulness activities either individually or with patients who come to us for brief medication visits can have a profound influence on the therapeutic process.

The extent to which antidepressant use during pregnancy is associated with increased risks of postnatal adaptation syndrome, persistent pulmonary hypertension in the newborn, first-trimester teratogenicity, stillbirth, and infant mortality is explored in 2 recent studies. A close up look here. . .

Drug interactions are more frequent in elderly patients because more medications are taken. In addition, drug interactions may be more serious because of insufficient physiological reserves. When new medications are started or stopped in elderly patients, it is very important to take note of potential interactions with other drugs or foods.

Given the likelihood that insufficient numbers of patients will be available for a randomized controlled trial of MAOIs in refractory depression or atypical depression, we must still rely on consensus guidelines and expert opinion.

Knowledge of how different antidepressants are likely to affect parameters of sleep can provide an important basis for selecting an appropriate antidepressant drug among the roughly 2 dozen marketed options to meet the needs of depressed patients.

Studies of mammalian species suggest that they possess awareness of self and even more subtle “human” qualities associated with empathy and social joy.

Have you heard the news that citalopram should no longer be used at doses greater than 40 mg? Steven Moffic, MD, explores the issues surrounding this recent recommendation.

This article explores the use of functional analytic psychotherapy (FAP)-a behavioral, evidenced-based approach to psychotherapy that can add psychotherapeutic benefit to your existing brief approaches during medication checks.

The report notes that pain is a significant public health problem that affects more than 100 million Americans, costs our society at least $560 to $659 billion annually, and can be severely detrimental to the lives of sufferers.

Depression, anxiety, and delirium are 3 examples of common but frequently challenging areas of distress in pediatric palliative care patients.

Addressing the Underlying Causes of Treatment Resistance

Treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition. Numerous evidence-based treatments exist for all phases of bipolar disorder, and these should be optimized and fully explored.

We will have many medications in the future, he prophesied; that will not be a problem. Our challenge will be in teaching doctors how to use them, “otherwise it would be like giving a driver’s license to someone who can’t drive.”

Dr Fogelson discusses how science has refined research designs to measure the efficacy of psychotropic drugs.

A meta-analysis sheds new light on the safety and efficacy of antidepressants in the acute treatment of bipolar disorder.

CATIE can be viewed as a switch study. Switches offer both opportunity and risk. Data from CATIE demonstrate differences in overall effectiveness, but these differences depend on the individual patient context.

Major depressive disorder is common during childbearing. Depression that interferes with function develops in an estimated 14.5% of pregnant women. Some statistics are troubling in that only 13.8% of pregnant women who screen positive for depression actually receive treatment.

There is currently a small but impressive evidence base that shows that psychological and interpersonal factors play a pivotal role in pharmacological treatment responsiveness.

Persistent pain is not an inevitable part of aging, but it is, unfortunately, fairly common among those aged 65 years and older. Between 25% and 50% of the general geriatric population and 45% to 80% of those in nursing homes have this problem.

Lord, protect me from all the institutions that want to guard me from harm-Congress, PhRMA, academics, journal publishers, and even my APA. They fear I will be brainwashed. They fear-heaven forefend- I may use drugs “off-label.” I hesitate to inform you-it’s too late! I already prescribe medications offlabel, and I do it every day.

Although several studies indicate that psychotherapy (alone or in combination with medications) can help psychiatric patients reach recovery faster and stay well longer, a declining number of office-based psychiatrists are providing psychotherapy to their patients.

Treatment of negative symptoms of schizophrenia -- eg, problems with motivation, social withdrawal, diminished affective responsiveness, speech, and movement -- is associated with a variety of improved functional outcomes and is a vital unmet clinical need.