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PubMed2005

Issues in the psychopharmacologic assessment and treatment of the orthodox Jewish patient.

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.

Adult↗
PubMed2003

Psychopharmacologic strategies for the treatment of aggression in juveniles.

Maladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

Adolescent↗
PubMed2000

Pioneers in Psychopharmacology II.

In 1998, the first Pioneers in Psychopharmacology Awards were presented at the XXIst CINP Meeting in Glasgow to Pierre Deniker, Joel Elkes and Heinz Lehmann. These three individuals had distinguished themselves and Psychopharmacology not only by the quality of their work but also by their ability to persuade others of the importance of the new field that was opening up (Healy, 1998). At the XXIInd CINP Meeting in Brussels in July 2000, Paul Janssen, Mogens Schou and Alec Coppen became the second group to receive such awards for distinguished achievement.

Journal Article↗
PubMedDate not supplied

Psychopharmacology of male rat sexual behavior: modeling human sexual dysfunctions?

Most of our current understanding of the neurobiology, neuroanatomy and psychopharmacology of sexual behavior and ejaculatory function has been derived from preclinical studies in the rat. When a large population of male rats is tested on sexual activity during a number of successive tests, over time individual rats display a very stable sexual behavior that is either slow, normal or fast as characterized by the number of ejaculations performed. These sexual endophenotypes are postulated as rat counterparts of premature (fast rats) or retarded ejaculation (slow rats). Psychopharmacology in these endophenotypes helps to delineate the underlying mechanisms and pathology. This is illustrated by the effects of serotonergic antidepressants and serotonergic compounds on sexual and ejaculatory behavior of rats. These preclinical studies and models contribute to a better understanding of the neurobiology of ejaculation and boost the development of novel drug targets to treat ejaculatory disorders such as premature and retarded ejaculation.

Animals↗
PubMedDate not supplied

Nursing students' use of a psychopharmacology game for client empowerment.

Theoretical support is evaluated for nursing students' use of an innovative educational intervention, the Psychopharmacology R.A.C.E. (Wissman and Tankel, Kansas City, MO) game, as an empowerment tool with mental health clients. Based on mutual trust and respect, the interpersonal process occurs between an individual or group (e.g., client, student) with a desire for competency growth (e.g., knowledge, proactive health behaviors, negotiation), and development of a sense of control and self-determination and another individual or group (e.g., nurse) who serves as an enabler, supporter, and resource mobilizer. A review of empowerment literature identifies: (1) support of education as an empowerment tool; (2) identification of specific teaching methods and behaviors that promote empowerment; (3) empowerment as an outcome of involvement; and (4) support of the empowerment value of group participation. Preliminary clinical observations reveal strong support for nursing students' use of the Psychopharmacology R.A.C.E. game as a method to empower mental health clients.

Education, Nursing↗
PubMed2003

[Functional magnetic resonance imaging of psychopharmacological brain effects: an update].

Functional magnetic resonance imaging (fMRI) is well established for the examination of functional activity in the living brain. The method permits the development of functional activation maps during perceptual, cognitive and emotional efforts with a high temporal and spatial resolution. As of late there has been growing interest in using this technique to investigate regionally specific brain activity following the administration of drugs such as nicotine, cocaine, lorazepam, scopolamine, antipsychotics or antidepressants. Studies in experimental animals investigate signal changes associated with the administration of psychopharmacological substances in different brain areas using a high magnetising field (> 4 Tesla). FMRI-studies in healthy human volunteers and psychiatric patients focus on cerebral activity following acute drug administration (single challenge) and on adaptive effects of the CNS due to long- term medication. Their results provide insights into brain physiology and neuropharmacological mechanisms which are in turn relevant for preclinical pharmacological studies, responder analyses and for the investigation of pathogenetic models in psychiatric diseases. However, with these new opportunities, additional methodological considerations and limitations emerge. Besides the need of controlling motion artefacts, the influence of interfering psychological variables, an exact specification of the experimental design, a standardised analysis for data adjustment and technical limitations have to be considered. This article provides an overview of the underlying model of brain function, present applications, future possibilities and methodological limitations of fMRI for the understanding of human psychopharmacology.

Animals↗
PubMed2003

[Patients' perspective on the quality of informed consent into psychopharmacological treatment in schizophrenia and depression].

BACKGROUND: Respect for autonomy and the right to self-determination require informed consent of patients before any medical procedure. So far the majority of empirical studies on informed consent deal mainly with single aspects e. g. delivery and recall of information and legal questions from a physicians' perspective. In our study we examine the quality of informed consent to psychopharmacological treatment from the perspective of patients with schizophrenia and depression in a German university department of psychiatry. METHODS: Face to face interviews using a structured questionnaire by a research psychiatrist. The participants taking part in this study were inpatients diagnosed with schizophrenia and depression. All patients received medication for their condition. RESULTS: Half of the patients rated the information they received and the process of informed consent positive. Only a minority recalls information regarding the aim and the risks of the treatment. 20 % indicated that they have been informed about alternative treatment options. A quarter of the patients did not know that they had a right to refuse any treatment. CONCLUSION: Compared with studies including patients with somatic illnesses the participants in our study judge the process of informed consent rather critical. The results need to be discussed in the light of the special aspects of psychopharmacological treatment and different cultural and institutional settings.

Adolescent↗
PubMed1996

Regulatory issues in pediatric psychopharmacology.

Labeling claims for the effectiveness of drugs in the treatment of psychiatric illnesses in children and adolescents must be based on data from adequate and well-controlled investigations. The preferred design for demonstrating the effectiveness of a drug in pediatric psychopharmacology is generally a placebo-controlled trial. Safety information in labeling may be derived from more diverse sources. The Food and Drug Administration (FDA) has taken several steps to encourage more informative labeling of drugs for pediatric use, including a recent labeling initiative that emphasizes the possibility of extrapolating effectiveness data from adult studies to pediatric populations under appropriate circumstances. This recently finalized regulation requires pharmaceutical sponsors to reexamine existing data for their drugs to determine whether there is a sufficient basis for modifying labeling for pediatric use. Included in this new rule is a reminder that in certain situations the FDA may require new pediatric studies, thereby signaling the FDA's determination to improve labeling for the pediatric use of drugs. Improved preclinical models for predicting drug effects on growth and development, as well as improved clinical methods for detecting such changes, need to keep pace with the expansion of research in pediatric psychopharmacology.

Adolescent↗
PubMed1996

Issues in the design of trials for the evaluation of psychopharmacological treatments for social phobia.

Social phobia was neglected by psychopharmacologically oriented researchers until the past decade. Benefitting from the experience with other anxiety and other affective disorders, however, and also from unique interdisciplinary collaborative arrangements between psychopharmacological and cognitive behavioral investigators, treatment research in social phobia has made remarkable progress in the past few years. Not only has the field itself advanced, but investigative models have been created that are now being adopted and adapted for other disorders.

Clinical Trials as Topic↗
PubMed2002

Behavioral and psychopharmacological treatment of the paraphilic and hypersexual disorders.

In this article, the second of a two-part series, the authors present information on the clinical assessment of individuals with paraphilias and hypersexual disorders. They review ethical considerations in the assessment and treatment of individuals with paraphilias. The role of interview and subjective and objective instruments in the assessment of individuals with paraphilias and hypersexual disorders is discussed. The authors discuss the use of penile plethysmography or phallometry, polygraphy, and viewing time assessments. Risk assessment of sexual offenders is reviewed. The authors then discuss behavioral, environmental, and psychopharmacological treatments for paraphilias and hypersexual disorders. Cognitive-behavioral therapy appears to be the most effective nonpharmacological strategy. The authors describe cognitive-behavioral techniques for decreasing and/or controlling sexual urges (e.g., satiation, covert sensitization, fading, cognitive restructuring, victim empathy therapy) as well as methods for enhancing appropriate sexual interest and arousal (e.g., social skills training, assertiveness skills training, sex education, couples therapy). The authors also discuss the role of relapse prevention therapy and 12-step programs, as well as other nonbiological therapies such as surveillance networks. The importance of providing appropriate treatment for comorbid conditions (e.g., depression, substance abuse or dependence) is stressed. The authors then review psychopharmacological treatments, including serotonin reuptake inhibitors (SRIs) and antiandrogens, in particular, the use of gonadotropin-releasing hormone (GNRH) agonists. SRIs have been studied in these disorders in an uncontrolled way and appear promising. Earlier antiandrogens (e.g., estrogen, progesterone, and cyproterone acetate) have demonstrated efficacy in the treatment of paraphilias. The newer GNRH agonists have the advantage over the earlier treatments of being available in long-acting depot formulations and having fewer side effects. Preliminary studies and case reports with these agents appear promising. Further study of both the SRIs and GNRH agonists in these disorders is needed. The article concludes with a treatment algorithm, in which the authors suggest beginning with less restrictive treatments (e.g., behavioral or verbal therapies), if possible, and moving to more restrictive alternatives (e.g., biological therapies, institutionalization) as needed. A guide for clinicians and patients about where and how to find appropriate clinicians and treatment resources in the United States is provided.

Journal Article↗
PubMed1998

Transcultural psychopharmacology: present and future.

Transcultural psychopharmacology is a field that seeks to determine whether differences exist in the pharmacokinetic and pharmacodynamic handling of psychotherapeutic drugs among various ethnic groups and, where present, to determine the reasons for such variation. During the past two decades a number of studies have reported differences in the pharmacokinetics and pharmacodynamics of psychotropic medications among various ethnic groups. These variations appear to be mainly determined by genetic predisposition but can be influenced by other factors such as environment, psychosocial supports, and physicians' prescribing habits. Due to study design limitations, many questions regarding the transcultural aspects of psychotropic medications still remain unanswered. This critical review discusses the transcultural psychopharmacology of Asian versus non-Asian populations. It will also include data on tardive dyskinesia, discuss new developments, touch on the problems associated with present research in the area, and provide recommendations for designing future research studies.

Cross-Cultural Comparison↗
PubMed1979

Psychopharmacological treatment of psychotic children. A survey.

Controlled investigations on the psychopharmacological treatment of psychotic children are reviewed. Children with infantile autism might benefit from psychopharmacological medication when they grow older, e.g. above the age of 7 years. Learning might be facilitated when the psychoactive medication is able to inhibit psychotic preoccupations and idiosyncratic reactions. Schizophrenic and manic-depressive psychoses are rarely seen in childhood. A subgroup of the children with infantile autism might develop schizophrenic symptoms. Schizophrenia and manic-depressive psychosis in children are treated as in adults. Special caution must be paid to the toxic effects of imipramine.

Antipsychotic Agents↗
PubMed1983

Quality review of outpatient psychopharmacological practice with APA Task Force criteria.

The authors conducted quality review of outpatient psychopharmacological practice in 180 cases with the screening criteria of the APA Task Force on Psychopharmacological Criteria Development and a subset of 12 criteria involving higher-risk practices. Excessive duration of drug treatment was the most common questionable practice, and no relationship was found between frequency of questionable practices and patients' sex, age, social class, or Global Assessment Scale score. An educational exercise based on the audit resulted in a nonsignificant decrease in the higher-risk practices.

Adolescent↗
PubMed1996

Guidelines for the use of placebo controls in clinical trials of psychopharmacologic agents. Loma Linda University Institutional Review Board.

Federal regulations governing pharmacologic research require scientific proof of efficacy. Although these regulations are often interpreted to mean that a placebo-controlled trial is necessary, it is difficult to justify use of placebo controls when effective standard therapy exists. Justification is especially problematic in psychopharmacologic research because of the added concern that subjects with compromised decision-making capacity cannot give valid consent. To promote discussion and consensus, this article presents guidelines for the ethically justifiable use of placebo controls in research with psychopharmacologic agents. The guidelines, developed by a university's institutional review board, are designed to help investigators design studies and to protect vulnerable subjects.

Clinical Trials as Topic↗
PubMed1998

Psychopharmacological profile of the selective serotonin reuptake inhibitor, paroxetine: implication of noradrenergic and serotonergic mechanisms.

The present study was designed to evaluate the psychopharmacological profile of the selective serotonin reuptake inhibitor paroxetine, and thus assess potential noradrenergic and/or serotonergic activity. Paroxetine dose-dependently increased mobility time in the mouse forced swimming test (8, 16, 32 and 64 mg/kg, i.p.) and reduced spontaneous locomotor activity when administered at a high dose (64 mg/kg, i.p.). Prior administration of 8-hydroxy-2-(di-n-propylamino)tetralin (1 mg/kg, i.p.), (+/-) pindolol (32 mg/kg, i.p.) or 5-methoxy-3-(1,2,3,6-tetrahydro-4-pyridyl)-1H-indole (RU 24969) (1 mg/kg, i.p.) potentiated the antidepressant-like effects of subactive doses of paroxetine (1, 2 and 4 mg/kg, i.p.) in the mouse forced swimming test. These effects were antagonized by prior administration of 1-(2-methoxyphenyl)-4-[-(2-phthalimido)butyl]piperazine) (0.5 mg/kg, i.p.). Complementary studies suggested that RU24969-induced anti-immobility effects were a result of an increase in locomotor activity; other interactions were without increase/decrease in locomotor activity. Acute administration of paroxetine (8, 16, and 32 mg/kg, i.p.) antagonized the hypothermia induced by the D2/D1 receptor agonist, apomorphine (16 mg/kg, s.c.), while repeated treatment with paroxetine (32 mg/kg) attenuated clonidine-induced (0.5 mg/kg, i.p.) hypothermia. Pre-treatment with the serotonergic neurotoxin, para-chlorophenylalanine attenuated the anti-immobility effects of low doses of paroxetine (8 and 16 mg/kg, i.p.) in the forced swimming test, whereas a higher dose of paroxetine remained active (32 mg/kg, i.p.). The results of the present study indicated that paroxetine displayed both noradrenergic-like and serotonergic-like activity in the pre-clinical psychopharmacological tests employed.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed2001

Developmental neurobiology: implications for pediatric psychopharmacology.

Pediatric psychopharmacology can only be properly understood within the context of developmental neurobiology. Normal maturation of the brain is characterized by the complex anatomic, molecular, and organizational changes required for optimal adaptive functioning. In many areas of the developing nervous system, neurons, cell processes, neurotransmitters, and trophic nerve growth factors are produced in far greater numbers and in different areas than in the mature brain. Psychopathology and stressful environments can lead to enduring changes in brain structure and functioning. A few select psychopharmacological treatments are reviewed to assess their potential impact on CNS development. More clinical and basic science studies are needed to determine whether current treatments have neurotoxic or neuroprotective effects when administered over extended critical early periods of the lifespan.

Adolescent↗
PubMed1998

Psychopharmacology of severe self-injury associated with learning disabilities.

BACKGROUND: Many sedative and antipsychotic agents have been used in the management of severe self-injury associated with learning disabilities. Their efficacy has been questioned. Recent research has identified some biological abnormalities associated with severe self-injury and allowed a more rational selection of treatment. METHOD: Review of published literature, including trials, previous reviews and case reports. REPORTS: There is evidence for the efficacy of opiate antagonists in the management of severe self-injury, and recent research has identified potential methods of predicting treatment response. Dopamine D1 antagonists and some agents affecting serotonin turnover may also be of benefit. CONCLUSIONS: More rational psychopharmacological treatments for severe self-injurious behaviour may become available. Such treatments are difficult to evaluate for methodological and ethical reasons. They usually involve the clinical use of compounds for unlicensed indications, rather than trials of agents developed specifically to treat severe self-injurious behaviour. Combining psychopharmacological and psychological interventions may provide additional benefits.

Humans↗
PubMed1990

Psychopharmacology of the psychiatric disorders of childhood and adolescence.

The literature on the psychopharmacology of child and adolescent psychiatric disorders is reviewed. The scanty epidemiological data suggest that psychotherapeutic drugs are utilized more widely than research findings would warrant, especially in preschool-age children. With the exception of hyperactivity, the disorders of childhood and adolescence for which the use of psychopharmacological agents is well-established are rare. This highlights the need for careful prescribing, in which the child's rights, problems with compliance and developmental and behavioural adverse effects are important considerations.

Adolescent↗