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PubMed2006

Psychopharmacology in adolescent medicine.

Psychopharmacology is a challenge for health care providers treating adolescents. A detailed and accurate assessment, including developmental issues relevant to adolescence in general and to the individual adolescent, guides clinicians in formulating thoughtful and effective treatment plans to meet the needs of each patient. Parents play an important role in providing family history regarding psychiatric diagnoses and the response to various drugs, in making decisions to initiate medication and to change a medication regimen, and in monitoring an adolescent's adherence to a prescribed regimen. The role of parents is especially important for younger patients. Following the biopsychosocial model, rarely should psychopharmacologic agents be used as the sole means to treat a psychiatric condition in adolescents. Pharmacologic agents described in this article are tools that have their effect in the biological domain of central neurotransmitters, but psychosocial interventions addressing the emotional and behavioral issues that are the indications for such medication are generally also required. The development of newer medications holds promise for more effective treatment of target symptoms with minimal side effects.

Adolescent↗
PubMed2006

Psychopharmacologic treatment in juvenile offenders.

This article first reviews ways to assess children in the justice system who may benefit from psychopharmacologic treatments. Second, it summarizes the emerging understanding of the nature of aggression and violence and the utility of using the schema of reactive ("hot") and proactive ("cold") aggression as a way to consider pharmacologic options. Third, it summarizes the current published studies on the treatment of conduct disorder, which roughly corresponds to the population of children in the juvenile justice system. Finally, it examines the ways that different classes of medications might be considered when approaching juvenile delinquents and the ways that psychopharmacology could be used as part of an overall treatment plan.

Adolescent↗
PubMed2006

Evolutionary theory, psychiatry, and psychopharmacology.

Darwin's seminal publications in the nineteenth century laid the foundation for an evolutionary approach to psychology and psychiatry. Advances in 20th century evolutionary theory facilitated the development of evolutionary psychology and psychiatry as recognized areas of scientific investigation. In this century, advances in understanding the molecular basis of evolution, of the mind, and of psychopathology, offer the possibility of an integrated approach to understanding the proximal (psychobiological) and distal (evolutionary) mechanisms of interest to psychiatry and psychopharmacology. There is, for example, growing interest in the question of whether specific genetic variants mediate psychobiological processes that have evolutionary value in specific contexts, and of the implications of this for understanding the vulnerability to psychopathology and for considering the advantages and limitations of pharmacotherapy. The evolutionary value, and gene-environmental mediation, of early life programming is potentially a particularly rich area of investigation. Although evolutionary approaches to psychology and to medicine face important conceptual and methodological challenges, current work is increasingly sophisticated, and may prove to be an important foundational discipline for clinicians and researchers in psychiatry and psychopharmacology.

Animals↗
PubMed2000

Implementation of an electronic medical record system in a pediatric psychopharmacology program.

The design, implementation, and utilization of an electronic medical record system (EMRS) in a pediatric psychopharmacology clinic is described. The EMRS is a relational database with information entered directly by the clinician during a patient visit. It has been used during more than 2590 patient visits with 805 patients. Complete clinical documentation and simultaneous data entry as well as computer generated prescriptions for the patient were accomplished 75% of the time within a 20-min medication management session. One hundred consecutive parents of patients were asked to fill out a five-question survey to begin to assess the impact of the application. Of the 87 parents who responded, all (100%) noted that the doctor paid attention to their concerns. Between 88 and 90% of the parents reported that the use of the computer is a 'good' thing, made it easier to work with the doctor, and that they understood why the computer was being used. The findings support that the development and implementation of an EMRS with direct clinician information entry within pediatric psychopharmacology clinic, is feasible.

Attitude to Computers↗
PubMed2005

Magnetoencephalography (MEG): a non-invasive tool for studying cortical effects in psychopharmacology.

Magnetoencephalography (MEG) is a non-invasive method for studying magnetic fields generated by simultaneously firing neurons outside the skull. The skull, scalp and brain tissue do not distort magnetic fields, so the cortical activity can be easily measured. MEG is starting to be used to explore the effects of various psychopharmacological agents on resting brain, sensory and cognitive processing. Scopolamine and agents enhancing GABA functions have shown differential effects on cortical neural oscillations. Further, with GABA, serotonin, dopamine and acetylcholine transmissions have differential effects on early cortical and pre-attentional processing in the auditory and frontal cortices. Monoamines also differently regulate the activity of the somatosensory cortex. Taken together, MEG with a resolution of milliseconds allows exploration of focal cortical effects of psychopharmacological agents giving information different from other brain-imaging modalities.

Brain Mapping↗
PubMed2006

Psychopharmacology's debt to experimental psychology.

The role of experimental psychology in the development of psychopharmacology has largely been ignored in recent historical accounts. In this article the authors attempt to redress that gap by outlining work in early experimental psychology that contributed significantly to the field. While psychiatrists focused on the therapeutic nature of drugs or their mimicry of psychopathology, experimental psychologists used psychoactive drugs as tools to study individual differences in normal behavior as well as to develop methodologies using behavior to study mechanisms of drug action. Experimental work by Kraepelin, Rivers, and Hollingworth was particularly important in establishing drug-screening protocols still used today. Research on nitrous oxide and on the effects of drug combinations is discussed to illustrate the importance of experimental psychology to psychopharmacology.

History, 19th Century↗
PubMed2002

Psychopharmacological treatment of child and adolescent psychiatric inpatients in Finland.

OBJECTIVE: The objective of this study was to investigate the use of psychopharmacological treatment in child and adolescent psychiatric inpatient treatment in Finland. METHODS: The study is a cross-sectional study conducted in January 2000. The psychiatrist responsible for the inpatient treatment was asked to fill in a questionnaire for every inpatient who occupied a child or adolescent psychiatric bed during the chosen study day (n = 504 patients). Information on psychopharmacological treatment was obtained for 475 patients. RESULTS: Forty-three percent had scheduled medication and 28% had "as required" medication. Of those with scheduled medication, 56% had neuroleptics and 45% antidepressants. In multivariate analysis, older age (13-18 years), involuntary treatment, and psychotic disorder were independently associated with scheduled medication, neuroleptic treatment, and as required medication prescription. Neurolepic treatment was also associated with a very low general functioning level (Children's Global Assessment Scale < 41). A diagnosis of depression and older age were associated with antidepressant treatment. Almost all patients with antidepressant treatment were treated with selective serotonin reuptake inhibitors. CONCLUSIONS: Compared with data from a similarly conducted study in 1988, there is an increase especially in the use of antidepressant medication in inpatient care. Considering the increasing use of psychopharmacotherapy during the last 10 years as shown in the present study, the lack of research-based data on the efficacy and safety supporting their clinical use is a major problem in the treatment of disabling childhood mental health problems.

Adolescent↗
PubMedDate not supplied

History of modern psychopharmacology: a personal view with an emphasis on antidepressants.

OBJECTIVE: This article provides the chemical basis for the molecular modification of H1 antihistamines in the rational development of some antidepressant and antipsychotic drugs. METHODS: A review of the literature and personal experiences have been compiled. CONCLUSIONS: The contributions of many basic scientists, the crucial observations of clinicians, and the desire of the drug industry to make money have resulted in the currently available psychopharmacological treatments. The future development of psychopharmacology depends on better clinical research to generate new hypotheses of the chemical and behavioral pathology of mental disease. Psychosomatic medicine can make a unique contribution in its interdisciplinary role of stressing brain, body, and mind relationships.

Antidepressive Agents↗
PubMedDate not supplied

The role of the pharmaceutical industry in teaching psychopharmacology: a growing problem.

OBJECTIVE: To describe and examine the role of the pharmaceutical industry in the teaching of psychopharmacology to residents and medical students and to make recommendations for changes in curriculum and policy based on these findings. METHODS: Literature reviews and discussions with experts, educators, and trainees. RESULTS: The pharmaceutical industry currently plays an extensive role in teaching psychopharmacology to trainees, both directly and indirectly. Attendance at industry-sponsored lectures and drug lunches, meetings with pharmaceutical representatives, and interactions involving the acceptance of various gifts are the most obvious venues. Less apparent but equally pervasive are the influence of industry-sponsored faculty and research and industry's effect on the climate of practice and the profession as a whole. Replacing medical education with industry promotion in the guise of scholarship causes demonstrable harm to trainees, the public, and the profession. CONCLUSIONS: In light of these findings, the medical profession must reassert control of medical education and draw a firm barrier between commercial and professional pursuits. These issues must be actively, explicitly, and rigorously discussed with our colleagues and students.

Conflict of Interest↗
PubMed2000

Psychopharmacology research in the English-speaking Caribbean.

Ethnic differences in patients' responses to drugs used to treat psychiatric disorders have been increasingly reported. Differences can be found in the English-speaking Caribbean population due to its multi-ethnic composition. With the goal of identifying studies on psychopharmacology and ethnicity, we searched for all abstracts and full papers on clinical psychopharmacology emerging from research in the English-speaking Caribbean published in the West Indies Medical Journal, the Caribbean Medical Journal and Medline. We found no studies focusing on this topic, although there were some which may indirectly imply the existence of such differences. High blood levels of imipramine have been found in Barbadian patients, and the majority of cases of neuroleptic malignant syndrome have been reported in Africans, as well as high levels of CPK. However, the numbers of patients studied have not been large enough to be representative. A significantly higher incidence of alcoholism has also been reported in males of East Indian origin. We concluded there is an urgent need in the region for undertaking this type of research to ensure a more favorable treatment outcome of patients treated with such drugs.

Caribbean Region↗
PubMedDate not supplied

An HMO psychopharmacology service.

A pilot HMO psychopharmacology service is described. The program utilized a consultant psychopharmacologist (14 hours per week on-site) and two master's degreed nurse-clinicians who spent four and eight hours per week treating psychopharmacology patients. The psychopharmacologist evaluated all patients, initiated drug therapy, and referred selected patients to the nurse-clinicians for follow-up. The latter functioned as independent clinicians, making treatment decisions and writing prescriptions (which were countersigned by the psychopharmacologist or other staff psychiatrists). Support services (e.g., emergency triage) were provided by the mental health department. At the end of one year, the service was managing a caseload of 184 patients, 64 of whom were being followed by the two nurse-clinicians). Patient acceptance was good, and the service was supported by other mental health and medical personnel, who viewed it in pragmatic terms of increasing access to care. Issues related to the implementation of such a service in HMO settings are discussed.

Boston↗
PubMed2000

Recovery-oriented psychopharmacology: redefining the goals of antipsychotic treatment.

The traditional goals of psychopharmacology stem from the medical model. Rehabilitation interventions attempt to improve aspects of functioning in patients with chronic illnesses that are not responsive to biological intervention. Recovery is a concept emanating from the consumer self-help movement. It describes a move away from the patient role defined by a diagnostic label toward community membership defined by relationships and responsibilities in the community. Comprehensive care for people with psychotic disorders can include attention to each realm. This article provides an overview of the 3 models of care and describes a role for the psychopharmacologist in each as well as his or her unique potential to incorporate all 3. We outline potential synergistic benefits of integrating recovery-, rehabilitation-, and medical-model thinking into the practice of psychopharmacology and explore implications for the goals and outcomes of treatment for people with psychotic disorders.

Adaptation, Psychological↗
PubMed2002

Emerging significance of P-glycoprotein in understanding drug disposition and drug interactions in psychopharmacology.

P-glycoprotein (P-gp) is a member of the superfamily of energy-dependent efflux protein pumps involved in the transport of a wide variety of endogenous and exogenous substrates. The role of P-gp has been extensively studied in the development of multidrug resistance (MDR) in cancer cells during chemotherapy. However, recent data suggest that P-gp is also present in normal tissue, such as the gut, blood-brain barrier, lymphocytes, liver, kidney, and other organs, where it plays a role in the absorption, distribution, metabolism, and elimination of a multitude of drugs. Psychotropic drugs, as well as many other drugs, act as substrates, inhibitors, or inducers of P-gp function. While there is a growing interest in developing inhibitors of this transporter as an approach to increasing drug bioavailability, the utility of exploiting inducers of the protein is less clear. Changes in P-gp transport activity have recently been linked to clinically significant drug-drug and drug-herb interactions. Because of its wide tissue distribution and its effect on drug disposition, clinicians should recognize the potential impact of P-gp modulation on the therapeutic efficacy and adverse events of psychopharmacologic agents that are substrates for this transporter. More research is needed in the field of psychopharmacology to classify central nervous system-active P-gp substrates and to characterize the utility of modulating P-gp activity at the blood-brain barrier.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMedDate not supplied

Evaluation of psychopharmacological effects of petroleum ether extract of Cuscuta reflexa Roxb. stem in mice.

The petroleum ether extract of Cuscuta reflexa Roxb. stem (PECR) was evaluated for its psychopharmacological activities in several experimental models using Swiss albino mice. The PECR was found to cause significant reduction in spontaneous activity and exploratory behavioral profiles. It also showed reduction in muscle relaxant activity by rotarod, 30 degrees inclined screen tests and showed significant analgesic properties as well as potentiated remarkably the pentobarbitone sodium, diazepam and meprobamate--induced sleeping time. All these results were compared with respective controls for the evaluation of significance. The presence of steroids in the PECR might he responsible for psychopharmacological activities.

Alkanes↗
PubMed1986

Psychobiology and psychopharmacology: issues in clinical research training.

Although the scope of basic studies in psychopharmacology and psychobiology has been expanding steadily for about 30 years, relatively few clinical psychiatrists, psychologists, and psychopharmacologists now choose to become researchers or teachers in these disciplines. Such training is crucial to the future vitality of both academic and private-practice psychiatry, and in view of increasing constraints on training funds, student researchers may well be an endangered species. With these concerns in mind, at its 1984 meeting, the American College of Neuropsychopharmacology's Education and Training Committee organized a symposium of investigators, administrators, and former trainees to explore aspects of effective clinical research training in psychobiology and psychopharmacology. Aspects discussed included mentoring, settings and content of training, depth versus breadth of curriculum, and the effect of a critical mass of colleagues at various stages of professional development. Following a brief overview, selected panelists addressed the issues from their individual perspectives.

National Institute of Mental Health (U.S.)↗
PubMedDate not supplied

[Psychopharmacology and psychiatric aspects of pain].

The psychological and psychopathological aspects of pain serve to emphasize the therapeutic importance of psychopharmacological drugs in the treatment of this frequent symptom. Using the classification of psychotropic drugs made by Delay and Deniker, the author analyses the practical applications of some psycholeptics, some psychoanaleptics, and even some psychodysleptics in anti-pain therapeutics. The analysis of some statistics on the frequency of pain in different patient samples, from general medicine as well as from psychiatry, helps to comment upon the great advance implied by the psychopharmacological revolution.

Age Factors↗
PubMed1983

[Various current problems in clinical psychopharmacology].

On the basis of author's findings and those reported in the literature, advances and shortcomings of contemporary psychopharmacology are analyzed. Despite the fact that psychopharmacotherapy, in comparison with the previous methods, is a principally new stage in the treatment of psychic diseases; in its present form it is incapable of meeting all the requirements of psychiatric practice (a tendency toward chronicity characteristic of psychic diseases has not been overcome, some patients still continue to display resistance to known psychotropic agents, aggravation of some psychopathologic disturbances and the development of persistent incurable conditions can be observed in the course of psychopharmacotherapy). In view of the fact that with the currently available drugs and their medicinal forms, psychopharmacology as a method of therapy is at the outer limits of its possibilities, ways of its optimization are discussed. General guidelines for its further development, most promising in terms of their realization and scientific validation, are identified.

Ambulatory Care↗