Psychopharmacology Current Trends

The landmark description by Delay and Deniker in 1952 of chlorpromazine's effect in psychosis suddenly eclipsed all other progress in psychopharmacology over the previous centuries. Since this report 35 years ago, a vast amount of research has contributed to the major advances in treatment that have improved the lives of millions of patients who would otherwise be incapacitated by their psychiatric disorders. This research has also led to valuable new insights into the causes of mental illnesses and the mechanisms of action of therapeutic drugs. However, there is much more work to be done. Thus, it is of great value periodically to assess the present state of knowledge as a first step to charting future directions. This symposium held in Denmark in 1987 covered many critical issues in psychopharmacology. The etiology, pathogenetic mechanisms, clinical aspects, and future directions of research in schizophrenia, affective disorders, anxiety, and dementia are addressed. Several of the problems with current therapeutic agents, such as side effects and limited efficacy, are also reviewed. Preclinical strategies with existing and new animal and computer models are discussed to point the way for developing better psychopharmacologic treatments of all psychiatric disorders.

The areas of experimental and clinical psychopharmacology have continued to grow in terms of the numbers of studies appearing in the literature as well as the activity generated by other disciplines that has influenced the output of behavioral pharmacology research. Psychoactive drugs have been considered for their comparative effects upon selected behaviors or for their effect upon diverse behaviors. Behavioral circum stances certainly influence not only the metabolism and action of psycho tropic drugs behaviorally, but also the disposition of these agents and/ or their metabolites in regions of the central nervous system. There can hardly be a psychopharmacology without a neuropharmacology, and the latter would seem to depend upon a neurochemistry. There would appear to be variables that exert potent influences upon the disposition and action of psychotropic drugs, that also relate quite directly to their effects upon behavior; these include drug interactions, nutritional status, environmental effects such as temperature, photic and tactile stimulation, and stress, and the basal status upon which such drug treatment is superimposed. In this volume of Current Developments in Psychopharmacology, which will be the last to appear in this format, we have sought to focus upon a series of current topical reviews that highlight representative areas of experimental and clinical research activity in psychopharmacology. In the first chapter, Dr. Lagerspetz reviews a frequently neglected aspect of psychopharmacological research-the actions of psychoactive agents upon the nervous system and behavior of non-mammalian species.

"The troubling increase in treatment resistance in psychiatry has many culprits: the rise of biomedical psychiatry and corresponding sidelining of psychodynamic and psychosocial factors; the increased emphasis on treating the symptoms rather than the person; and a greater focus on the electronic medical record rather than the patient, all of which point to a breakdown in the person-centered prescriber-patient relationship. Psychodynamic Psychopharmacology illuminates a new path forward. It examines the psychological and interpersonal mechanisms of pharmacological treatment resistance, integrating research on evidence-based prescribing processes with psychodynamic insights and skills to enhance treatment outcomes for patients who are difficult to treat. The first part of the book explores the evidence base that guides how, rather than simply what, to prescribe. It describes precisely what psychodynamic psychopharmacology is and why its emphasis on combining the often-neglected psychosocial aspects of medication with biomedical considerations provides a more optimized approach to addressing treatment resistance. Part II delves into the psychodynamics that contribute to pharmacological treatment resistance, both when patients' ambivalence about their illness, the medication itself, or their prescriber manifests in nonadherence and when medications support a negative identity or are used as replacements for healthy capacities. Readers will gain basic skills for addressing the psychological and interpersonal dynamics that underpin both scenarios and will be better positioned to ameliorate interferences with the healthy use of medications. The final section of the book offers detailed technical recommendations for addressing pharmacological treatment resistance. It tackles issues that include countertransference-driven irrational prescribing; primitive dynamics, such as splitting and projective identification; and the overlap between psychopharmacological treatment resistance and the dynamics of treatment nonadherence and nonresponse in integrated and collaborative medical care settings. By putting the individual patient back at the center of the therapeutic equation, psychodynamic psychopharmacology, as outlined in this book, offers a model that moves beyond compliance and emphasizes instead the alliance between patient and prescriber. In doing so, it empowers patients to become more active contributors in their own recovery"--

Delivers a succinct yet thorough overview of modern psychopharmacology covering everything from basic neurotransmitter function to specific pharmacological approaches for treating such conditions as depression, anxiety, addiction, and neurodegenerative diseases. This updated edition describes new developments in drug therapy and research and includes approximately 300 new references.

The APA Handbook of Psychopharmacology provides working knowledge of basic pharmacology and psychopharmacology, examines psychopharmacology for treatment of various emotional and behavioral conditions, and discusses related professional and social issues.