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Sample records for psychopharmacology

  1. Competent psychopharmacology.

    PubMed

    Gardner, David M

    2014-08-01

    There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care.

  2. Competent Psychopharmacology

    PubMed Central

    Gardner, David M

    2014-01-01

    There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care. PMID:25161064

  3. Psychopharmacology Curriculum Field Test

    ERIC Educational Resources Information Center

    Zisook, Sidney; Balon, Richard; Benjamin, Sheldon; Beresin, Eugene; Goldberg, David A.; Jibson, Michael D.; Thrall, Grace

    2009-01-01

    Objective: As part of an effort to improve psychopharmacology training in psychiatric residency programs, a committee of residency training directors and associate directors adapted an introductory schizophrenia presentation from the American Society of Clinical Psychopharmacology's Model Psychopharmacology Curriculum to develop a multimodal,…

  4. Psychopharmacology Curriculum Field Test

    ERIC Educational Resources Information Center

    Zisook, Sidney; Balon, Richard; Benjamin, Sheldon; Beresin, Eugene; Goldberg, David A.; Jibson, Michael D.; Thrall, Grace

    2009-01-01

    Objective: As part of an effort to improve psychopharmacology training in psychiatric residency programs, a committee of residency training directors and associate directors adapted an introductory schizophrenia presentation from the American Society of Clinical Psychopharmacology's Model Psychopharmacology Curriculum to develop a multimodal,…

  5. A Counselor's Guide to Psychopharmacology.

    ERIC Educational Resources Information Center

    Ponterotto, Joseph G.

    1985-01-01

    Presents basic information on psychopharmacology and discusses the major antipsychotic, antidepressant, anti-anxiety, and lithium salt medications used with adults. The importance and implications of psychopharmacology for the counseling profession are highlighted. (Author)

  6. A Counselor's Guide to Psychopharmacology.

    ERIC Educational Resources Information Center

    Ponterotto, Joseph G.

    1985-01-01

    Presents basic information on psychopharmacology and discusses the major antipsychotic, antidepressant, anti-anxiety, and lithium salt medications used with adults. The importance and implications of psychopharmacology for the counseling profession are highlighted. (Author)

  7. Toward a Hippocratic psychopharmacology.

    PubMed

    Ghaemi, S Nassir

    2008-03-01

    To provide a conceptual basis for psychopharmacology. This review compares contemporary psychopharmacology practice with the Hippocratic tradition of medicine by examining the original Hippocratic corpus and modern interpretations (by William Osler and Oliver Wendell Holmes). The Hippocratic philosophy is that only some, not all, diseases should be treated and, even then, treatments should enhance the natural healing process, not serve as artificial cures. Hippocratic ethics follow from this philosophy of disease and treatment. Two rules for Hippocratic medicine are derived from the teachings of Osler (treat diseases, not symptoms) and Holmes (medications are guilty until proven innocent). The concept of a diagnostic hierarchy is also stated explicitly: Not all diseases are created equal. This idea helps to avoid mistaking symptoms for diseases and to avoid excessive diagnosis of comorbidities. Current psychopharmacology is aggressive and non-Hippocratic: symptom-based, rather than disease oriented; underemphasizing drug risks; and prone to turning symptoms into diagnoses. These views are applied to bipolar disorder. Contemporary psychopharmacology is non-Hippocratic. A proposal for moving in the direction of a Hippocratic psychopharmacology is provided.

  8. Teaching Psychopharmacology: Two Trainees' Perspectives

    ERIC Educational Resources Information Center

    Georgiopoulos, Anna M.; Huffman, Jeff C.

    2005-01-01

    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…

  9. Teaching Psychopharmacology: Two Trainees' Perspectives

    ERIC Educational Resources Information Center

    Georgiopoulos, Anna M.; Huffman, Jeff C.

    2005-01-01

    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…

  10. Philosophy of clinical psychopharmacology.

    PubMed

    Aragona, Massimiliano

    2013-03-01

    The renewal of the philosophical debate in psychiatry is one exciting news of recent years. However, its use in psychopharmacology may be problematic, ranging from self-confinement into the realm of values (which leaves the evidence-based domain unchallenged) to complete rejection of scientific evidence. In this paper philosophy is conceived as a conceptual audit of clinical psychopharmacology. Its function is to criticise the epistemological and methodological problems of current neopositivist, ingenuously realist and evidence-servant psychiatry from within the scientific stance and with the aim of aiding psychopharmacologists in practicing a more self-aware, critical and possibly useful clinical practice. Three examples are discussed to suggest that psychopharmacological practice needs conceptual clarification. At the diagnostic level it is shown that the crisis of the current diagnostic system and the problem of comorbidity strongly influence psychopharmacological results, new conceptualizations more respondent to the psychopharmacological requirements being needed. Heterogeneity of research samples, lack of specificity of psychotropic drugs, difficult generalizability of results, need of a phenomenological study of drug-induced psychopathological changes are discussed herein. At the methodological level the merits and limits of evidence-based practice are considered, arguing that clinicians should know the best available evidence but that guidelines should not be constrictive (due to several methodological biases and rhetorical tricks of which the clinician should be aware, sometimes respondent to extra-scientific, economical requests). At the epistemological level it is shown that the clinical stance is shaped by implicit philosophical beliefs about the mind/body problem (reductionism, dualism, interactionism, pragmatism), and that philosophy can aid physicians to be more aware of their beliefs in order to choose the most useful view and to practice coherently

  11. Ethical issues in psychopharmacology.

    PubMed

    McHenry, L

    2006-07-01

    The marketing of selective serotonin reuptake inhibitors in the psychopharmacological industry presents a serious moral problem for the corporate model of medicine. In this paper I examine ethical issues relating to the efficacy and safety of these drugs. Pharmaceutical companies have a moral obligation to disclose all information in their possession bearing on the true risks and benefits of their drugs. Only then can patients make fully informed decisions about their treatment.

  12. Ethical issues in psychopharmacology

    PubMed Central

    McHenry, L

    2006-01-01

    The marketing of selective serotonin reuptake inhibitors in the psychopharmacological industry presents a serious moral problem for the corporate model of medicine. In this paper I examine ethical issues relating to the efficacy and safety of these drugs. Pharmaceutical companies have a moral obligation to disclose all information in their possession bearing on the true risks and benefits of their drugs. Only then can patients make fully informed decisions about their treatment. PMID:16816041

  13. Who Is Teaching Psychopharmacology? Who Should Be Teaching Psychopharmacology?

    ERIC Educational Resources Information Center

    Dubovsky, Steven L.

    2005-01-01

    Objective: To review the current status of psychopharmacology education for medical students, residents, and practitioners in psychiatry and other specialties. Methods: A search of the MEDLINE and PsychInfo data bases was conducted using four keywords: pharmacology, psychopharmacology, teaching, and student. Additional references were obtained…

  14. Who Is Teaching Psychopharmacology? Who Should Be Teaching Psychopharmacology?

    ERIC Educational Resources Information Center

    Dubovsky, Steven L.

    2005-01-01

    Objective: To review the current status of psychopharmacology education for medical students, residents, and practitioners in psychiatry and other specialties. Methods: A search of the MEDLINE and PsychInfo data bases was conducted using four keywords: pharmacology, psychopharmacology, teaching, and student. Additional references were obtained…

  15. [Research in Psychopharmacology].

    PubMed

    Ferrero, Alejandro

    2015-01-01

    Research in psychopharmacology began around 1950 with the description of antipsychotic effect of chlorpromazine followed shortly later with the mechanism of action of antidepressants. In these initial phases, pharmacy industry was open to knowledge and made efforts tending to the development to new drugs that showed efficacy and good safety profiles. In parallel development of theories attempting to find the etiology of psychiatric disorders acquired impulse. This review summarizes the new drugs for the treatment of psychiatric disorders currently under development and also presents a short list of the main biomarkers proposed for the diagnosis or the comprehension of the etiopathogeny in Psychiatry. Several questions arose when brain structures, biochemical pathways, proteins and genes began to be identified in the search for a better comprehension of etiopathogeny of mental disorders. Pharmaceutical industry virtually moved away from this field of research. Epistemological and methodological obstacles in psychopharmacological investigation together with the lack of priority given by industry to this field allow us to predict few advances for the treatment in Psychiatry in the short term.

  16. Psychopharmacology: a house divided.

    PubMed

    Dean, Charles E

    2011-01-15

    Psychopharmacology and psychiatry during the past 50 years have focused on the specificity model in which it is assumed that psychiatric disorders are specific entities which should respond to drugs with specific mechanisms of action. However, the validity of this model has been challenged by the approval of multiple drugs for the same disorder, as well as the approval of single agents for a variety of disorders which have little in common. As an example of this unacknowledged paradigm shift, I will examine the foundation for using antipsychotics in the treatment of depression. An extensive literature search of studies investigating various mechanisms of actions of antipsychotics and antidepressants with the goal of identifying neurochemical processes common to both. The neurochemical differences in these classes of drugs appear to be profound, although several processes are common in both, including some degree of neuroprotection and changes in the epigenome. Whether these common features have any effect on clinical outcome remains in doubt. While psychopharmacology and psychiatry remain largely committed to the specificity model, it appears that clinicians are prescribing on a dimensional model wherein symptoms are being treated with a variety of drugs, regardless of the diagnosis. Published by Elsevier Inc.

  17. Motivational Interviewing and Adolescent Psychopharmacology

    ERIC Educational Resources Information Center

    Dilallo, John J.; Weiss, Gony

    2009-01-01

    The use of motivational interviewing strategies in the practice of adolescent psychopharmacology is described. Motivational interviewing is an efficient and collaborative style of clinical interaction and this helps adolescent patients to integrate their psychiatric difficulties into a more resilient identity.

  18. Motivational Interviewing and Adolescent Psychopharmacology

    ERIC Educational Resources Information Center

    Dilallo, John J.; Weiss, Gony

    2009-01-01

    The use of motivational interviewing strategies in the practice of adolescent psychopharmacology is described. Motivational interviewing is an efficient and collaborative style of clinical interaction and this helps adolescent patients to integrate their psychiatric difficulties into a more resilient identity.

  19. Psychopharmacology in cancer.

    PubMed

    Thekdi, Seema M; Trinidad, Antolin; Roth, Andrew

    2015-01-01

    Depression, anxiety, delirium, and other psychiatric symptoms are highly prevalent in the cancer setting, and pharmacological intervention is an important component in the overall psychosocial care of the patient. Psychopharmacology is also used as a primary or adjuvant treatment for the management of cancer-related symptoms stemming from the disease itself and/or its treatment, including sleep disturbance, loss of appetite, neuropathic pain, nausea, fatigue, and hot flashes. Psychiatrists, oncologists, and palliative care physicians working as members of a multidisciplinary team have the opportunity to target multiple symptoms that negatively affect a patient's quality of life with the strategic use of psychotropic medications when deemed appropriate. This article aims to review the indications for use of antidepressants, psychostimulants, anxiolytics, antipsychotics, and mood stabilizers in oncology. An updated review of the relevant literature is discussed and referenced in each section.

  20. Psychopharmacology and memory

    PubMed Central

    Glannon, W

    2006-01-01

    Psychotropic and other drugs can alter brain mechanisms regulating the formation, storage, and retrieval of different types of memory. These include “off label” uses of existing drugs and new drugs designed specifically to target the neural bases of memory. This paper discusses the use of beta‐adrenergic antagonists to prevent or erase non‐conscious pathological emotional memories in the amygdala. It also discusses the use of novel psychopharmacological agents to enhance long term semantic and short term working memory by altering storage and retrieval mechanisms in the hippocampus and prefrontal cortex. Although intervention in the brain to alter memory as therapy or enhancement holds considerable promise, the long term effects of experimental drugs on the brain and memory are not known. More studies are needed to adequately assess the potential benefits and risks of these interventions. PMID:16446410

  1. Psychopharmacology in autism.

    PubMed

    Tsai, L Y

    1999-01-01

    Autism is a neurobiological disorder. The core clinical features of autism include impairment in social interaction, impairments in verbal and nonverbal communication, and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. Autism often has coexisting neuropsychiatric disorders, including seizure disorders, attention deficit hyperactivity disorder, affective disorders, anxiety disorder, obsessive-compulsive disorder, and Tourette disorder. No etiology-based treatment modality has been developed to cure individuals with autism. However, comprehensive intervention, including parental counseling, behavior modification, special education in a highly structured environment, sensory integration training, speech therapy, social skill training, and medication, has demonstrated significant treatment effects in many individuals with autism. Findings from preliminary studies of major neurotransmitters and other neurochemical agents strongly suggest that neurochemical factors play a major role in autism. The findings also provide the rationale for psychopharmacotherapy in individuals with autism. This article reviews studies of neurochemical systems and related psychopharmacological research in autism and related neuropsychiatric disorders. Clinical indications for pharmacotherapy are described, and uses of various medications are suggested. This article also discusses new avenues of investigation that may lead to the development of more effective medication treatments in persons with autism.

  2. Pioneers in Psychopharmacology.

    PubMed

    Healy, David

    1998-12-01

    In pursuing the history of any field, even one in which many of the main exponents are still alive, it can be very difficult to establish facts and priorities. Detailed scrutiny of the events leading to the recognition of the antidepressant effects of iproniazid, in which Nathan Kline was involved, may fail to establish the exact sequence of events or the sources of inspiration for a discovery (Healy, 1997). Quite apart from the 'facts' behind the antidepressant story, Kline's role in the story beautifully illustrates one of the sayings of Francis Galton, to the effect that in history the driving force may not lie with the first discoverer of a new scientific fact, but rather with the individual who was the first to persuade the world of the importance of a particular discovery. This maxim applies with some force to the three individuals who have been honoured by the CINP in 1998 for their pioneering roles in psychopharmacology - Pierre Deniker, Joel Elkes and Heinz Lehmann whose contributions to the field have included original research and also key initiatives to capture the central ground of academic and public opinion for the new science. They have been science makers rather than just scientists.

  3. Psychiatric pharmacogenomics in pediatric psychopharmacology.

    PubMed

    Wall, Christopher A; Croarkin, Paul E; Swintak, Cosima; Koplin, Brett A

    2012-10-01

    This article provides an overview of where psychiatric pharmacogenomic testing stands as an emerging clinical tool in modern psychotropic prescribing practice, specifically in the pediatric population. This practical discussion is organized around the state of psychiatric pharmacogenomics research when choosing psychopharmacologic interventions in the most commonly encountered mental illnesses in youth. As with the rest of the topics on psychopharmacology for children and adolescents in this publication, a clinical vignette is presented, this one highlighting a clinical case of a 16 year old genotyped during hospitalization for recalcitrant depression.

  4. Alternate Methods of Teaching Psychopharmacology

    ERIC Educational Resources Information Center

    Zisook, Sidney; Benjamin, Sheldon; Balon, Richard; Glick, Ira; Louie, Alan; Moutier, Christine; Moyer, Trenton; Santos, Cynthia; Servis, Mark

    2005-01-01

    Objective: This article reviews methods used to teach psychopharmacology to psychiatry residents that utilize principles of adult learning, enlist active participation of residents, and provide faculty with skills to seek, analyze, and use new information over the course of their careers. Methods: The pros and cons of five "nonlecture" methods of…

  5. Alternate Methods of Teaching Psychopharmacology

    ERIC Educational Resources Information Center

    Zisook, Sidney; Benjamin, Sheldon; Balon, Richard; Glick, Ira; Louie, Alan; Moutier, Christine; Moyer, Trenton; Santos, Cynthia; Servis, Mark

    2005-01-01

    Objective: This article reviews methods used to teach psychopharmacology to psychiatry residents that utilize principles of adult learning, enlist active participation of residents, and provide faculty with skills to seek, analyze, and use new information over the course of their careers. Methods: The pros and cons of five "nonlecture" methods of…

  6. Psychopharmacology's debt to experimental psychology.

    PubMed

    Schmied, Lori A; Steinberg, Hannah; Sykes, Elizabeth A B

    2006-05-01

    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.

  7. Psychopharmacology of autism spectrum disorders.

    PubMed

    Kaplan, Gabriel; McCracken, James T

    2012-02-01

    At present, no evidence-based effective pharmacologic options are available for treating the core deficits of autism spectrum disorders (ASDs), which are best addressed by behavioral and educational interventions. However, such evidence exists for several of the frequently associated/comorbid symptoms such as aggression and severe irritability, hyperactivity, and repetitive behaviors, which can become a major source of additional distress and interference in functioning. This article offers information on the psychopharmacology of ASD that is current, relevant, and organized in a user-friendly manner, to form a concise but informative reference guide for primary pediatric clinicians. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Evolutionary theory, psychiatry, and psychopharmacology.

    PubMed

    Stein, Dan J

    2006-07-01

    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.

  9. Dimensional psychopharmacology in somatising patients.

    PubMed

    Biondi, Massimo; Pasquini, Massimo

    2015-01-01

    Despite the recent DSM-5 review of somatoform disorders, which are now called somatic symptom and related disorders, the categorical definitions of these syndromes have inherent limitations because their causal mechanism or presumed aetiologies are still unknown. These limitations may affect everyday clinical practice and decision-making abilities. As a result, physicians have limited information at their disposal to treat these patients. Furthermore, the clinical presentations of somatic disorders may vary a lot. The purpose of this chapter is to illustrate a psychopathological dimensional approach to the somatising patient. This approach is constantly unconsciously applied in clinical practice using continuous variables, such as rating scales. Moreover, treatment strategies might be improved by adding a dimensional approach, simply recognising the prominent components of the presenting psychopathology of a given patient and addressing them with drugs according to their different mechanisms, targeting circuits and neurotransmitters. Some authors have proposed a shift from the nosological to functional application of psychotropic drugs, in which functional psychopharmacology will be dysfunction oriented and therefore inevitably geared towards utilising drug combinations. Here, we present a summary of the advantages of functional/dimensional psychopharmacology for the treatment of somatic symptoms and related disorders.

  10. Psychopharmacology: an update for psychiatric home care.

    PubMed

    Finkelman, A W

    2000-10-01

    Psychopharmacology is a critical component of psychiatric home care. Nurses play an important role in medication management for patients who require this intervention. Knowledge of psychopharmacologic assessment, phases of psychopharmacologic treatment, psychobiology, and critical issues related to specific classes of medication is essential in developing a treatment plan with the patient and implementing it. Recent psychobiology research has indicated the importance of neurotransmitters, genetics, and the effect of the immune and endocrine systems. Critical issues related to anxiolytic medications, mood stabilizers, antidepressants, and antipsychotic (neuroleptic) medications are described.

  11. Psychopharmacologic treatment of borderline personality disorder.

    PubMed

    Ripoll, Luis H

    2013-06-01

    The best available evidence for psychopharmacologic treatment of borderline personality disorder (BPD) is outlined here. BPD is defined by disturbances in identity and interpersonal functioning, and patients report potential medication treatment targets such as impulsivity, aggression, transient psychotic and dissociative symptoms, and refractory affective instability Few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, although multiple reviews have converged on the effectiveness of specific anticonvulsants, atypical antipsychotic agents, and omega-3 fatty acid supplementation. Stronger evidence exists for medication providing significant improvements in impulsive aggression than in affective or other interpersonal symptoms. Future research strategies will focus on the potential role of neuropeptide agents and medications with greater specificity for 2A serotonin receptors, as well as optimizing concomitant implementation of evidence-based psychotherapy and psychopharmacology, in order to improve BPD patients' overall functioning.

  12. Psychopharmacologic treatment of borderline personality disorder

    PubMed Central

    Ripoll, Luis H.

    2013-01-01

    The best available evidence for psychopharmacologic treatment of borderline personality disorder (BPD) is outlined here. BPD is defined by disturbances in identity and interpersonal functioning, and patients report potential medication treatment targets such as impulsivity, aggression, transient psychotic and dissociative symptoms, and refractory affective instability Few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, although multiple reviews have converged on the effectiveness of specific anticonvulsants, atypical antipsychotic agents, and omega-3 fatty acid supplementation. Stronger evidence exists for medication providing significant improvements in impulsive aggression than in affective or other interpersonal symptoms. Future research strategies will focus on the potential role of neuropeptide agents and medications with greater specificity for 2A serotonin receptors, as well as optimizing concomitant implementation of evidence-based psychotherapy and psychopharmacology, in order to improve BPD patients' overall functioning. PMID:24174895

  13. Teaching the Teachers of Clinical Psychopharmacology.

    PubMed

    Salzman, Carl; Glick, Ira D

    2015-08-01

    This commentary focuses on psychopharmacology teachers and their teaching. The authors offer broadly based pedagogic suggestions on how to deliver evidence-based and neurobiologically informed prescribing information to clinicians at all levels of experience. They argue that teaching essential psychopharmacology knowledge and practice must be up-to-date, accurate, and consistent with the reality of an individual patient's life experience and beliefs. They stress that educators must teach that nonpsychopharmacological factors in a patient's life may be as relevant to the treatment setting as the actual pharmacological basis of psychotropic drug therapeutics.

  14. Teaching pearls from the lost art of psychopharmacology.

    PubMed

    Glick, Ira D; Balon, Richard J; Ballon, Jacob; Rovine, Deborah

    2009-09-01

    Rapid advances in neuroscience and clinical research have made the practice of quality clinical psychopharmacology increasingly difficult. While practice guidelines, model psychopharmacology curricula, and clinical algorithms have helped "the science" of psychopharmacology, they often fail to provide guidance for clinicians in specific clinical situations with individual patients. Quality psychopharmacology practice is based on a combination of knowledge, experience, judgment, and luck. In this article, the authors present their collection of psychopharmacology "pearls" for trainees as well as experienced clinicians. (Journal of Psychiatric Practice 2009;15:423-426).

  15. Teaching Critical Appraisal of Articles on Psychopharmacology

    ERIC Educational Resources Information Center

    Mohr, Pavel; Hoschl, Cyril; Volavka, Jan

    2012-01-01

    Objective: Psychiatrists and other physicians sometimes read publications superficially, relying excessively on abstracts. The authors addressed this problem by teaching critical appraisal of individual articles. Method: The authors developed a 23-item appraisal instrument to assess articles in the area of psychopharmacology. The results were…

  16. Editorial to Child and Adolescence Psychopharmacology.

    PubMed

    Juckel, G

    2016-11-01

    The editors of Pharmacopsychiatry have decided in 2016 to prepare special issues regularly in order provide our readers volumes of the journal with a thematic focus 1. The first such special issue is dedicated to the field of child and adolescent psychopharmacology. Many young patients are treated with psychotherapeutic, but also pharmacotherapeutic, methods worldwide. Most of our psychopharmacological agents are not approved by the federal institutions for persons under 18 years old. However, severe mental illnesses like schizophrenia, depression, anxiety, ADHD, and bipolar disorder frequently require pharmacological treatments in children and adolescents. We also see a wide range of rather unspecific emotional and behavioral disturbances up to excitation crises or suicidal acts in this young population, so that we see the necessity for standardized and valid psychopharmacological treatment regimens based on meta-analyses, randomized controlled trials, and guidelines 2. Child and adolescent psychiatry is unfortunately far away from this; industry-supported research is rare in this area, but also not all child and adolescent psychiatrists see the importance of psychopharmacological treatment and trust specific psychotherapy, psychoeducation, and educational strategies. These are all extremely important treatments, but one can/should think that psychopharmacotherapy is an important addition and often a cornerstone for the other treatments.

  17. Individual differences and evidence-based psychopharmacology.

    PubMed

    Belmaker, Rh; Bersudsky, Yuly; Agam, Galila

    2012-09-27

    Individual differences in response to pharmacologic treatment limits the usefulness of mean data obtained from randomized controlled trials. These individual differences exist even in genetically uniform inbred mouse strains. While stratification can be of value in large studies, the individual patient history is the most effective currently available guide for personalized medicine in psychopharmacology.

  18. Geriatric psychopharmacology: evolution of a discipline.

    PubMed

    Meyers, Barnett S; Jeste, Dilip V

    2010-11-01

    The development of geriatric psychopharmacology was built on advances in geriatric psychiatry nosology and clinical pharmacology and on increased investment in aging research by the National Institute of Mental Health and by academic institutions. Application of the US Food and Drug Administration's geriatric labeling rule provided further impetus. Developments in the knowledge about 3 principal classes of medications (antidepressants, antipsychotics, and treatments for Alzheimer's disease) illustrate the trajectory of geriatric psychopharmacology research. Nonetheless, the loss of information about age effects that has resulted from applying age exclusion criteria in studies limited to either younger adults or geriatric patients is regrettable. Antidepressant trials have moved from studying younger and medically well "geriatric" samples to focusing on "older old" persons and those with significant medical comorbidity including coronary artery disease, cerebrovascular disease, and dementia. Increased specificity is reflected in studies of relationships between specific neuropsychological deficits, specific brain abnormalities, and antidepressant responsiveness. Clinical trials in older adults have demonstrated that the efficacy of antipsychotic medications continues across the lifespan, but that sensitivity to specific side effects changes in older age, with poor tolerability frequently mitigating the benefits of treatment. Treatments for Alzheimer's disease have fallen within the purview of geriatric psychopharmacology. The research focus is increasingly shifting from treatments to slow the course of cognitive decline to studies of early diagnosis and of interventions designed to prevent the development of deficits in vulnerable individuals. The importance of geriatric psychopharmacology will grow further as the average lifespan increases all over the world.

  19. Psychopharmacology with the Behaviorally Disturbed: A Review.

    ERIC Educational Resources Information Center

    McClain, William A.; Jerman, George

    Reviewed on a layman's level was research on psychopharmacology with the emotionally and behaviorally disturbed. General conclusions drawn from the man y studies were that the effect of drugs on intellectual functioning had not been determined and that there was little evidence to indicate that the learning process was consistently and reliably…

  20. Computer-Assisted Education System for Psychopharmacology.

    ERIC Educational Resources Information Center

    McDougall, William Donald

    An approach to the use of computer assisted instruction (CAI) for teaching psychopharmacology is presented. A project is described in which, using the TUTOR programing language on the PLATO IV computer system, several computer programs were developed to demonstrate the concepts of aminergic transmitters in the central nervous system. Response…

  1. Teaching Critical Appraisal of Articles on Psychopharmacology

    ERIC Educational Resources Information Center

    Mohr, Pavel; Hoschl, Cyril; Volavka, Jan

    2012-01-01

    Objective: Psychiatrists and other physicians sometimes read publications superficially, relying excessively on abstracts. The authors addressed this problem by teaching critical appraisal of individual articles. Method: The authors developed a 23-item appraisal instrument to assess articles in the area of psychopharmacology. The results were…

  2. [Therapeutic and cosmetic psychopharmacology. Risks and limits].

    PubMed

    Echarte Alonso, Luis E

    2009-01-01

    In this paper, I analyze risks and limits of the current psychopharmacology and how both are promoting a new social interpretation of health concept. Besides, I show how such interpretation can be detected in four issues related to safety, equality, psychiatrization of human condition, and autonomy. In the conclusions, I defend, first, the obligation of physician to inform patients about the important long-term uncertainties around psychopharmacology. Second, I justify the necessity of promote more prolonged monitoring of patients treated with such kind of drugs. Third, I insist in the relevance of increasing research about drugs ' adverse effects extended over a long time. And forth, I bring up the utility of health concept to avoid the subjective stigmatization of cognitive or affective traits, to prevent potential problems of inequality and coercion, and to keep from mental disorders caused by attempts of getting psychical states supposedly optimized.

  3. Teaching the Prescriber's Role: The Psychology of Psychopharmacology

    ERIC Educational Resources Information Center

    Mintz, David L.

    2005-01-01

    Objective: The author examines one aspect of the psychopharmacology curriculum: the psychology of psychopharmacology. Method: Drawing from his experience teaching this subject to trainees at many different levels and from an emerging evidence base suggesting that psychosocial factors in the doctor-patient relationship may be crucial for medication…

  4. Prescription Privileges, Psychopharmacology and School Psychology: An Overview.

    ERIC Educational Resources Information Center

    Carlson, Cindy; Kubiszyn, Tom

    1994-01-01

    Focuses on psychopharmacology and prescription privileges for psychologists. Summarizes nine major findings from Task Force on Psychopharmacology in the Schools, created to review literature on prescription privileges for psychologists; identify specific issues attendant to use of psychoactive medications with children; and clarify implications…

  5. The Limited Role of Expert Guidelines in Teaching Psychopharmacology

    ERIC Educational Resources Information Center

    Salzman, Carl

    2005-01-01

    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…

  6. Advancing Social Work Curriculum in Psychopharmacology and Medication Management

    ERIC Educational Resources Information Center

    Farmer, Rosemary L.; Bentley, Kia J.; Walsh, Joseph

    2006-01-01

    The authors reviewed current literature and curriculum resources on psychopharmacology and social work. They argue that baccalaureate and master of social work courses need to routinely include more in-depth knowledge on psychopharmacology and provide a more critical social work-focused approach to this content due to the increasing complexity of…

  7. Treatment of Bulimia Nervosa: Psychological and Psychopharmacologic Considerations.

    ERIC Educational Resources Information Center

    Phillips, Elaine L.; Greydanus, Donald E.; Pratt, Helen D.; Patel, Dilip R.

    2003-01-01

    Reviews the current literature on psychological and psychopharmacologic treatments for bulimia nervosa in the adolescent population. Describes the two most researched psychological treatments--cognitive behavior therapy and interpersonal therapy--in terms of treatment protocols and outcome research. Reviews psychopharmacologic treatment, including…

  8. Treatment of Bulimia Nervosa: Psychological and Psychopharmacologic Considerations.

    ERIC Educational Resources Information Center

    Phillips, Elaine L.; Greydanus, Donald E.; Pratt, Helen D.; Patel, Dilip R.

    2003-01-01

    Reviews the current literature on psychological and psychopharmacologic treatments for bulimia nervosa in the adolescent population. Describes the two most researched psychological treatments--cognitive behavior therapy and interpersonal therapy--in terms of treatment protocols and outcome research. Reviews psychopharmacologic treatment, including…

  9. Prescription Privileges, Psychopharmacology and School Psychology: An Overview.

    ERIC Educational Resources Information Center

    Carlson, Cindy; Kubiszyn, Tom

    1994-01-01

    Focuses on psychopharmacology and prescription privileges for psychologists. Summarizes nine major findings from Task Force on Psychopharmacology in the Schools, created to review literature on prescription privileges for psychologists; identify specific issues attendant to use of psychoactive medications with children; and clarify implications…

  10. Advancing Social Work Curriculum in Psychopharmacology and Medication Management

    ERIC Educational Resources Information Center

    Farmer, Rosemary L.; Bentley, Kia J.; Walsh, Joseph

    2006-01-01

    The authors reviewed current literature and curriculum resources on psychopharmacology and social work. They argue that baccalaureate and master of social work courses need to routinely include more in-depth knowledge on psychopharmacology and provide a more critical social work-focused approach to this content due to the increasing complexity of…

  11. The Limited Role of Expert Guidelines in Teaching Psychopharmacology

    ERIC Educational Resources Information Center

    Salzman, Carl

    2005-01-01

    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…

  12. Teaching the Prescriber's Role: The Psychology of Psychopharmacology

    ERIC Educational Resources Information Center

    Mintz, David L.

    2005-01-01

    Objective: The author examines one aspect of the psychopharmacology curriculum: the psychology of psychopharmacology. Method: Drawing from his experience teaching this subject to trainees at many different levels and from an emerging evidence base suggesting that psychosocial factors in the doctor-patient relationship may be crucial for medication…

  13. Psychopharmacology of the hallucinogenic sage Salvia divinorum.

    PubMed

    Prisinzano, Thomas E

    2005-12-22

    At present, the Mexican mint Salvia divinorum is an unregulated hallucinogen. This has resulted in various on-line botanical companies advertising and selling S. divinorum as a legal alternative to other regulated plant hallucinogens. It is predictable that its misuse will increase rapidly. The active ingredient in S. divinorum is the neoclerodane diterpene, salvinorin A (1a), which has been shown to be a kappa agonist both in vitro and in vivo. This review will cover the current state of research into the psychopharmacology of S. divinorum.

  14. Psychopharmacological interventions in autism spectrum disorder.

    PubMed

    Accordino, Robert E; Kidd, Christen; Politte, Laura C; Henry, Charles A; McDougle, Christopher J

    2016-01-01

    Individuals with autism spectrum disorder (ASD) commonly present for treatment of emotional and behavioral disturbances associated with ASD's "core" symptoms. Psychotropic medications are widely utilized in alleviating associated emotional and behavioral symptoms. Emotional and behavioral disturbances associated with ASD include irritability/severely disruptive behavior, which comprises the heaviest symptom burden; hyperactivity and other Attention-Deficit-Hyperactivity-Disorder (ADHD)-type symptoms; repetitive/stereotyped behaviors; and social withdrawal. Existing evidence for medications for each of these symptom clusters will be examined in this review. Psychopharmacological treatment of core and associated symptoms in ASD is challenging, in large part because of the heterogeneity in the presentation of ASD. Furthermore, children and adolescents with ASD are more vulnerable to the side effects of psychopharmacological intervention than their age-matched, typically developing counterparts. Currently, risperidone and aripiprazole are the only medications that have been (relatively) reliably shown to help treat certain symptom clusters associated with ASD, namely severely disruptive behavior and hyperactivity. Recent studies have begun to look at medications with mechanisms that are novel in the treatment of ASD and that may address underlying pathophysiology and/or core symptoms such as glutamate-modulating agents. Overall, randomized, placebo-controlled studies of medications for the treatment of ASD are scarce.

  15. Complementary and Alternative Medicine (CAM) Treatments and Pediatric Psychopharmacology

    ERIC Educational Resources Information Center

    Rey, Joseph M.; Walter, Garry; Soh, Nerissa

    2008-01-01

    Children and adolescents often use complementary and alternative medicine (CAM) treatments outside their indications, particularly to lose weight. Some of the herbal remedies and dietary supplements that may of relevance for psychopharmacological practice are discussed with respect to CAM treatments.

  16. Complementary and Alternative Medicine (CAM) Treatments and Pediatric Psychopharmacology

    ERIC Educational Resources Information Center

    Rey, Joseph M.; Walter, Garry; Soh, Nerissa

    2008-01-01

    Children and adolescents often use complementary and alternative medicine (CAM) treatments outside their indications, particularly to lose weight. Some of the herbal remedies and dietary supplements that may of relevance for psychopharmacological practice are discussed with respect to CAM treatments.

  17. Review of safety assessment methods used in pediatric psychopharmacology.

    PubMed

    Greenhill, Laurence L; Vitiello, Benedetto; Riddle, Mark A; Fisher, Prudence; Shockey, Erin; March, John S; Levine, Jerome; Fried, Jane; Abikoff, Howard; Zito, Julie M; McCracken, James T; Findling, Robert L; Robinson, James; Cooper, Thomas B; Davies, Mark; Varipatis, Elena; Labellarte, Michael J; Scahill, Lawrence; Walkup, John T; Capasso, Lisa; Rosengarten, Jennifer

    2003-06-01

    Elicitation is an essential and critical step in ascertaining adverse events (AEs). This report reviews elicitation methods used in published clinical trials of psychopharmacological agents in children. Pediatric psychopharmacology reports were reviewed for safety methods in the Medline database. Studies were included if they were published 1980 or later, provided data on AEs, and described the ascertainment methodology used for determining them. A review of 196 pediatric psychopharmacology articles depicting safety assessments in clinical studies over the past 22 years revealed that there was no common method used for eliciting or reporting AE data. The current inconsistency in safety data ascertainment is a major limitation that likely impairs the ability to promptly and accurately identify drug-induced AEs. Research on how best to standardize safety methods should be considered a priority in pediatric psychopharmacology.

  18. Precision medicine for psychopharmacology: a general introduction.

    PubMed

    Shin, Cheolmin; Han, Changsu; Pae, Chi-Un; Patkar, Ashwin A

    2016-07-01

    Precision medicine is an emerging medical model that can provide accurate diagnoses and tailored therapeutic strategies for patients based on data pertaining to genes, microbiomes, environment, family history and lifestyle. Here, we provide basic information about precision medicine and newly introduced concepts, such as the precision medicine ecosystem and big data processing, and omics technologies including pharmacogenomics, pharamacometabolomics, pharmacoproteomics, pharmacoepigenomics, connectomics and exposomics. The authors review the current state of omics in psychiatry and the future direction of psychopharmacology as it moves towards precision medicine. Expert commentary: Advances in precision medicine have been facilitated by achievements in multiple fields, including large-scale biological databases, powerful methods for characterizing patients (such as genomics, proteomics, metabolomics, diverse cellular assays, and even social networks and mobile health technologies), and computer-based tools for analyzing large amounts of data.

  19. Teaching critical appraisal of articles on psychopharmacology.

    PubMed

    Mohr, Pavel; Höschl, Cyril; Volavka, Jan

    2012-03-01

    Psychiatrists and other physicians sometimes read publications superficially, relying excessively on abstracts. The authors addressed this problem by teaching critical appraisal of individual articles. The authors developed a 23-item appraisal instrument to assess articles in the area of psychopharmacology. The results were collected with an electronic voting system. A discussion of each of the item followed; tutors shared their views and provided key ratings. Six publications were evaluated in the course of three workshops by a total of 58 trainees. Evaluation of the papers yielded varying results, reflecting variations of the participants' theoretical background as well as varied quality of the publications. The authors present detailed analysis of one paper as an illustrative example. The discussion format and voting stimulated active participation of the trainees. Active involvement, facilitated by the structured assessment tool, followed by feedback with discussion, may enhance the learning process.

  20. Psychopharmacology of the endocannabinoids: far beyond anandamide.

    PubMed

    Pamplona, F A; Takahashi, R N

    2012-01-01

    The study of endocannabinoid pharmacology has proceeded from the discovery of Δ9-tetrahydrocannabinol, the main psychoactive compound in Cannabis sativa, to the identification of an endogenous endocannabinoid system that is essential for physiological modulation of neuronal functions. We have not yet achieved a complete understanding of the various roles of the endocannabinoids, but this is one of the fastest-growing fields in psychopharmacology. This review starts with a brief historical description of the discovery of the endocannabinoids and then focuses on recent pharmacological advances and recently discovered endocannabinoid mechanisms of action (e.g. functional selectivity, allosterism, and receptor trafficking). Finally, we will discuss the contention that the existence of evidence-based therapeutic applications for cannabinoids and the wide range of physiological functions affected by endocannabinoids suggests that the careful study of the endocannabinoid system may lead to the development of novel therapeutic drugs with higher societal acceptability and lower side effects profiles.

  1. [Psychopharmacology in medical illness: cardiology, nephrology, hepatology].

    PubMed

    Telles-Correia, Diogo; Guerreiro, Diogo F; Coentre, Ricardo; Zuzarte, Pedro; Figueira, Luísa

    2009-01-01

    The high prevalence of psychiatric disturbances in the context of medical illness and its association with worse prognostic of the last one, are the reasons for which it becomes essential that the doctor, not psychiatrist, has the skills in the use of psychopharmaceuticals. A systematic review of the literature published until January of 2006 was done, through MEDLINE, using as key-words psychiatric illness, renal illness, hepatic illness, cardiovascular illness, psychopharmacology. The reviewed studies include original articles, reviews and observational studies. 39 articles were selected for its adequacy and acquired for the accomplishment of this revision. The authors intend to review the use of the several classes of psychopharmaceuticals, its risks and benefits, according to the different medical illnesses. The first part of this article will have is focus in the area of cardiology, nephrology and hepatology.

  2. Psychopharmacology training in clinical psychology: a renewed call for action.

    PubMed

    Julien, Robert M

    2011-04-01

    Knowledge of psychopharmacology is essential for a clinical psychologist to practice his/her profession, regardless of whether one desires to become licensed to prescribe psychoactive medications. This commentary reiterates a call made almost 20 years ago for all practitioners to gain and utilize this knowledge. Without psychopharmacology knowledge, one is extremely limited in the ability to interact with medical prescribers and to optimally serve their patients as a valued member of the health care team.

  3. Cosmetic psychopharmacology and the President's Council on Bioethics.

    PubMed

    Cerullo, Michael A

    2006-01-01

    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.

  4. Using game format to teach psychopharmacology to medical students.

    PubMed

    Shiroma, Paulo R; Massa, Alfredo A; Alarcon, Renato D

    2011-01-01

    Most psychiatric programs provide lectures on basic principles of psychopharmacology. Yet, this traditional approach has been criticized due to excessive information and passive transfer of expert knowledge. An alternative teaching method is the use of "academic games." To investigate medical students' acquisition of knowledge on psychopharmacology, and their perception of a game playing approach compared to traditional lectures. Two senior residents designed, implemented, and executed a randomized pretest-posttest study to teach psychopharmacology, using an academic game and a lecture format, to third-year medical students during a 6-week Psychiatry clerkship. Both didactic interventions were delivered concurrently for five consecutive weeks covering five psychopharmacology modules: antidepressants I (selective serotonin reuptake inhibitors and atypical antidepressants), antidepressants II (monoamine oxidase inhibitors and tricyclic antidepressants), mood stabilizers, antipsychotics, and anti-anxiety agents/sedatives/hypnotics. The game follows similar rules of the famous TV show, "Jeopardy" using a power point grid and a multiple choice question format. Forty-three medical students participated (29 assigned to the game approach, 14 to the traditional lecture approach). None of the demographic variables (age, gender, years after graduation, Graduate Point Averages, and United States Medical Licensing Examination 1) were significantly associated with the pre/posttest score difference between groups. Both groups improved their knowledge on psychotropic drugs [(game group t = 10.86, p < 0.001); control t = 4.82, p < 0.001)] throughout the 6-week Psychiatry rotation. Students in the game group had a better perception of this educational method as measured by perceived enjoyment, increased knowledge of psychopharmacology, and stimulating interest in the subject compared to those in the lecture group (p < 0.05). Teaching psychopharmacology in medical students by using

  5. Psychopharmacologic treatment of eating disorders: emerging findings.

    PubMed

    McElroy, Susan L; Guerdjikova, Anna I; Mori, Nicole; Keck, Paul E

    2015-05-01

    Psychopharmacologic treatment is playing a greater role in the management of patients with eating disorders. In this paper, we review randomized, placebo-controlled trials (RCTs) conducted in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other eating disorders over the past 3 years. Fluoxetine remains the only medication approved for an eating disorder, that being BN. RCTs of antipsychotics in AN have had mixed results; the only agent with some evidence of efficacy is olanzapine. One study suggests dronabinol may induce weight gain in AN. Preliminary studies suggest lack of efficacy of alprazolam, dehydroepiandrosterone, or physiologic estrogen replacement in AN; erythromycin in BN; and the opioid antagonist ALKS-33 in BED. In BED with obesity or overweight, bupropion may cause mild weight loss without seizures, and chromium may improve glucose regulation. Also in BED, three RCTs suggest the stimulant prodrug lisdexamfetamine may reduce binge eating episodes, and another RCT suggests intranasal naloxone may decrease time spent binge eating. There remains a disconnection between the size of eating disorders as a public health problem and the lack of pharmacotherapy research of these conditions.

  6. Psychiatric safety of ketamine in psychopharmacology research.

    PubMed

    Perry, Edward B; Cramer, Joyce A; Cho, Hyun-Sang; Petrakis, Ismene L; Karper, Laurence P; Genovese, Angelina; O'Donnell, Elizabeth; Krystal, John H; D'Souza, D Cyril

    2007-06-01

    A growing number of investigators are studying ketamine effects in healthy human subjects, but concerns remain about its safety as a research tool. Therefore, it is timely to revisit the safety of subanesthetic doses of ketamine in experimental psychopharmacology studies. To report on the safety of laboratory studies with subanesthetic doses of ketamine in healthy humans using an existing dataset. Medically healthy subjects with no personal or familial Axis I psychotic spectrum disorders were administered subanesthetic doses of ketamine by intravenous infusion in a series of clinical investigations from 1989 to 2005. The safety of ketamine administration was monitored in these subjects. Four hundred and fifty subjects received at least one dose of active ketamine. Eight hundred and thirty three active ketamine and 621 placebo infusions were administered. Ten adverse mental status events were documented in nine subjects/infusions that were deemed related to ketamine administration (2% of subjects, 1.45% of infusions). All but one adverse reaction resolved by the end of the test session. The side effects in the remaining individual were no longer clinically significant within 4 days of the test session. No residual sequelae were observed. Ketamine administration at subanesthetic doses appears to present an acceptable level of risk for carefully screened populations of healthy human subjects in the context of clinical research programs that intensively monitor subjects throughout their study participation.

  7. Ethical considerations in clinical training, care and research in psychopharmacology.

    PubMed

    Strous, Rael D

    2011-04-01

    Psychopharmacology is a powerful tool in psychiatry; however, it is one that demands responsibility in order to deal with the ethical complexities that accompany advances in the field. It is important that questions are asked and that ethical mindfulness and sensitivity are developed along with clinical skills. In order to cultivate and deepen ethical awareness and subsequently solve issues in optimal fashion, investment should be made in the development of an ethical decision-making process as well as in education in the ethics of psychopharmacology to trainees in the field at all stages of their educational development. A clear approach to identifying ethical problems, engaging various ethical concepts in considering solutions and then applying these principles in problem resolution is demanded. An openness in identifying and exploring issues has become crucial to the future development and maturation of psychopharmacologists, both research and clinical. Consideration must be given to the social implications of psychopharmacological practice, with the best interests of patients always paramount. From both a research and clinical perspective, psychopharmacology has to be practised with fairness, sensitivity and ethical relevance to all. While ethical issues related to psychopharmacological practice are varied and plentiful, this review focuses on advances in technology and biological sciences, personal integrity, special populations, and education and training.

  8. Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives.

    PubMed

    Persico, Antonio M; Arango, Celso; Buitelaar, Jan K; Correll, Christoph U; Glennon, Jeffrey C; Hoekstra, Pieter J; Moreno, Carmen; Vitiello, Benedetto; Vorstman, Jacob; Zuddas, Alessandro

    2015-10-01

    Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking contrast, pharmacological treatment options presently available in child and adolescent psychiatry are dramatically limited. The most important currently unmet needs in paediatric psychopharmacology are: the frequent off-label prescription of medications to children and adolescents based exclusively on data from randomized controlled studies involving adult patients; the frequent lack of age-specific dose, long-term efficacy and tolerability/safety data; the lack of effective medications for many paediatric psychiatric disorders, most critically autism spectrum disorder; the scarcity and limitations of randomized placebo-controlled trials in paediatric psychopharmacology; the unexplored potential for the prevention of psychiatric disorders with adolescent- and adult-onset; the current lack of biomarkers to predict treatment response and severe adverse effects; the need for better preclinical data to foster the successful development of novel drug therapies; and the effective dissemination of evidence-based treatments to the general public, to better inform patients and families of the benefits and risks of pharmacological interventions during development. Priorities and strategies are proposed to overcome some of these limitations, including the European Child and Adolescent Clinical Psychopharmacology Network, as an overarching Pan-European infrastructure aimed at reliably carrying out much needed psychopharmacological trials in children and adolescents, in order to fill the identified gaps and improve overall outcomes.

  9. Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management

    PubMed Central

    Fornaro, Michele; Martino, Matteo

    2010-01-01

    Background: Subjective tinnitus is a frequent, impairing condition, which may also cause neurotransmitter imbalance at the cochlea. Psychopharmacologic agents, although not being the first-line treatment for tinnitus, may modulate cochlear neurotransmission, thereby influencing the subjective tinnitus experience. Method: A comprehensive review of MEDLINE literature (from January 1990–January 2010) was performed searching for: “tinnitus”, major classes of psychopharmacological agents, and psychiatric disorders. The most relevant clinical evidence is reported briefly along with a concise description of the main neurotransmitters purported to be involved in tinnitus, in order to provide the reader with a rational evaluation of tinnitus therapy with psychopharmacological agents. Results: Although strong methodological issues limit the reliability of the current results, a broad number of psychopharmacological agents have already been considered for tinnitus, both as candidate triggers or potential therapies. Conclusions: Selected psychopharmacological drugs may play a role in the clinical management of this disorder. While the rational use of these agents for the treatment of tinnitus should not be overlooked, research should be undertaken on their neuromodulating actions at the cochlea. PMID:20628627

  10. Psychopharmacology education software. The first of a series.

    PubMed Central

    Gitlow, S.; Tanner, T. B.

    1991-01-01

    A psychopharmacology testing package was generated by Multiple Choice, a Claris HyperCard 2.1 based software application. Multiple Choice was developed specifically to allow for the simple preparation of non-networked computerized testing. It permits tests of unlimited length to incorporate true/false, multiple choice (with 3-5 possible answers), and K-type questions. These examinations may incorporate explanations if desired. The tests maintain records to more easily permit the examination's creator to quickly determine scores and question-specific results. The psychopharmacology testing package is a multi-level group of three examinations. It is to be the first in a series of psychiatry exams targeting medical students, psychiatry residents, and other interested professionals. Work is also in progress to convert both the psychopharmacology testing package and Multiple Choice itself to the PC-compatible platform. PMID:1807762

  11. Psychopharmacology of Autism Spectrum Disorders: A Selective Review

    ERIC Educational Resources Information Center

    Mohiuddin, Sarah; Ghaziuddin, Mohammad

    2013-01-01

    While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span.…

  12. Psychopharmacology in School-Based Mental Health Services.

    ERIC Educational Resources Information Center

    Del Mundo, Amor S.; Pumariega, Andres J.; Vance, Hubert R.

    1999-01-01

    Discusses issues regarding the use of a pharmacological approach to the treatment of children with serious emotional and mental disorders that interfere with learning. Addresses the current state of psychopharmacological treatment for diagnostic entities and behavioral symptomatology. Discusses the roles of the child, family, and health and…

  13. Psychopharmacology: A Guide for Helping Professionals. ERIC Digest.

    ERIC Educational Resources Information Center

    Smith, Robert L.; Garcia, Elda E.

    Certain mental disorders are caused by or accompanied by neurochemical abnormalities. The use of psychotropic medications has dramatically increased over the past two decades in all age groups, particularly with children. Therefore, psychopharmacology, the branch of pharmacology dealing with the psychological effects of drugs, needs to be…

  14. Psychopharmacology and Mental Retardation: A 10 Year Review (1990- 1999).

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Bamburg, Jay W.; Mayville, Erik A.; Pinkston, Jim; Bielecki, Joanne; Kuhn, David; Smalls, Yemonja; Logan, James R.

    2000-01-01

    Review of the literature on psychopharmacology and mental retardation from 1990-1999 found most studies had major methodological flaws. Also, most drug administrations were not based in science, were not evaluated appropriately, and generally did not follow best practices for treatment of persons with mental retardation. A table lists the studies…

  15. Child Psychopharmacology: How School Psychologists Can Contribute to Effective Outcomes

    ERIC Educational Resources Information Center

    DuPaul, George J.; Carlson, John S.

    2005-01-01

    Psychopharmacological treatments have been used with increased frequency to treat a variety of internalizing and externalizing disorders in children. Given the potential impact that medication has on children's school performance, school psychologists should be involved in helping physicians and families make effective decisions by assisting with…

  16. Improving the Pedagogy Associated with the Teaching of Psychopharmacology

    ERIC Educational Resources Information Center

    Glick, Ira D.; Salzman, Carl; Cohen, Bruce M.; Klein, Donald F.; Moutier, Christine; Nasrallah, Henry A.; Ongur, Dost; Wang, Po; Zisook, Sidney

    2007-01-01

    Objective: The authors summarize two special sessions focused on the teaching of psychopharmacology at the 2003 and 2004 annual meeting of the American College of Neuropsychopharmacology (ACNP). The focus was on whether "improving the teaching-learning process" in psychiatric residency programs could improve clinical practice. Method: Problems of…

  17. Using Game-Based Learning to Teach Psychopharmacology

    ERIC Educational Resources Information Center

    Scarlet, Janina; Ampolos, Lauren

    2013-01-01

    This article reviews several approaches used to teach psychopharmacology for graduate clinical psychology students. In order to promote engagement and increase student interest, students were broken up into groups and were asked to demonstrate their understanding of the material through a variety of interactive games (i.e., game-based learning, or…

  18. Teaching a Psychopharmacology Course to Counselors: Justification, Structure, and Methods.

    ERIC Educational Resources Information Center

    Ingersoll, R. Elliot

    2000-01-01

    In the last decade, the use of medication to treat psychological disorders has greatly expanded. In order to work effectively in school and community settings, counselors will need a sophisticated knowledge of psychopharmacology. This article describes the curriculum, structure, resources, and teaching methods suggested for effective instruction…

  19. 76 FR 65736 - Psychopharmacologic Drugs Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-24

    ... HUMAN SERVICES Food and Drug Administration Psychopharmacologic Drugs Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and Drug Administration (FDA). The meeting will be...

  20. 75 FR 47309 - Psychopharmacologic Drugs Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-05

    ... HUMAN SERVICES Food and Drug Administration Psychopharmacologic Drugs Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and Drug Administration (FDA). The meeting will be...

  1. 78 FR 13349 - Psychopharmacologic Drugs Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ... HUMAN SERVICES Food and Drug Administration Psychopharmacologic Drugs Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and Drug Administration (FDA). The meeting will be...

  2. Teaching a Psychopharmacology Course to Counselors: Justification, Structure, and Methods.

    ERIC Educational Resources Information Center

    Ingersoll, R. Elliot

    2000-01-01

    In the last decade, the use of medication to treat psychological disorders has greatly expanded. In order to work effectively in school and community settings, counselors will need a sophisticated knowledge of psychopharmacology. This article describes the curriculum, structure, resources, and teaching methods suggested for effective instruction…

  3. Psychopharmacology of Autism Spectrum Disorders: A Selective Review

    ERIC Educational Resources Information Center

    Mohiuddin, Sarah; Ghaziuddin, Mohammad

    2013-01-01

    While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span.…

  4. Child Psychopharmacology: How School Psychologists Can Contribute to Effective Outcomes

    ERIC Educational Resources Information Center

    DuPaul, George J.; Carlson, John S.

    2005-01-01

    Psychopharmacological treatments have been used with increased frequency to treat a variety of internalizing and externalizing disorders in children. Given the potential impact that medication has on children's school performance, school psychologists should be involved in helping physicians and families make effective decisions by assisting with…

  5. Using Game-Based Learning to Teach Psychopharmacology

    ERIC Educational Resources Information Center

    Scarlet, Janina; Ampolos, Lauren

    2013-01-01

    This article reviews several approaches used to teach psychopharmacology for graduate clinical psychology students. In order to promote engagement and increase student interest, students were broken up into groups and were asked to demonstrate their understanding of the material through a variety of interactive games (i.e., game-based learning, or…

  6. Psychopharmacology and Mental Retardation: A 10 Year Review (1990- 1999).

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Bamburg, Jay W.; Mayville, Erik A.; Pinkston, Jim; Bielecki, Joanne; Kuhn, David; Smalls, Yemonja; Logan, James R.

    2000-01-01

    Review of the literature on psychopharmacology and mental retardation from 1990-1999 found most studies had major methodological flaws. Also, most drug administrations were not based in science, were not evaluated appropriately, and generally did not follow best practices for treatment of persons with mental retardation. A table lists the studies…

  7. Improving the Pedagogy Associated with the Teaching of Psychopharmacology

    ERIC Educational Resources Information Center

    Glick, Ira D.; Salzman, Carl; Cohen, Bruce M.; Klein, Donald F.; Moutier, Christine; Nasrallah, Henry A.; Ongur, Dost; Wang, Po; Zisook, Sidney

    2007-01-01

    Objective: The authors summarize two special sessions focused on the teaching of psychopharmacology at the 2003 and 2004 annual meeting of the American College of Neuropsychopharmacology (ACNP). The focus was on whether "improving the teaching-learning process" in psychiatric residency programs could improve clinical practice. Method: Problems of…

  8. Psychopharmacology in School-Based Mental Health Services.

    ERIC Educational Resources Information Center

    Del Mundo, Amor S.; Pumariega, Andres J.; Vance, Hubert R.

    1999-01-01

    Discusses issues regarding the use of a pharmacological approach to the treatment of children with serious emotional and mental disorders that interfere with learning. Addresses the current state of psychopharmacological treatment for diagnostic entities and behavioral symptomatology. Discusses the roles of the child, family, and health and…

  9. Practical clinical trials in psychopharmacology: a systematic review.

    PubMed

    Vitiello, Benedetto

    2015-04-01

    Practical clinical trials (PCTs) are randomized experiments under typical practice conditions with the aim of testing the "real-life" benefits and risks of therapeutic interventions. Influential PCTs have been conducted in cardiology, oncology, and internal medicine. Psychotropic medications are widely and increasingly used in medical practice. This review examines recent progress in conducting PCTs in psychopharmacology. The January 2000 to October 2014 MEDLINE, Scopus, and ClinicalTrials.gov databases were searched for peer-reviewed publications of PCTs with at least 100 subjects per treatment arm. Most PCTs in psychiatry evaluated mental health services or psychosocial interventions rather than specific pharmacotherapies. Of 157 PCTs in psychiatry, 30 (19%) were in psychopharmacology, with a median of 2 publications per year and no increase during the period of observation. Sample size ranged from 200 to 18,154; only 11 studies randomized 500 patients or more. Psychopharmacology PCTs were equally likely to be funded by industry as by public agencies. There were 10 PCTs of antidepressants, for a total of 4206 patients (in comparison with at least 46 PCTs of antihypertensive medications, for a total of 208,014 patients). Some psychopharmacology PCTs used suicidal behavior, treatment discontinuation, or mortality as primary outcome and produced effectiveness and safety data that have influenced both practice guidelines and regulatory decisions. Practical clinical trials can constitute an important source of information for clinicians, patients, regulators, and policy makers but have been relatively underused in psychopharmacology. Electronic medical records and integrated practice research networks offer promising platforms for a more efficient conduct of PCTs.

  10. Practical Clinical Trials in Psychopharmacology: a Systematic Review

    PubMed Central

    Vitiello, Benedetto

    2015-01-01

    Practical clinical trials (PCT) are randomized experiments under typical practice conditions with the aim of testing the “real life” benefits and risks of therapeutic interventions. Influential PCTs have been conducted in cardiology, oncology, and internal medicine. Psychotropic medications are widely and increasingly used in medical practice. This review examines recent progress in conducting PCTs in psychopharmacology. The January 2000 – October 2014 MEDLINE, Scopus, and ClinicalTrials.gov databases were searched for peer-reviewed publications of PCTs with at least 100 subjects per treatment arm. Most PCTs in psychiatry evaluated mental health services or psychosocial interventions rather than specific pharmacotherapies. Of 157 PCTs in psychiatry, 30 (19%) were in psychopharmacology, with a median of 2 publications per year and no increase over the period of observation. Sample size ranged from 200 to 18,154; only 11 studies randomized 500 patients or more. Psychopharmacology PCTs were equally likely to be funded by industry as by public agencies. There were 10 PCTs of antidepressants, for a total of 4,206 patients (in comparison with at least 46 PCT of antihypertensive medications, for a total of 208,014 patients). Some psychopharmacology PCTs used suicidal behavior, treatment discontinuation, or mortality as primary outcome, and produced effectiveness and safety data that have influenced both practice guidelines and regulatory decisions. PCTs can constitute an important source of information for clinicians, patients, regulators, and policy makers, but have been relatively underutilized in psychopharmacology. Electronic medical records and integrated practice research networks offer promising platforms for a more efficient conduct of PCTs. PMID:25679131

  11. Traditional Chinese medicine and Western psychopharmacology: building bridges.

    PubMed

    Shorter, Edward; Segesser, Kathryn

    2013-12-01

    This paper demonstrates that in the treatment of psychiatric disorders, there are striking similarities between the mechanisms of psychoactive agents used in Traditional Chinese Medicine (TCM) and those of western psychopharmacology. While western researchers search for new treatments and novel mechanisms of action, investigators in Asia are analyzing traditional remedies in order to understand the mechanisms responsible for their effectiveness. A review of contemporary pharmacologic studies of agents used in TCM for psychiatric indications reveals that virtually all of the active principles of drug action established in 20th century psychopharmacology were encountered empirically in Chinese herbal medicine over the past 2000 years. Building bridges between these two traditions may thus be of benefit to both cultures. In addition to providing western patients with a wider selection of treatment options, the effort may help Asian clinicians and researchers avoid some of the errors that have troubled their western counterparts.

  12. Reflections on ethical issues in psychopharmacology: an American perspective.

    PubMed

    Gutheil, Thomas G

    2012-01-01

    Psychopharmacology has revolutionized psychiatric practice but raises a number of ethical issues. This review from an American perspective first describes ethics analyses and attempts to portray the ethical practitioner. Pressures that interfere with appropriate prescribing come from outside the prescriber and from within, including from insurers, other treatment staff and the prescriber's own will to act for the patient. Clinicians also face binds in which alternate choices seem to have merit and leave the prescriber feeling pulled in contradictory directions, frequently related to risk-benefit dilemmas. The ethics of psychopharmacology poses many questions that cannot yet be answered at the current state of the field. Pharmacology also seems to promote extremes of attitudes, such as "All such drugs are poisons" and the like. This review then provides some risk management principles, and concludes that such a review, though not comprehensive, may serve to open questions that are not always considered by clinicians.

  13. Somatic treatments excluding psychopharmacology in obsessive- compulsive disorder: a review.

    PubMed

    Atmaca, Murad

    2013-06-01

    Somatic treatments other than psychotropic drugs are increasingly used in the patients with obsessive compulsive disorder (OCD), however there has been little systematic review of them. Therefore, the present review deals with a variety of somatic treatment methods excluding psychotropic drugs. A literature search was performed on the PubMed database from the beginning of 1980, to September 2012, for published English, Turkish and French-language articles of somatic treatment approaches (excluding psychopharmacological agents) in the treatment of OCD. The search was carried out by using some terms in detail. Afterwards, the obtained investigations on electroconvusive therapy (ECT), deep brain stimulation (DBS), neurosurgical methods and transcranial magnetic stimulation (TMS) were presented. Although psychopharmacological treatment and psychotherapeutic approaches are primary treatment modalities in the management of OCD, other somatic treatment options seem to be used as alternatives, especially for patients with treatmentresistant OCD.

  14. Psychopharmacology and preschoolers: a critical review of current conditions.

    PubMed

    Fanton, John; Gleason, Mary Margaret

    2009-07-01

    Rates of prescriptions for very young children have increased notably in the last 20 years. These changes have occurred in the context of increasing attention to early childhood mental health, availability of medications perceived to be safer than older medications, application of the medical model to the mental health care of young children, as well as other cultural shifts. Psychopharmacological treatment for any patient, but especially very young children, requires consideration of central nervous system (CNS) and metabolic development and issues of diagnostic validity and should be guided by an empirical literature. In young children, this literature is quite limited. In this article, the authors review developmental issues involved in psychopharmacological treatment and present existing literature and practical guidelines for common preschool diagnoses, recognizing that for some disorders, the extant literature does not support even consideration of medications.

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

    PubMed

    Olivier, B; Chan, J S W; Pattij, T; de Jong, T R; Oosting, R S; Veening, J G; Waldinger, M D

    2006-01-01

    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.

  16. Improving the pedagogy associated with the teaching of psychopharmacology.

    PubMed

    Glick, Ira D; Salzman, Carl; Cohen, Bruce M; Klein, Donald F; Moutier, Christine; Nasrallah, Henry A; Ongur, Dost; Wang, Po; Zisook, Sidney

    2007-01-01

    The authors summarize two special sessions focused on the teaching of psychopharmacology at the 2003 and 2004 annual meeting of the American College of Neuropsychopharmacology (ACNP). The focus was on whether "improving the teaching-learning process" in psychiatric residency programs could improve clinical practice. Problems of strategies and pedagogic techniques that have been used were presented from multiple perspectives (e.g., from a dean, department chair, training director, and former students). There was a consensus that action involving psychopharmacology organizations and the American Association of Directors of Residency Training in Psychiatry (AADPRT) was necessary to improve "evidence-based" competencies before graduation and to follow prescribing patterns into clinical practice to determine whether the standards of care could be improved.

  17. Traditional Chinese Medicine and Western Psychopharmacology: Building Bridges

    PubMed Central

    Shorter, Edward; Segesser, Kathryn

    2013-01-01

    This paper demonstrates that in the treatment of psychiatric disorders, there are striking similarities between the mechanisms of psychoactive agents used in Traditional Chinese Medicine (TCM) and those of western psychopharmacology. While western researchers search for new treatments and novel mechanisms of action, investigators in Asia are analyzing traditional remedies in order to understand the mechanisms responsible for their effectiveness. A review of contemporary pharmacologic studies of agents used in TCM for psychiatric indications reveals that virtually all of the active principles of drug action established in 20th century psychopharmacology were encountered empirically in Chinese herbal medicine over the past 2000 years. Building bridges between these two traditions may thus be of benefit to both cultures. In addition to providing western patients with a wider selection of treatment options, the effort may help Asian clinicians and researchers avoid some of the errors that have troubled their western counterparts. PMID:23418138

  18. Teaching ethics of psychopharmacology research in psychiatric residency training programs.

    PubMed

    Beresin, Eugene V; Baldessarini, Ross J; Alpert, Jonathan; Rosenbaum, Jerrold

    2003-12-01

    American psychiatric residency training programs are now required to teach principles of research ethics. This task is especially pressing in light of evolving guidelines pertaining to human subjects, including psychiatric patients, especially when psychopharmacology is involved. Residents need to understand principles of research ethics and implications of roles of psychiatrists as investigators and clinicians. We consider major contemporary ethical issues in clinical psychiatric research, with an emphasis on psychopharmacology, and implications of addressing them within residency training programs. We reviewed recent literature on ethical issues in clinical research and on medical education in bioethics. This report considers: (1) an overview of current training; (2) perceived needs and rationales for training in research ethics, (3) recommended educational content and methods; (4) issues that require further study (including demonstration of acquired knowledge, practice issues, and the treatment versus-investigation misconception); and (5) conclusions. Recommended components of residency training programs include basic ethical principles; scientific merit and research design; assessment of risks and benefits; selection and informed consent of patient-subjects; and integrity of the clinical investigator, including definition of roles, conflicts-of-interest, and accountability. Evaluation of educational effectiveness for both trainees and faculty is a recommended component of such programs. We recommend that psychiatric training include education about ethical aspects of clinical research, with a particular emphasis on psychopharmacology. These activities can efficiently be incorporated into teaching of other aspects of bioethics, research methods, and psychopharmacology. Such education early in professional development should help to clarify roles of clinicians and investigators, improve the planning, conduct and reporting of research, and facilitate career

  19. Females' participation in psychopharmacology research as authors, editors, and subjects.

    PubMed

    Poling, Alan; Durgin, Amy; Bradley, Kelly P; Porter, Lindsay K; Van Wagner, Karen; Weeden, Marc; Panos, John J

    2009-04-01

    This study determined the involvement of women as first authors and other authors for every article published in Experimental and Clinical Psychopharmacology, Pharmacology Biochemistry and Behavior, and Psychopharmacology in 1991, 1996, 2001, and 2006. Their involvement as editors also was determined. Women's participation as authors, but not as editors, slightly increased over time. In 2006, 43% of first authors, 38% of other authors, and 24% of editors were women. The gender of subjects was examined for the same years and journals, but could not be determined for 6% and 9% of articles employing nonhuman and human subjects, respectively. In 2006, when subjects' gender could be determined, 77% of articles involving nonhuman subjects used only males, 9% only females, and 14% both males and females. In articles using human subjects in that same year, 17% involved only males, 6% only females, and 77% both males and females. Women researchers clearly make substantial contributions to the psychopharmacology literature, but are nonetheless underrepresented as editors. Findings regarding subjects indicate that there is growing recognition of the importance of gender as a determinant of drug effects, although the vast majority of nonhuman studies continue to involve only male subjects.

  20. Safeguarding children's rights in psychopharmacological research: ethical and legal issues.

    PubMed

    Kölch, Michael; Ludolph, Andrea G; Plener, Paul L; Fangerau, Heiner; Vitiello, Benedetto; Fegert, Joerg M

    2010-01-01

    Research on psychopharmacological treatment in children and adolescents is the subject of ongoing ethical discussion, as minors with mental disorders constitute a vulnerable patient group. Considering the important legislative changes in pediatric research over the past decade in both the US and Western Europe, there is a need to review recent developments in this area. Based on a systematic literature review, a hermeneutical analysis focusing the main issues of ethics in child and adolescent psychopharmacology is provided. Legal and regulatory aspects of psychopharmacological research in children are compared between the US and Europe. Relevant issues were informed assent and consent to research participation, minimal risk and burden of research, ethics of pharmacogenetics, research on "me-too" medications, and justice in global research. Additionally, the concern about undue influence of financial interests in research is also addressed. Incentives for the conduct of clinical trials with children comparable to those contained in US legislation are now provided in the EU. Research to develop "me-too" preparations may have no significant benefit for children, but can cause research burden and detract from clinically more important projects by utilizing limited investigator time and patient resources. Thus far, pharmacogenetic studies may bring more individualized treatment approaches into child psychiatry but they remain at present a promise for the future. Finally, the issues of avoiding undue influence from funders and conflicts of interest remain a prominent concern which can be solved by declaring conflicts and publishing all results of studies extensively.

  1. Ethical considerations in psychopharmacological research involving children and adolescents.

    PubMed

    Vitiello, Benedetto

    2003-12-01

    Increased community utilization of psychotropic medications among children has brought attention to pediatric psychopharmacology research and associated ethical issues. To discuss ethical aspects of child participation in psychopharmacology protocols. Selective review of relevant scientific and regulatory literature. Efficacy and safety of psychotropics in children cannot be entirely inferred from adult data and direct participation of children in research is necessary. Child research must follow special regulations that are in addition to those common to all human research. For research with prospect of direct benefit, a critical factor is whether the risk/benefit ratio is favorable to the participating child. For research without such a prospect, the concepts of minimal risk and minor increase over minimal risk apply. However, the interpretation and application of these principles to specific protocols vary across settings and among ethics committees. Thus far, little empirical investigation has been conducted on children and parents' motivation for research participation, effectiveness of the informed consent and assent procedures, possibility of persistent consequences of exposure to experimental treatments and placebo, and validation of the concepts of minimal risk and minor increase over minimal risk. Research on human subject issues relevant to child participation is a promising approach to improving ethical methods and procedures of pediatric psychopharmacology.

  2. The 2009 Schizophrenia PORT Psychopharmacological Treatment Recommendations and Summary Statements

    PubMed Central

    Buchanan, Robert W.; Kreyenbuhl, Julie; Kelly, Deanna L.; Noel, Jason M.; Boggs, Douglas L.; Fischer, Bernard A.; Himelhoch, Seth; Fang, Beverly; Peterson, Eunice; Aquino, Patrick R.; Keller, William

    2010-01-01

    In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to recommend specific dosage ranges for the acute and maintenance treatment of first-episode and multi-episode schizophrenia and to endorse the practice of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge, including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia. PMID:19955390

  3. Assessment of Psychopharmacology on the American Board of Psychiatry and Neurology Examinations

    ERIC Educational Resources Information Center

    Juul, Dorthea; Winstead, Daniel K.; Sheiber, Stephen C.

    2005-01-01

    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…

  4. A Survey of School Psychologists' Knowledge and Training in Child Psychopharmacology

    ERIC Educational Resources Information Center

    Carlson, John S.; Demaray, Michelle Kilpatrick; Hunter-Oehmke, Shana

    2006-01-01

    A national sample of 320 school-based, practicing members of the National Association of School Psychologists provided information on (a) their caseloads receiving medications, (b) types of school psychopharmacology training opportunities available and perceptions of their current training in child psychopharmacology, and (c) information about…

  5. Survey of Nationally Certified School Psychologists' Roles and Training in Psychopharmacology

    ERIC Educational Resources Information Center

    Shahidullah, Jeffrey D.; Carlson, John S.

    2014-01-01

    A randomly selected group of Nationally Certified School Psychologists (NCSPs; n = 817) were mailed the 42-item "School Psychopharmacology Roles and Training Evaluation" (SPRTE) which inquired about their caseloads, practice roles as proposed by DuPaul and Carlson ([DuPaul, G. J., 2005]), and prior training in psychopharmacology. A…

  6. A Survey of School Psychologists' Knowledge and Training in Child Psychopharmacology

    ERIC Educational Resources Information Center

    Carlson, John S.; Demaray, Michelle Kilpatrick; Hunter-Oehmke, Shana

    2006-01-01

    A national sample of 320 school-based, practicing members of the National Association of School Psychologists provided information on (a) their caseloads receiving medications, (b) types of school psychopharmacology training opportunities available and perceptions of their current training in child psychopharmacology, and (c) information about…

  7. Assessment of Psychopharmacology on the American Board of Psychiatry and Neurology Examinations

    ERIC Educational Resources Information Center

    Juul, Dorthea; Winstead, Daniel K.; Sheiber, Stephen C.

    2005-01-01

    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…

  8. Survey of Nationally Certified School Psychologists' Roles and Training in Psychopharmacology

    ERIC Educational Resources Information Center

    Shahidullah, Jeffrey D.; Carlson, John S.

    2014-01-01

    A randomly selected group of Nationally Certified School Psychologists (NCSPs; n = 817) were mailed the 42-item "School Psychopharmacology Roles and Training Evaluation" (SPRTE) which inquired about their caseloads, practice roles as proposed by DuPaul and Carlson ([DuPaul, G. J., 2005]), and prior training in psychopharmacology. A…

  9. Traditional and alternative research designs and methods in clinical pediatric psychopharmacology.

    PubMed

    Fava, M

    1996-10-01

    To review both traditional and alternative research designs and methods in pediatric psychopharmacology. Study designs used in clinical trials in psychiatry were selected for review with the special considerations of pediatric psychopharmacological trials in mind. Where possible, a reference to a specific published trial in pediatric psychopharmacology was provided for each design. It appears that pediatric psychopharmacology trials require a relatively greater flexibility in design to avoid significant study biases. Alternative research designs may be preferable to the traditional approaches, particularly when the use of the latter may raise important issues of feasibility. Evolution of a clinical research hypothesis to a study protocol in pediatric psychopharmacology is a manageable task if one keeps in mind essential elements such as selection of study design, population, sample size, treatment duration, and efficacy assessments.

  10. Name that neurotransmitter: using music to teach psychopharmacology concepts.

    PubMed

    Hermanns, Melinda; Lilly, Mary LuAnne; Wilson, Kathy; Russell, Nathan Andrew

    2012-09-01

    The purpose of this article is to discuss the use of music (i.e., two original songs, "Neurotransmitter Twitter" and "Parkinson's Shuffle") to teach aspects of psychopharmacology to students in the course Psychiatric/Mental Health Nursing. Songs were incorporated in both the clinical and classroom settings. This innovative teaching method allowed students the opportunity to revisit the information through multiple exposures of the content for reinforcement and enhancement of student learning in a fun, creative approach. Brain-based research will be discussed, along with the process of development.

  11. Psychopharmacology in Medical Practice—The Benefits and the Risks

    PubMed Central

    Sack, Robert L.; Shore, James H.

    1981-01-01

    Psychopharmacology has become a major approach to treatment in primary medical care. However, combined psychiatric and medical illness can give rise to some challenging diagnostic problems. Furthermore, drug treatment of patients with such illnesses can involve important drug-disease interactions and drug-drug interactions. One should keep in mind the issues that arise when an emotionally troubled patient would benefit from a psychotropic drug but a concurrent medical illness complicates this treatment. An awareness of both the medical and psychiatric issues involved may make successful treatment possible. PMID:7269559

  12. The EU paediatric regulation: effects on paediatric psychopharmacology in Europe.

    PubMed

    Stoyanova-Beninska, Violeta V; Wohlfarth, Tamar; Isaac, Maria; Kalverdijk, Luuk J; van den Berg, Henk; Gispen-de Wied, Christine

    2011-08-01

    Child and adolescent psychiatry is a relatively young field and the recognition, classification, and treatment of disorders in children and adolescents lag behind those in adults. In recent years there is an increasing awareness of the differences between children and adults in psychopathology and pharmacology. Related to this new paediatric regulations have been introduced. This article reviews the regulatory and legislative measures that were adopted in the EU in 2007 and the subsequent impact of these measures on the field of paediatric psychopharmacology. The consequences of the paediatric regulation in the EU are reflected in several domains: regulatory, research aimed at drug development and clinical practices. In the regulatory domain, the consequences include: new paediatric indications, inclusion of special (class) warnings, specification of dose regimens, and information on safety specific to children and adolescents, and development of new medicinal formulations. The paediatric regulation leads to timely development of paediatric friendly formulations and better quality of the clinical evidence. In clinical practices, an increased awareness of the uniqueness of paediatric pharmacology is emerging among medical professionals, and subsequent improvement of medical care (i.e. correct doses, appropriate formulation, monitoring for expected adverse events). In addition, clinical guidelines will have to be revised more frequently in order to integrate the recently acquired knowledge. The new regulations stimulate transparency and discussions between academia, pharmaceutical industry, and regulators. The purpose is to optimize clinical research and obtain evidence for paediatric psychopharmacology, thereby providing adequate support for treatment.

  13. How (not what) to prescribe: nonpharmacologic aspects of psychopharmacology.

    PubMed

    Mintz, David L; Flynn, David F

    2012-03-01

    Despite advances in psychopharmacology over the past several decades, treatment outcomes for depression have not substantially improved. Depression is not being eradicated. If anything, the evidence suggests that the problem of depression and treatment-resistant depression is growing, not shrinking. As biologically reductionistic approaches dominate psychiatric practice, patient care has steered away from considering the potent effects of meaning and relationships in the psychopharmacologic treatment of our patients. By construing patients as passive recipients of concrete, specific, and straightforward medical interventions, the field has succumbed to a delusion of precision, and unwittingly moved into an era of treatment resistance in which some of our most potent tools are wasted. In such a model we have settled for treating a disorder rather than a whole person. This article is intended as a step toward remedy. Meaning effects, therapeutic alliance, ambivalence, and patient autonomy, among others, have a powerful and measurable impact on the use of medication that should be considered if we are to treat the whole person. Bringing these elements together into a coherent model of treatment, however, is only a starting point. More research is needed if we are to understand the effects these elements have when used together in an integrated model that is simultaneously personalized and evidence-based.

  14. Psychopharmacology of autism spectrum disorders: a selective review.

    PubMed

    Mohiuddin, Sarah; Ghaziuddin, Mohammad

    2013-11-01

    While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span. This selective review examines recent studies about the use of psychotropic medications in persons with autism spectrum disorder. The aim was to focus on randomized controlled trials conducted from 1990 to 2010 on this topic. A comprehensive literature search was performed using PubMed and Cochrane databases. Out of 105 studies identified for the review, only 24 were randomized controlled trials. Thus, despite the common use of these medications in autism spectrum disorder, more controlled studies are needed to determine their long-term efficacy and safety.

  15. Clinical psychopharmacology and medical malpractice: the four Ds.

    PubMed

    Preskorn, Sheldon H

    2014-09-01

    The four Ds of medical malpractice are duty, dereliction (negligence or deviation from the standard of care), damages, and direct cause. Each of these four elements must be proved to have been present, based on a preponderance of the evidence, for malpractice to be found. The principles of psychopharmacology and the information in the package insert for a drug often play a central role in deciding whether dereliction and direct cause for damages were or were not applicable in a particular case. The author uses data from two cases in which patients were inadvertently fatally poisoned by medication to illustrate two ways in which such information can affect the outcome. In one case, the clinician should have known that he was giving a toxic dose to the patient, whereas that was not true in the other case.

  16. Cause versus association in observational studies in psychopharmacology.

    PubMed

    Andrade, Chittaranjan

    2014-08-01

    Hypotheses may be generated (and conclusions drawn) from observational studies in areas where information from randomized controlled trials (RCTs) is unavailable. However, observational studies can only establish that significant associations exist between predictor and outcome variables. Observational studies cannot establish that the associations identified represent cause-and-effect relationships. This article discusses examples of associations that were identified in observational studies and that were subsequently refuted in RCTs. Examples are also provided of associations that have yet to be confirmed or refuted but that are nevertheless influential in psychopharmacologic practice. Explanations are offered about how confounding might explain significant relationships between variables that are not related by cause and effect. As a conclusion of this exercise, clinicians are cautioned against placing too much reliance on the findings of observational research.

  17. Psychopharmacological studies on (--)-nuciferine and its Hofmann degradation product atherosperminine.

    PubMed

    Bhattacharya, S K; Bose, R; Ghosh, P; Tripathi, V J; Ray, A B; Dasgupta, B

    1978-09-15

    (--)-Nuciferine and its Hofmann degradation product atherosperminine showed divergent psychopharmacological effects. Because nuciferine has been reported to be a neuroleptic and atherosperminine has some chemical resemblance to dopamine, they were investigated for their dopamine-receptor activities. Nuciferine had a pharmacologic profile of action associated with dopamine-receptor blockade; i.e., it induced catalepsy, inhibited spontaneous motor activity, conditioned avoidance response, amphetamine toxicity and stereotypy. On the other hand, atherosperminine produced effects associated with dopamine receptor stimulation, i.e., stereotypy, increase in spontaneous motor activity and amphetamine toxicity, reversal of haloperidol-induced catalepsy and inhibition of conditioned avoidance response, inhibition of morphine analgesia, and potentiation of the anticonvulsant action of diphenylhydantoin. The results are discussed on the basis of the chemical configuration of the two compounds.

  18. Genetic Testing for Psychopharmacology: Is It Ready for Prime Time?

    PubMed

    Leahy, Laura G

    2017-03-01

    Genetic testing in psychiatric practice may be a beneficial adjunct to the nursing toolbox of considerations used to improve patient outcomes. Since 2004, the psychiatric community has used genotyping to personalize medication options for their patients. Although not a definitive or exact science, pharmacogenetic testing for psychopharmacological treatment options offers nurses and their patients insights into potential treatments that will reduce the current trial-and-error prescribing practices and more quickly improve patients' quality of life. The current article guides nurses through the process of conducting genetic testing, interpreting the results, and applying the results in clinical practice using a fictitious case example. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 19-23.]. Copyright 2017, SLACK Incorporated.

  19. The ethics of clinical innovation in psychopharmacology: Challenging traditional bioethics.

    PubMed

    Ghaemi, S Nassir; Goodwin, Frederick K

    2007-11-08

    To assess the scientific and ethical basis for clinical innovation in psychopharmacology. We conducted a literature review, utilizing MEDLINE search and bibliographic cross-referencing, and historical evidence regarding the discovery and development of new medications in psychiatry. Clinical innovation was defined as use of treatments in a clinical setting which have not been well-proven in a research setting. Empirical data regarding the impact of clinical innovation in psychopharmacology are lacking. A conceptual and historical assessment of this topic highlights the ethical and scientific importance of clinical innovation. Ethically, it touches a borderline that, in our judgment, is not adequately framed in contemporary mainstream bioethics. Currently, research is viewed as not at all benefiting the patients who participate in it, while clinical care is viewed as being solely for the benefit of patients. Clinical innovation straddles these two worlds, uncomfortably at times. While many argue that clinical innovation should either be avoided or folded into research projects, we argue that clinical innovation is necessary for progress in psychopharmacology research, and that it can prosper best when guided by the following ethical principles: 1.) The treatment should be based on a viable hypothesis. 2.) Whenever possible, one's clinical observations should be reported so they can be evaluated by the scientific community. 3.) One should be willing to report unexpected observations of drug effects. 4.) A high standard of informed consent should be maintained. Again, this proposal goes against the standard view among bioethicists that research and clinical care are categorically opposed activities, as made clear by the either-or dichotomy of the Belmont Report on bioethics. This approach has so polarized our profession into clinicians versus researchers, that many clinicians will not apply new knowledge produced by clinical research until it eventually gets

  20. Challenges in psychopharmacology: a drug information centre perspective.

    PubMed

    Schjøtt, J

    2016-02-01

    Questions about psychotropic drugs are frequently submitted to drug information centres (DICs). Twenty years' experience from Norwegian DICs was used to identify particular challenges in responding to those questions. Questions about psychopharmacological therapy are usually patient-related and are often difficult to answer. Frequent questions about psychotropic drugs come from experienced senior physicians in disciplines like psychiatry, geriatrics, general practice and neurology. The physicians often ask about specific drug use in pregnancy or breastfeeding, drug combinations and interactions, drug switching and formulations, and drug-withdrawal reactions. There is a lack of relevant information in drug monographs and guidelines to inform answers to the questions posed for the care of individual patients. There is a clear need for these topics to be highlighted in the pre- and postgraduate teaching of physicians. The issues highlighted are likely to be of international relevance based on our experience of the use of international sources of drug information. © 2016 John Wiley & Sons Ltd.

  1. The ethics of clinical innovation in psychopharmacology: Challenging traditional bioethics

    PubMed Central

    Ghaemi, S Nassir; Goodwin, Frederick K

    2007-01-01

    Objective To assess the scientific and ethical basis for clinical innovation in psychopharmacology. Methods We conducted a literature review, utilizing MEDLINE search and bibliographic cross-referencing, and historical evidence regarding the discovery and development of new medications in psychiatry. Clinical innovation was defined as use of treatments in a clinical setting which have not been well-proven in a research setting. Results Empirical data regarding the impact of clinical innovation in psychopharmacology are lacking. A conceptual and historical assessment of this topic highlights the ethical and scientific importance of clinical innovation. Ethically, it touches a borderline that, in our judgment, is not adequately framed in contemporary mainstream bioethics. Currently, research is viewed as not at all benefiting the patients who participate in it, while clinical care is viewed as being solely for the benefit of patients. Clinical innovation straddles these two worlds, uncomfortably at times. While many argue that clinical innovation should either be avoided or folded into research projects, we argue that clinical innovation is necessary for progress in psychopharmacology research, and that it can prosper best when guided by the following ethical principles: 1.) The treatment should be based on a viable hypothesis. 2.) Whenever possible, one's clinical observations should be reported so they can be evaluated by the scientific community. 3.) One should be willing to report unexpected observations of drug effects. 4.) A high standard of informed consent should be maintained. Again, this proposal goes against the standard view among bioethicists that research and clinical care are categorically opposed activities, as made clear by the either-or dichotomy of the Belmont Report on bioethics. This approach has so polarized our profession into clinicians versus researchers, that many clinicians will not apply new knowledge produced by clinical research until it

  2. Brave New World versus Island--utopian and dystopian views on psychopharmacology.

    PubMed

    Schermer, M H N

    2007-06-01

    Aldous Huxley's Brave New World is a famous dystopia, frequently called upon in public discussions about new biotechnology. It is less well known that 30 years later Huxley also wrote a utopian novel, called Island. This paper will discuss both novels focussing especially on the role of psychopharmacological substances. If we see fiction as a way of imagining what the world could look like, then what can we learn from Huxley's novels about psychopharmacology and how does that relate to the discussion in the ethical and philosophical literature on this subject? The paper argues that in the current ethical discussion the dystopian vision on psychopharmacology is dominant, but that a comparison between Brave New World and Island shows that a more utopian view is possible as well. This is illustrated by a discussion of the issue of psychopharmacology and authenticity. The second part of the paper draws some further conclusions for the ethical debate on psychopharmacology and human enhancement, by comparing the novels not only with each other, but also with our present reality. It is claimed that the debate should not get stuck in an opposition of dystopian and utopian views, but should address important issues that demand attention in our real world: those of evaluation and governance of enhancing psychopharmacological substances in democratic, pluralistic societies.

  3. A proposal for a psychopharmacology-pharmacotherapy catalogue of learning objectives and a curriculum in Europe.

    PubMed

    Baumann, Pierre; Spies, Marie; Möller, Hans-Jürgen; Kasper, Siegfried; Bitter, Istvan; Laux, Gerd

    2017-02-01

    Objectives Post-graduate training for specialisation in psychiatry and psychotherapy is part of a 4-6-year programme. This paper aims to inform on the general situation of teaching and training of psychopharmacology-psychopharmacotherapy in Europe. It presents the need for a psychopharmacotherapy education in psychiatric training programmes. Arguments as well as a proposal for a catalogue of learning objectives and an outline of a psychopharmacology curriculum are presented. Methods Based on their experience and on an analysis of the literature, the authors, experts in psychopharmacology-pharmacotherapy teaching, critically analyse the present situation and propose the development of a curriculum at the European level. Results Teaching programmes vary widely between European countries and, generally, teaching of psychopharmacology and pharmacotherapy does not exceed two-dozen hours. This is insufficient if one considers the central importance of psychopharmacology. A psychopharmacology-psychopharmacotherapy curriculum for the professional training of specialists in psychiatry and psychotherapy is proposed. Conclusions As the number of hours of theoretical teaching and practical training is insufficient, a catalogue of learning objectives should be established, which would then be part of a comprehensive curriculum at the European level. It could be inspired partly by those few previously proposed by other groups of authors and organisations.

  4. The Role of the Therapeutic Relationship in Psychopharmacological Treatment Outcomes: A Meta-analytic Review.

    PubMed

    Totura, Christine M Wienke; Fields, Sherecce A; Karver, Marc S

    2017-09-15

    Patient nonadherence to psychopharmacological treatment is a significant barrier to effective treatment. The therapeutic relationship is known to be a critical component of effective psychological treatment, but it has received limited study. A meta-analysis was conducted to examine the role of the therapeutic relationship in the delivery of effective psychopharmacological treatment. PubMed, PsycINFO, CINAHL, Google Scholar, Ingenta, and the Web of Science-Science Citation Index were searched, including reference lists of found articles. Meta-analytic methods were used to examine the association between the physician-patient therapeutic relationship and outcomes in psychopharmacological treatment. Eight independent studies of psychopharmacological treatment reported in nine articles met the inclusion criterion (1,065 participants) of being an empirically based study in which measures of the therapeutic relationship were administered and psychiatric treatment outcomes were assessed. The overall average weighted effect size for the association between the therapeutic relationship and treatment outcomes was z=.30 (95% confidence interval=.20-.39), demonstrating a statistically significant, moderate effect. Findings indicate that a positive therapeutic relationship or alliance between the physician and the psychiatric patient is associated with patient improvement over the course of psychopharmacological treatment. Results suggest that more attention should be paid to psychiatrist communication skills that may enhance the therapeutic alliance in psychopharmacological treatment.

  5. Odds and ends in psychopharmacology from the past 10 years.

    PubMed

    Howland, Robert H

    2015-01-01

    Seven topics previously described in this column are revisited. The use of quantitative electroencephalography has been shown in a prospective study to be effective for predicting antidepressant treatment response. A novel antidepressant drug, agomelatine, has generated much controversy, and its development for the U.S. market was discontinued. A long awaited revised system for categorizing the safety of medications during pregnancy and lactation has finally been published by the Food and Drug Administration. Dextromethorphan/quinidine, eslicarbazepine acetate, levomilnacipran, and esketamine are recent examples of drugs that were developed based on the complex concepts of chirality and stereochemistry. Lisdexamfetamine, a stimulant drug, failed to show benefit as an augmentation therapy for the treatment of depression. The combination drug naltrexone/bupropion was finally approved as a therapy for obesity, after its cardiovascular safety was confirmed in a prospective premarketing study. Further development of the glucocorticoid receptor antagonist drug mifepristone as a treatment for psychotic depression was stopped based on a large negative trial, but the drug continues to be investigated for other potential psychiatric indications. These examples illustrate how the field of psychopharmacology continues to evolve.

  6. Authenticity Anyone? The Enhancement of Emotions via Neuro-Psychopharmacology.

    PubMed

    Kraemer, Felicitas

    2011-04-01

    This article will examine how the notion of emotional authenticity is intertwined with the notions of naturalness and artificiality in the context of the recent debates about 'neuro-enhancement' and 'neuro-psychopharmacology.' In the philosophy of mind, the concept of authenticity plays a key role in the discussion of the emotions. There is a widely held intuition that an artificial means will always lead to an inauthentic result. This article, however, proposes that artificial substances do not necessarily result in inauthentic emotions. The literature provided by the philosophy of mind on this subject usually resorts to thought experiments. On the other hand, the recent literature in applied ethics on 'enhancement' provides good reasons to include real world examples. Such case studies reveal that some psychotropic drugs such as antidepressants actually cause people to undergo experiences of authenticity, making them feel 'like themselves' for the first time in their lives. Beginning with these accounts, this article suggests three non-naturalist standards for emotions: the authenticity standard, the rationality standard, and the coherence standard. It argues that the authenticity standard is not always the only valid one, but that the other two ways of assessing emotions are also valid, and that they can even have repercussions on the felt authenticity of emotions. In conclusion, it sketches some of the normative implications if not ethical intricacies that accompany the enhancement of emotions.

  7. The impact of classification on psychopharmacology and biological psychiatry

    PubMed Central

    van Praag, Herman M.

    1999-01-01

    Nosological classification in psychiatry, as it is currently applied, does not facilitate biological and psychopharmacological research. • Syndromal acuity has disappeared. Consequently, it is impossible to determine: (i) vi/hether a particular drug affects a particular symptom configuration; (ii) what exactly the behavioral correlate of a particular biological disturbance is. The problem of unfocused diagnoses is greatly magnified by the phenomenon called comorbidity. • The boundary between distress and disorder is illdefined. • Symptom configuration and certain nonsymptomatological variables such as duration and severity are prematurely linked, so as to conceptualize categorical entities. The validity of those constructs has not been sufficiently demonstrated. This undermines the validity of biological studies and leads to “nosologomania,” ie, an ever-growing series of undervalidated psychiatric “disorders.” • Symptoms are grouped horizontally as if they all had the same diagnostic “valence.” This, however, is highly unlikely. • The nosological disease model is unconditionally and uncritically accepted. Alternative models are ignored, particularly the reaction-form model, though it has substantial heuristic value, and deserves to be thoroughly scrutinized. (Research) strategies to remedy this situation are pointed out. PMID:22034250

  8. Clinical psychopharmacology of AD/HD: implications for animal models.

    PubMed

    Solanto, M V

    2000-01-01

    A working knowledge of the clinical psychopharmacology of the psychostimulants in AD/HD is essential to the development of valid animal models of the disorder. The clinical pharmacokinetics and pharmacodynamics of D-amphetamine (D-AMP) and methylphenidate (MPH) have been well-studied. The plasma half-life of these compounds in children is approximately 5 h, with an onset of therapeutic action within a half-hour, and peak action at 1-3 h. The effective dose range for D-AMP in children is 0.2-0.5 mg/kg, and for MPH 0.3-1.0 mg/kg. In humans, psychostimulants bring about reductions in activity level and impulsivity, and improvement in attention span. Enhancement of executive processes mediated in the pre-frontal cortex in humans (especially tolerance for delay) is believed to mediate these therapeutic effects. There are no long-term remedial effects of the drug on behavior-i.e. symptoms return when the drugs are withdrawn. When used in the therapeutic dose range, there is no evidence of the development of significant tolerance or sensitization. These and other clinical findings to be discussed must guide and constrain the development of animal models of stimulant drug effects in AD/HD.

  9. Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach

    PubMed Central

    De las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

    2017-01-01

    Purpose To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients’ adherence to psychopharmacological medications. Method A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Results Structural equation modeling demonstrated that psychiatric patients’ treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients’ trust in their psychiatrists (doctors’ subscale), 3) negatively with patients’ belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. Conclusion This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients’ adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients’ psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications. PMID:28405160

  10. Integrating psychosocial concepts into psychopharmacology training: a survey study of program directors and chief residents.

    PubMed

    Mallo, C Jason; Mintz, David L; Lewis, Katie C

    2014-06-01

    A growing body of evidence suggests that psychiatric medication outcomes are shaped significantly by psychological and social factors surrounding the prescribing process. Little, however, is known about the extent to which psychiatry programs integrate this evidence base into residency training or the methods by which this is accomplished. Psychiatry residency program directors and chief residents participated in an exploratory online survey to establish how psychosocial factors known to impact medication outcomes are integrated into psychopharmacology education. While participants highly valued the importance of psychosocial factors in the prescribing process, there was limited emphasis of these factors in psychopharmacology training. Additionally, some teaching methods that could advance understanding of complex interactions in the psychopharmacology relationship were found to be underutilized. Given that medication outcomes are significantly influenced by psychosocial factors, psychiatric educators have a responsibility to teach residents about the evidence base available. Residents exposed to this evidence base will be better equipped to manage the complexities of the psychopharmacology role. The results of this study offer clues as to how psychosocial factors may be more fully integrated into residency psychopharmacology training.

  11. A bibliometric analysis of research in psychopharmacology by psychology departments (1987-2007).

    PubMed

    Portillo-Salido, Enrique F

    2010-05-01

    From the very outset of scientific Psychology, psychologists have shown interest for drugs and their effects on behavior. This has given rise to numerous contributions, mostly in the form of Psychopharmacology publications. The aim of this study was to quantitatively evaluate these contributions and compare them with other academic disciplines related to Psychopharmacology. Using the PubMed database, we retrieved information about articles from 15 journals included in the Pharmacology and Pharmacy category of the Journal Citation Reports database for a 21-year period (1987 to 2007). There were 37540 articles which about 52% were represented by 3 journals. About 70% of psychology publications were represented by 2 of these journals. Psychology departments accounted for the 11% of the published papers, which places Psychology third behind Psychiatry and Pharmacology, which contributed to 22.69 and 13% respectively. Psychology contributed to the greatest number of studies in 3 journals, second in 3 and third in 8. This report represents the first effort to explore the contribution of academic Psychology to the multidisciplinary science of psychopharmacology. Although leaders of production of psychopharmacology research were from Psychiatry and Pharmacology, Psychology departments are an important source of studies and thus of knowledge in the field of Psychopharmacology.

  12. Assessment of psychopharmacology on the American Board of Psychiatry and Neurology examinations.

    PubMed

    Juul, Dorthea; Winstead, Daniel K; Sheiber, Stephen C

    2005-01-01

    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). 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. 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. This review indicated that knowledge of psychopharmacology was a significant component of the ABPN's core competencies and of its certification and recertification exams.

  13. Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.

    PubMed

    De Las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

    2017-01-01

    To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications. A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

  14. The interaction of ethnicity, sociocultural factors, and gender in clinical psychopharmacology.

    PubMed

    Dawkins, K

    1996-01-01

    There is increased interest in the role that ethnicity, sociocultural factors, and gender play in research, health care delivery, and response to intervention. The impact of these factors on AIDS awareness programs, on the phenomenology of suicide and anorexia nervosa, and on clinical psychopharmacology in a homogeneous population is discussed. Risky sex practices can be related to cultural norms that stigmatize condom use and sex education; economic deprivation; and male dominance. Gender, cultural, and ethnic demographics can identify high-risk groups as well as influence effective interventions. Suicide rates and risk factors are compared in African-American, Canadian Native, and South Korean adolescents. Academic stress was a differential risk factor for the Koreans. Anorexia nervosa predominantly affects women and has cultural differences in prevalence. The homogeneous population in Hong Kong illustrates the impact of ethnicity, sociocultural factors, and gender on clinical psychopharmacology. Attention to ethnicity, sociocultural factors, and gender can individualize and improve the effectiveness of clinical psychopharmacology.

  15. [A unique psychopharmacologic profile of adrafinil in mice].

    PubMed

    Rambert, F A; Pessonnier, J; de Sereville, J E; Pointeau, A M; Duteil, J

    1986-01-01

    The following psychopharmacological effects of adrafinil have been observed in mice: increase in locomotor activity (64-256 mg.kg-1), antagonism (16-128 mg.kg-1) of the hypnotic effects of barbitone but not of pentobarbitone, reduction of immobility duration in the forced swimming test (16-256 mg.kg-1); slight antagonism (256 mg.kg-1) of electroshock-induced convulsions; no modification of rectal temperature; no stereotyped or climbing behaviour; no increase in lethality in aggregated mice (LD50 isolated = 1022 mg.kg-1, LD50 aggregated = 859 mg.kg-1); lack of effects on the provisional tests for antidepressants: no interaction with reserpine-, oxotremorine-, or apomorphine-induced hypothermia but potentiation of yohimbine-induced toxicity; lack of peripheral sympathetic effects (no mydriasis, no salivation, no contraction of the pilomotor muscles, no antagonism of reserpine-induced ptosis); lack of peripheral anticholinergic effects (no mydriasis, no antagonism of oxotremorine-induced salivation or lacrimation). As compared to no analeptic, anticholinergic or antidepressant drugs, adrafinil shows a unique behavioural profile in mice defined on the one hand by a specific stimulant activity associated with antidepressant-like effects that do no seem related to a beta-adrenergic mechanism and on the other hand by a lack of dopaminergic effects. Most adrafinil-induced effects (increase in locomotor activity, reduction of immobility duration in the forced swimming test) may correspond to a central alpha 1-adrenergic stimulation, but the unexpected lack of peripheral sympathetic effects remains unexplained.

  16. Psychodynamic Trojan horses: using psychopharmacology to teach psychodynamics.

    PubMed

    Mintz, David

    2006-01-01

    Concurrences of scientific, cultural, and economic developments in the past decade have changed psychiatric practice and psychiatric training. The explosion in neurobiological sciences has left residents with an overwhelming amount of neurobiology to master at the same time that managed care has led to a de-emphasis on psychiatrists providing psychotherapy. Consequently, many residents are left questioning the relevance of psychodynamics for psychiatry, given that the majority will function primarily as prescribers. However, the illusion, increasingly common in our culture, that medications are a simple fix leaves residents unprepared to make sense of the complex and irrational processes that happen in the acts of prescribing and taking medications (or not taking medications). Consequently, residents may feel confused, angry, hopeless, and/or abandoned in their role. These residents are often hungry for a context to explain why they feel hopeless, confused, or defeated in carrying out the "simple" task of prescribing. A psychodynamic understanding can provide such a holding context, just as it can give residents tools for backing out of futile and/or destructive enactments and turning conflicts around medications to some therapeutic good. Many psychodynamic concepts that initially may have seemed to residents part of some arcane and outmoded pseudoscience suddenly become relevant when they provide both a context for understanding the resident's distress and useful clinical tools. Those psychodynamic psychiatrists wishing to promulgate a psychodynamic understanding may need to meet psychiatric trainees at their developmental level and take seriously the current emphasis on providing effective somatic treatments. By engaging trainees at the junction of psychodynamics and psychopharmacology, psychodynamic psychiatrists may find a more receptive audience and open the door for greater interest in developing psychodynamic understanding and technical skills.

  17. Methylxanthines are the psycho-pharmacologically active constituents of chocolate.

    PubMed

    Smit, Hendrik J; Gaffan, Elizabeth A; Rogers, Peter J

    2004-11-01

    Liking, cravings and addiction for chocolate ("chocoholism") are often explained through the presence of pharmacologically active compounds. However, mere "presence" does not guarantee psycho-activity. Two double-blind, placebo-controlled studies measured the effects on cognitive performance and mood of the amounts of cocoa powder and methylxanthines found in a 50 g bar of dark chocolate. In study 1, participants ( n=20) completed a test battery once before and twice after treatment administration. Treatments included 11.6 g cocoa powder and a caffeine and theobromine combination (19 and 250 mg, respectively). Study 2 ( n=22) comprised three post-treatment test batteries and investigated the effects of "milk" and "dark" chocolate levels of these methylxanthines. The test battery consisted of a long duration simple reaction time task, a rapid visual information processing task, and a mood questionnaire. Identical improvements on the mood construct "energetic arousal" and cognitive function were found for cocoa powder and the caffeine+theobromine combination versus placebo. In chocolate, both "milk chocolate" and "dark chocolate" methylxanthine doses improved cognitive function compared with "white chocolate". The effects of white chocolate did not differ significantly from those of water. A normal portion of chocolate exhibits psychopharmacological activity. The identical profile of effects exerted by cocoa powder and its methylxanthine constituents shows this activity to be confined to the combination of caffeine and theobromine. Methylxanthines may contribute to the popularity of chocolate; however, other attributes are probably much more important in determining chocolate's special appeal and in explaining related self-reports of chocolate cravings and "chocoholism".

  18. Posttraumatic Stress Disorder in Children and Adolescents: A Review of Psychopharmacological Treatment

    ERIC Educational Resources Information Center

    Huemer, J.; Erhart, F.; Steiner, H.

    2010-01-01

    PTSD in children and adolescents differs from the adult disease. Therapeutic approaches involve both psychotherapy and psychopharmacotherapy. Objectives: The current paper aims at reviewing studies on psychopharmacological treatment of childhood and adolescent PTSD. Additionally, developmental frameworks for PTSD diagnosis and research along with…

  19. Practical Paediatric Psychopharmacological Prescribing in Autism: The Potential and the Pitfalls.

    ERIC Educational Resources Information Center

    Gringras, Paul

    2000-01-01

    This article discusses the evidence behind two approaches to psychopharmacological management in children with autism: selecting and treating target symptoms or treatment or curing the primary social impairment underlying autism. The effectiveness of stimulants, antidepressants, melatonin, naltrexone, fenfluramine, and secretin is appraised. The…

  20. Psychopharmacological Treatment Options for Global Child and Adolescent Mental Health: The WHO Essential Medicines Lists

    ERIC Educational Resources Information Center

    Kutcher, Stan; Murphy, Andrea; Gardner, David

    2008-01-01

    The article examines the World Health Organization's Model List of Essential Medicines (EML) and suggests modification for appropriate psychopharmacological treatment of child- and adolescent-onset mental disorders. The EML enlists few of the psychotropic medicines that are useful for the treatment of young people thereby limiting the…

  1. Mental Health Issues among College Students: Who Gets Referred for Psychopharmacology Evaluation?

    ERIC Educational Resources Information Center

    Kirsch, Daniel J.; Doerfler, Leonard A.; Truong, Debbie

    2015-01-01

    Objective: To describe diagnostic and psychotropic medication prescription characteristics among college students referred by college counseling centers for psychopharmacologic evaluation. Participants: Participants were 540 college students referred by 6 college counseling centers in Massachusetts between November 2005 and May 2011. Methods:…

  2. Psychopharmacological Treatment Options for Global Child and Adolescent Mental Health: The WHO Essential Medicines Lists

    ERIC Educational Resources Information Center

    Kutcher, Stan; Murphy, Andrea; Gardner, David

    2008-01-01

    The article examines the World Health Organization's Model List of Essential Medicines (EML) and suggests modification for appropriate psychopharmacological treatment of child- and adolescent-onset mental disorders. The EML enlists few of the psychotropic medicines that are useful for the treatment of young people thereby limiting the…

  3. Pediatric Psychopharmacology and Prescription Privileges: Implications and Opportunities for School Psychology.

    ERIC Educational Resources Information Center

    Kubiszyn, Tom

    1994-01-01

    Reviews literature on pediatric psychopharmacology practice, lack of empirical support for efficacy and safety of most psychotropics for pediatric use, and need for further basic and clinical trials research and evaluation. Identifies shortcomings in training and experience that must be addressed if school psychology is to meet demands of three…

  4. Comparison of Increasingly Detailed Elicitation Methods for the Assessment of Adverse Events in Pediatric Psychopharmacology.

    ERIC Educational Resources Information Center

    Greenhill, Laurence L.; Vitiello, Benedetto; Fisher, Prudence; Levine, Jerome; Davies, Mark; Abikoff, Howard; Chrisman, Allan K.; Chuang, Shirley; Findling, Robert L.; March, John; Scahill, Lawrence; Walkup, John; Riddle, Mark A.

    2004-01-01

    Objective: To improve the gathering of adverse events (AEs) in pediatric psychopharmacology by examining the value and acceptability of increasingly detailed elicitation methods. Method: Trained clinicians administered the Safety Monitoring Uniform Report Form (SMURF) to 59 parents and outpatients (mean age [+ or -] SD = 11.9 [+ or -] 3.2 years)…

  5. Child and Adolescent Psychopharmacology in the New Millennium: A Workshop for Academia, Industry, and Government

    ERIC Educational Resources Information Center

    Deveaugh-Geiss, Joseph; March, John; Shapiro, Mark; Andreason, Paul J.; Emslie, Graham; Ford, Lisa M.; Greenhill, Laurence; Murphy, Dianne; Prentice, Ernest; Roberts, Rosemary; Silva, Susan; Swanson, James M.; van Zwieten-Boot, Barbara; Vitiello, Benedetto; Wagner, Karen Dineen; Mangum, Barry

    2006-01-01

    Objective: To give academic researchers, government officials, and industry scientists an opportunity to assess the state of pediatric psychopharmacology and identify challenges facing professionals in the field. Method: Increased federal spending and the introduction of pediatric exclusivity led to large increases in pediatric psychopharmacology…

  6. The Role of the Pharmaceutical Industry in Teaching Psychopharmacology: A Growing Problem

    ERIC Educational Resources Information Center

    Brodkey, Amy C.

    2005-01-01

    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…

  7. The Challenge of Teaching Psychopharmacology in the New Millennium: The Role of Curricula

    ERIC Educational Resources Information Center

    Glick, Ira D.; Zisook, Sidney

    2005-01-01

    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…

  8. The Formal Instruction of Psychopharmacology in CACREP-Accredited Counselor Education Programs

    ERIC Educational Resources Information Center

    Sepulveda, Victoria I.

    2011-01-01

    Counseling professionals and researchers have advocated for counselor training in psychopharmacology in order to heighten counselors' awareness of client needs and treatment standards (Ingersoll, 2000; King & Anderson, 2004; Smith & Garcia, 2003). There has been a lack of this training within counselor education graduate programs (Buelow, Hebert,…

  9. Back to the future of psychopharmacology: A perspective on animal models in drug discovery.

    PubMed

    Hendriksen, Hendrikus; Groenink, Lucianne

    2015-07-15

    Psychopharmacology has had some bad publicity lately. Frankly, there have been some major problems along the way in developing new effective drugs for psychiatric disorders. After a prolonged period of high investments but low success rates, big pharmaceutical companies seem to retract their activities in the psychopharmacology field. Yet, the burden of mental disorders is likely to keep on growing in the next decades. In this position paper, we focus on drug development for depression and anxiety disorders, to narrow the scope of the assay. We describe the current situation of the psychopharmacology field, and analyse some of the methods and paradigms that have brought us here, but which should perhaps change to bring us even further. In addition, some of the factors contributing to the current stagnation in psychopharmacology are discussed. Finally, we suggest a number of changes that could lead to a more rational strategy for central nervous system drug development and which may circumvent some of the pitfalls leading to "me too" approaches. Central to the suggested changes, is the notion that mental disorders do not lead to several symptoms, but a network of causally related symptoms convolutes into a mental disorder. We call upon academia to put these changes in the early phases of drug development into effect.

  10. Current Practices and Future Directions in Psychopharmacological Training and Collaboration in School Psychology

    ERIC Educational Resources Information Center

    Sulkowski, Michael L.; Jordan, Cary; Nguyen, Matthew L.

    2009-01-01

    School psychologists frequently examine children who are prescribed psychotropic medications. With advanced training in psychological assessment and professional consultation, school psychologists may play an integral role in assisting with children's psychopharmacological treatment regimens. In this vein, this article discusses various ways for…

  11. Guidelines, Algorithms, and Evidence-Based Psychopharmacology Training for Psychiatric Residents

    ERIC Educational Resources Information Center

    Osser, David N.; Patterson, Robert D.; Levitt, James J.

    2005-01-01

    Objective: The authors describe a course of instruction for psychiatry residents that attempts to provide the cognitive and informational tools necessary to make scientifically grounded decision making a routine part of clinical practice. Methods: In weekly meetings over two academic years, the course covers the psychopharmacology of various…

  12. Psychopharmacology for Children and Adolescents: Commentary on Current Issues and Future Challenges.

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.

    1994-01-01

    Notes that biological interventions have been relatively neglected within field of school psychology in terms of its professional training, research agendas, and professional relationships with other specialties within psychology. Responds to previous articles in this special miniseries on psychopharmacology with children and adolescents, and…

  13. [Notes for a discussion on the notion of resistance in psychopharmacology].

    PubMed

    Levin, Santiago

    2005-01-01

    The present work's purpose is to open a discussion on the notion of Resistance in Psychopharmacology. Despite the fact that the phenomenon is observable in psychiatric practice, its meaning and consequences for medical practice are not sufficiently established, so that a critical reformulation is required for the sake of greater conceptual clarity in this area.

  14. Integrating Genetic, Psychopharmacological and Neuroimaging Studies: A Converging Methods Approach to Understanding the Neurobiology of ADHD

    ERIC Educational Resources Information Center

    Durston, Sarah; Konrad, Kerstin

    2007-01-01

    This paper aims to illustrate how combining multiple approaches can inform us about the neurobiology of ADHD. Converging evidence from genetic, psychopharmacological and functional neuroimaging studies has implicated dopaminergic fronto-striatal circuitry in ADHD. However, while the observation of converging evidence from multiple vantage points…

  15. Psychopharmacology Research for Individuals with Mental Retardation: Methodological Issues and Suggestions.

    ERIC Educational Resources Information Center

    Matson, Johnny L.; Bielecki, JoAnne; Mayville, Stephen B.; Matson, Michael L.

    2003-01-01

    A review found many of the studies that have assessed the efficacy of psychotropic medications with individuals with mental retardation (MR) are methodologically flawed. It details suggestions to improve the quality of medication studies and avoid methodological problems that prevent the scientific advancement of psychopharmacological research…

  16. The Formal Instruction of Psychopharmacology in CACREP-Accredited Counselor Education Programs

    ERIC Educational Resources Information Center

    Sepulveda, Victoria I.

    2011-01-01

    Counseling professionals and researchers have advocated for counselor training in psychopharmacology in order to heighten counselors' awareness of client needs and treatment standards (Ingersoll, 2000; King & Anderson, 2004; Smith & Garcia, 2003). There has been a lack of this training within counselor education graduate programs (Buelow, Hebert,…

  17. Current Practices and Future Directions in Psychopharmacological Training and Collaboration in School Psychology

    ERIC Educational Resources Information Center

    Sulkowski, Michael L.; Jordan, Cary; Nguyen, Matthew L.

    2009-01-01

    School psychologists frequently examine children who are prescribed psychotropic medications. With advanced training in psychological assessment and professional consultation, school psychologists may play an integral role in assisting with children's psychopharmacological treatment regimens. In this vein, this article discusses various ways for…

  18. The Role of the Pharmaceutical Industry in Teaching Psychopharmacology: A Growing Problem

    ERIC Educational Resources Information Center

    Brodkey, Amy C.

    2005-01-01

    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…

  19. Guidelines, Algorithms, and Evidence-Based Psychopharmacology Training for Psychiatric Residents

    ERIC Educational Resources Information Center

    Osser, David N.; Patterson, Robert D.; Levitt, James J.

    2005-01-01

    Objective: The authors describe a course of instruction for psychiatry residents that attempts to provide the cognitive and informational tools necessary to make scientifically grounded decision making a routine part of clinical practice. Methods: In weekly meetings over two academic years, the course covers the psychopharmacology of various…

  20. Mental Health Issues among College Students: Who Gets Referred for Psychopharmacology Evaluation?

    ERIC Educational Resources Information Center

    Kirsch, Daniel J.; Doerfler, Leonard A.; Truong, Debbie

    2015-01-01

    Objective: To describe diagnostic and psychotropic medication prescription characteristics among college students referred by college counseling centers for psychopharmacologic evaluation. Participants: Participants were 540 college students referred by 6 college counseling centers in Massachusetts between November 2005 and May 2011. Methods:…

  1. Child and Adolescent Psychopharmacology in the New Millennium: A Workshop for Academia, Industry, and Government

    ERIC Educational Resources Information Center

    Deveaugh-Geiss, Joseph; March, John; Shapiro, Mark; Andreason, Paul J.; Emslie, Graham; Ford, Lisa M.; Greenhill, Laurence; Murphy, Dianne; Prentice, Ernest; Roberts, Rosemary; Silva, Susan; Swanson, James M.; van Zwieten-Boot, Barbara; Vitiello, Benedetto; Wagner, Karen Dineen; Mangum, Barry

    2006-01-01

    Objective: To give academic researchers, government officials, and industry scientists an opportunity to assess the state of pediatric psychopharmacology and identify challenges facing professionals in the field. Method: Increased federal spending and the introduction of pediatric exclusivity led to large increases in pediatric psychopharmacology…

  2. Comparison of Increasingly Detailed Elicitation Methods for the Assessment of Adverse Events in Pediatric Psychopharmacology.

    ERIC Educational Resources Information Center

    Greenhill, Laurence L.; Vitiello, Benedetto; Fisher, Prudence; Levine, Jerome; Davies, Mark; Abikoff, Howard; Chrisman, Allan K.; Chuang, Shirley; Findling, Robert L.; March, John; Scahill, Lawrence; Walkup, John; Riddle, Mark A.

    2004-01-01

    Objective: To improve the gathering of adverse events (AEs) in pediatric psychopharmacology by examining the value and acceptability of increasingly detailed elicitation methods. Method: Trained clinicians administered the Safety Monitoring Uniform Report Form (SMURF) to 59 parents and outpatients (mean age [+ or -] SD = 11.9 [+ or -] 3.2 years)…

  3. Pediatric Psychopharmacology and Prescription Privileges: Implications and Opportunities for School Psychology.

    ERIC Educational Resources Information Center

    Kubiszyn, Tom

    1994-01-01

    Reviews literature on pediatric psychopharmacology practice, lack of empirical support for efficacy and safety of most psychotropics for pediatric use, and need for further basic and clinical trials research and evaluation. Identifies shortcomings in training and experience that must be addressed if school psychology is to meet demands of three…

  4. The Challenge of Teaching Psychopharmacology in the New Millennium: The Role of Curricula

    ERIC Educational Resources Information Center

    Glick, Ira D.; Zisook, Sidney

    2005-01-01

    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…

  5. Psychopharmacology for Children and Adolescents: Commentary on Current Issues and Future Challenges.

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.

    1994-01-01

    Notes that biological interventions have been relatively neglected within field of school psychology in terms of its professional training, research agendas, and professional relationships with other specialties within psychology. Responds to previous articles in this special miniseries on psychopharmacology with children and adolescents, and…

  6. An Update on Psychopharmacologic Medication: What Teachers, Clinicians, and Parents Need To Know.

    ERIC Educational Resources Information Center

    Sweeney, Dwight P.; Forness, Steven R.; Kavale, Kenneth A.; Levitt, Jennifer G.

    1997-01-01

    Discusses the potential uses and abuses of psychopharmacologic therapy with children or adolescents who display learning, emotional, or behavioral disorders. Explores the indications and contraindications of such therapy and enumerates the known side effects of the most frequently prescribed medications, including psychostimulants,…

  7. Practical Paediatric Psychopharmacological Prescribing in Autism: The Potential and the Pitfalls.

    ERIC Educational Resources Information Center

    Gringras, Paul

    2000-01-01

    This article discusses the evidence behind two approaches to psychopharmacological management in children with autism: selecting and treating target symptoms or treatment or curing the primary social impairment underlying autism. The effectiveness of stimulants, antidepressants, melatonin, naltrexone, fenfluramine, and secretin is appraised. The…

  8. Integrating Genetic, Psychopharmacological and Neuroimaging Studies: A Converging Methods Approach to Understanding the Neurobiology of ADHD

    ERIC Educational Resources Information Center

    Durston, Sarah; Konrad, Kerstin

    2007-01-01

    This paper aims to illustrate how combining multiple approaches can inform us about the neurobiology of ADHD. Converging evidence from genetic, psychopharmacological and functional neuroimaging studies has implicated dopaminergic fronto-striatal circuitry in ADHD. However, while the observation of converging evidence from multiple vantage points…

  9. Psychopharmacology Training and Canadian Counsellors: Are We Getting What We Want and Need?

    ERIC Educational Resources Information Center

    Schaefer, David; Wong-Wylie, Gina

    2008-01-01

    The psychopharmacology training experiences and attitudes of Canadian counsellors were the focus of our national Internet-based survey. This study was part of a larger investigation on Canadian counsellors' attitudes, practices, and training experiences related to clients on antidepressants. Results of the current study indicate Canadian…

  10. An Update on Psychopharmacologic Medication: What Teachers, Clinicians, and Parents Need To Know.

    ERIC Educational Resources Information Center

    Sweeney, Dwight P.; Forness, Steven R.; Kavale, Kenneth A.; Levitt, Jennifer G.

    1997-01-01

    Discusses the potential uses and abuses of psychopharmacologic therapy with children or adolescents who display learning, emotional, or behavioral disorders. Explores the indications and contraindications of such therapy and enumerates the known side effects of the most frequently prescribed medications, including psychostimulants,…

  11. Mentoring treatment teams to integrate behavioral and psychopharmacological treatments in developmental disabilities.

    PubMed

    Singh, Nirbhay N; Wahler, Robert G; Sabaawi, Mohamed; Goza, Amanda B; Singh, Subhashni D; Molina, Enrique J; Winton, Alan S W; Strand, Paul S; Hill, Oliver W; Singh, Judy; Barber, Jack W; El-Sabaawi, Mohamed; Dumas, Jean

    2002-01-01

    Individuals with developmental disabilities often have a concomitant psychiatric disorder severe enough to require treatment. The behavioral endpoint of psychiatric disorders may require integrated behavioral and psychopharmacological treatments to stabilize their condition and enhance their quality of life. We used a mindfulness-based mentoring model to facilitate the integration of behavioral and psychopharmacological treatments at the treatment team level. Using a multiple baseline design across treatment teams, we assessed the degree of integration of these two treatment modalities using a 23-item rating scale, and then introduced mentoring successively across the three treatment teams. Following mentoring, six follow-up assessments at monthly intervals were undertaken to assess functioning of the treatment teams in the absence of mentoring. The low levels of integration of behavioral and psychopharmacological treatments occurring during baseline improved significantly within each team commensurate with the mentoring. Further, the enhanced treatment team functioning was maintained during a 6-month follow-up period. Mentoring of treatment teams may be an effective first step in integrating behavioral and psychopharmacological treatments that are deemed essential in the care and treatment of individuals with developmental disabilities and mental illness.

  12. Does psychopharmacology training enhance the knowledge of mental health nurses who prescribe?

    PubMed

    Jones, M; Robson, D; Whitfield, S; Gray, R

    2010-11-01

    The implementation of Mental Health Nurse (MHN) prescribing in the UK remains disappointing. A much cited critique of MHNs prescribing is that it would be unsafe, as MHN would not have the appropriate knowledge of pharmacology to practise mental health prescribing. The knowledge of pharmacology of MHNs with the prescribing qualification has not been assessed in the UK. In addition, the views of MHNs with the prescribing qualification who have undertaken a psychopharmacology course have not been explored. The aims of this study are to measure the efficacy of a 10-day advanced training programme on psychopharmacology on the knowledge levels of MHNs with the prescribing qualification; and to explore the positive and negative experiences of individual participants of the training in psychopharmacology and how it supported their prescribing practice. A repeated measures design was used in which participants acted as their own controls. Participants were assessed 10 weeks before the training programme and again on day one of the training programme using a Multiple Choice Questionnaire. In addition, a series of focus groups were conducted to explore the helpful and unhelpful aspects of the course in sustaining the MHNs' prescribing practice. Following the training period there were significant increases in the MHNs' knowledge of psychopharmacology in comparison with the two base line means. Participants when interviewed 18 months after completing the training described the training as a helpful though they described it had not resulted in large increases in prescribing practice, citing systemic barriers to its implementation. Short and focussed training for MHNs who prescribe may increase their knowledge of psychopharmacology. The development of such programmes may well be part of the solution to support MHNs with the prescribing qualification to prescribe, supported by the views of the MHNs who participated in the focus groups. However, further work is required to remove

  13. Applying the principles of adult learning to the teaching of psychopharmacology: overview and finding the focus.

    PubMed

    Stahl, Stephen M; Davis, Richard L

    2009-04-01

    Medical education in psychopharmacology can be designed according to modern principles of adult learning. The goal is to go beyond merely exposing learners to novel content, to the documentation that learning has occurred and that behaviors have changed, namely the upgrading of skills in clinical practice. The many aspects of this approach to medical education are discussed in overview here. Future installments of "Trends in Psychopharmacology" will periodically deal with specific aspects of the best practices for medical educators outlined here only in brief. This article considers whether the focus of medical education instructors should be the medical content they present, the medical educator that does the presenting, or the learner. The perspective here is that the focus of medical education should be the learner, and that the content should be structured and executed in a manner that facilitates learning instead of inhibiting it.

  14. Psychopharmacological boundaries of schizophrenia with comorbid cannabis use disorder: a critical review.

    PubMed

    Lazary, Judit

    2012-01-01

    Although cannabis use disorder is strongly related to schizophrenia and treatment of patients with double diagnosis provides serious problem, specific pharmacological, molecular and therapeutical data on this subgroup are poorly available. In this paper we present a critical review on psychopharmacological boundaries of schizophrenia with concurrent cannabis use. The relevant data available in the literature suggest that a weaker compliance, poorer therapy response and higher sensitivity for extrapyramidal side effects are key features of schizophrenia and comorbid cannabis use disorder and represent a clinical challenge. Because of paucity of available research in the field there is not enough evidence to clearly depict the exact psychopharmacological profile of cannabis related schizophrenia. Further investigations are needed to assess phenotypic characteristics of this entity and to tailor effective treatment options accordingly.

  15. [The century of the receptor, history of ideas that launched psychopharmacology].

    PubMed

    Serra, Héctor A; Fadel, Daniel O

    2012-01-01

    Nowadays, the term receptor is obvious in psychopharmacology. However, this was not so obvious a century ago. To try to explain how drugs act, European scientists began to develop theories that turned into deeds with the scientific progress. Thus, the receptor concept and their applications in medicine and psychiatry began to gain substance. In this paper we relate the facts that have led to the current knowledge of receptor, the cornerstone of pharmacology.

  16. Psychopharmacological treatment of neurocognitive deficits in people with schizophrenia: a review of old and new targets.

    PubMed

    Ahmed, Anthony O; Bhat, Ishrat A

    2014-04-01

    Neurocognitive impairments significantly contribute to disability and the overall clinical picture in schizophrenia spectrum disorders. There has therefore been a concerted effort, guided by the discovery of neurotransmitter and synaptic systems in the central nervous system, to develop and test compounds that may ameliorate neurocognitive deficits. The current article summarizes the results of efforts to test neurocognitive-enhancing agents in schizophrenia. Overall, existing clinical trials provide little reason to be enthusiastic about the benefits of psychopharmacological agents at enhancing neurocognition in schizophrenia-a state of affairs that may reflect the inadequacy of single neurotransmitter or receptor models. The etiologic and phenomenological complexity of neurocognitive deficits in schizophrenia may be better served by psychopharmacological agents that (i) target neurotransmitter systems proximal in the causal chain to neurocognitive deficits; (ii) enhance distal survival processes in the central nervous system-neurogenesis, neuronal growth, synaptogenesis, and connectivity; and (iii) counteract the negative effects of aberrant neurodevelopment in schizophrenia, such as neuroinflammation and oxidative stress. Future efforts to develop psychopharmacological agents for neurocognitive impairment in schizophrenia should reflect the knowledge of its complex etiology by addressing aberrations along its causal chain. Clinical trials may benefit methodologically from (i) an appreciation of the phenomenological heterogeneity of neurocognitive deficits in schizophrenia; (ii) a characterization of the predictors of treatment response; and (iii) a recognition of issues of sample size, statistical power, treatment duration, and dosing.

  17. The Intimate Geographies of Panic Disorder: Parsing Anxiety through Psychopharmacological Dissection.

    PubMed

    Callard, Felicity

    2016-01-01

    The category of panic disorder was significantly indebted to early psychopharmacological experiments (in the late 1950s and early 1960s) by the psychiatrist Donald Klein, in collaboration with Max Fink. Klein's technique of "psychopharmacological dissection" underpinned his transformation of clinical accounts of anxiety and was central in effecting the shift from agoraphobic anxiety (with its spatial imaginary of city squares and streets) to panic. This technique disaggregated the previously unitary affect of anxiety-as advanced in psychoanalytic accounts-into two physiological and phenomenological kinds. "Psychopharmacological dissection" depended on particular modes of clinical observation to assess drug action and to interpret patient behavior. The "intimate geographies" out of which panic disorder emerged comprised both the socio-spatial dynamics of observation on the psychiatric ward and Klein's use of John Bowlby's model of separation anxiety-as it played out between the dyad of infant and mother-to interpret his adult patients' affectively disordered behavior. This essay, in offering a historical geography of mid-twentieth-century anxiety and panic, emphasizes the importance of socio-spatial setting in understanding how clinical and scientific experimentation opens up new ways in which affects can be expressed, shaped, observed, and understood.

  18. Principle standards and problems regarding proof of efficacy in clinical psychopharmacology.

    PubMed

    Möller, Hans-Jürgen; Broich, Karl

    2010-02-01

    Proof of efficacy of a psychotropic medicinal product is the key point of clinical psychopharmacology. This especially concerns the licensing of a new compound, but apart from this special case, lots of efficacy questions need to be answered in clinical psychopharmacology, such as, e.g. the question of the efficacy of a combination therapy. The methodology of the scientific proof of efficacy has already had a long tradition and has been developed further in the recent past under different aspects. Especially the double-blind randomised parallel group comparison has been developed as a design of highest methodological standard. However, often designs have their place and justification under certain conditions and in relation to certain questions. Although in the recent past, with the over-emphasis of so-called effectiveness studies, the inherent methodological limitations of these studies have not been addressed properly (Möller in Eur Arch Psychiatry Clin Neurosci 258:257-270, 2008), which in consequence devaluated the scientific merits of the classical double-blind randomised control group study designs in the view of those colleagues, who are not that experienced in study design issues. Therefore, it seems to be timely and necessary to review the principle standards and problems concerning the proof of efficacy in clinical psychopharmacology.

  19. Teaching all the evidence bases: reintegrating psychodynamic aspects of prescribing into psychopharmacology training.

    PubMed

    Mallo, C Jason; Mintz, David L

    2013-03-01

    The discipline of psychiatry appears poised at the edge of a paradigm shift. Enthusiasm about psychopharmacological treatments and neuroscientific understandings is giving way to a sobering recognition of the limitations of current biologically oriented approaches. Psychiatry training programs have both an opportunity and a responsibility to address the challenges presented by the evidence. Although the average psychiatrist would profess a biopsychosocial ideal, an examination of our practice, journals, and training curricula suggests that we still have a long way to go before we employ a truly integrated model. There is a compelling, though oft-neglected evidence base demonstrating that pharmacologic treatment outcomes are as dependent on psychological and interpersonal factors as on medical ones. In order to maximize our usefulness to patients, psychiatry must embrace more complex and integrated understandings, transcending reductionistic models that promote mind-body splits. This article explores some of the costs of a model that places disproportionate emphasis on a biological framework. Relevant evidence bases are reviewed that demonstrate the utility of emphasizing the psychology of psychopharmacology. Implications for psychiatric training are considered, and suggestions are made for better integrating meaning factors into psychopharmacology education.

  20. Beyond the question of placebo controls: ethical issues in psychopharmacological drug studies.

    PubMed

    Frank, Ellen; Novick, Danielle M; Kupfer, David J

    2003-12-01

    There is a broad range of complex ethical issues in the conduct of psychopharmacological drug studies that go beyond the question of the ethics of placebo controls. However, our empirical knowledge with respect to these issues is very limited. This review, although not exhaustive, highlights an array of ethical issues that arose from discussions within the NIMH Human Subjects Research Council Workgroup. To delineate issues in psychopharmacological drug studies that require debate and would benefit from research leading to the development of empirically-supported guidelines. Information included in this report was drawn from the first author's participation as chair of the NIMH Human Subjects Research Council Workgroup, guidelines for the ethical conduct of research proposed by professional organizations to which the first and third author belong, and relevant research literature. We have focused on general issues relating to informed consent, research with special populations, and long-term treatment studies. Additionally, we raise issues relevant to large research-oriented institutions. The essential ethical challenge in psychopharmacological trials is to balance risks and benefits in the context of the needs and capacities of individual research subjects. The IRB system must become evidence-based and not rely on unproven assumptions. Specific research studies should be undertaken to address many of the issues of informed consent and research ethics postulated in this paper.

  1. Evolution of psychopharmacology trial design and analysis: six decades in the making.

    PubMed

    Leon, Andrew C

    2011-03-01

    The evolution of trial design and analysis during the lifespan of psychopharmacology is examined. The clinical trial methodology used to evaluate psychopharmacologic agents has evolved considerably over the past 6 decades. The first and most productive decade was characterized by case series, each with a small number of patients. These trials used nonstandardized clinical observation as outcomes and seldom had a comparison group. The crossover design became widely used to examine acute psychiatric treatments in the 1950s and 1960s. Although this strategy provided comparison data, it introduced problems in study implementation and interpretation. In 1962, the US Food and Drug Administration began to require "substantial evidence of effectiveness from adequate and well-controlled studies." Subsequent decades saw remarkable advances in clinical trial design, assessment, and statistical analyses. Standardized instruments were developed and parallel groups, double-blinding, and placebo controls became the benchmark. Sample sizes increased and data analytic procedures were developed that could accommodate the problems of attrition. Randomized withdrawal designs were introduced in the 1970s to examine maintenance therapies. Ethical principles for research became codified in the United States at that time. A wave of regulatory approvals of novel antipsychotics, antidepressants, and anticonvulsants came in the 1980s and 1990s, each based on data from randomized double-blind, parallel-group, placebo-controlled clinical trials. These trial designs often involved fixed-dose comparisons based, in part, on a greater appreciation that much of the benefit and harm in psychopharmacology was dose related. Despite the progress in randomized controlled trial (RCT) design, the discovery of new mechanisms of action and blockbuster interventions has slowed during the past decade. © Copyright 2011 Physicians Postgraduate Press, Inc.

  2. Toward standardized usage of the word serendipity in the historiography of psychopharmacology.

    PubMed

    Baumeister, Alan A; Hawkins, Mike F; López-Muñoz, Francisco

    2010-07-01

    Contradictory views are expressed in the literature about the role played by serendipity in discoveries that led to modern psychopharmacology. This article attempts to resolve these contradictions by providing an operational definition of serendipity. The utility of the proposed definition is explored in the context of 18 discoveries. The results show that the most common pattern in the development of early psychiatric medications is serendipitous observation leading to non-serendipitous demonstration of clinical utility. The analysis also reveals examples of relatively pure serendipitous and non-serendipitous discoveries. The proposed definition appears to be reliable and valid.

  3. Molecular properties of psychopharmacological drugs determining non-competitive inhibition of 5-HT3A receptors.

    PubMed

    Kornhuber, Johannes; Terfloth, Lothar; Bleich, Stefan; Wiltfang, Jens; Rupprecht, Rainer

    2009-06-01

    We developed a structure-property-activity relationship (SPAR)-model for psychopharmacological drugs acting as non-competitive 5-HT(3A) receptor antagonists by using a decision-tree learner provided by the RapidMiner machine learning tool. A single molecular descriptor, namely the molecular dipole moment per molecular weight (mu/MW), predicts whether or not a substance non-competitively antagonizes 5-HT-induced Na(+) currents. A low mu/MW is compatible with drug-cumulation in apolar lipid rafts. This study confirms that size-intensive descriptors allow the development of compact SPAR models.

  4. Ziziphus spinosa seeds for insomnia: A review of chemistry and psychopharmacology.

    PubMed

    Shergis, Johannah Linda; Ni, Xiaojia; Sarris, Jerome; Zhang, Anthony Lin; Guo, Xinfeng; Xue, Charlie C; Lu, Chuanjian; Hugel, Helmut

    2017-10-15

    In Chinese medicine, Ziziphus jujuba Mill. var. spinosa (Bunge) Hu ex H. F. Chou is widely used for the treatment of insomnia. This paper summarises the chemistry, psychopharmacology, and compares the pharmaceutical effects of the seeds of Ziziphus jujuba plant, Ziziphus spinosa (ZS) seeds, with benzodiazepines. Whole extracts and constituent compounds have been evaluated in preclinical and clinical studies. ZS secondary metabolites modulate GABAergic activity and the serotonergic system. The actual therapeutic agents require further confirmation/identification so that new insomnia phytomedicines can be discovered. Copyright © 2017 Elsevier GmbH. All rights reserved.

  5. A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry.

    PubMed

    Molina-Ruiz, Rosa M; Martín-Carballeda, Julia; Asensio-Moreno, Inmaculada; Montañés-Rada, Francisco

    2017-03-01

    Background Subjects with intellectual disability are at increased risk of having comorbid psychiatric disorders and worse response to psychotherapeutic and psychopharmacological treatment interventions. On the other hand, available data on best treatment approach in this population are scarce and lack scientific evidence due to methodological limitations. The present study aims to perform a systematic review of the literature to facilitate the use of psychotropic drugs in clinical practice and better establish future research targets in this field. Objectives To review the available psychopharmacological strategies for patients with intellectual disabilities, psychiatric disorders, and behavioural disturbances. Serve as a quick guide for clinicians working in the field of intellectual disability. Methods We conducted a selective evidence-based review of the literature using Pubmed and EMBASE databases and selected most recent and relevant papers for this review. Results There are several available psychotropic drugs for the treatment of patients with intellectual disability and comorbid psychiatric disorders, although scientific evidence is limited. Treatment should be individualized according to risk-benefit balance. Discussion Further studies are needed and new available drugs should be considered to gain knowledge in effectiveness of different therapeutic approaches available in this population.

  6. A Review of Psychopharmacological Interventions Post-Disaster to Prevent Psychiatric Sequelae

    PubMed Central

    Birur, Badari; Math, Suresh Bada; Fargason, Rachel E.

    2017-01-01

    Background Disasters are mega-scale catastrophic events which cause trauma and mental health sequelae. A review of early pharmacological interventions for the prevention of psychiatric disorders following disasters is sorely needed. Methods A literature search of “Psychiatric Sequelae AND Disasters”, “Disaster mental health/Disaster psychiatry”, “Psychotropics AND Disasters”, and “Drug therapy AND Disasters” yielded 213 articles, 38 of which were included in the review. Results Common post-disaster psychiatric conditions are: posttraumatic stress disorder (PTSD), depressive and anxiety disorders, substance use disorders and medically-unexplained psychological symptoms. Early psychopharmacological interventions to prevent PTSD provide promising evidence for hydrocortisone in medically ill trauma populations. Less robust benefits were noted for other pharmacological interventions. No reported trials have explored prevention of depression or other common post-disaster psychiatric conditions. Conclusion Hydrocortisone shows promise in preventing and reducing the psychiatric sequelae of PTSD following disasters. Further evaluation of hydrocortisone and other potentially beneficial psychopharmacological interventions are needed. PMID:28138200

  7. Experience sampling and ecological momentary assessment studies in psychopharmacology: A systematic review.

    PubMed

    Bos, Fionneke M; Schoevers, Robert A; aan het Rot, Marije

    2015-11-01

    Experience sampling methods (ESM) and ecological momentary assessment (EMA) offer insight into daily life experiences, including symptoms of mental disorders. The application of ESM/EMA in psychopharmacology can be a valuable addition to more traditional measures such as retrospective self-report questionnaires because they may help reveal the impact of psychotropic medication on patients' actual experiences. In this paper we systematically review the existing literature on the use of ESM/EMA in psychopharmacology research. To this end, we searched the PsycInfo and Medline databases for all available ESM/EMA studies on the use of psychotropic medication in patients with DSM-III-R and DSM-IV disorders. Dissertations were excluded. We included 18 studies that applied ESM/EMA to study the effects of medication on patients with major depressive disorder, substance use disorder, attention-deficit hyperactivity disorder, psychotic disorder, and anxiety disorder. We found that ESM/EMA may allow researchers and clinicians to track patients during different phases of treatment: before treatment to predict outcome, during treatment to examine the effects of treatment on symptoms and different aspects of daily life experience, and after treatment to detect vulnerability for relapse. Moreover, ESM/EMA can potentially help determine how long and in what contexts medications are effective. Thus, ESM/EMA may benefit both researchers and clinicians and might prove to be an effective tool for improving the treatment of psychiatric patients.

  8. 'Is getting well ever an art?': Psychopharmacology and madness in Robert Lowell's Day by Day.

    PubMed

    Travis, Isabelle

    2011-12-01

    On the publication of Robert Lowell's Life Studies in 1959, some critics were shocked by the poet's use of seemingly frank autobiographical material, in particular the portrayal of his hospitalizations for bipolar disorder. During the late fifties and throughout the sixties, a rich vein, influenced by Lowell, developed in American poetry. Also during this time, the nascent science of psychopharmacology competed with and complemented the more established somatic treatments, such as psychosurgery, shock treatments, and psychoanalytical therapies. The development of Thorazine was a remarkable breakthrough allowing patients previously thought incurable to leave hospital. In 1955, the release of Miltown, the first 'minor' tranquilizer, was heralded with a media fanfare promising a new dawn of psychological cure-all. These two events blurred the boundary between 'normality' and madness by making treatment in the community more widely possible and by medicalizing more commonplace distress. Lowell's early depictions of madness situate it as emblematic of the cultural malaise of 'the tranquilized fifties.' By his final collection, Day by Day (1977), mental illness had lost its symbolic power. These late poems explore the power of art as a way of representing and remedying suffering in a culture where psychopharmacology has normalized madness.

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

    PubMed

    Brodkey, Amy C

    2005-01-01

    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. Literature reviews and discussions with experts, educators, and trainees. 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. 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.

  10. Research in child and adolescent psychopharmacology: recent accomplishments and new challenges.

    PubMed

    Vitiello, Benedetto

    2007-03-01

    Research in pediatric psychopharmacology has expanded considerably in the last 10 years. Still, controversy remains about the effectiveness and safety of commonly used psychotropics and their role in child treatment, thus pointing to the need for more in-depth and targeted investigations. To review recent accomplishments and current limitations of pediatric psychopharmacology, and discuss approaches to further research. Selective review of the relevant literature and research in progress. Controlled clinical trials have been conducted in many common psychiatric disorders in children and adolescents, thus providing a basis on which evidence-based treatment guidelines can be constructed. Little innovation has, however, occurred in treatment development and testing. Safety concerns are prominent and have a major influence on clinical practice and drug utilization. While a research infrastructure has been successfully built for conducting pediatric clinical trials, important aspects such as long-term treatment effects, optimal sequencing and individualization of interventions, and integration of neuroscience findings into innovative, theory-driven treatment development remain to be addressed.

  11. Ethical issues in child psychopharmacology research and practice: emphasis on preschoolers.

    PubMed

    Spetie, Lacramioara; Arnold, L Eugene

    2007-03-01

    Psychoactive drug prescription for preschoolers has increased over the past decade and has been a controversial topic for those who prescribe, regulate, and research the use of psychotropics in this population. Children and adolescents are deemed vulnerable populations, at risk of being harmed by unethical or suboptimal practice and research and are in need of special protection. Historically, preschoolers have been therapeutic and research "orphans," excluded from pharmacological studies so that the evidence base for their treatment has to be extrapolated from other ages. Within the past few decades, several ethical principles guiding pediatric psychopharmacological research have been developed. The same principles could effectively guide the treatment of these patients. Further studies are needed to elucidate the safety and effectiveness of psychotropics, and sound ethical guidelines for their involvement in psychiatric research are needed. This article reviews some challenges facing mental health care providers involved in prescribing or researching the use of psychoactive drugs in preschoolers. Some of these challenges are general to medical treatment and research with children, and others are particular to child psychopharmacological treatment and research.

  12. The psychopharmacology algorithm project at the Harvard South Shore Program: an update on schizophrenia.

    PubMed

    Osser, David N; Roudsari, Mohsen Jalali; Manschreck, Theo

    2013-01-01

    This article is an update of the algorithm for schizophrenia from the Psychopharmacology Algorithm Project at the Harvard South Shore Program. A literature review was conducted focusing on new data since the last published version (1999-2001). The first-line treatment recommendation for new-onset schizophrenia is with amisulpride, aripiprazole, risperidone, or ziprasidone for four to six weeks. In some settings the trial could be shorter, considering that evidence of clear improvement with antipsychotics usually occurs within the first two weeks. If the trial of the first antipsychotic cannot be completed due to intolerance, try another until one of the four is tolerated and given an adequate trial. There should be evidence of bioavailability. If the response to this adequate trial is unsatisfactory, try a second monotherapy. If the response to this second adequate trial is also unsatisfactory, and if at least one of the first two trials was with risperidone, olanzapine, or a first-generation (typical) antipsychotic, then clozapine is recommended for the third trial. If neither trial was with any these three options, a third trial prior to clozapine should occur, using one of those three. If the response to monotherapy with clozapine (with dose adjusted by using plasma levels) is unsatisfactory, consider adding risperidone, lamotrigine, or ECT. Beyond that point, there is little solid evidence to support further psychopharmacological treatment choices, though we do review possible options.

  13. [Critical flicker fusion frequency in psychopathology and psychopharmacology. Review of the literature].

    PubMed

    Bobon, D P; Lecoq, A; von Frenckell, R; Mormont, I; Lavergne, G; Lottin, T

    1982-01-01

    As far back as the second century, Ptolemy reported the apparent immobility of wheel radius at a certain speed. The psychophysical laws of this flicker fusion phenomenon related to the frequency of the light stimulus were established in 1834-1835 by the Englishman Talbot and by the Belgian Plateau, whose thesis in Liège is described as a landmark in the field. CFF is more a measurement of cortical arousal than of visual functions. In psychophysiology, CFF underwent periods of success and oblivion, at the mercy of researcher's enthusiasm or disappointment. At the turn of this century, Pierre Janet measured CFF in the laboratory of physiology of the Salpêtrière Hospital and demonstrated its decrease 'in hysteria, in states of depression, of lowered tension'. All reviewers of CFF literature have overlooked these observations, reported by Henri Piéron in the 'Melanges dedicated to Monsieur Pierre Janet'. When CFF falls into disgrace, it is because of the variability of its results, due to differences in apparatus and designs of the trials as well as the great number and the intrication of the variables which modify CFF thresholds, among them the nonsensory variables. When CFF is reappraised, as it has been the case in psychopharmacology in recent years, the reason is that it represents a brief, easy and economical measure of vigilance which, under certain conditions, seems to be also reliable, valid and sensitive. In the present monograph, the first in French on CFF, the authors try to analyze the most important contributions of the literature from the standpoint of the most relevant variables: characteristics of the stimulus (light intensity, wave form, wavelength, light-dark-ratio, diameter of the flickering point), test procedure (light vs. dark adaptation, visual angle, continuous vs. discontinuous presentation, monocular vs. binocular vision), influence of various physiological or psychological conditions (pupillary diameter, age, training, IQ; anxiety

  14. Ahead of the game: the use of gaming to enhance knowledge of psychopharmacology.

    PubMed

    Beek, Terra S; Boone, Cheryl; Hubbard, Grace

    2014-12-01

    Experiential teaching strategies have the potential to more effectively help students with critical thinking than traditional lecture formats. Gaming is an experiential teaching-learning strategy that reinforces teamwork, interaction, and enjoyment and introduces the element of play. Two Bachelor of Science in Nursing students and a clinical instructor created a Jeopardy!(®)-style game to enhance understanding of psychopharmacology, foster student engagement in the learning process, and promote student enjoyment during clinical postconference. The current article evaluates the utility, relevance, and effectiveness of gaming using a Jeopardy!(®)-style format for the psychiatric clinical setting. Students identified the strengths of this learning activity as increased awareness of knowledge deficits, as well as the reinforcement of existing knowledge and the value of teamwork.

  15. Cost of treatment as a placebo effect in psychopharmacology: importance in the context of generic drugs.

    PubMed

    Andrade, Chittaranjan

    2015-04-01

    Nonspecific factors have long been known in both psychotherapy and psychopharmacology. In recent years, 2 studies showed that placebo benefits were lower when the treated subjects were told that the placebo, presented as an active treatment, cost less. One of these studies had assessed motor and other outcomes in Parkinson disease patients; the other had assessed analgesia in paid, healthy volunteers to whom electric shocks were administered. The implication of the finding that lower treatment cost may diminish treatment gains is that patients who receive generic medicines may have lower expectations and may consequently derive less placebo-related benefit. This could be of concern in psychiatric disorders that are characterized by a large placebo response. Although the 2 "placebo cost" studies cannot be easily generalized to clinical and especially psychiatric contexts, clinicans should consider offering reassurance to patients receiving generic drugs that cost, per se, has no bearing on treatment-related benefit. © Copyright 2015 Physicians Postgraduate Press, Inc.

  16. [Antidepressive effects of 3 endogenous monoamines: psychopharmacologic profiles of noradrenaline, octopamine and phenethylamine].

    PubMed

    Bulach, C; Doaré, L; Massari, B; Simon, P

    1984-01-01

    Norepinephrine (NE), octopamine (OA) and phenethylamine (PEA) are easily destroyed by M.A.O. but we could show, even injected intraperitoneally that they are active upon tests used generally to reveal an "antidepressant" effect. This effect is especially studied by using antagonism of apomorphine, reserpine, oxotremorine-induced hypothermia. The psychopharmacological spectra of NE and OA are close to the one of salbutamol and the observed effects correspond to alpha- and beta-adrenergic stimulations. The PEA spectrum is similar to the one of amphetamine and the observed effects correspond to adrenergic stimulations and to a dopaminergic stimulation. The mechanisms involved in the tests realized to show an "antidepressant" effect could reflect an activity not only through endogeneous NA but also possibly through endogeneous OA and PEA.

  17. Effects of psychopharmacological treatment with antipsychotic drugs on the vascular system.

    PubMed

    Kahl, Kai G; Westhoff-Bleck, Mechthild; Krüger, Tillmann H C

    2017-09-06

    Psychopharmacological treatment with antipsychotic drugs is an essential part of guideline-based treatment strategies in psychotic disorders, such as schizophrenia, schizoaffective disorders, and delusional disorders. Other mental disorders frequently treated with antipsychotic drugs are bipolar disorders, and major depressive disorder. Furthermore, antipsychotic drugs are often given in emergency and surgical units for the treatment of metabolic or postoperative delirium. Antipsychotic drugs can exert direct and indirect effects on the vascular system, potentially leading to severe complications such as thromboembolism. Therefore, knowledge of vascular side effects of antipsychotic drugs is important for clinicians. This clinical orientated review article covers direct and indirect effects of antipsychotics on the vascular system. Copyright © 2017. Published by Elsevier Inc.

  18. [Psychopharmacological drugs and ethiopathogenic theories in psychiatry. From discovery context to epistemological obstacle].

    PubMed

    Wikinski, Silvia

    2008-01-01

    This work postulates the thesis that the development of the contemporary psychopharmacology, which began with the chemical changes imposed to molecules with antihistaminergic properties, modelled the current ethiopatogenic theories of mental diseases. The development of chlorpromazine and imipramine was coincident with the beginning of the research about neurotransmission. This coincidence contributed for the construction of the dopaminergic theory of schizophrenia and in the monoaminergic theory of depression. Limitations of the effectivity of current drugs, as observed in the trials CATIE and STAR-D may justify a change of perspective in the search for new molecular targets for the treatment of both diseases. Historical data are provided to illustrate the above mentioned thesis, in the perspective of two epistemological concepts: the context of discovery proposed by Hans Reichenbach and the epistemological obstacle, proposed by Gaston Bachelard.

  19. Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence.

    PubMed

    Sarris, Jerome; Panossian, Alexander; Schweitzer, Isaac; Stough, Con; Scholey, Andrew

    2011-12-01

    Research in the area of herbal psychopharmacology has increased markedly over the past decades. To date however, a comprehensive review of herbal antidepressant, anxiolytic and hypnotic psychopharmacology and applications in depression, anxiety and insomnia has been absent. A search of MEDLINE (PubMed), CINAHL, PsycINFO, and the Cochrane Library databases was conducted (up to February 21st 2011) on commonly used psychotropic herbal medicines. A review of the literature was conducted to ascertain mechanisms of action of these botanicals, in addition to a systematic review of controlled clinical trials for treatment of mood, anxiety and sleep disorders, which are common comorbid psychiatric disorders. Specific emphasis was given to emerging phytomedicines. Analysis of evidence levels was conducted, as were effect sizes (Cohen's d) where data were available. Results provided evidence of a range of neurochemical, endocrinological, and epigenetic effects for 21 individual phytomedicines, which are detailed in this paper. Sixty six controlled studies were located involving eleven phytomedicines. Several of these provide a high level of evidence, such as Hypericum perforatum for major depression, and Piper methysticum for anxiety disorders. Several human clinical trials provide preliminary positive evidence of antidepressant effects (Echium amoenum, Crocus sativus, and Rhodiola rosea) and anxiolytic activity (Matricaria recutita, Ginkgo biloba, Passiflora incanata, E. amoenum, and Scutellaria lateriflora). Caution should however be taken when interpreting the results as many studies have not been replicated. Several herbal medicines with in vitro and in vivo evidence are currently unexplored in human studies, and along with use of emerging genetic technologies "herbomics", are areas of potential future research.

  20. The variation of psychopharmacological prescription rates for people with autism spectrum disorder (ASD) in 30 countries.

    PubMed

    Wong, Angel Y S; Hsia, Yingfen; Chan, Esther W; Murphy, Declan G M; Simonoff, Emily; Buitelaar, Jan K; Wong, Ian C K

    2014-10-01

    There is significant variation in prescriptions among countries in clinical practice for the treatment of comorbidities associated with autism spectrum disorder (ASD). It has been suggested that many people with mental health disorders in low-/middle-income countries do not receive adequate treatment. Hence, this study investigated psychopharmacological treatment patterns for ASD comorbidities in 30 countries and the association between country's income and prescription rates. The IMS Prescribing Insights database was used to investigate prescription patterns for ASD comorbidity treatment from 2007 to 2012. Data were obtained from 30 countries in continents of Europe, Asia, Oceania, Central America, South America, and Africa. The gross domestic product (GDP) per capita was used as a proxy for each country's income. Spearman correlation was used to examine the association between prescription rate and GDP per capita. The highest prescription rates were found in Western Europe (3.89-36.36/10,000) while the lowest prescription rates were found in Asian countries, such as Turkey, Indonesia, Saudi Arabia, and Pakistan (0.04-0.82/10,000). The most commonly prescribed drug for ASD comorbidity treatment in most of the countries was risperidone, but antidepressants and antiepileptic drugs were also frequently prescribed. There was a significant positive correlation between GDP per capita and prescription rate (Spearman ρ = 0.60; P = 0.0011; 95% confidence interval 0.27-0.81), that is, the higher the GDP per capita, the higher the prescription rate. There are marked international differences in prescription rates, and this is partially accounted by economic factors. Future research should combine more data for ASD comorbidity treatment to explore the disparity of psychopharmacological treatment between countries.

  1. Multiple Psychopharmacological Effects of the Traditional Japanese Kampo Medicine Yokukansan, and the Brain Regions it Affects

    PubMed Central

    Mizoguchi, Kazushige; Ikarashi, Yasushi

    2017-01-01

    Yokukansan (YKS), a traditional Japanese Kampo medicine, has indications for use in night crying and irritability in children, as well as neurosis and insomnia. It is currently also used for the remedy of the behavioral and psychological symptoms of dementia (BPSD), such as aggressiveness, agitation, and hallucinations. In parallel with clinical evidence, a significant amount of fundamental researches have been undertaken to clarify the neuropsychopharmacological efficacies of YKS, with approximately 70 articles, including our own, being published to date. Recently, we reviewed the neuropharmacological mechanisms of YKS, including its effects on glutamatergic, serotonergic, and dopaminergic neurotransmission, and pharmacokinetics of the ingredients responsible for the effects. This review is aimed to integrate the information regarding the psychopharmacological effects of YKS with the brain regions known to be affected, to facilitate our understanding of the clinical efficacy of YKS. In this review, we first show that YKS has several effects that act to improve symptoms that are similar to BPSDs, like aggressiveness, hallucinations, anxiety, and sleep disturbance, as well as symptoms like tardive dyskinesia and cognitive deficits. We next provide the evidence showing that YKS can interact with various brain regions, including the cerebral cortex, hippocampus, striatum, and spinal cord, dysfunctions of which are related to psychiatric symptoms, cognitive deficits, abnormal behaviors, and dysesthesia. In addition, the major active ingredients of YKS, geissoschizine methyl ether and 18β-glycyrrhetinic acid, are shown to predominantly bind to the frontal cortex and hippocampus, respectively. Our findings suggest that YKS has multiple psychopharmacological effects, and that these are probably mediated by interactions among several brain regions. In this review, we summarize the available information about the valuable effects of a multicomponent medicine YKS on complex

  2. Development of a Diverse Learning Experience for Diverse Psychiatry Resident Needs: A Four-Year Biological Psychiatry Curriculum Incorporating Principles of Neurobiology, Psychopharmacology, and Evidence-Based Practice.

    PubMed

    Muzyk, Andrew J; Gagliardi, Jane P; Rakesh, Gopalkumar; Jiroutek, Michael R; Radhakrishnan, Rajiv; Pae, Chi-Un; Masand, Prakash S; Szabo, Steven T

    2017-05-01

    A clinically relevant approach to patient care grounded in neurobiological constructs and evidence based practice which emphasizes a relevant psychopharmacology is needed to optimally train psychiatry residents. We implemented a biological psychiatry course that now incorporates neurobiology, psychopharmacology, and evidence-based practice in conjunction with a Research Domain Criteria (RDoC) perspective. A survey launched prior to course implementation and following each class session, served as the outcome metric of residents' attitudes toward the new curriculum and followed a baseline attitudinal survey designed to evaluate the program. Greater than 90% of the psychiatry residents at Duke University who took the attitudinal survey agreed or strongly agreed with needing a course that helped them develop an understanding of neurobiology, psychopharmacology, and evidence-based practice concepts. Most residents also indicated a less than adequate understanding of the neurobiology and psychopharmacology of psychiatric disorders prior to sessions. Our biological psychiatry curriculum was associated with enthusiasm among residents regarding the incorporation of neurobiology, psychopharmacology, and evidence-based practice into course topics and discussions. A biological psychiatry curriculum with integrated neurobiology and psychopharmacology built on an evidence base approach is possible, well-received, and needed in training of future psychiatrists.

  3. Development of a Diverse Learning Experience for Diverse Psychiatry Resident Needs: A Four-Year Biological Psychiatry Curriculum Incorporating Principles of Neurobiology, Psychopharmacology, and Evidence-Based Practice

    PubMed Central

    Gagliardi, Jane P.; Rakesh, Gopalkumar; Jiroutek, Michael R.; Radhakrishnan, Rajiv; Pae, Chi-Un; Masand, Prakash S.; Szabo, Steven T.

    2017-01-01

    Objective A clinically relevant approach to patient care grounded in neurobiological constructs and evidence based practice which emphasizes a relevant psychopharmacology is needed to optimally train psychiatry residents. Methods We implemented a biological psychiatry course that now incorporates neurobiology, psychopharmacology, and evidence-based practice in conjunction with a Research Domain Criteria (RDoC) perspective. A survey launched prior to course implementation and following each class session, served as the outcome metric of residents' attitudes toward the new curriculum and followed a baseline attitudinal survey designed to evaluate the program. Results Greater than 90% of the psychiatry residents at Duke University who took the attitudinal survey agreed or strongly agreed with needing a course that helped them develop an understanding of neurobiology, psychopharmacology, and evidence-based practice concepts. Most residents also indicated a less than adequate understanding of the neurobiology and psychopharmacology of psychiatric disorders prior to sessions. Conclusion Our biological psychiatry curriculum was associated with enthusiasm among residents regarding the incorporation of neurobiology, psychopharmacology, and evidence-based practice into course topics and discussions. A biological psychiatry curriculum with integrated neurobiology and psychopharmacology built on an evidence base approach is possible, well-received, and needed in training of future psychiatrists. PMID:28539947

  4. Dextromethorphan-quinidine-responsive pseudobulbar affect (PBA): psychopharmacological model for wide-ranging disorders of emotional expression?

    PubMed

    Stahl, Stephen M

    2016-12-01

    The symptoms of emotional dysregulation associated with the syndrome known as pseudobulbar affect (PBA) can be effectively treated by the sigma, glutamate, and serotonergic agent dextromethorphan combined with quinidine. If the same brain circuits affected in PBA are also compromised in related disorders of emotional expression, dextromethorphan-quinidine and other novel sigma-glutamate-serotonin agents could prove to be novel psychopharmacologic treatments for these conditions as well.

  5. Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers

    PubMed Central

    Lichtor, Stephanie A.

    2008-01-01

    Rationale Nonmedical use and abuse of prescription opioids is a significant problem in the USA. Little attention has been paid to assessing the relative psychopharmacological profile (including abuse liability-related effects) of specific prescription opioids. Objectives The aim of this study is to directly compare the psychopharmacological profile of two oral opioids within the same subject. Methods A randomized, placebo-controlled, crossover study was done in which 20 non-drug-abusing volunteers ingested 10 and 20 mg of oxycodone, 30 and 60 mg of morphine, and placebo in separate sessions. Drug doses were equated on an objective measure of opiate effects: miosis. Subjective, psychomotor, reinforcing, and physiological effects of the opioids were assessed. Results In general, the two opioids at equimiotic doses produced similar prototypic opiate-like effects and psychomotor impairment of similar magnitude. However, several effects were found only with 20 mg oxycodone. Both drugs produced abuse liability-related subjective effects but also dysphoric effects, particularly with 60 mg morphine. Neither drug at either dose functioned as a reinforcer, as measured by the Multiple Choice Procedure. Relative potency ratios indicated an average oxycodone:morphine ratio of 1:3. Conclusions The psychopharmacological profile of oxycodone and morphine at equimiotic doses had many similarities; however, differences were found in producing abuse liability-related and dysphoric effects. In the medical community, it is commonly accepted that oral oxycodone is 1.5 to 2 times as potent as oral morphine in producing analgesia; using this ratio, although patients may experience similar degrees of pain relief, those receiving oxycodone may be experiencing stronger and potentially different psychopharmacological effects. PMID:17899018

  6. Changes in clinical trials methodology over time: a systematic review of six decades of research in psychopharmacology.

    PubMed

    Brunoni, André R; Tadini, Laura; Fregni, Felipe

    2010-03-03

    There have been many changes in clinical trials methodology since the introduction of lithium and the beginning of the modern era of psychopharmacology in 1949. The nature and importance of these changes have not been fully addressed to date. As methodological flaws in trials can lead to false-negative or false-positive results, the objective of our study was to evaluate the impact of methodological changes in psychopharmacology clinical research over the past 60 years. We performed a systematic review from 1949 to 2009 on MEDLINE and Web of Science electronic databases, and a hand search of high impact journals on studies of seven major drugs (chlorpromazine, clozapine, risperidone, lithium, fluoxetine and lamotrigine). All controlled studies published 100 months after the first trial were included. Ninety-one studies met our inclusion criteria. We analyzed the major changes in abstract reporting, study design, participants' assessment and enrollment, methodology and statistical analysis. Our results showed that the methodology of psychiatric clinical trials changed substantially, with quality gains in abstract reporting, results reporting, and statistical methodology. Recent trials use more informed consent, periods of washout, intention-to-treat approach and parametric tests. Placebo use remains high and unchanged over time. Clinical trial quality of psychopharmacological studies has changed significantly in most of the aspects we analyzed. There was significant improvement in quality reporting and internal validity. These changes have increased study efficiency; however, there is room for improvement in some aspects such as rating scales, diagnostic criteria and better trial reporting. Therefore, despite the advancements observed, there are still several areas that can be improved in psychopharmacology clinical trials.

  7. Changes in Clinical Trials Methodology Over Time: A Systematic Review of Six Decades of Research in Psychopharmacology

    PubMed Central

    Brunoni, André R.; Tadini, Laura; Fregni, Felipe

    2010-01-01

    Background There have been many changes in clinical trials methodology since the introduction of lithium and the beginning of the modern era of psychopharmacology in 1949. The nature and importance of these changes have not been fully addressed to date. As methodological flaws in trials can lead to false-negative or false-positive results, the objective of our study was to evaluate the impact of methodological changes in psychopharmacology clinical research over the past 60 years. Methodology/Principal Findings We performed a systematic review from 1949 to 2009 on MEDLINE and Web of Science electronic databases, and a hand search of high impact journals on studies of seven major drugs (chlorpromazine, clozapine, risperidone, lithium, fluoxetine and lamotrigine). All controlled studies published 100 months after the first trial were included. Ninety-one studies met our inclusion criteria. We analyzed the major changes in abstract reporting, study design, participants' assessment and enrollment, methodology and statistical analysis. Our results showed that the methodology of psychiatric clinical trials changed substantially, with quality gains in abstract reporting, results reporting, and statistical methodology. Recent trials use more informed consent, periods of washout, intention-to-treat approach and parametric tests. Placebo use remains high and unchanged over time. Conclusions/Significance Clinical trial quality of psychopharmacological studies has changed significantly in most of the aspects we analyzed. There was significant improvement in quality reporting and internal validity. These changes have increased study efficiency; however, there is room for improvement in some aspects such as rating scales, diagnostic criteria and better trial reporting. Therefore, despite the advancements observed, there are still several areas that can be improved in psychopharmacology clinical trials. PMID:20209133

  8. Reassessing the cultural and psychopharmacological significance of Banisteriopsis caapi: preparation, classification and use among the Piaroa of Southern Venezuela.

    PubMed

    Rodd, Robin

    2008-09-01

    Recent attention to the monoamine oxidase inhibiting properties of Banisteriopsis caapi's harmala alkaloids has precluded a balanced assessment of B. caapi's overall significance to indigenous South American societies. Relatively little attention has been paid to the cultural contexts, local meanings and patterns of use of B. caapi among snuff-using societies, such as the Piaroa, who do not prepare decoctions containing N,N-dimethyltryptamine (DMT) admixtures. This article reviews the psychopharmacological literature on B. caapi in light of recent ethnographic work conducted among the Piaroa of southern Venezuela. Piaroa shamans use only B. caapi's cambium, identify at least five distinct varieties of B. caapi, and emphasise the plant's importance for heightening empathy. Some Piaroa people also attribute a range of extra-shamanic uses to B. caapi, including as a stimulant and hunting aid. In light of the psychopharmacological complexity of harmala alkaloids, and ethnographic evidence for a wide range of B. caapi uses,future research should reconsider B. caapi's cultural heritage and psychopharmacological potential as a stimulant and antidepressant-like substance.

  9. Clinic-Based Retrospective Analysis of Psychopharmacology for Behavior in Fragile X Syndrome

    PubMed Central

    Berry-Kravis, Elizabeth; Sumis, Allison; Hervey, Crystal; Mathur, Shaguna

    2012-01-01

    Fragile X syndrome (FXS) is associated with behavior that limits functioning, including distractibility, hyperactivity, impulsivity, hyperarousal, anxiety, mood dysregulation, and aggression. Medication response and side effect data were reviewed retrospectively for 257 patients (age 14 ± 11 years, range 4–60 years, 203 M, 54 F) attending an FXS clinic. Treatment success rates were defined as the percentage of positive response in the form of documented clinical report of improvement in the behavior(s) being targeted over at least a 6-month period on the medication, without side effects requiring medication discontinuance, while failures were defined as discontinuance of medication due to lack of clinical effectiveness or side effects. Success rate for treatment of targeted behaviors with trials of individual medications was 55% for stimulants, 53% for antidepressants, 62% for alpha2-agonists, and 54% for antipsychotics. With sequential trials of different medications in the same class, success rate improved to 73–77%. Side effect-related failures were highest for antipsychotics. Systematic psychopharmacologic intervention targeted to behavioral symptoms appears helpful in the majority of patients with FXS. PMID:22899942

  10. Getting the timing right: experimental protocols for investigating time with functional neuroimaging and psychopharmacology.

    PubMed

    Coull, Jennifer T

    2014-01-01

    Functional Magnetic Resonance Imaging (fMRI) is an effective tool for identifying brain areas and networks implicated in human timing. But fMRI is not just a phrenological tool: by careful design, fMRI can be used to disentangle discrete components of a timing task and control for the underlying cognitive processes (e.g. sustained attention and WM updating) that are critical for estimating stimulus duration in the range of hundreds of milliseconds to seconds. Moreover, the use of parametric designs and correlational analyses allows us to better understand not just where, but also how, the brain processes temporal information. In addition, by combining fMRI with psychopharmacological manipulation, we can begin to uncover the complex relationship between cognition, neurochemistry and anatomy in the healthy human brain. This chapter provides an overview of some of the key findings in the functional imaging literature of both duration estimation and temporal prediction, and outlines techniques that can be used to allow timing-related activations to be interpreted more unambiguously. In our own studies, we have found that estimating event duration, whether that estimate is provided by a motor response or a perceptual discrimination, typically recruits basal ganglia, SMA and right inferior frontal cortex, and can be modulated by dopaminergic activity in these areas. By contrast, orienting attention to predictable moments in time in order to optimize behaviour, whether that is to speed motor responding or improve perceptual accuracy, recruits left inferior parietal cortex.

  11. How human electrophysiology informs psychopharmacology: from bottom-up driven processing to top-down control.

    PubMed

    Kenemans, J Leon; Kähkönen, Seppo

    2011-01-01

    This review surveys human event-related brain potential (ERP) and event-related magnetic field (ERF) approaches to psychopharmacology and psychopathology, and the way in which they complement behavioral studies and other neuroimaging modalities. The major paradigms involving ERP/ERF are P50 suppression, loudness-dependent auditory evoked potential (LDAEP), mismatch negativity (MMN), P300, mental chronometry, inhibitory control, and conflict processing (eg, error-related negativity (ERN)). Together these paradigms cover a range of more bottom-up driven to more top-down controlled processes. A number of relationships between the major neurotransmitter systems and electrocortical mechanisms are highlighted. These include the role of dopamine in conflict processing, and perceptual processing vs motor preparation; the role of serotonin in P50 suppression, LDAEP, and MMN; glutamate/NMDA and MMN; and the role of acetylcholine in P300 generation and memory-related processes. A preliminary taxonomy for these relationships is provided, which should be helpful in attuning possible new treatments or new applications of existing treatments to various disorders.

  12. Innovative trends in the design of therapeutic trials in psychopharmacology and psychotherapy.

    PubMed

    Fava, Giovanni A; Tomba, Elena; Tossani, Eliana

    2013-01-10

    The standard randomized controlled trial design is still based on the acute disease model. This is in sharp contrast with the fact that the patient is likely to have experienced other treatments before, that may actually modify clinical course and responsiveness. The current standard of therapeutic trial in psychiatry is represented by the large, multi-center, controlled randomized trial with broad inclusion criteria, and little attention to other factors such as the clinical history of patients and comorbidity. The heterogeneous features of these patients would then affect the outcome of the trial. Conflicting results among randomized controlled trials can represent a spectrum of outcomes, based on different patient groups, more than bias or random variability. If a treatment is tested by a series of small trials with inclusion criteria for specific characteristics (including treatment history, subgroups and comorbidity), we may have a better knowledge of its indications and contraindications. Further, there is increasing need of expanding the content of customary clinical information, by including evaluation of variables such as stress, lifestyle, well-being, illness behavior and psychological symptoms. These joint strategies would actually constitute a paradigm shift in psychopharmacology and psychotherapy research.

  13. State of the art psychopharmacological treatment options in seasonal affective disorder.

    PubMed

    Yildiz, Mesut; Batmaz, Sedat; Songur, Emrah; Oral, Esat Timuçin

    2016-03-01

    Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly.

  14. Changes in autonomic regulation with age: implications for psychopharmacologic treatments in children and adolescents.

    PubMed

    Galanter, C A; Wasserman, G; Sloan, R P; Pine, D S

    1999-01-01

    Developmental changes in the cardiovascular system could have an impact on risks associated with psychopharmacological interventions. Children may be more vulnerable to adverse cardiac events due to immaturity in autonomic control of the heart. These changes are incompletely understood and are characterized in this study. A consecutive series of 70 boys, aged 6-14 years, was recruited. Developmental variation in the autonomic nervous system was evaluated by assessing heart period variability (HPV), pulse, and blood pressure in response to orthostasis. Increased age correlated significantly with greater heart rate and diastolic blood pressure response to orthostasis. HPV at rest and in response to tilt did not significantly correlate with age. Boys with family histories of hypertension had a significantly greater blood pressure response to orthostasis. These findings suggest that developmental age-related changes in the sympathetic nervous system, as reflected by changes of pulse and blood pressure response to tilt, occur across this age range. Parasympathetic changes, as reflected by HPV, do not. In light of these findings, more research is needed on children's and adolescents' relative cardiac risk with psychotropic medications as opposed to adults'.

  15. [The virtue of that precious balsam...: approach to Don Quixote from the psychopharmacological perspective].

    PubMed

    Lopez-Munoz, F; Garcia-Garcia, P; Alamo, C

    2007-01-01

    The most outstanding novel of the Spanish literature, Don Quixote, represents the source to which the different specialists who intend to deepen their knowledge of the late Renaissance society usually address. This masterpiece of Miguel de Cervantes has been frequently approached from the psychopathological perspective to obtain a psychiatric diagnosis of its main character, Alonso Quijano. Also, other clinical approaches from the traumatological and general therapeutical view (oils, ointments, balms and other pharmacy preparations) have been frequent. We have tackled Don Quixote from the psychopharmacological perspective, a barely explored field. In this work, we intend to study the therapeutical cures used during the Cervantine time for the treatment of insane and mentally disturbed people (sedatives like opium, laxatives like hellebore, tonics, irritants and surgical techniques like bloodlettings and ) and we analyze the limited and unspecific therapies, mainly of herbal origin (balms, purgatives and emetics), which Cervantes reveals to us in his novel. Among them, rhubarb root (Rumex alpinus), seeds of spurge (Euphorbia lathyris), St. John's Wort (Hypericum perforatum), main ingredient of Aparicio's oil, and rosemary (Rosmarinus officinalis), primary component of the famous balsam of Fierabras, should be highlighted. We have also examined the possible scientific influences which might have inspired Cervantes in this field, mainly the works of Juan Huarte de San Juan The examination of men's wits and the one of Andres Laguna Dioscorides' materia medica.

  16. How Human Electrophysiology Informs Psychopharmacology: from Bottom-up Driven Processing to Top-Down Control

    PubMed Central

    Kenemans, J Leon; Kähkönen, Seppo

    2011-01-01

    This review surveys human event-related brain potential (ERP) and event-related magnetic field (ERF) approaches to psychopharmacology and psychopathology, and the way in which they complement behavioral studies and other neuroimaging modalities. The major paradigms involving ERP/ERF are P50 suppression, loudness-dependent auditory evoked potential (LDAEP), mismatch negativity (MMN), P300, mental chronometry, inhibitory control, and conflict processing (eg, error-related negativity (ERN)). Together these paradigms cover a range of more bottom-up driven to more top-down controlled processes. A number of relationships between the major neurotransmitter systems and electrocortical mechanisms are highlighted. These include the role of dopamine in conflict processing, and perceptual processing vs motor preparation; the role of serotonin in P50 suppression, LDAEP, and MMN; glutamate/NMDA and MMN; and the role of acetylcholine in P300 generation and memory-related processes. A preliminary taxonomy for these relationships is provided, which should be helpful in attuning possible new treatments or new applications of existing treatments to various disorders. PMID:20927044

  17. Mental health issues among college students: who gets referred for psychopharmacology evaluation?

    PubMed

    Kirsch, Daniel J; Doerfler, Leonard A; Truong, Debbie

    2015-01-01

    To describe diagnostic and psychotropic medication prescription characteristics among college students referred by college counseling centers for psychopharmacologic evaluation. Participants were 540 college students referred by 6 college counseling centers in Massachusetts between November 2005 and May 2011. Students completed self-report measures of depression, anxiety, suicidal ideation and attempts, and substance use. Information regarding DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis, previous history of medication prescription, and current psychotropic medication(s) prescribed by the consulting psychiatrist was obtained from medical records. Depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) were the most common psychiatric problems identified in students. Half of these students had been prescribed mediation prior to evaluation. Antidepressant medication was the most frequently prescribed medication. A large proportion of students reported previous thoughts of suicide, and 12% had made at least 1 suicide attempt. Depression, anxiety, and ADHD are common among students referred by college counseling centers for medication evaluation and treatment.

  18. Elevation of liver enzyme levels during psychopharmacological treatment is associated with weight gain.

    PubMed

    Himmerich, Hubertus; Kaufmann, Christian; Schuld, Andreas; Pollmächer, Thomas

    2005-01-01

    Increased circulating levels of liver enzymes emerging during treatment with psychotropic drugs are frequently encountered and, in general, attributed to drug metabolism or toxic effects. Because obesity was shown to be associated with elevated liver enzyme levels in different non-psychiatric study samples, we hypothesized that drug-induced weight gain might be an additional causative factor. We tested this hypothesis in 67 inpatients who received psychopharmacological treatment across five weeks. Stepwise linear regression was used to predict changes in the serum levels of aspartate-amino transferase (ASAT) and alanine-amino transferase (ALAT) by changes in the body mass index (BMI), by changes in other biological parameters related to body weight (tumor necrosis factor-alpha [TNF-alpha], soluble TNF receptors [sTNF-R], interleukin-6 [IL-6], leptin plasma levels) and by the respective liver enzyme baseline level. BMI changes from baseline to endpoint were significantly associated with the changes in ALAT and ASAT levels across five weeks of treatment and with ALAT and ASAT levels at the end point of the study. The baseline levels of ALAT and ASAT also had a significant impact on these liver enzyme level changes, whereas all other variables had not. These results suggest that weight gain-associated metabolic changes occurring during treatment with psychotropic drugs have consistent and clinically relevant effects on the liver.

  19. The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Algorithm for Generalized Anxiety Disorder.

    PubMed

    Abejuela, Harmony Raylen; Osser, David N

    2016-01-01

    This revision of previous algorithms for the pharmacotherapy of generalized anxiety disorder was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. Algorithms from 1999 and 2010 and associated references were reevaluated. Newer studies and reviews published from 2008-14 were obtained from PubMed and analyzed with a focus on their potential to justify changes in the recommendations. Exceptions to the main algorithm for special patient populations, such as women of childbearing potential, pregnant women, the elderly, and those with common medical and psychiatric comorbidities, were considered. Selective serotonin reuptake inhibitors (SSRIs) are still the basic first-line medication. Early alternatives include duloxetine, buspirone, hydroxyzine, pregabalin, or bupropion, in that order. If response is inadequate, then the second recommendation is to try a different SSRI. Additional alternatives now include benzodiazepines, venlafaxine, kava, and agomelatine. If the response to the second SSRI is unsatisfactory, then the recommendation is to try a serotonin-norepinephrine reuptake inhibitor (SNRI). Other alternatives to SSRIs and SNRIs for treatment-resistant or treatment-intolerant patients include tricyclic antidepressants, second-generation antipsychotics, and valproate. This revision of the GAD algorithm responds to issues raised by new treatments under development (such as pregabalin) and organizes the evidence systematically for practical clinical application.

  20. Likelihood of Being Helped or Harmed as a Measure of Clinical Outcomes in Psychopharmacology.

    PubMed

    Andrade, Chittaranjan

    2017-01-01

    The likelihood of being helped or harmed (LHH) ratio is an indirect measure of effect size. It tells the reader how much as likely a patient is to benefit from a treatment as to suffer from an adverse outcome with that treatment; larger values for LHH indicate more favorable treatment outcomes. The numerator for LHH is usually a measure of response or remission with a treatment, and the denominator is usually a measure of all-cause discontinuation or discontinuation due to adverse events; so, there can be more than 1 LHH statistic for a study. As an example, an LHH of 5 could indicate that after removal of placebo effects a patient is 5 times as likely to respond to a treatment as to drop out of treatment because of the experience of an adverse event. This article explains the LHH with the help of a worked example, shows how the LHH can be derived from the numbers needed to treat and harm (NNT, NNH) statistics, discusses practical issues related to the concept, and considers its limitations. The LHH is little used in clinical psychopharmacology, and authors who report or review clinical trial data should consider presenting all the LHH information that is clinically relevant in addition to NNT, NNH, and other information. Because LHH statistics present the results of risk-benefit trade-off analyses, they can help clinicians and patients more easily evaluate potential treatments during decision-making processes.

  1. Psychopharmacological effects of tianeptine analogous hetero[2,1] benzothiazepine derivatives.

    PubMed

    Sánchez-Mateo, Candelaria C; Darias, Victoriano; Albertos, Luz M; Expósito-Orta, María A

    2003-01-01

    The psychopharmacological effects of a number of thieno and pyrazolo[2,1] benzothiazepine derivatives as well as several synthetic intermediate compounds were investigated in mice. Previously published studies in mice have shown that some of these compounds were effective in the tetrabenazine and Porsolt tests. In the present study, 7 of the 15 compounds under study clearly antagonized the apomorphine (16 mg/kg s.c.)-induced hypothermia, but no significant potentiation of the 5-hydroxytryptophan (5-HTP) and amphetamine actions was found. Five of them inhibited the syndrome induced by 5-HTP (250 mg/kg i.p.). Moreover, some of them were effective in the plus-maze test and antagonized the apomorphine (3 mg/kg s.c.)-induced effects. On the other hand, these compounds produced a moderate inhibition of exploratory behaviour in the hole-board test, but they had no significant muscle relaxant and anticonvulsant activities. The results indicate that some of the compounds under study combine a spectrum of antidepressant, anxiolytic and neuroleptic properties in mice with a lack of muscle relaxant and anticonvulsant activities.

  2. Potential benefits and limits of psychopharmacological therapies in pervasive developmental disorders.

    PubMed

    Molteni, Massimo; Nobile, Maria; Cattaneo, Dario; Radice, Sonia; Clementi, Emilio

    2014-01-01

    The core symptoms of Autistic Spectrum Disorder (ASD) are impairment in reciprocal social interaction, communication, narrow interests, and stereotyped behaviour. These are frequently severe and persistent, although their severity may change over the course of life. Furthermore, the frequently associated symptoms of self-injury, aggressive behaviour, impulsivity, poor attention, anxiety, depression, and sleep disruption, can become a major source of additional distress and interference in functioning. The causes of autism are not yet known, but there is a general consensus that ASDs are highly heritable. Comprehension of the neurobiological basis for autism-spectrum disorders is still in its initial stages: a large body of research, however, has established ASD signs and symptoms are of neurological origin, and suggest that autism is a distributed neural system disorder, which disproportionately impairs many higher order abilities. Currently available medical treatments, primarily address co-morbid symptoms, rather than core symptoms. Thus, in spite of recent advances in psychopharmacology, the treatment approach still has important limits and shows poor efficacy on global outcomes. A potential pathway for improving clinical outcomes is that of the personalised treatment for autism, by using therapeutic drug monitoring (TDM) - a valuable tool for drugs with narrow therapeutic index - as well as systematic genetic background assessment, foreseen in future applications. However, it is already possible to implement an active surveillance programme to address safety concerns and to optimise therapeutic drug interventions in ASD.

  3. Psychopharmacology of Tobacco and Alcohol Comorbidity: a Review of Current Evidence.

    PubMed

    Adams, Sally

    2017-01-01

    Comorbidity of alcohol and tobacco use is highly prevalent and may exacerbate the health effects of either substance alone. However, the mechanisms underlying this comorbidity are not well understood. This review will examine the evidence for shared neurobiological mechanisms of alcohol and nicotine comorbidity and experimental studies of the behavioural consequences of these interactions. Studies examining the shared neurobiology of alcohol and nicotine have identified two main mechanisms of comorbidity: (1) cross-reinforcement via the mesolimbic dopamine pathway and (2) cross-tolerance via shared genetic and nAChR interaction. Animal and human psychopharmacological studies demonstrate support for these two mechanisms of comorbidity. Human behavioural studies indicate that (1) alcohol and tobacco potentiate each other's rewarding effects and (2) nicotine reduces the sedative and intoxication effects of alcohol. Together, these findings provide a strong evidence base to support the role of the cross-reinforcement and cross-tolerance as mechanisms underlying the comorbidity of alcohol and tobacco use. Methodological concerns in the literature and recommendations for future studies are discussed alongside implications for treatment of comorbid alcohol and tobacco use.

  4. Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study.

    PubMed

    Bjørklund, Louise; Horsdal, Henriette Thisted; Mors, Ole; Østergaard, Søren Dinesen; Gasse, Christiane

    2016-04-01

    In bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy. Cohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest. We identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants. The results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.

  5. AACAP 2002 research forum: placebo and alternatives to placebo in randomized controlled trials in pediatric psychopharmacology.

    PubMed

    March, John; Kratochvil, Christopher; Clarke, Gregory; Beardslee, William; Derivan, Albert; Emslie, Graham; Green, Evelyn P; Heiligenstein, John; Hinshaw, Stephen; Hoagwood, Kimberly; Jensen, Peter; Lavori, Philip; Leonard, Henrietta; McNulty, James; Michaels, M Alex; Mossholder, Andrew; Osher, Trina; Petti, Theodore; Prentice, Ernest; Vitiello, Benedetto; Wells, Karen

    2004-08-01

    The use of placebo in the pediatric age group has come under increasing scrutiny. At the 2002 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Academy's Workgroup on Research conducted a research forum. The purpose was to identify challenges and their solutions regarding the use of placebo in randomized controlled trials in pediatric psychopharmacology. Workgroups focused on problems and solutions in five areas: ethics and human subjects, research design and statistics, partnering with consumers, U.S. Food and Drug Administration and pharmaceutical industry perspectives, and psychosocial treatments. In many but not all circumstances, inclusion of a placebo control is essential to meet the scientific goals of treatment outcome research. Innovative research designs; involvement of consumers in planning and implementing research; flexibility by industry, academia, the National Institutes of Health, and regulatory agencies acting in partnership; and concomitant use of evidence-based psychosocial services can and should assist in making placebo-controlled trials acceptable. Properly designed placebo-controlled trials remain necessary, ethical, and feasible.

  6. Unveiling the role of melatonin MT2 receptors in sleep, anxiety and other neuropsychiatric diseases: a novel target in psychopharmacology.

    PubMed

    Comai, Stefano; Gobbi, Gabriella

    2014-01-01

    Melatonin (MLT) is a pleiotropic neurohormone controlling many physiological processes and whose dysfunction may contribute to several different diseases, such as neurodegenerative diseases, circadian and mood disorders, insomnia, type 2 diabetes and pain. Melatonin is synthesized by the pineal gland during the night and acts through 2 G-protein coupled receptors (GPCRs), MT1 (MEL1a) and MT2 (MEL1b). Although a bulk of research has examined the physiopathological effects of MLT, few studies have investigated the selective role played by MT1 and MT2 receptors. Here we have reviewed current knowledge about the implications of MT2 receptors in brain functions. We searched PubMed, Web of Science, Scopus, Google Scholar and articles' reference lists for studies on MT2 receptor ligands in sleep, anxiety, neuropsychiatric diseases and psychopharmacology, including genetic studies on the MTNR1B gene, which encodes the melatonin MT2 receptor. These studies demonstrate that MT2 receptors are involved in the pathophysiology and pharmacology of sleep disorders, anxiety, depression, Alzheimer disease and pain and that selective MT2 receptor agonists show hypnotic and anxiolytic properties. Studies examining the role of MT2 receptors in psychopharmacology are still limited. The development of novel selective MT2 receptor ligands, together with further preclinical in vivo studies, may clarify the role of this receptor in brain function and psychopharmacology. The superfamily of GPCRs has proven to be among the most successful drug targets and, consequently, MT2 receptors have great potential for pioneer drug discovery in the treatment of mental diseases for which limited therapeutic targets are currently available.

  7. Schizophrenia patients' and psychiatrists' perspectives on ethical aspects of symptom re-emergence during psychopharmacological research participation.

    PubMed

    Roberts, Laura Weiss; Warner, Teddy D; Nguyen, Khanh P; Geppert, Cynthia M A; Rogers, Melinda K; Roberts, Brian B

    2003-12-01

    Study designs involving medication-free intervals have become the subject of controversy in the current dialogue on the ethics of serious mental-illness research. Schizophrenia patients ( n=59; response rate 75%; 48% inpatients) and psychiatrists ( n=70; response rate 83%) responded to ten questions about a hypothetical scenario in which a schizophrenia study participant experienced the re-emergence of serious symptoms during the "wash-out" phase of a psychopharmacological trial. Patients provided their personal views, and psychiatrists gave their personal views and made predictions as to how schizophrenia patients in general would respond. Schizophrenia patients and psychiatrists judged the hypothetical protocol as moderately harmful. Both expressed relatively low likelihood of willingness to participate in the study, given this potential outcome. Schizophrenia patients and psychiatrists found the decision fairly easy. Psychiatrists underestimated the level of harm and overestimated the difficulty of the decision as perceived by schizophrenia patients. Schizophrenia patients acknowledged that the offer of money and request by their doctor or family would increase the likelihood of their participation, and psychiatrists accurately predicted these responses. In hypothetical decisions about the symptomatic study participant, 38% of patients and 39% of psychiatrists said they would allow him to leave the hospital. A majority of both groups (63% and 52%, respectively) indicated that medication should be given despite the study participant's objection. Psychiatrists incorrectly predicted this response, expecting instead that most schizophrenia patients would support the discharge request and few would support involuntary administration of medication. Patients and psychiatrists offered similar reasons for participation decisions but differed in their strategies for handling the situation. These findings suggest potential strengths of decisionally capable schizophrenia

  8. [Psychopharmacologic studies on the combined effect of alcohol and oxazepam on reactivity pattern. II. Subjective feeling and reaction behavior].

    PubMed

    Staak, M; Gottwald, K; Mallach, H J; Schubring, G

    1977-05-01

    Psychopharmacological investigations of the subjective state of being and the reactivity pattern of a group of 14 probands show a good agreement with the alterations of performance reported in the first part of this publication and with the data on polarity profiles. In addition to a sedative effect the interaction of alcohol and oxazepam in the oxazepam trial results in dysphoric changes of mood and related significant alterations of polarity profiles. A correlation of the changes of performance and the alterations of the polarity profiles with the respective blood levels of alcohol and oxazepam could be demonstrated.

  9. Critical thinking about adverse drug effects: lessons from the psychology of risk and medical decision-making for clinical psychopharmacology.

    PubMed

    Nierenberg, Andrew A; Smoller, Jordan W; Eidelman, Polina; Wu, Yelena P; Tilley, Claire A

    2008-01-01

    Systematic biases in decision-making have been well characterized in medical and nonmedical fields but mostly ignored in clinical psychopharmacology. The purpose of this paper is to sensitize clinicians who prescribe psychiatric drugs to the issues of the psychology of risk, especially as they pertain to the risk of side effects. Specifically, the present analysis focuses on heuristic organization and framing effects that create cognitive biases in medical practice. Our purpose is to increase the awareness of how pharmaceutical companies may influence physicians by framing the risk of medication side effects to favor their products.

  10. Investigation of serotonin-1A receptor function in the human psychopharmacology of MDMA.

    PubMed

    Hasler, F; Studerus, E; Lindner, K; Ludewig, S; Vollenweider, F X

    2009-11-01

    Serotonin (5-HT) release is the primary pharmacological mechanism of 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') action in the primate brain. Dopamine release and direct stimulation of dopamine D2 and serotonin 5-HT2A receptors also contributes to the overall action of MDMA. The role of 5-HT1A receptors in the human psychopharmacology of MDMA, however, has not yet been elucidated. In order to reveal the consequences of manipulation at the 5-HT1A receptor system on cognitive and subjective effects of MDMA, a receptor blocking study using the mixed beta-adrenoreceptor blocker/5-HT1A antagonist pindolol was performed. Using a double-blind, placebo-controlled within-subject design, 15 healthy male subjects were examined under placebo (PL), 20 mg pindolol (PIN), MDMA (1.6 mg/kg b.wt.), MDMA following pre-treatment with pindolol (PIN-MDMA). Tasks from the Cambridge Neuropsychological Test Automated Battery were used for the assessment of cognitive performance. Psychometric questionnaires were applied to measure effects of treatment on core dimensions of Altered States of Consciousness, mood and state anxiety. Compared with PL, MDMA significantly impaired sustained attention and visual-spatial memory, but did not affect executive functions. Pre-treatment with PIN did not significantly alter MDMA-induced impairment of cognitive performance and only exerted a minor modulating effect on two psychometric scales affected by MDMA treatment ('positive derealization' and 'dreaminess'). Our findings suggest that MDMA differentially affects higher cognitive functions, but does not support the hypothesis from animal studies, that some of the MDMA effects are causally mediated through action at the 5-HT1A receptor system.

  11. The psychopharmacology algorithm project at the Harvard South Shore Program: an algorithm for acute mania.

    PubMed

    Mohammad, Othman; Osser, David N

    2014-01-01

    This new algorithm for the pharmacotherapy of acute mania was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. The authors conducted a literature search in PubMed and reviewed key studies, other algorithms and guidelines, and their references. Treatments were prioritized considering three main considerations: (1) effectiveness in treating the current episode, (2) preventing potential relapses to depression, and (3) minimizing side effects over the short and long term. The algorithm presupposes that clinicians have made an accurate diagnosis, decided how to manage contributing medical causes (including substance misuse), discontinued antidepressants, and considered the patient's childbearing potential. We propose different algorithms for mixed and nonmixed mania. Patients with mixed mania may be treated first with a second-generation antipsychotic, of which the first choice is quetiapine because of its greater efficacy for depressive symptoms and episodes in bipolar disorder. Valproate and then either lithium or carbamazepine may be added. For nonmixed mania, lithium is the first-line recommendation. A second-generation antipsychotic can be added. Again, quetiapine is favored, but if quetiapine is unacceptable, risperidone is the next choice. Olanzapine is not considered a first-line treatment due to its long-term side effects, but it could be second-line. If the patient, whether mixed or nonmixed, is still refractory to the above medications, then depending on what has already been tried, consider carbamazepine, haloperidol, olanzapine, risperidone, and valproate first tier; aripiprazole, asenapine, and ziprasidone second tier; and clozapine third tier (because of its weaker evidence base and greater side effects). Electroconvulsive therapy may be considered at any point in the algorithm if the patient has a history of positive response or is intolerant of medications.

  12. Trends in psychopharmacologic treatment of tic disorders in children and adolescents in Germany.

    PubMed

    Bachmann, Christian J; Roessner, Veit; Glaeske, Gerd; Hoffmann, Falk

    2015-02-01

    Data on medical treatment of children and adolescents with tic disorders are scarce. This study examined the administrative prevalence of psychopharmacological prescriptions in this patient group in Germany. Data of the largest German health insurance fund were analysed. In outpatients aged 0-19 years with diagnosed tic disorder, psychotropic prescriptions were evaluated for the years 2006 and 2011. In 2011, the percentage of psychotropic prescriptions was slightly higher than in 2006 (21.2 vs. 18.6%). The highest prescription prevalence was found in Tourette syndrome (51.5 and 53.0%, respectively). ADHD drugs were most frequently prescribed, followed by antipsychotics. In 2011, prescriptions of second generation antipsychotics (SGA) were higher and prescriptions of first generation antipsychotics (FGA) lower than in 2006. Concerning prescribed antipsychotic substances, in 2011 risperidone prescriptions were higher and tiapride prescriptions lower. Paediatricians issued 37.4%, and child and adolescent psychiatrists issued 37.1% of psychotropic prescriptions. The FGA/SGA ratio was highest in GPs (1.25) and lowest in child and adolescent psychiatrists (0.96). From 2006 to 2011, there was only a slight increase in psychotropic prescriptions for children and adolescents with a diagnosis of tic disorder in Germany, which stands in contrast towards the significant increase in psychotropic prescriptions in other child and adolescent psychiatric disorders (e.g. ADHD). There were marked differences in treatment patterns by tic disorder subgroups, with Tourette syndrome patients receiving most frequently psychopharmacotherapy. Risperidone prescriptions increased, probably reflecting a switch in prescribing practice towards up-to-date treatment guidelines. In primary care physicians, dissemination of current tic disorder treatment guidelines might constitute an important educational goal.

  13. A data mining approach to in vivo classification of psychopharmacological drugs.

    PubMed

    Kafkafi, Neri; Yekutieli, Daniel; Elmer, Greg I

    2009-02-01

    Data mining is a powerful bioinformatics strategy that has been successfully applied in vitro to screen for gene-expression profiles predicting toxicological or carcinogenic response ('class predictors'). In this report we used a data mining algorithm named Pattern Array (PA) in vivo to analyze mouse open-field behavior and characterize the psychopharmacological effects of three drug classes--psychomotor stimulant, opioid, and psychotomimetic. PA represents rodent movement with approximately 100,000 complex patterns, defined as multiple combinations of several ethologically relevant variables, and mines them for those that maximize any effect of interest, such as the difference between drug classes. We show that PA can discover behavioral predictors of all three drug classes, thus developing a reliable drug-classification scheme in small group sizes. The discovered predictors showed orderly dose dependency despite being explicitly mined only for class differences, with the high doses scoring 4-10 standard deviations from the vehicle group. Furthermore, these predictors correctly classified in a dose-dependent manner four 'unknown' drugs (ie that were not used in the training process), and scored a mixture of a psychomotor stimulant and an opioid as being intermediate between these two classes. The isolated behaviors were highly heritable (h(2)>50%) and replicable as determined in 10 inbred strains across three laboratories. PA can in principle be applied for mining behaviors predicting additional properties, such as within-class differences between drugs and within-drug dose-response, all of which can be measured automatically in a single session per animal in an open-field arena, suggesting a high potential as a tool in psychotherapeutic drug discovery.

  14. ASD, ADHD, mental health conditions and psychopharmacology in neurogenetic syndromes: parent survey.

    PubMed

    Reilly, C; Senior, J; Murtagh, L

    2015-04-01

    There are a number of neurogenetic syndromes with well described behavioural phenotypes including fragile X syndrome, Prader-Willi syndrome, Williams syndrome and velo-cardio-facial syndrome (VCFS). Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and psychiatric conditions are often associated with the syndromes. Parents (n = 381) of school-aged children with one of the four syndromes in the UK and Ireland were asked whether their child had been professionally diagnosed with ASD, ADHD or a mental health condition. Parents were also asked whether their child had been prescribed medication for behavioural or psychiatric reasons. The highest level of reported diagnoses of ASD and ADHD was in fragile X syndrome. In all syndrome groups, lower rates of diagnosis were reported in comparison to previously published research. Prescribing of medication for behavioural/psychiatric reasons was highest in fragile X syndrome although the highest usage of melatonin was in Williams syndrome. Reasons for a lower recognition of ASD, ADHD and mental health conditions in clinical practice compared with research studies may include 'diagnostic overshadowing' due to presence of intellectual disability and a genetic syndrome. However, there may also be a lack of belief in the utility of such diagnoses in neurogenetic syndromes among relevant professionals and/or lack of access to professionals with sufficient expertise in the recognition of such diagnoses in those with neurogenetic syndromes. The low rates of prescribing of medication for behavioural/psychiatric reasons may reflect the low level of clinical diagnoses or lack of belief in the utility of psychopharmacology in this population. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  15. [The method of joined multi-center studies in clinical psychopharmacology].

    PubMed

    Fleischhauer, J

    1975-01-01

    Joined multicentered studies are of interest more and more growing up in the field of clinical psychopharmacology. Only such studies should be carried out which have a high scientific value to avoid unnecessary waste. According to this fact the preconditions are greater than such required for a single-center study. Also long-term studies require more preconditions than short-term studies. Pilot studies with clinically more or less unknown drugs should be avoided in multicentered studies for the same reasons. Of great importance is the selection of subjects. The single centers should have well comparable groups of patients. Nevertheless the number of selection criterias should be as few as possible, because also with only some few simple criterias the total number of patients is greatly restricted. The most likely group would consist of patients with acut diseases either recently admitted to the hospital or outpatients who conform to some good defined criterias. Of great importance is the control group. Ethical problems are playing an important role in this field. In view of the fact that the precise action mechanism of drugs is unknown at present, the randomization method will appear to be the best available selection method at the moment. The cross-over-method in mentally ill patients seems hardly suitable out of diverse reasons. Considering the dosage it seems that a limited and fixed dosage is a practicable compromise. Of greatest importance naturally is the good documentation and quantification of the results. Rating-Scales therefore are more suitable than check-lists. Some well introduced and validated rating-scales are existing and mentioned. As important instruments as the rating-scales are the self-rating-scales. Furthermore of great interest in such studies can be the multicentered additional measuring of some psychophysiological variables, for example with the polygraph.

  16. Psychopharmacological properties of an aqueous extract of Tetracarpidium conophorum Hutch. & Dalziel in mice.

    PubMed

    Aladeokin, Aderemi C; Umukoro, Solomon

    2011-07-01

    The extract of the nut of Tetracarpidium conophorum (TC), commonly known as African walnut, is widely used to relieve pain, increase sperm count, enhance sexual performance in males and as a nerve tonic in ethnomedicine. This study describes the psychopharmacological properties of the aqueous extract of the nut of TC in mice. The spectrum of activities studied were the effects of TC on the duration of immobility in the forced swim test of the behavioural despair model of depression; prolongation of the duration of sleep produced by thiopentone; amphetamine-induced stereotyped behaviour; and on pain episodes produced by acetic acid and by formalin. Orally administered TC (50-200 mg/kg) produced a significant and dose-related decrease in the duration of immobility in the forced swim test in mice. TC also exhibited analgesic property, as shown by its ability to reduce the frequency of abdominal constrictions induced by acetic acid and to inhibit the nociceptive responses produced by formalin. However, at the tested oral doses of 50-200 mg/kg, TC did not prolong the duration of sleep produced by thiopentone nor alter the pattern of the stereotyped behaviour induced by amphetamine. This investigation provides evidence that may support the ethnomedicinal applications of the extract of the nut of TC in the treatment of pain. The study also revealed that TC seems to demonstrate antidepressant-like activity, as evidenced by its ability to shorten the period of immobility in the forced swim test; however, further studies are necessary to clearly define the role of TC in depression.

  17. [Review of psychopharmacological treatments in adolescents and adults with autistic disorders].

    PubMed

    Baghdadli, A; Gonnier, V; Aussilloux, C

    2002-01-01

    Autism is an early developmental disorder. It leads to severe and durable disturbances. Given this problem, no treatment can be excluded a priori. Thus, many approaches are used to deal with autistic disorders. In France, pharmacological treatments are, for instance, largely and mostly used in adults. In the USA, these treatments concern 50% of persons with autism of any age. Nevertheless, they are rarely based on controlled studies. At the present, however, prescriptions and expected effects appear to be hard to localize. Furthermore, only few controlled studies validate their use. Aim - We offer a review of studies about medical treatments used in adolescents and adults with autism. They are classified in 3 categories: the first (category I) includes drugs used for their neurochemical effects focusing on autistic signs. The second (category II) covers drugs used for treatment of behavioural disorders frequently associated with autism. The third (category III) corresponds to a wide range of drugs or vitamins for wich only few case studies exist reporting irregular positive effects. The main hypothesis of this review is that autism involves a dysfunction of the neuromediation systems. This hypothesis opens new perspectives in the research of medical treatments in autism by focusing on molecules, which are supposed to have an effect on neuromediation systems. Method - Our review is based on studies, which have been published during the past twenty years. For many studies, data are limited to adolescents and adults. So we expanded our review to data available in children. The data bases that we have used are medline and psyclit. Keywords have been chosen according to: pharmacological considerations (psychotropic, psychoactive drugs, psychopharmacology) and clinical symptoms (autism, automutilations, aggressive behavior, and hyperactivity). Hypothesis of a dysfunction in the neuromediation systems in autism - Many studies exist about biochemical abnormalities in

  18. Evidence-based guidelines for treating bipolar disorder: revised second edition--recommendations from the British Association for Psychopharmacology.

    PubMed

    Goodwin, G M

    2009-06-01

    The British Association for Psychopharmacology guidelines specify the scope and target of treatment for bipolar disorder. The second version, like the first, is based explicitly on the available evidence and presented, like previous Clinical Practice guidelines, as recommendations to aid clinical decision making for practitioners: they may also serve as a source of information for patients and carers. The recommendations are presented together with a more detailed but selective qualitative review of the available evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. The strength of supporting evidence was rated. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in treatment of episodes, relapse prevention and stopping treatment.

  19. Cannabinoid mitigation of neuronal morphological change important to development and learning: insight from a zebra finch model of psychopharmacology.

    PubMed

    Soderstrom, Ken; Gilbert, Marcoita T

    2013-03-19

    Normal CNS development proceeds through late-postnatal stages of adolescent development. The activity-dependence of this development underscores the significance of CNS-active drug exposure prior to completion of brain maturation. Exogenous modulation of signaling important in regulating normal development is of particular concern. This mini-review presents a summary of the accumulated behavioral, physiological and biochemical evidence supporting such a key regulatory role for endocannabinoid signaling during late-postnatal CNS development. Our focus is on the data obtained using a unique zebra finch model of developmental psychopharmacology. This animal has allowed investigation of neuronal morphological effects essential to establishment and maintenance of neural circuitry, including processes related to synaptogenesis and dendritic spine dynamics. Altered neurophysiology that follows exogenous cannabinoid exposure during adolescent development has the potential to persistently alter cognition, learning and memory.

  20. Lights! Camera! Action Projects! Engaging Psychopharmacology Students in Service-based Action Projects Focusing on Student Alcohol Abuse

    PubMed Central

    Kennedy, Susan

    2016-01-01

    Alcohol abuse continues to be an issue of major concern for the health and well-being of college students. Estimates are that over 80% of college students are involved in the campus “alcohol culture.” Annually, close to 2000 students die in the United States due to alcohol-related accidents, with another 600,000 sustaining injury due to alcohol-related incidents (NIAAA, 2013). Students enrolled in a Psychopharmacology course engaged in action projects (community outreach) focused on alcohol abuse on our campus. Research has indicated that these types of projects can increase student engagement in course material and foster important skills, including working with peers and developing involvement in one’s community. This paper describes the structure and requirements of five student outreach projects and the final projects designed by the students, summarizes the grading and assessment of the projects, and discusses the rewards and challenges of incorporating such projects into a course. PMID:27385923

  1. Lights! Camera! Action Projects! Engaging Psychopharmacology Students in Service-based Action Projects Focusing on Student Alcohol Abuse.

    PubMed

    Kennedy, Susan

    2016-01-01

    Alcohol abuse continues to be an issue of major concern for the health and well-being of college students. Estimates are that over 80% of college students are involved in the campus "alcohol culture." Annually, close to 2000 students die in the United States due to alcohol-related accidents, with another 600,000 sustaining injury due to alcohol-related incidents (NIAAA, 2013). Students enrolled in a Psychopharmacology course engaged in action projects (community outreach) focused on alcohol abuse on our campus. Research has indicated that these types of projects can increase student engagement in course material and foster important skills, including working with peers and developing involvement in one's community. This paper describes the structure and requirements of five student outreach projects and the final projects designed by the students, summarizes the grading and assessment of the projects, and discusses the rewards and challenges of incorporating such projects into a course.

  2. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology.

    PubMed

    Barnes, Thomas R E

    2011-05-01

    These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.

  3. Cannabinoid mitigation of neuronal morphological change important to development and learning: insight from a zebra finch model of psychopharmacology

    PubMed Central

    Soderstrom, Ken; Gilbert, Marcoita T.

    2012-01-01

    Normal CNS development proceeds through late-postnatal stages of adolescent development. The activity-dependence of this development underscores significance of CNS-active drug exposure prior to completion of brain maturation. Exogenous modulation of signaling important in regulating normal development is of particular concern. This mini-review presents a summary of accumulated behavioral, physiological and biochemical evidence supporting such a key regulatory role for endocannabinoid signaling during late-postnatal CNS development. Our focus is on data obtained using a unique zebra finch model of developmental psychopharmacology. This animal has allowed investigation of neuronal morphological effects essential to establishment and maintenance of neural circuitry, including processes related to synaptogenesis and dendritic spine dynamics. Altered neurophysiology that follows exogenous cannabinoid exposure during adolescent development has potential to persistently alter cognition, learning and memory. PMID:22884809

  4. The role of psychopharmacology in the medical abuses of the Third Reich: from euthanasia programmes to human experimentation.

    PubMed

    López-Muñoz, Francisco; Alamo, Cecilio; García-García, Pilar; Molina, Juan D; Rubio, Gabriel

    2008-12-16

    German psychiatry and pharmacology both enjoyed an extraordinary international reputation prior to the promulgation of the Third Reich. However, with the triumph of eugenic ideas and the imposition of a "racial hygiene" policy by the Nazi regime, various organs of the German health system saw themselves involved in a perverse system of social control, in which the illicit use of psychopharmacological tools became customary. In the present work, we review, from the historical perspective, the factors that helped to bring about this situation and we analyze the abuses (known and documented) committed through the specific use of psychotropic drugs during the Nazi period. Among such abuses we can identify the following illegitimate activities: the use of psychoactive drugs, mainly sedatives from the barbiturates family, in the different euthanasia programmes implemented by the Nazi authorities, in police activity and various types of repression, and for purely criminal and extermination purposes within the so-called "Final Solution"; psychopharmacological research on the mentally ill, without the slightest ethical requirements or legal justification; and the use of psychotropic agents in research on healthy subjects, recruited from concentration camps. Finally, we refer to the role of poisonous nerve agents (tabun, sarin and soman) as instruments of chemical warfare and their development by the German authorities. Many of these activities, though possibly only a small portion of the total - given the destruction of a great deal of documentation just before the end of World War II - came to light through the famous Nuremberg Trials, as well as through other trials in which specific persons were brought to justice unilaterally by individual Allied nations or by the authorities of the new German government after the War.

  5. A psychopharmacology course for psychiatry residents utilizing active-learning and residents-as-teachers to develop life-long learning skills.

    PubMed

    Muzyk, Andrew J; White, Crystal D; Kinghorn, Warren A; Thrall, Grace C

    2013-09-01

    The authors describe the implementation and evaluation of a 1-year psychopharmacology course using residents-as-teachers and active-learning exercises intended to improve understanding of current psychopharmacology and its evidence base, and skills for life-long learning. Weekly classes were devoted to psychotropic medications, treating specific disorders, and use of psychotropics in special patient populations. Each class was divided into three sections: a pharmacology review, a literature review and a faculty-led discussion of clinical questions. Each class included residents as teachers, an audience response system and questions for self-assessment. Resident and faculty presenters evaluated the course weekly and all residents were given a year-end evaluation Resident and faculty evaluations indicated an overall positive response. The residents reported improved perception of knowledge and engagement with this interactive format. The course was well received, demonstrating the viability and value of residents taking a more active role in their own learning.

  6. Psychopharmacological treatment of psychotic mania and psychotic bipolar depression compared to non-psychotic mania and non-psychotic bipolar depression.

    PubMed

    Bjørklund, Louise B; Horsdal, Henriette T; Mors, Ole; Gasse, Christiane; Østergaard, Søren D

    2017-06-08

    An evidence base for the treatment of mania and bipolar depression with psychotic symptoms is lacking. Nevertheless, clinicians may have a preference for treating episodes of bipolar disorder with or without psychotic symptoms in different ways, which is likely to reflect notions of differential efficacy of treatments between these subtypes. This study aimed to investigate whether the psychopharmacological treatment of psychotic and non-psychotic episodes of mania and bipolar depression, respectively, differs in clinical practice. We conducted a register-based study assessing the psychopharmacological treatment of all individuals receiving their first diagnosis of mania or bipolar depression between 2010 and 2012. The psychopharmacological treatment within 3 months following the time of diagnosis was considered. Potential differences in psychopharmacological treatment between the psychotic and non-psychotic subtypes of mania and bipolar depression, respectively, were investigated by means of Pearson's χ(2) test and logistic regression adjusted for sex and age at diagnosis of bipolar disorder. A total of 827 patients were included in the analyses. The adjusted odds ratio (aOR) for treatment with an antipsychotic was 1.71 (95% confidence interval [CI]: 1.18-2.48, P<.01) for psychotic mania and 3.89 (95% CI: 1.95-7.76, P<.001) for psychotic bipolar depression. The aOR for treatment with the combination of an antipsychotic and an anticonvulsant was 1.60 (95% CI: 1.06-2.43, P<.05) for psychotic mania. The aOR for treatment with the combination of an antipsychotic and an antidepressant was 2.50 (95% CI: 1.43-4.37, P<.01) for bipolar psychotic depression. It would be of interest to conduct studies evaluating whether antipsychotics represent the superior pharmacological treatment for psychotic mania and psychotic bipolar depression. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. The interface between publicly funded and industry-funded research in pediatric psychopharmacology: opportunities for integration and collaboration.

    PubMed

    Vitiello, Benedetto; Heiligenstein, John H; Riddle, Mark A; Greenhill, Laurence L; Fegert, Jörg M

    2004-07-01

    Pediatric psychopharmacology research is undergoing a major expansion consequent to increasing use of psychotropic medications in children and recent legislative incentives to industry. In this rapidly changing context, the interface between publicly and privately funded research needs to be reconsidered to integrate activities and avoid unnecessary duplication of efforts. Once, by default, the almost exclusive domain of public research, child research is now increasingly funded by industry. There are, however, important issues unlikely to be addressed through private funding for which public support is needed, such as direct comparisons between active medications, between pharmacological and psychosocial interventions, or between combined and single treatment modalities; development of effective treatment strategies for patients unresponsive to first-line treatments; development of better research methods to assess efficacy and safety; identification of moderators and mechanisms of treatment response; and impact of treatment on illness course and prognosis. Industry-sponsored research is limited by the restricted access to proprietary databases, which impedes independent analyses and meta-analyses. Translation of basic neuroscience discoveries into treatment applications for children with mental illness is a critical area of inquiry that can benefit from integration of efforts and collaborations among academia, government, and industry.

  8. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines.

    PubMed

    Cleare, Anthony; Pariante, C M; Young, A H; Anderson, I M; Christmas, D; Cowen, P J; Dickens, C; Ferrier, I N; Geddes, J; Gilbody, S; Haddad, P M; Katona, C; Lewis, G; Malizia, A; McAllister-Williams, R H; Ramchandani, P; Scott, J; Taylor, D; Uher, R

    2015-05-01

    A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.

  9. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology.

    PubMed

    Goodwin, G M; Haddad, P M; Ferrier, I N; Aronson, J K; Barnes, Trh; Cipriani, A; Coghill, D R; Fazel, S; Geddes, J R; Grunze, H; Holmes, E A; Howes, O; Hudson, S; Hunt, N; Jones, I; Macmillan, I C; McAllister-Williams, H; Miklowitz, D R; Morriss, R; Munafò, M; Paton, C; Saharkian, B J; Saunders, Kea; Sinclair, Jma; Taylor, D; Vieta, E; Young, A H

    2016-06-01

    The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. © The Author(s) 2016.

  10. THE AMERICAN SOCIETY OF CLINICAL PSYCHOPHARMACOLOGY SURVEY OF PSYCHOPHARMACOLOGISTS' PRACTICE PATTERNS FOR THE TREATMENT OF MOOD DISORDERS.

    PubMed

    Goldberg, Joseph F; Freeman, Marlene P; Balon, Richard; Citrome, Leslie; Thase, Michael E; Kane, John M; Fava, Maurizio

    2015-08-01

    Optimal successive treatment decisions are not well established after an initial medication nonresponse in major depressive disorder or bipolar disorder. While practice guidelines offer consensus-based expert treatment recommendations, little is known about "real world" pharmacology decision making by practicing psychopharmacologists. We surveyed via Internet the national membership of the American Society of Clinical Psychopharmacology (ASCP) to study preferred pharmacotherapy strategies and factors that influence medication choices for patients with mood disorders. Surveys were returned by 154/752 ASCP members (21%). After nonresponse to a serotonin reuptake inhibitor in major depressive disorder, participants equally favored switching within or across antidepressant classes. After a partial response, adjunctive bupropion was the preferred intervention, followed by changing antidepressant classes. Atypical antipsychotic augmentation was only a fourth-line consideration, even though moderate or marked efficacy was perceived in most instances with olanzapine, aripiprazole, and quetiapine. Respondents favored avoiding antidepressants in bipolar I patients with mixed/cycling features or prior antidepressant-associated mania/hypomania. In rapid cyclers, they advocated antidepressant cessation and preferred the use of atypical antipsychotics and lamotrigine. Participating psychopharmacologists treating adults with mood disorders report prescribing medications that largely mirror the evidence base with only a few notable exceptions, in consideration of the characteristics of definable clinical subpopulations. © 2015 Wiley Periodicals, Inc.

  11. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders.

    PubMed

    Wilson, S J; Nutt, D J; Alford, C; Argyropoulos, S V; Baldwin, D S; Bateson, A N; Britton, T C; Crowe, C; Dijk, D-J; Espie, C A; Gringras, P; Hajak, G; Idzikowski, C; Krystal, A D; Nash, J R; Selsick, H; Sharpley, A L; Wade, A G

    2010-11-01

    Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.

  12. Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology

    PubMed Central

    Goodwin, G.M.; Haddad, P. M.; Ferrier, I.N.; Aronson, J.K.; Barnes, T.R.H.; Cipriani, A.; Coghill, D.R.; Fazel, S.; Geddes, J.R.; Grunze, H.; Holmes, E.A.; Howes, O.; Hudson, S.; Hunt, N.; Jones, I.; Macmillan, I.C.; McAllister-Williams, H.; Miklowitz, D.M.; Morriss, R.; Munafò, M.; Paton, C.; Saharkian, B.J.; Saunders, K.E.A.; Sinclair, J.M.A.; Taylor, D.; Vieta, E.; Young, A.H.

    2016-01-01

    The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines: in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. PMID:26979387

  13. The psychopharmacology of aggressive behavior: a translational approach: part 2: clinical studies using atypical antipsychotics, anticonvulsants, and lithium.

    PubMed

    Comai, Stefano; Tau, Michael; Pavlovic, Zoran; Gobbi, Gabriella

    2012-04-01

    Patients experiencing mental disorders are at an elevated risk for developing aggressive behavior. In the past 10 years, the psychopharmacological treatment of aggression has changed dramatically owing to the introduction of atypical antipsychotics on the market and the increased use of anticonvulsants and lithium in the treatment of aggressive patients.This review (second of 2 parts) uses a translational medicine approach to examine the neurobiology of aggression, discussing the major neurotransmitter systems implicated in its pathogenesis (serotonin, glutamate, norepinephrine, dopamine, and γ-aminobutyric acid) and the neuropharmacological rationale for using atypical antipsychotics, anticonvulsants, and lithium in the therapeutics of aggressive behavior. A critical review of all clinical trials using atypical antipsychotics (aripiprazole, clozapine, loxapine, olanzapine, quetiapine, risperidone, ziprasidone, and amisulpride), anticonvulsants (topiramate, valproate, lamotrigine, and gabapentin), and lithium are presented. Given the complex, multifaceted nature of aggression, a multifunctional combined therapy, targeting different receptors, seems to be the best strategy for treating aggressive behavior. This therapeutic strategy is supported by translational studies and a few human studies, even if additional randomized, double-blind, clinical trials are needed to confirm the clinical efficacy of this framework.

  14. CCNP Award Paper: Unveiling the role of melatonin MT2 receptors in sleep, anxiety and other neuropsychiatric diseases: a novel target in psychopharmacology

    PubMed Central

    Comai, Stefano; Gobbi, Gabriella

    2014-01-01

    Background Melatonin (MLT) is a pleiotropic neurohormone controlling many physiological processes and whose dysfunction may contribute to several different diseases, such as neurodegenerative diseases, circadian and mood disorders, insomnia, type 2 diabetes and pain. Melatonin is synthesized by the pineal gland during the night and acts through 2 G-protein coupled receptors (GPCRs), MT1 (MEL1a) and MT2 (MEL1b). Although a bulk of research has examined the physiopathological effects of MLT, few studies have investigated the selective role played by MT1 and MT2 receptors. Here we have reviewed current knowledge about the implications of MT2 receptors in brain functions. Methods We searched PubMed, Web of Science, Scopus, Google Scholar and articles reference lists for studies on MT2 receptor ligands in sleep, anxiety, neuropsychiatric diseases and psychopharmacology, including genetic studies on the MTNR1B gene, which encodes the melatonin MT2 receptor. Results These studies demonstrate that MT2 receptors are involved in the pathophysiology and pharmacology of sleep disorders, anxiety, depression, Alzheimer disease and pain and that selective MT2 receptor agonists show hypnotic and anxiolytic properties. Limitations Studies examining the role of MT2 receptors in psychopharmacology are still limited. Conclusion The development of novel selective MT2 receptor ligands, together with further preclinical in vivo studies, may clarify the role of this receptor in brain function and psychopharmacology. The superfamily of GPCRs has proven to be among the most successful drug targets and, consequently, MT2 receptors have great potential for pioneer drug discovery in the treatment of mental diseases for which limited therapeutic targets are currently available. PMID:23971978

  15. A Pharmacovigilance Study in First Episode of Psychosis: Psychopharmacological Interventions and Safety Profiles in the PEPs Project

    PubMed Central

    Bioque, Miquel; Llerena, Adrián; Cabrera, Bibiana; Mezquida, Gisela; Lobo, Antonio; González-Pinto, Ana; Díaz-Caneja, Covadonga M.; Corripio, Iluminada; Aguilar, Eduardo J.; Bulbena, Antoni; Castro-Fornieles, Josefina; Vieta, Eduard; Lafuente, Amàlia; Mas, Sergi; Parellada, Mara; Saiz-Ruiz, Jerónimo; Cuesta, Manuel J.

    2016-01-01

    Background: The characterization of the first episode of psychosis and how it should be treated are principal issues in actual research. Realistic, naturalistic studies are necessary to represent the entire population of first episode of psychosis attended in daily practice. Methods: Sixteen participating centers from the PEPs project recruited 335 first episode of psychosis patients, aged 7 to 35 years. This article describes and discusses the psychopharmacological interventions and safety profiles at baseline and during a 60-day pharmacovigilance period. Results: The majority of first episode of psychosis patients received a second-generation antipsychotic (96.3%), orally (95%), and in adjusted doses according to the product specifications (87.2%). A total of 24% were receiving an antipsychotic polytherapy pattern at baseline, frequently associated with lower or higher doses of antipsychotics than the recommended ones. Eight patients were taking clozapine, all in monotherapy. Males received higher doses of antipsychotic (P=.043). A total of 5.2% of the patients were being treated with long-acting injectable antipsychotics; 12.2% of the patients received anticholinergic drugs, 12.2% antidepressants, and 13.7% mood stabilizers, while almost 40% received benzodiazepines; and 35.52% reported at least one adverse drug reaction during the pharmacovigilance period, more frequently associated with higher antipsychotic doses and antipsychotic polytherapy (85.2% vs 45.5%, P<.001). Conclusions: These data indicate that the overall pharmacologic prescription for treating a first episode of psychosis in Spain follows the clinical practice guideline recommendations, and, together with security issues, support future research of determinate pharmacological strategies for the treatment of early phases of psychosis, such as the role of clozapine, long-acting injectable antipsychotics, antipsychotic combination, and the use of benzodiazepines. PMID:26506856

  16. A Pharmacovigilance Study in First Episode of Psychosis: Psychopharmacological Interventions and Safety Profiles in the PEPs Project.

    PubMed

    Bioque, Miquel; Llerena, Adrián; Cabrera, Bibiana; Mezquida, Gisela; Lobo, Antonio; González-Pinto, Ana; Díaz-Caneja, Covadonga M; Corripio, Iluminada; Aguilar, Eduardo J; Bulbena, Antoni; Castro-Fornieles, Josefina; Vieta, Eduard; Lafuente, Amàlia; Mas, Sergi; Parellada, Mara; Saiz-Ruiz, Jerónimo; Cuesta, Manuel J; Bernardo, Miguel

    2016-04-01

    The characterization of the first episode of psychosis and how it should be treated are principal issues in actual research. Realistic, naturalistic studies are necessary to represent the entire population of first episode of psychosis attended in daily practice. Sixteen participating centers from the PEPs project recruited 335 first episode of psychosis patients, aged 7 to 35 years. This article describes and discusses the psychopharmacological interventions and safety profiles at baseline and during a 60-day pharmacovigilance period. The majority of first episode of psychosis patients received a second-generation antipsychotic (96.3%), orally (95%), and in adjusted doses according to the product specifications (87.2%). A total of 24% were receiving an antipsychotic polytherapy pattern at baseline, frequently associated with lower or higher doses of antipsychotics than the recommended ones. Eight patients were taking clozapine, all in monotherapy. Males received higher doses of antipsychotic (P=.043). A total of 5.2% of the patients were being treated with long-acting injectable antipsychotics; 12.2% of the patients received anticholinergic drugs, 12.2% antidepressants, and 13.7% mood stabilizers, while almost 40% received benzodiazepines; and 35.52% reported at least one adverse drug reaction during the pharmacovigilance period, more frequently associated with higher antipsychotic doses and antipsychotic polytherapy (85.2% vs 45.5%, P<.001). These data indicate that the overall pharmacologic prescription for treating a first episode of psychosis in Spain follows the clinical practice guideline recommendations, and, together with security issues, support future research of determinate pharmacological strategies for the treatment of early phases of psychosis, such as the role of clozapine, long-acting injectable antipsychotics, antipsychotic combination, and the use of benzodiazepines. © The Author 2015. Published by Oxford University Press on behalf of CINP.

  17. Assessment in multisite randomized clinical trials of patients with autistic disorder: the Autism RUPP Network. Research Units on Pediatric Psychopharmacology.

    PubMed

    Arnold, L E; Aman, M G; Martin, A; Collier-Crespin, A; Vitiello, B; Tierney, E; Asarnow, R; Bell-Bradshaw, F; Freeman, B J; Gates-Ulanet, P; Klin, A; McCracken, J T; McDougle, C J; McGough, J J; Posey, D J; Scahill, L; Swiezy, N B; Ritz, L; Volkmar, F

    2000-04-01

    Assessment of autistic disorder (autism) symptoms, primary and secondary, poses more challenging problems than ordinarily found in multisite randomized clinical trial (RCT) assessments. For example, subjects may be uncommunicative and extremely heterogeneous in problem presentation, and current pharmacological treatments are not likely to alter most core features of autism. The Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved some of these problems during the design of a risperidone RCT in children/adolescents. The inappropriateness of the usual anchors for a Clinical Global Impression of Severity (CGI-S) was resolved by defining uncomplicated autism without secondary symptoms as a CGI-S of 3, mildly ill. The communication problems, compromising use of the patient as an informant, were addressed by several strategies, including careful questioning of care providers, rating scales, laboratory tests, and physical exams. The broad subject heterogeneity requires outcome measures sensitive to individual change over a wide spectrum of treatment response and side effects. The problems of neuropsychologically testing nonverbal, lower functioning, sometimes noncompliant subjects requires careful instrument selection/adaptation and flexible administration techniques. The problems of assessing low-end IQs, neglected by most standardized test developers, was resolved by an algorithm of test hierarchy. Scarcity of other autism-adapted cognitive and neuropsychological tests and lack of standardization required development of a new, specially adapted battery. Reliability on the Autism Diagnostic Interview (currently the most valid diagnostic instrument) and other clinician instruments required extensive cross-site training (in-person, videotape, and teleconference sessions). Definition of a treatment responder required focus on individually relevant target symptoms, synthesis of possible modest improvements in many domains, and acceptance of

  18. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 3: The Clinical Guidelines

    PubMed Central

    Grunze, Heinz; Vieta, Eduard; Young, Allan; Yatham, Lakshmi; Blier, Pierre; Kasper, Siegfried; Moeller, Hans Jurgen

    2017-01-01

    Abstract Background: The current paper introduces the actual International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder. Concept and structure of the guidelines: The current clinical guidelines are based on evidence-based data, but they also intend to be clinically useful, while a rigid algorithm was developed on the basis of firm evidence alone. Monotherapy was prioritized over combination therapy. There are separate recommendations for each of the major phases of bipolar disorder expressed as a 5-step algorithm. Discussion: The current International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder are the most up-to-date guidance and are as evidence based as possible. They also include recommendations concerning the use of psychotherapeutic interventions, again on the basis of available evidence. This adherence of the workgroup to the evidence in a clinically oriented way helped to clarify the role of specific antidepressants and traditional agents like lithium, valproate, or carbamazepine. The additional focus on specific clinical characteristics, including predominant polarity, mixed features, and rapid cycling, is also a novel approach. Many issues need further studies, data are sparse and insufficient, and many questions remain unanswered. The most important and still unmet need is to merge all the guidelines that concern different phases of the illness into a single one and in this way consider BD as a single unified disorder, which is the real world fact. However, to date the research data do not permit such a unified approach. PMID:27941079

  19. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology.

    PubMed

    Bolea-Alamañac, Blanca; Nutt, David J; Adamou, Marios; Asherson, Phillip; Bazire, Stephen; Coghill, David; Heal, David; Müller, Ulrich; Nash, John; Santosh, Paramala; Sayal, Kapil; Sonuga-Barke, Edmund; Young, Susan J

    2014-03-01

    Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal burden. The present guidelines summarise current literature, generating expert consensus recommendations for the treatment of ADHD in children and adults. These guidelines also provide a review of recent research in the fields of neuroimaging, neuropsychology and genetics of ADHD. Novel discoveries in these areas have informed physiological models for the disease. Since the publication of the previous British Association for Psychopharmacology guidelines in 2008, new drugs have been licensed and further compounds are being investigated. The publication of randomised controlled trials of psychological interventions has contributed to the range of treatment options for ADHD. As the disorder has been diagnosed more frequently there has been greater focus on comorbid conditions and how they impact treatment. Services have continued to develop for the treatment of ADHD in adults and care agreements have been introduced to facilitate access to treatment.

  20. Introduction to the special issue: 50th anniversary of APA Division 28: The past, present, and future of psychopharmacology and substance abuse.

    PubMed

    Stoops, William W; Sigmon, Stacey C; Evans, Suzette M

    2016-08-01

    This is an introduction to the special issue "50th Anniversary of APA Division 28: The Past, Present, and Future of Psychopharmacology and Substance Abuse." Taken together, the scholarly contributions included in this special issue serve as a testament to the important work conducted by our colleagues over the past five decades. Division 28 and its members have advanced and disseminated knowledge on the behavioral effects of drugs, informed efforts to prevent and treat substance abuse, and influenced education and policy issues more generally. As past and current leaders of the division, we are excited to celebrate 50 years of Division 28 and look forward to many more successful decades for our division and its members. (PsycINFO Database Record

  1. Development of military performance models for the assessment of psychopharmacological agent impact. Annual report (Final), 1 September 1984-30 September 1987

    SciTech Connect

    Laughery, K.D.; Drews, C.

    1987-11-01

    In time of war, the human operators of military systems may be exposed to harmful psychopharmacological agents. Certain pretreatment drugs are known to ward off the harmful effects of chemical agents, but these drugs have adverse side effects that may degrade a soldier's ability to perform an operation. This report describes the development of a task network modeling tool which is used to simulate the effect of drugs on human performance. This tool is a software package known as Micro SAINT. It runs on an IBM PC or compatible microcomputer. The construction of models is entirely menu-driven, and does not require knowledge of computer programming. This report contains recommended procedures for conducting simulation analysis. Micro SAINT is presently being used in over 55 government installations.

  2. Data acquisition instruments: Psychopharmacology

    SciTech Connect

    Hartley, D.S. III

    1998-01-01

    This report contains the results of a Direct Assistance Project performed by Lockheed Martin Energy Systems, Inc., for Dr. K. O. Jobson. The purpose of the project was to perform preliminary analysis of the data acquisition instruments used in the field of psychiatry, with the goal of identifying commonalities of data and strategies for handling and using the data in the most advantageous fashion. Data acquisition instruments from 12 sources were provided by Dr. Jobson. Several commonalities were identified and a potentially useful data strategy is reported here. Analysis of the information collected for utility in performing diagnoses is recommended. In addition, further work is recommended to refine the commonalities into a directly useful computer systems structure.

  3. Psychopharmacology of compulsive buying.

    PubMed

    Bullock, Kim; Koran, Lorrin

    2003-09-01

    No standard treatment exists for the DSM-IV Impulse Control Disorders, Not Elsewhere Classified, including Compulsive Buying Disorder. This paper reviews the suggested pharmacotherapies for this disorder and their theoretical basis. McElroy et al. first reported benefit from antidepressant therapy in three cases of Compulsive Buying Disorder with comorbid depression and anxiety. In a retrospective chart review, McElroy's group reported on 20 patients that benefited from antidepressants, often in combination with mood stabilizers. Lejoyeux reported on two patients in whom treatment of a comorbid mood disorder led to remission of compulsive buying behavior. Black reported fluvoxamine to be effective in patients without comorbid major depression, suggesting that improvement was independent of the treatment of mood symptoms. Kim reported improvement with naltrexone, an opioid antagonist, in a case series. Two double-blind placebo-controlled trials found fluvoxamine no better than placebo; however, in both studies patients kept shopping logs, which may have confounded the results. An open-label trial of citalopram and a double-blind crossover trial which excluded shopping logs both reported positive results. Twelve-month follow-up data for the open-label group found that remission rates at quarterly time points were independent of continuing drug therapy. The data reviewed above suggest that pharmacologic interventions may be effective for compulsive buying disorder. Whether pharmacological treatment is superior to placebo and whether it is more, less or equally effective compared to psychotherapeutic interventions remains to be established.

  4. Psychopharmacology of lycanthropy.

    PubMed Central

    Davis, W M; Wellwuff, H G; Garew, L; Kydd, O U

    1992-01-01

    OBJECTIVE: To develop pharmacotherapies for the orphan disease lycanthropy through the pursuit of the etiologic hypothesis of a genetically determined hypersecretion of endogenous lycanthropogens. DESIGN: Quadruple-blind, Rubik's Cube matrix analysis. SETTING: Community practice and malpractice. PARTICIPANTS: Subjects selected from inbred Ruficolla populations in Mississippi, Georgia, North Carolina and Minnesota. All who entered the study finished it. INTERVENTIONS: Chemical screening of blood samples over a hypothesized secretory cycle of lycanthropogen peaking on the day of maximum lunar illumination. Administration of synthetic lycanthropogens for behavioural testing. Experimental lycosomatization through the illumination method of Kirschbaum. OUTCOME MEASURES: None were post hoc, but some are still in hock. MAIN RESULTS: Two putative lycanthropogens were isolated from the blood samples. Structural elucidation and synthesis permitted animal and clinical trials; in each of these, behavioural dysfunction was observed. Antilycanthropogen strategies included application of the principle of caged compounds and generation of a therapeutic immunoglobulin. The effects of a newly developed antihirsutic agent seemed promising. An interaction of the lycanthropogen-secretion system and ethanol was noted, which may explain behavioural aspects of alcoholism. CONCLUSIONS: The incidence of lycomania in North America is underestimated. Soon-to-be-available pharmacotherapies should promote its early detection and treatment. Full control may depend upon advances in gene therapy. PMID:1555146

  5. Neuroimaging and Psychopharmacology

    ERIC Educational Resources Information Center

    Semrud-Clikeman, Margaret; Pliszka, Steve R.

    2005-01-01

    This review presents the most recent research concerning neuroimaging in developmental disabilities. Changes in structure and activation have been found in children with ADHD and learning disabilities, following intervention. For the children with learning disabilities changes in activation have been found following intensive behavioral and…

  6. Psychopharmacology in the Schools

    ERIC Educational Resources Information Center

    Abrams, Laura; Flood, Jillian; Phelps, LeAdelle

    2006-01-01

    Psychotropic medications prescribed frequently to children and adolescents for the treatment of anxiety, depression, and attention deficit hyperactivity disorder are reviewed. Pediatric pharmacological options based on double-blind, randomized studies are examined. We advocate that psychotropic medications be used only in conjunction with…

  7. Psychopharmacology and Bariatric Surgery.

    PubMed

    Roerig, James L; Steffen, Kristine

    2015-11-01

    Currently, it has been demonstrated that psychotropic drugs, particularly antidepressants, are frequently prescribed for patients who seek bariatric surgery. Many bariatric surgery patients have a history of a mood disorder. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery antidepressants use is only slightly reduced. The Roux-en-Y procedure is most frequently associated with alteration in drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients, although data are sparse at this time. This paper will review the current evidence regarding the effect of bariatric surgery on drug treatment including mechanism of interference as well as the extent of changes identified to date. Data will be presented as controlled trials followed by case series and reports.

  8. Brain Peptides and Psychopharmacology

    ERIC Educational Resources Information Center

    Arehart-Treichel, Joan

    1976-01-01

    Proteins isolated from the brain and used as drugs can improve and apparently even transfer mental states and behavior. Much of the pioneering work and recent research with humans and animals is reviewed and crucial questions that are being posed about the psychologically active peptides are related. (BT)

  9. Serendipity and psychopharmacology.

    PubMed

    Howland, Robert H

    2010-10-01

    This article describes several examples where the development of drugs and devices for use in psychiatry followed from initial serendipitous observations. The potential psychotropic properties of chlorpromazine (Thorazine(®)) were first noted in surgical patients when the drug was being investigated as a potentiator of anesthesia. Similar findings were noted with iproniazid (Marsilid(®)), developed for the treatment of tuberculosis, and the drug was later released for clinical use as an antidepressant agent. The development of meprobamate (Miltown(®)), an approved treatment for anxiety, evolved from initial efforts to find a chemical that would inhibit the enzymatic destruction of the antibiotic drug penicillin. The psychiatric uses of lamotrigine (Lamictal(®)) and vagus nerve stimulation were prompted by initial observations that epilepsy patients receiving these treatments had positive mood effects. Nurses should be familiar with the concept of serendipity, as they often are in the best position to observe, record, and report on unexpected clinical effects in patients taking any kind of prescription or nonprescription medication.

  10. Psychopharmacology in the Schools

    ERIC Educational Resources Information Center

    Abrams, Laura; Flood, Jillian; Phelps, LeAdelle

    2006-01-01

    Psychotropic medications prescribed frequently to children and adolescents for the treatment of anxiety, depression, and attention deficit hyperactivity disorder are reviewed. Pediatric pharmacological options based on double-blind, randomized studies are examined. We advocate that psychotropic medications be used only in conjunction with…

  11. Neuroimaging and Psychopharmacology

    ERIC Educational Resources Information Center

    Semrud-Clikeman, Margaret; Pliszka, Steve R.

    2005-01-01

    This review presents the most recent research concerning neuroimaging in developmental disabilities. Changes in structure and activation have been found in children with ADHD and learning disabilities, following intervention. For the children with learning disabilities changes in activation have been found following intensive behavioral and…

  12. [Methodologic aspects in psychopharmacology].

    PubMed

    Kaumeier, H S

    1982-01-01

    During the planning and carrying out of clinical trials on potential psychotropic agents various difficulties arise when applying experimental-psychological procedures, especially on self- and non-self-rated behaviour. The action of these substances is extraordinarily complex and the behaviour, which is the most obvious component, is only an indirect measure of central effects. Thus, it is also essential to take into consideration the physiological and biochemical components in order to clarify the relationship between effects on the brain and finally on behaviour. It is possible, for example, to register changes in EEG in connection with attention and reaction time tests also in healthy persons. Actually, most psychotropic substances can only be differentiated by means of their effects on human beings. That means that ingenious methods must be elaborated in order to be able to recognize the influence on the human brain and thus to explain the mechanism of action.

  13. Psychopharmacology of tic disorders.

    PubMed

    Srour, Myriam; Lespérance, Paul; Richer, Francois; Chouinard, Sylvain

    2008-08-01

    Tics disorders and Tourette syndrome are commonly encountered in clinical practice. Currently, a vast number of behavioural, pharmacological and surgical treatments are available. Relevant and recent articles about clinical features, neurobiology and treatment of tic disorders and Tourette syndrome were reviewed and summarized. Tic disorders and Tourette syndrome are frequently associated with comorbid conditions such as obsessive compulsive symptoms, attention deficit and hyperactivity disorder, anxiety and depression, behavioural disorders and sleep difficulties. Fronto-striatal circuits and the dopaminergic system are believed to be involved in the pathophysiology of TS and tics. Pharmacological options that have been studied for treatment of tic disorders are reviewed. Behavioural therapy such as habit reversal training, and surgical treatment are other options. It is essential to identify and address comorbid conditions such as attention deficit disorder, obsessive-compulsive symptoms, depression, behavioural disorders and sleep disturbances, as they often cause more distress and disability than the tics themselves. Tic disorders frequently do not require pharmacological treatment, but if required, first line treatment options include dopamine modulators, tetrabenazine, clonidine and behavioural therapy.

  14. Treating the Synapse in Major Psychiatric Disorders: The Role of Postsynaptic Density Network in Dopamine-Glutamate Interplay and Psychopharmacologic Drugs Molecular Actions

    PubMed Central

    Tomasetti, Carmine; Iasevoli, Felice; Buonaguro, Elisabetta Filomena; De Berardis, Domenico; Fornaro, Michele; Fiengo, Annastasia Lucia Carmela; Martinotti, Giovanni; Orsolini, Laura; Valchera, Alessandro; Di Giannantonio, Massimo; de Bartolomeis, Andrea

    2017-01-01

    Dopamine-glutamate interplay dysfunctions have been suggested as pathophysiological key determinants of major psychotic disorders, above all schizophrenia and mood disorders. For the most part, synaptic interactions between dopamine and glutamate signaling pathways take part in the postsynaptic density, a specialized ultrastructure localized under the membrane of glutamatergic excitatory synapses. Multiple proteins, with the role of adaptors, regulators, effectors, and scaffolds compose the postsynaptic density network. They form structural and functional crossroads where multiple signals, starting at membrane receptors, are received, elaborated, integrated, and routed to appropriate nuclear targets. Moreover, transductional pathways belonging to different receptors may be functionally interconnected through postsynaptic density molecules. Several studies have demonstrated that psychopharmacologic drugs may differentially affect the expression and function of postsynaptic genes and proteins, depending upon the peculiar receptor profile of each compound. Thus, through postsynaptic network modulation, these drugs may induce dopamine-glutamate synaptic remodeling, which is at the basis of their long-term physiologic effects. In this review, we will discuss the role of postsynaptic proteins in dopamine-glutamate signals integration, as well as the peculiar impact of different psychotropic drugs used in clinical practice on postsynaptic remodeling, thereby trying to point out the possible future molecular targets of “synapse-based” psychiatric therapeutic strategies. PMID:28085108

  15. A pilot study of actigraphy as an objective measure of SSRI activation symptoms; results from a randomized placebo controlled psychopharmacological treatment study

    PubMed Central

    Bussing, Regina; Reid, Adam M.; McNamara, Joseph P.H.; Meyer, Johanna M.; Guzick, Andrew G.; Mason, Dana M.; Storch, Eric A.; Murphy, Tanya K.

    2015-01-01

    Selective serotonin reuptake inhibitors (SSRIs) are an efficacious and effective treatment for pediatric obsessive-compulsive disorder (OCD) but have received scrutiny due to a potential side effect constellation called activation syndrome. While recent research introduced a subjective measure of activation syndrome, objective measures have not been tested. This pilot study, using data from a larger randomized-controlled trial, investigated the potential of actigraphy to provide an objective measure of activation symptoms in 44 youths with OCD beginning an SSRI medication regimen. Data were collected over the first four weeks of a multisite, parallel, double-blind, randomized, placebo controlled psychopharmacological treatment study and statistical modeling was utilized to test how activation syndrome severity predicts daily and nightly activity levels. Results indicated that youths with higher activation symptoms had lower daytime activity levels when treatment averages were analyzed; in contrast youths who experienced onset of activation symptoms one week were more likely to have higher daytime and night-time activity ratings that week. Results support actigraphy as a potential objective measure of activation symptoms. Subsequent studies are needed to confirm these findings and test clinical applications for use by clinicians to monitor activation syndrome during SSRI treatment. National Institutes of Health (5UO1 MH078594-01); NCT00382291. PMID:25535011

  16. The Sleep Elaboration-Awake Pruning (SEAP) theory of memory: long term memories grow in complexity during sleep and undergo selection while awake. Clinical, psychopharmacological and creative implications.

    PubMed

    Charlton, Bruce G; Andras, Peter

    2009-07-01

    , psychopharmacological and creative domains. For example, it would be predicted that states of insufficient alertness such as delirium would produce errors of commission (memory distortion and false memories, as with psychotic delusions), while sleep deprivation would produce errors of memory omission (memory loss). Ultimately, the main argument in favour of SEAP is that long term memory must be a complex adaptive system, and complex systems arise, are selected and sustained according to the principles of systems theory; and therefore LTM cannot be functioning in the way assumed by 'representation-consolidation' theories.

  17. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.

    PubMed

    Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A; Christmas, David M; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O'Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich

    2014-05-01

    This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

  18. Psychopharmacological enhancement: a conceptual framework

    PubMed Central

    2012-01-01

    The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values. PMID:22244084

  19. The ethics of elective psychopharmacology

    PubMed Central

    Mohamed, Ahmed D.; Sahakian, Barbara J.

    2012-01-01

    Pharmacological cognitive enhancers (PCEs) are used to improve cognitive functions, such as attention, learning, memory and planning in patients with impairments in cognition resulting from traumatic brain injury (TBI) or from neuropsychiatric disorders such as Alzheimer's disease (AD), mild cognitive impairment, schizophrenia, and attention deficit hyperactivity disorder (ADHD). Moreover, PCEs have been shown to improve cognition in healthy volunteers with no psychiatric disorders. This article describes the rationale behind the need for their use in neuropsychiatric patients and illustrates how PCEs can ameliorate cognitive impairments, improve quality of life and wellbeing, and therefore reduce the economic burden associated with these disorders. We also describe evidence that PCEs are being used as cognitive enhancers by healthy people. Crucially, as the lifestyle use of these drugs becomes very popular in the healthy population, a final aim is to present an overview of the current and future neuroethical considerations of enhancing the healthy brain. As information regarding their actual use, benefits and harms in various healthy populations is currently lacking, we propose research that aims to obtain relevant empirical data, monitor the short- and long-term effectiveness and side-effects, and initiate accurate surveys to determine current patterns and quantity of usage of PCE drugs by healthy people. Furthermore, in order to instigate a dialogue between neuroethics and neuropsychopharmacology, we urge scientists to explore and communicate the social and ethical implications of their research to the public. Finally, we discuss and highlight other means of enhancing cognition in both patients and healthy adults, including education and physical exercise. PMID:21396152

  20. Psychopharmacology of aggression: an overview.

    PubMed

    Valzelli, L

    1981-01-01

    Aggression is not a single unitary behavioral entity, then it is impossible to find a single drug showing "specific' and "universal' antiaggressive efficacy and potency. Furthermore, spontaneous aggression is essential to the self-and species preservation, and plays an important role in the process of evolution. In contrast, aggressiveness induced by prolonged socioenvironmental deprivation or isolation, raises the feature of anomalous behavior. The effect of drugs on aggressive behavior must therefore be considered in the light of this distinction, that accounts for discrepancies between the results of literature on "antiaggressive' properties and potency of psychoactive drugs. In addition, and impaired inhibitory control of the brain may be responsible for violent aggression and drugs capable of restoring such control may prove useful in managing the pathology of aggressiveness.

  1. Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology.

    PubMed

    Nutt, D J; Fone, K; Asherson, P; Bramble, D; Hill, P; Matthews, K; Morris, K A; Santosh, P; Sonuga-Barke, E; Taylor, E; Weiss, M; Young, S

    2007-01-01

    Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children's services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

  2. Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts.

    PubMed

    Teusch, L; Scherbaum, N; Böhme, H; Bender, S; Eschmann-Mehl, G; Gastpar, M

    1995-05-01

    Little is known about sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. In the present study schizophrenic patients (n = 45, mostly under neuroleptic treatment), neurotic patients (n = 50, mostly treated without medication), methadone-substituted opiate addicts (n = 37), and normal controls (n = 41) were included. They were interviewed with the aid of a sex-differentiated semistructured questionnaire on sexual function. All the methadone-substituted opiate addicts and nearly all the schizophrenic patients suffered from dysfunctions in at least one criterion. The three clinical groups differed significantly from the controls in sexual interest, emotional arousal, physiological arousal (erectile function/vaginal lubrication), performance (ejaculatory function/vaginism, dyspareunia), and orgasm satisfaction. Characteristic patterns of dysfunction were found in the male patients. The schizophrenic patients had significantly more dysfunctions of interest, physiological arousal, performance, and orgasm than the controls. Emotional arousal, erectile and ejaculatory functions, and orgasm satisfaction were impaired more frequently in the male schizophrenics than in the neurotic patients. Reduced sexual interest, emotional arousal, and orgasm satisfaction were reported more frequently by the methadone-substituted opiate addicts than by the neurotic men. Emotional arousal was even more frequently reduced than in the schizophrenic men. There was no correlation between sexual dysfunction and particular neuroleptics or neuroleptic or methadone dosage. The results are compared with the literature and suggestions made for further investigations.

  3. Neuroanatomical and psychopharmacological evidence for interaction between opioid and GABAergic neural pathways in the modulation of fear and defense elicited by electrical and chemical stimulation of the deep layers of the superior colliculus and dorsal periaqueductal gray matter.

    PubMed

    Eichenberger, G C D; Ribeiro, S J; Osaki, M Y; Maruoka, R Y; Resende, G C C; Castellan-Baldan, L; Corrêa, S A L; Da Silva, L A; Coimbra, N C

    2002-01-01

    The effects of central administration of opioid antagonists on the aversive responses elicited by electrical (at the freezing and escape thresholds) or chemical stimulation (crossings, rearings, turnings and jumps, induced by microinjections of bicuculline) of the midbrain tectum were determined. Central microinjections of naloxone and naltrexone in the mesencephalic tectum caused a significant increase in the freezing and escape thresholds elicited by electrical midbrain tectum stimulation. Furthermore, both opioid antagonists caused a significant decrease in the mean incidence of aversive behavioral responses induced by microinjections of bicuculline in the deep layers of the superior colliculus (DLSC) and in dorsal aspects of the periaqueductal gray matter (DPAG), as compared with controls. These findings suggest an opioid modulation of the GABAergic inhibitory inputs controlling the aversive behavior elicited by midbrain tectum stimulation. In fact, immunohistochemical evidence suggests that the dorsal mesencephalon is rich in beta-endorphin-containing neurons and fibers with varicosities. Iontophoretical microinjections of the neurotracer biodextran in the substantia nigra, pars reticulata (SNpr), show nigro-tectal pathways connecting SNpr with the same neural substrate of the DPAG rich in neuronal cells immunoreactive for opioid peptides. Labeled neurons of the DLSC and periaqueductal gray matter send inputs with varsicosities to ipsi- and contralateral DPAG and ipsilateral SNpr. These findings, in addition to the psychopharmacological evidence for the interaction between opioid and GABAergic mechanisms, offer a neuroanatomical basis of a possible presynaptic opioid inhibition of GABAergic nigro-tectal neurons modulating the fear in aversive structures of the cranial mesencephalon, in a short link, and maybe through a major neural circuit, also in GABA-containing perikarya of nigro-tectal neurons.

  4. Psychopharmacological Practice: The DSM Versus The Brain

    PubMed Central

    Schwartz, Thomas L.

    2013-01-01

    In 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) system of creating, validating, studying and employing a diagnostic system in clinical psychiatric practice was introduced. There have been several updates and revisions to this manual and, regardless of its a theoretical framework, it actually does have a framework and presupposition. Essentially the DSM dictates that all psychiatric disorders are syndromes, or a collection of symptoms that commonly occur together and impair psychosocial functioning. These syndromes allow for homogenous groups of patients to be studied and psychotherapies and pharmacotherapies to be developed. This editorial will examine the DSM system with regards to its applicability to central nervous system dysfunction where psychiatric disorders are concerned. Specifically, the brain does not follow categorical, or syndromal, constructs. In fact, the psychiatric patient likely inherits several risk genes that promote abnormal proteins along several neuropathways in the brain. These abnormalities create dysfunctional neurocircuits which create individual psychiatric symptoms, but not a categorical syndrome or diagnosis. The concept that the DSM may be excellent for clinical diagnostic purposes, but less correct in its assumptions for a psychopharmacologist's treatment approaches will be discussed. PMID:23678236

  5. A group approach to psychopharmacology with schizophrenics.

    PubMed Central

    Skolnick, M. R.

    1985-01-01

    Theoretical and practical issues involved in integrating pharmacotherapy and psychosocial therapy in a long-term day hospital for schizophrenics are addressed. The limitations and risks of relying too heavily on a biomedical conceptual framework are discussed. In addition to diagnosis, target symptoms, pharmacodynamics, and pharmacokinetics, individual interpersonal, family, and institutional dynamics can exert profound effects on the effectiveness of medication. Through case illustrations it is shown how an open systems model and a group approach can allow for an integration of the many variables involved in the medication process. A weekly medication group which emphasizes education, informed choice, patient responsibility, and the examination of the boundary between medication effect and the need for psychological work is described. It is shown that the chemical control of psychosis alone may reinforce the psychosocial aspects of the schizophrenic syndrome. A distinction is drawn between chemical control of psychosis and the sensitive use of medication as a facilitator of growth-promoting psychosocial treatment. PMID:2864762

  6. Antidepressant psychopharmacology and the social brain.

    PubMed

    Novick, Andrew M

    2011-01-01

    Antidepressant drugs are a mainstay in psychiatric treatment and have the ability to influence neural substrates related to social bonding and interaction. This article explores the potential neurobiological overlap between social attachment and antidepressant mechanisms and reviews work related to the effects of antidepressants on separation distress, social affiliation, dominance hierarchies, romantic love, and socio-emotional processing. It is proposed that similarities between antidepressant pharmacology and the neurobiological effects of an effective care-giver may help create a sense of safety that in turn promotes changes in behavior and mood.

  7. The psychopharmacologic treatment of violent youth.

    PubMed

    Gilligan, James; Lee, Bandy

    2004-12-01

    Aggressive violence has been described as the greatest problem and the most frequent reason for referrals in child and adolescent psychiatry. In this country we have only partially emerged from an epidemic of violence that was really an epidemic of youth violence. Thus it is hardly surprising that psychiatrists are being asked more and more frequently whether psychiatric medications might help to diminish the toll from this behavioral plague. Medications are useful and appropriate for only a small minority of the people who commit serious violence. Even when they are indicated, they can never be the sole treatment modality, but should be supplemented by psychological and social therapies. When the violence is a byproduct or symptom of an underlying mental illness, treating that illness is generally the most effective method of preventing future violence on a long-term basis. However, most violence is not committed by those who are mentally ill, and most of the mentally ill never commit a serious act of violence. That is why many attempts have been made to discover whether there are drugs that diminish the symptom, violence, even when there is no underlying mental illness for which drugs would normally be prescribed. In fact there are several, and their indications and use are reviewed here. Different principles govern the acute short-term emergency treatment of a violent crisis and the long-term treatment of those who are chronically and repetitively violent, and these differences are also summarized here.

  8. Overview of Psychopharmacology in Children and Adolescents.

    ERIC Educational Resources Information Center

    Brown, Ronald T.; And Others

    1994-01-01

    Identifies children who may benefit from medication and discusses systematic monitoring of efficacy and side effects of various psychotropic drugs. Makes case for active participation of school psychologists in research programs involving various psychotropic agents, particularly those that affect learning and cognition. Presents classification of…

  9. Clinical Issues in Child and Adolescent Psychopharmacology.

    ERIC Educational Resources Information Center

    Gadow, Kenneth D.

    1991-01-01

    Notes that psychopharmacologists have made considerable strides in establishing safety and efficacy of psychotropic drug therapy for childhood behavior disorders. Discusses controversy pertaining to appropriateness of medication or inadequacies of clinical management. Presents brief overview of the safety and efficacy of psychotropic drugs and the…

  10. Principles of psychopharmacology for the adolescent patient.

    PubMed

    Reeve, Alya

    2013-08-01

    Physicians are presented with great challenges when attempting to integrate information from multiple sources, often with conflicting recommendations, to meet the present and future needs of adolescents and the expectations of their families and caregivers. For this reason, this article attempts to outline a general strategy in assessment and use of information. General history of presenting symptoms, results of examination details, and additional history from family or other contexts lead to the development of a reasoned hypothesis. The working hypothesis is the basis for subsequent treatment. Revisiting the ongoing data, including response to therapeutic intervention, leads to revised hypotheses that provide the basis for the new treatment formulation. Patients and their families become informed self-advocates and partners in achieving improved outcomes.

  11. A primer on confidence intervals in psychopharmacology.

    PubMed

    Andrade, Chittaranjan

    2015-02-01

    Research papers and research summaries frequently present results in the form of data accompanied by 95% confidence intervals (CIs). Not all students and clinicians know how to interpret CIs. This article provides a nontechnical, nonmathematical discussion on how to understand and glean information from CIs; all explanations are accompanied by simple examples. A statistically accurate explanation about CIs is also provided. CIs are differentiated from standard deviations, standard errors, and confidence levels. The interpretation of narrow and wide CIs is discussed. Factors that influence the width of a CI are listed. Explanations are provided for how CIs can be used to assess statistical significance. The significance of overlapping and nonoverlapping CIs is considered. It is concluded that CIs are far more informative than, say, mere P values when drawing conclusions about a result.

  12. Training School Psychologists in Psychopharmacology Consultation

    ERIC Educational Resources Information Center

    Roberts, Holly J.; Floress, Margaret T.; Ellis, Cynthia R.

    2009-01-01

    The number of children taking psychotropic medications has dramatically increased in recent years. These children typically take medication during school hours, thereby making the school setting an optimal venue in which evaluate the effectiveness of medications. Given their training in data-based decision making, intervention, and assessment,…

  13. Glutamate-based antidepressants: preclinical psychopharmacology.

    PubMed

    Pilc, Andrzej; Wierońska, Joanna M; Skolnick, Phil

    2013-06-15

    Over the past 20 years, converging lines of evidence have both linked glutamatergic dysfunction to the pathophysiology of depression and demonstrated that the glutamatergic synapse presents multiple targets for developing novel antidepressants. The robust antidepressant effects of the N-methyl-D-aspartate receptor antagonists ketamine and traxoprodil provide target validation for this family of ionotropic glutamate receptors. This article reviews the preclinical evidence that it may be possible to develop glutamate-based antidepressants by not only modulating ionotropic (N-methyl-D-aspartate and alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid) and metabotropic glutamate (mGlu) receptors, including mGlu2/3, mGLu5 and mGlu7 receptors, but also by altering synaptic concentrations of glutamate via specialized transporters such as glial glutamate transporter 1 (excitatory amino-acid transporter 2).

  14. Pediatric Psychopharmacology for Prepubertal Internalizing Disorders

    ERIC Educational Resources Information Center

    Kubiszyn, Tom; Carlson, John S.; DeHay, Tamara

    2005-01-01

    Evidence-based studies of drug, psychosocial and combined treatments for prepubertal internalizing disorders (depression, obsessive-compulsive disorder [OCD], and non-OCD anxiety) were reviewed. No age effects were found. Although no combined studies met evidence-based criteria, efficacious and possibly efficacious psychosocial and pharmacological…

  15. Looking back to the future of psychopharmacology.

    PubMed

    Hirshbein, Laura

    2012-12-01

    In 1967, select members of the American College of Neuropsychopharmacology (ACNP) met to discuss the future of the field. In their publication from this meeting, Psychotropic Drugs in the Year 2000, in 1971, the group imagined wild possibilities for chemical alteration of human behaviors and experience. These men thought that drugs could be used to solve social problems for all people. Not surprisingly, few of the predictions came true because the ACNP members could not have foreseen changes in American society and politics, a separation between street drugs and prescribed medications, and the increasing power of the pharmaceutical industry.

  16. Psychopharmacology of theobromine in healthy volunteers

    PubMed Central

    Baggott, Matthew J.; Childs, Emma; Hart, Amy B.; de Bruin, Eveline; Palmer, Abraham A.; Wilkinson, Joy E.; de Wit, Harriet

    2013-01-01

    Background Theobromine, a methylxanthine related to caffeine and present in high levels in cocoa, may contribute to the appeal of chocolate. However, currently evidence for this is limited. Objectives We conducted a within-subjects placebo-controlled study of a wide range of oral theobromine doses (250, 500, and 1000 mg) using an active control dose of caffeine (200 mg) in 80 healthy participants. Results Caffeine had the expected effects on mood including feelings of alertness, and cardiovascular parameters. Theobromine responses differed according to dose: it showed limited subjective effects at 250 mg and negative mood effects at higher doses. It also dose-dependently increased heart rate. In secondary analyses we also examined individual differences in the drugs' effects in relation to genes related to their target receptors, but few associations were detected. Conclusions This study represents the highest dose of theobromine studied in humans. We conclude that theobromine at normal intake ranges may contribute to the positive effects of chocolate, but at higher intakes effects become negative. PMID:23420115

  17. Low Dose Effects in Psychopharmacology: Ontogenetic Considerations

    PubMed Central

    Spear, Linda Patia; Varlinskaya, Elena I.

    2005-01-01

    Low doses of psychoactive drugs often elicit a behavioral profile opposite to that observed following administration of more substantial doses. Our laboratory has observed that these effects are often age-specific in rats. For instance, whereas moderate to high doses of the dopamine agonist apomorphine increase locomotion, suppressed locomotor activity is seen following low dose exposure, with this low dose effect not emerging consistently until adolescence. A somewhat earlier emergence of a low dose “paradoxical” effect is seen with the 5HT1a receptor agonist, 8-OH-DPAT, with late preweanling, but not neonatal, rats showing increases in ingestive behavior at low doses but suppression at higher doses. In contrast to these ontogenetic increases in expression of low dose drug effects, low dose facilitation of social behavior is seen following ethanol only in adolescent rats and not their mature counterparts, although suppression of social interactions at higher doses is seen at both ages. This hormesis-like low dose stimulation appears related in part to overcompensation, with brief social suppression preceding the subsequent stimulation response, and also bears a number of ontogenetic similarities to acute tolerance, a well characterized, rapidly emerging adaptation to ethanol. Implications of these and other ontogenetic findings for studies of hormesis are discussed. PMID:19330157

  18. CHRONIC SCHIZOPHRENIA—A PSYCHOPHARMACOLOGICAL APROACH1

    PubMed Central

    Ban, Thomas A.; Guy, William; Prakash, Rudra

    1984-01-01

    SUMMARY Our work suggests that the Leonhard classification system holds much pron.ise as a framework for future neurological development. One might speculate along biochemical lines that the nonsystematic subpopulation of schizophrenics may suffer from altered dopamine β-hydroxylase activity which results in an excess of dopamine, This would eeplain why this class responds so well to dopamine receptor blocking agent when other patient do not. One might also speculate tint we are dealing with a number of diseases-each with different courses and progressing to different end states, but all with common pattern during the acute stage, e.g., increased dopamine levels or receptor sensitivity levels. This is probably why the acute stage can usually be controlled by the administration of a dopamine receptor blocking agent. A further speculation concerns the catatonic patient- who had begun to respond to psychosocial and milieu treatment prior to the introduction of neuroleptics. This particular group of patients do not seem to benefit from prophylactic treatment with neuroleptics. If, by activating a patient, catecholamines are released, it is hypothesized that the Catatonics are a completely separate subpopulation-not just clinically-but also biochemically. Completely different types of drugs may be helpful for the different schizophrenic subpopulations. Among the various substances, propranolol should be considered. Obviously, this drug will not be effective in all schizophrenics; but there arc certain types of patients who respond to β-blockers. There is also increasing evidence that clordine (which stimulates alpha-adrenergic receptors) may also have an effect on certain schizophrenics The most recent findings is that cholecystokinin-thought for Some time to be an exclusively peripheral substance-appears to be present in the brain and available in the form of ceulotide, a neuropeptide which is a dopamine agonist. This susbtance, also, seems to be effective in the treatment of certain schizophrenics. Chronic schizophrenia requires re-evaluation and it should be recognized that different drugs are effective in different types of patients. There is renewed interest in the various schizophrenic conditions and their end states. We must hope that the pharmacologists, provided with sufficient information, will search for new drugs with differentiated activities that will meaningfully influence the end states of schizophrenic disorders and/or prevent their development. PMID:21966007

  19. Training School Psychologists in Psychopharmacology Consultation

    ERIC Educational Resources Information Center

    Roberts, Holly J.; Floress, Margaret T.; Ellis, Cynthia R.

    2009-01-01

    The number of children taking psychotropic medications has dramatically increased in recent years. These children typically take medication during school hours, thereby making the school setting an optimal venue in which evaluate the effectiveness of medications. Given their training in data-based decision making, intervention, and assessment,…

  20. Pediatric Psychopharmacology for Prepubertal Internalizing Disorders

    ERIC Educational Resources Information Center

    Kubiszyn, Tom; Carlson, John S.; DeHay, Tamara

    2005-01-01

    Evidence-based studies of drug, psychosocial and combined treatments for prepubertal internalizing disorders (depression, obsessive-compulsive disorder [OCD], and non-OCD anxiety) were reviewed. No age effects were found. Although no combined studies met evidence-based criteria, efficacious and possibly efficacious psychosocial and pharmacological…

  1. Behavioral addictions: a novel challenge for psychopharmacology.

    PubMed

    Marazziti, Donatella; Presta, Silvio; Baroni, Stefano; Silvestri, Stefano; Dell'Osso, Liliana

    2014-12-01

    Although addictive syndromes have been traditionally related to substance-use disorders, during the last few decades a novel addictive group, including the so-called "behavioral or no-drug addictions," has been recognized and has attracted increasing attention for its relevant social impact. This group includes pathological gambling, compulsive shopping, TV/Internet/social network/videogame addictions, workaholism, sex and relationship addictions, orthorexia, and overtraining syndrome. Substance and behavioral addictions show similar phenomenological features, such as craving, dependence, tolerance, and abstinence, and perhaps they share a common possible pathophysiology. It is, however, controversial whether all or at least some of them should be considered real disorders or just normal, albeit extreme, behaviors. The aim of this article is to review current data on pharmacological treatment of behavioral addictions. As no specific and validated treatment algorithms are currently available, only an improved knowledge on their psychopathological, clinical, and neurobiological features may have relevant implications for more focused preventive and therapeutic strategies.

  2. Pavlovian psychopharmacology: the associative basis of tolerance.

    PubMed

    Siegel, S; Baptista, M A; Kim, J A; McDonald, R V; Weise-Kelly, L

    2000-08-01

    The Pavlovian conditioning analysis of drug tolerance emphasizes that cues present at the time of drug administration become associated with drug-induced disturbances. These disturbances elicit unconditional responses that compensate for the pharmacological perturbation. The drug-compensatory responses eventually come to be elicited by drug-paired cues. These conditional compensatory responses (CCRs) mediate tolerance by counteracting the drug effect when the drug is administered in the presence of cues previously paired with the drug. If the usual predrug cues are presented in the absence the drug, the unopposed CCRs are evident as withdrawal symptoms. Recent findings elucidate intercellular and intracellular events mediating CCRs and indicate the importance of internal stimuli (pharmacological cues and interoceptive cues inherent in self-administration) to the acquisition of drug tolerance and the expression of withdrawal symptoms.

  3. Psychopharmacologic Treatment: A Note on Classroom Effects.

    ERIC Educational Resources Information Center

    Forness, Steven R.; Kavale, Kenneth A.

    1988-01-01

    Intended for teachers, the article provides an introduction to the four major classes of psychotropic medication (stimulants, tranquilizers, anticonvulsants, and antidepressants) commonly prescribed for children with learning or behavioral disorders. Specific effects on the classroom are addressed. (DB)

  4. Clinical Issues in Child and Adolescent Psychopharmacology.

    ERIC Educational Resources Information Center

    Gadow, Kenneth D.

    1991-01-01

    Notes that psychopharmacologists have made considerable strides in establishing safety and efficacy of psychotropic drug therapy for childhood behavior disorders. Discusses controversy pertaining to appropriateness of medication or inadequacies of clinical management. Presents brief overview of the safety and efficacy of psychotropic drugs and the…

  5. Human psychopharmacology of N,N-dimethyltryptamine.

    PubMed

    Strassman, R J

    1996-01-01

    We generated dose-response data for the endogenous and ultra-short-acting hallucinogen, N,N-dimethyltryptamine (DMT), in a cohort of experienced hallucinogen users, measuring multiple biological and psychological outcome measures. Subjective responses were quantified with a new rating scale, the HRS, which provided better resolution of dose effects than did the biological variables. A tolerance study then was performed, in which volunteers received four closely spaced hallucinogenic doses of DMT. Subjective responses demonstrated no tolerance, while biological measures were inconsistently reduced over the course of the sessions. Thus, DMT remains unique among classic hallucinogens in its inability to induce tolerance to its psychological effects. To assess the role of the 5-HT1A site in mediating DMT's effects, a pindolol pre-treatment study was performed. Pindolol significantly increased psychological responses to DMT, suggesting a buffering effect of 5-HT1A agonism on 5-HT2-mediated psychedelic effects. These data are opposite to those described in lower animal models of hallucinogens' mechanisms of action.

  6. Psychopharmacologic Treatment: A Note on Classroom Effects.

    ERIC Educational Resources Information Center

    Forness, Steven R.; Kavale, Kenneth A.

    1988-01-01

    Intended for teachers, the article provides an introduction to the four major classes of psychotropic medication (stimulants, tranquilizers, anticonvulsants, and antidepressants) commonly prescribed for children with learning or behavioral disorders. Specific effects on the classroom are addressed. (DB)

  7. Body weight changes associated with psychopharmacology.

    PubMed

    Vanina, Yelena; Podolskaya, Anna; Sedky, Karim; Shahab, Hasan; Siddiqui, Abufarah; Munshi, Firoz; Lippmann, Steven

    2002-07-01

    The authors discuss changes in body weight associated with various psychopharmaceuticals. A large number of articles and books about drug-induced changes in body weight, selected on the basis of various literature searches and the authors' clinical experiences with psychopharmaceuticals, were reviewed. Many psychotropic drugs with antipsychotic, mood stabilizing, and antidepressant properties are associated with weight gain. Others, such as fluoxetine, isocarboxazid, nefazadone, topiramate, and psychostimulants, may cause weight loss. The antipsychotic drugs chlorpromazine, clozapine, and olanzapine are often associated with weight gain. Among antidepressants, amitriptyline and mirtazapine are known to cause weight gain. However, reductions are sometimes observed, and each antidepressant has its own unique weight-effect profile. Mood stabilizers, especially valproate-related products, are also associated with weight gain. Careful monitoring and consideration of alternative therapies are essential.

  8. Benefits of different drug formulations in psychopharmacology.

    PubMed

    Frijlink, Henderik W

    2003-09-01

    Adequate dosage forms are essential for achieving successful pharmacotherapy. Innovative dosage forms or delivery systems may direct a drug to its specific site of action, optimize the timing of the drug release, or increase comfort or convenience for the patient. Thus, such innovations may improve efficacy and tolerability and lead to improvements in health-related quality of life. Specialized dosage forms (e.g., depot injections, extended-release formulations) of several psychiatric agents have been extensively used. The latest addition is an orally disintegrating formulation of the antidepressant mirtazapine. This dosage form dissolves rapidly in the mouth and is convenient for the large proportion of patients who have difficulty in swallowing tablets.

  9. Psychopharmacology in HIV-infected patients.

    PubMed

    Repetto, Martin J; Petitto, John M

    2008-06-01

    Neuropsychiatric disorders and syndromes may be underdiagnosed and inadequately treated in individuals infected with HIV. Depression in particular is among the most prevalent diagnoses, and data from controlled clinical studies have shown that antidepressant medications are efficacious and safe for treating depression in HIV-infected persons. A significant shortcoming of this literature is that most of the available data are from studies conducted before the advent of highly active antiretroviral therapy. In addition, apart from antidepressant medications, controlled studies systematically assessing efficacy and safety issues for other classes of psychotropic drugs (e.g., antipsychotic and anxiolytic medications) in HIV-infected persons are lacking. This review summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of HIV. It includes a discussion of clinically relevant treatment considerations (e.g., side effects, drug-drug interactions) derived from the existing literature as well as judgments that clinicians face in the absence of research data. Despite some shortcomings of the existing literature, overall there is compelling evidence that the appropriate use of psychotropic medications (coupled with behavioral therapy) can improve the quality of life of mentally ill HIV-infected individuals.

  10. Medication Adherence in Psychopharmacologically Treated Adults with ADHD

    ERIC Educational Resources Information Center

    Safren, Steven A.; Duran, Petra; Yovel, Iftah; Perlman, Carol A.; Sprich, Susan

    2007-01-01

    Objective: One of the potential causes of residual symptoms of ADHD in adults can be difficulties with consistent adherence to medications. Method: This formative study examined self-reported medication adherence in adults with ADHD with clinically significant symptoms despite medication treatment. Results: Mean adherence for the two-week period…

  11. Psychopharmacologic treatment of children prenatally exposed to drugs of abuse.

    PubMed

    Hulvershorn, Leslie A; Schroeder, Kristen M; Wink, Logan K; Erickson, Craig A; McDougle, Christopher J

    2015-05-01

    This pilot study compared the pharmacologic treatment history and clinical outcomes observed in pediatric outpatients with psychiatric disorders exposed to drugs of abuse in utero to those of an age-matched, sex-matched and psychiatric disorder-matched, non-drug-exposed group. In this matched cohort study, medical records of children treated at an academic, child and adolescent psychiatry outpatient clinic were reviewed. Children with caregiver-reported history of prenatal drug exposure were compared with a non-drug-exposed control group being cared for by the same providers. Patients were rated with the Clinical Global Impressions-Severity scale (CGI-S) throughout treatment. The changes in pre-treatment and post-treatment CGI-S scores and the total number of medication trials were determined between groups. The drug-exposed group (n = 30) had a higher total number of lifetime medication trials compared with the non-drug-exposed group (n = 28) and were taking significantly more total medications, at their final assessment. Unlike the non-drug-exposed group, the drug-exposed group demonstrated a lack of clinical improvement. These results suggest that in utero drug-exposed children may be more treatment-refractory to or experience greater side effects from the pharmacologic treatment of psychiatric disorders than controls, although we cannot determine if early environment or drugs exposure drives these findings. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Activity monitoring in sleep research, medicine and psychopharmacology.

    PubMed

    Klösch, G; Gruber, G; Anderer, P; Saletu, B

    2001-04-17

    Motor activity as a diagnostic parameter has become an important feature in many fields of medicine and psychology. The concept of mobility and immobility implies the assumption that mental and behaviour disorders involve abnormal activity that can be measured to characterise the disorder itself, to diagnose its presence and to document the impact of treatment. In sleep research, activity monitoring by wrist actigraphs has proven its usefulness as an efficient method to assess the rest-activity cycle over long time periods and to estimate sleep-related features such as sleep efficiency and total sleep time. But like many other techniques and devices, activity monitoring has some limitations and drawbacks. This paper describes the basic features of wrist actigraphy in measuring nocturnal and daytime motor activity.

  13. Systems psychopharmacology: A network approach to developing novel therapies

    PubMed Central

    Gebicke-Haerter, Peter J

    2016-01-01

    The multifactorial origin of most chronic disorders of the brain, including schizophrenia, has been well accepted. Consequently, pharmacotherapy would require multi-targeted strategies. This contrasts to the majority of drug therapies used until now, addressing more or less specifically only one target molecule. Nevertheless, quite some searches for multiple molecular targets specific for mental disorders have been undertaken. For example, genome-wide association studies have been conducted to discover new target genes of disease. Unfortunately, these attempts have not fulfilled the great hopes they have started with. Polypharmacology and network pharmacology approaches of drug treatment endeavor to abandon the one-drug one-target thinking. To this end, most approaches set out to investigate network topologies searching for modules, endowed with “important” nodes, such as “hubs” or “bottlenecks”, encompassing features of disease networks, and being useful as tentative targets of drug therapies. This kind of research appears to be very promising. However, blocking or inhibiting “important” targets may easily result in destruction of network integrity. Therefore, it is suggested here to study functions of nodes with lower centrality for more subtle impact on network behavior. Targeting multiple nodes with low impact on network integrity by drugs with multiple activities (“dirty drugs”) or by several drugs, simultaneously, avoids to disrupt network integrity and may reset deviant dynamics of disease. Natural products typically display multi target functions and therefore could help to identify useful biological targets. Hence, future efforts should consider to combine drug-target networks with target-disease networks using mathematical (graph theoretical) tools, which could help to develop new therapeutic strategies in long-term psychiatric disorders. PMID:27014599

  14. Sex differences in the psychopharmacological treatment of depression.

    PubMed

    Sramek, John J; Murphy, Michael F; Cutler, Neal R

    2016-12-01

    Although a number of studies have observed that females respond better to serotonergic antidepressants than males and that postmenopausal females have a diminished response to antidepressants compared with younger females, there are also studies that conflict with both of these findings, making any generalizations regarding sex differences difficult to make. Sex variance in antidepressant efficacy and pharmacokinetics profiles have been attributed to sex-based physiological differences, behavioral differences, related disorders, and sex-specific conditions, including pregnancy and menopause. This paper will review the history and current research on sex effects of antidepressant treatment.

  15. The impact of psychopharmacology on contemporary clinical psychiatry.

    PubMed

    Vázquez, Gustavo H

    2014-08-01

    Clinical psychiatric evaluations of patients have changed dramatically in recent decades. Both initial assessments and follow-up visits have become brief and superficial, focused on searching for categorical diagnostic criteria from checklists, with limited inquiry into patient-reported symptomatic status and tolerability of treatments. The virtually exclusive therapeutic task has become selecting a plausible psychotropic, usually based on expert consensus guidelines. These guidelines and practice patterns rest mainly on published monotherapy trials that may or may not be applicable to particular patients but are having a profound impact, not only on modern psychiatric practice but also on psychiatric education, research, and theory.

  16. Challenges for translational psychopharmacology research--some basic principles.

    PubMed

    Miczek, Klaus A; de Wit, Harriet

    2008-08-01

    We introduce below several principles that recur in the discussion of translating preclinical findings to clinical applications, and conversely, developing animal models of human disorders: 1. The translation of preclinical data to clinical concerns is more successful when the scope of experimental models is restricted to a core symptom of a psychiatric disorder. 2. Preclinical experimental models gain in clinical relevance if they incorporate conditions that induce maladaptive behavioral or physiological changes that have some correspondence with species-normative behavioral adaptations. 3. Preclinical data are more readily translated to the clinical situation when they are based on converging evidence from several experimental procedures, each capturing cardinal features of the disorder. 4. The more closely a model approximates significant clinical symptoms, the more likely it is to generate data that will yield clinical benefits. 5. The choice of environmental, genetic, and/or physiological manipulations that induce a cardinal symptom or cluster of behavioral symptoms reveals the theoretical approach used to construct the model. 6. Preclinical experimental preparations that are validated by predicting treatment success with a prototypic agent are only able to detect alternative treatments that are based on the same mechanism as the existing treatment that was used to validate the screen. 7. The degree to which an experimental model fulfills the criteria of high construct validity relative to face or predictive validity depends on the purpose of the model. 8. Psychological processes pertinent to affect and cognition can only be studied in preclinical models if they are defined in behavioral and neural terms.

  17. Practitioner Review: Psychopharmacology in Children and Adolescents with Mental Retardation

    ERIC Educational Resources Information Center

    Handen, Benjamin L.; Gilchrist, Richard

    2006-01-01

    Background: The use of psychotropic medication to treat children and adults with mental retardation (MR) has a long and extensive history. There are no identified medications to address specific cognitive deficits among persons with MR. Instead, psychotropic medications are used to treat specific behavioral symptoms and/or psychiatric syndromes.…

  18. Efficacy Profiles of Psychopharmacology: Divalproex Sodium in Conduct Disorder

    ERIC Educational Resources Information Center

    Khanzode, Leena A.; Saxena, Kirti; Kraemer, Helena; Chang, Kiki; Steiner, Hans

    2006-01-01

    Little is known about how deeply medication treatment penetrates different levels of the mind/brain system. Psychopathology consists of relatively simple constructs (e.g., anger, irritability), or complex ones (e.g., responsibility). This study examines the efficacy of a specific compound, divalproex sodium (DVPX), on the various levels of…

  19. Effect of certain psychopharmacological preparations on adaptation under stress conditions

    NASA Technical Reports Server (NTRS)

    Stanishevskaya, A. V.; Mezentseva, L. N.

    1980-01-01

    Experiments staged on rats demonstrated that the formation of pathological states caused by stress and accompanied by the development of ulcerative lesion of the gastric mucosa are associated with the degree of the catecholamines level drop in the mesencephalon and hypothalamus. The application of seduxen and also of combinations consisting of L-DOPA with seduxen, or with an L-adrenoblocking agent pyroxan tends to reduce the frequency of developing alcerative lesions of the stomach. The protective effect produced by the combination of L-DOPA with an L-adrenoblocking agent pyroxan is barred by an additional administration of an B-adrenoblocking agent, inderal.

  20. Psychopharmacology in Fragile X Syndrome--Present and Future

    ERIC Educational Resources Information Center

    Berry-Kravis, Elizabeth; Potanos, Kristina

    2004-01-01

    In addition to cognitive disability, fragile X syndrome (FXS) is associated with behavioral problems that are often functionally limiting. There are few controlled trials to guide treatment; however, available information does suggest that medications can be quite helpful for a number of categories of behavioral disturbance in FXS. Specifically,…

  1. Pediatric psychopharmacology in primary care: a conceptual framework.

    PubMed

    Riddle, Mark A; dosReis, Susan; Reeves, Gloria M; Wissow, Lawrence S; Pruitt, David B; Foy, Jane Meschan

    2013-08-01

    In a 2009 policy statement focused on children's mental health, the American Academy of Pediatrics recommended that pediatric primary care physicians achieve competence in initiating care for children with attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, and substance use/abuse. Because treatment for 3 of these conditions--ADHD, anxiety, and depression--may, under certain conditions, include medication, the primary purpose of this article is to offer guidance to assist primary care physicians in decision-making about their use of psychotropic medications for these conditions. A few medications with proven efficacy and safety are emphasized. Secondarily, other medications that may be useful for other disorders are noted.

  2. Social isolation increases morphine intake: behavioral and psychopharmacological aspects.

    PubMed

    Raz, Sivan; Berger, Barry D

    2010-02-01

    Environmental and situational factors are important determinants of recreational drug use in humans. We aimed to develop a reliable animal model for studying the effects of environmental variables on drug-seeking behavior using the 'social isolation/social restriction' paradigm. Adult Wistar rats housed in short-term isolation (21 days) consumed significantly more morphine solution (0.5 mg/ml) than rats living in pairs, both in one-bottle and in two-bottle tests. No differences were found in their water consumption. This effect was observed in both males and females and the results were also replicated after reversal of housing conditions. We also found that as little as 60-min of daily social-physical interaction with another rat was sufficient to completely abolish the increase in morphine consumption in socially restricted animals. We discuss some possible interpretations for these effects. These results indicate that environmental and situational factors influence drug intake in laboratory rats as they do in humans, and thus may be of interest in studying drug-seeking behavior in humans.

  3. Early Onset Bipolar Spectrum Disorder: Psychopharmacological, Psychological, and Educational Management

    ERIC Educational Resources Information Center

    McIntosh, David E.; Trotter, Jeffrey S.

    2006-01-01

    Although published research continues to advocate medication as the first line of treatment for early onset bipolar spectrum disorder (EOBSD; N. Lofthouse & M.A. Fristad, 2004), preliminary research demonstrating the utility of cognitive, cognitive-behavioral, and psychoeducational therapies is promising. It appears as if future treatment of EOBSD…

  4. Brain Structural Effects of Psychopharmacological Treatment in Bipolar Disorder

    PubMed Central

    McDonald, Colm

    2015-01-01

    Bipolar disorder is associated with subtle neuroanatomical deficits including lateral ventricular enlargement, grey matter deficits incorporating limbic system structures, and distributed white matter pathophysiology. Substantial heterogeneity has been identified by structural neuroimaging studies to date and differential psychotropic medication use is potentially a substantial contributor to this. This selective review of structural neuroimaging and diffusion tensor imaging studies considers evidence that lithium, mood stabilisers, antipsychotic medication and antidepressant medications are associated with neuroanatomical variation. Most studies are negative and suffer from methodological weaknesses in terms of directly assessing medication effects on neuroanatomy, since they commonly comprise posthoc assessments of medication associations with neuroimaging metrics in small heterogenous patient groups. However the studies which report positive findings tend to form a relatively consistent picture whereby lithium and antiepileptic mood stabiliser use is associated with increased regional grey matter volume, especially in limbic structures. These findings are further supported by the more methodologically robust studies which include large numbers of patients or repeated intra-individual scanning in longitudinal designs. Some similar findings of an apparently ameliorative effect of lithium on white matter microstructure are also emerging. There is less support for an effect of antipsychotic or antidepressant medication on brain structure in bipolar disorder, but these studies are further limited by methodological difficulties. In general the literature to date supports a normalising effect of lithium and mood stabilisers on brain structure in bipolar disorder, which is consistent with the neuroprotective characteristics of these medications identified by preclinical studies. PMID:26412064

  5. Psychopharmacological treatment of behavioural problems in Sanfilippo syndrome.

    PubMed

    Santosh, Paramala; Parker, Jennifer Ruth; Jones, Lynn

    2009-01-01

    The present report illustrates successful use of psychotropic medication targeted at symptom clusters of behavioural disturbance in a 7-year-old girl with Sanfilippo syndrome, a mucopolysaccharidosis. By identifying and targeting symptom clusters, psychotropic medication was prescribed with significant results. This approach to treatment of behavioural disturbance in Sanfilippo syndrome has not been previously described to our knowledge. Caution with regards side effects and interaction of medication is advised.

  6. Understanding the agreements and controversies surrounding childhood psychopharmacology

    PubMed Central

    Parens, Erik; Johnston, Josephine

    2008-01-01

    The number of children in the US taking prescription drugs for emotional and behavioral disturbances is growing dramatically. This growth in the use of psychotropic drugs in pediatric populations has given rise to multiple controversies, ranging from concerns over off-label use and long-term safety to debates about the societal value and cultural meaning of pharmacological treatment of childhood behavioral and emotional disorders. This commentary summarizes the authors' eight main findings from the first of five workshops that seek to understand and produce descriptions of these controversies. The workshop series is convened by The Hastings Center, a bioethics research institute located in Garrison, New York, U.S.A. PMID:18261228

  7. Psychopharmacological treatment of mood and anxiety disorders during pregnancy.

    PubMed

    Krüger, Stephanie

    2012-01-01

    Many women with psychiatric disorders want to become mothers and only a minority seek advise prior to becoming pregnant. In those women, in whom pregnancy can be planned, the decision, if a medication is required for stabilisation and which one to choose if this is the case, is easier to make than in women in whom pregnancy occurs unplanned. The physician has to weigh the risk that a relapse of the psychiatric disorder during pregnancy poses to the foetus against the reproductive risk of psychotropic drugs. This presentation is intended to assist in understanding the general principles of pharmacotherapy during pregnancy as well as the morphological, perinatal and neurobehavioural toxicity of antidepressants, antipsychotics, benzodiazepines and mood stabilisers.

  8. Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA.

    PubMed

    Mithoefer, Michael C; Grob, Charles S; Brewerton, Timothy D

    2016-05-01

    4-phosphorloxy-N,N-dimethyltryptamine (psilocybin) and methylenedioxymethamfetamine (MDMA), best known for their illegal use as psychedelic drugs, are showing promise as therapeutics in a resurgence of clinical research during the past 10 years. Psilocybin is being tested for alcoholism, smoking cessation, and in patients with advanced cancer with anxiety. MDMA is showing encouraging results as a treatment for refractory post-traumatic stress disorder, social anxiety in autistic adults, and anxiety associated with a life-threatening illness. Both drugs are studied as adjuncts or catalysts to psychotherapy, rather than as stand-alone drug treatments. This model of drug-assisted psychotherapy is a possible alternative to existing pharmacological and psychological treatments in psychiatry. Further research is needed to fully assess the potential of these compounds in the management of these common disorders that are difficult to treat with existing methods. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Efficacy Profiles of Psychopharmacology: Divalproex Sodium in Conduct Disorder

    ERIC Educational Resources Information Center

    Khanzode, Leena A.; Saxena, Kirti; Kraemer, Helena; Chang, Kiki; Steiner, Hans

    2006-01-01

    Little is known about how deeply medication treatment penetrates different levels of the mind/brain system. Psychopathology consists of relatively simple constructs (e.g., anger, irritability), or complex ones (e.g., responsibility). This study examines the efficacy of a specific compound, divalproex sodium (DVPX), on the various levels of…

  10. Practitioner Review: Psychopharmacology in Children and Adolescents with Mental Retardation

    ERIC Educational Resources Information Center

    Handen, Benjamin L.; Gilchrist, Richard

    2006-01-01

    Background: The use of psychotropic medication to treat children and adults with mental retardation (MR) has a long and extensive history. There are no identified medications to address specific cognitive deficits among persons with MR. Instead, psychotropic medications are used to treat specific behavioral symptoms and/or psychiatric syndromes.…

  11. Psychopharmacology in Fragile X Syndrome--Present and Future

    ERIC Educational Resources Information Center

    Berry-Kravis, Elizabeth; Potanos, Kristina

    2004-01-01

    In addition to cognitive disability, fragile X syndrome (FXS) is associated with behavioral problems that are often functionally limiting. There are few controlled trials to guide treatment; however, available information does suggest that medications can be quite helpful for a number of categories of behavioral disturbance in FXS. Specifically,…

  12. Non-Antidepressant Psychopharmacologic Treatment of Specific Phobias.

    PubMed

    Khalil, Rami Bou

    2013-02-04

    Specific phobias are among the most frequently diagnosed disorders in community with a twelve-month prevalence of 8.7% and a lifetime prevalence of 12.5%. Exposure-based therapies constitute the most effective treatment for this type of anxiety disorders. However, pharmacotherapies can still be considered for patients suffering from specific phobias in case they were non-adherent or resistant to exposure-based therapies or in case this kind of therapies was not accessible for them. Few data support the use of antidepressant in the treatment of specific phobias. A literature search via MedLine has been done in order to review all available studies in the domain of non-antidepressant pharmacotherapy of specific phobias. The importance of benzodiazepines such as diazepam, alprazolam and midazolam resides in the short-term reduction of subjective self-reported fear during the exposure to the feared object or situation. General anesthesia for the treatment of dental phobia does not seem to be efficient unless conducted with the inhalation anesthetic nitrous oxide which seems to be efficient on the short and on the long-term. Beta-adrenergic antagonists have been essayed with conflicting results. Cognitive enhancers such as D-cycloserine, glucocorticoids and yohimbine hydrochloride, seem to be more effective than placebo after a short term period of follow-up in treating specific phobia sympotms. In conclusion, promising efficient pharmacotherapies for specific phobias consists of drugs that enhance the efficacy of exposure-based therapies sessions by reducing anticipating phobia-related fear and/or by enhancing cognition during these sessions.

  13. From descartes to desipramine: psychopharmacology and the self.

    PubMed

    Gold, Ian; Olin, Lauren

    2009-03-01

    Despite the remarkably widespread use of the new generation of antidepressants, almost everything we know about their effects comes from animal studies and clinical trials in which the sole parameter of interest is depressive symptomatology. Almost nothing is known about the effects that antidepressants have on cognition, affect, or motivation when used over a period of months or years. Nor do we understand what effects, if any, antidepressants have on what we think of as the self. In this article, we argue that neither psychiatry nor philosophy, in their current state, are well equipped to think about these issues. In order to explore this idea, we consider the neurobiology of romantic love and its relation to antidepressant neurochemistry. This case study, we suggest, supports the view that antidepressants are very likely to have significant effects on personhood as well as the suggestion that we are in need of new ways of thinking about the self and its pathologies.

  14. Essential Psychopharmacologic Information for Undergraduate Human Service Education Students.

    ERIC Educational Resources Information Center

    Taylor, Daniel

    2002-01-01

    In mental health settings, human service education students may participate in the administration, recording, and monitoring of prescribed psychoactive medications. This paper reviews three common groups of psychiatric medications, focusing on clinical applications, central effects, and how human service education students can assist in their safe…

  15. Psychopharmacology of topiramate: from epilepsy to bipolar disorder

    PubMed Central

    Mula, Marco; Cavanna, Andrea E; Monaco, Francesco

    2006-01-01

    Topiramate (TPM) is one of the novel antiepileptic drugs and exhibits a wide range of mechanisms of action. Efficacy of TPM has been demonstrated in partial-onset seizures and primary generalized seizures in adults and children, as both monotherapy and adjunctive therapy. More recently, TPM has been proposed as an add-on treatment for patients with lithium-resistant bipolar disorder, especially those displaying rapid-cycling and mixed states. This paper reviews the multiple mechanisms of action and the tolerability profile of TPM in the light of its therapeutic potential in affective disorders. Studies of TPM in bipolar disorder are evaluated, and the efficacy and tolerability issues as a mood stabilizing agent are discussed. PMID:19412496

  16. Medication Adherence in Psychopharmacologically Treated Adults with ADHD

    ERIC Educational Resources Information Center

    Safren, Steven A.; Duran, Petra; Yovel, Iftah; Perlman, Carol A.; Sprich, Susan

    2007-01-01

    Objective: One of the potential causes of residual symptoms of ADHD in adults can be difficulties with consistent adherence to medications. Method: This formative study examined self-reported medication adherence in adults with ADHD with clinically significant symptoms despite medication treatment. Results: Mean adherence for the two-week period…

  17. Brain Structural Effects of Psychopharmacological Treatment in Bipolar Disorder.

    PubMed

    McDonald, Colm

    2015-01-01

    Bipolar disorder is associated with subtle neuroanatomical deficits including lateral ventricular enlargement, grey matter deficits incorporating limbic system structures, and distributed white matter pathophysiology. Substantial heterogeneity has been identified by structural neuroimaging studies to date and differential psychotropic medication use is potentially a substantial contributor to this. This selective review of structural neuroimaging and diffusion tensor imaging studies considers evidence that lithium, mood stabilisers, antipsychotic medication and antidepressant medications are associated with neuroanatomical variation. Most studies are negative and suffer from methodological weaknesses in terms of directly assessing medication effects on neuroanatomy, since they commonly comprise posthoc assessments of medication associations with neuroimaging metrics in small heterogenous patient groups. However the studies which report positive findings tend to form a relatively consistent picture whereby lithium and antiepileptic mood stabiliser use is associated with increased regional grey matter volume, especially in limbic structures. These findings are further supported by the more methodologically robust studies which include large numbers of patients or repeated intra-individual scanning in longitudinal designs. Some similar findings of an apparently ameliorative effect of lithium on white matter microstructure are also emerging. There is less support for an effect of antipsychotic or antidepressant medication on brain structure in bipolar disorder, but these studies are further limited by methodological difficulties. In general the literature to date supports a normalising effect of lithium and mood stabilisers on brain structure in bipolar disorder, which is consistent with the neuroprotective characteristics of these medications identified by preclinical studies.

  18. [Psychopharmacological treatment of bipolar disorder in Latin American].

    PubMed

    Heeren, Oscar; Sánchez De Carmona, Manuel; Vásquez, Gustavo; Córdoba, Rodrigo; Forero, Jorge; Madrid, Luis; Lara, Diogo; Medina, Rafael; Meza, Luis

    2011-10-01

    This study assessed the treatment preferences among Latin-American psychiatrists for their bipolar disorder patients and if these preferences reflect the current guidelines. We designed a survey comprised of fourteen questions. All the questions were aimed at the treatment of bipolar I patients only. We distributed the survey by hand or e-mail to psychiatrists in eight different countries: Argentina, Brasil, Colombia, Costa Rica, Ecuador, México, Perú and Venezuela. Between May 2008 and June 2009, we were able to gather 1143 surveys. As the initial choice of treatment for a bipolar patient who debuts with mania, 61.3% choose a combination of an atypical antipsychotic and a mood stabilizer. Lithium Carbonate (50%) was the first choice for a mood stabilizer in a manic episode. Olanzapine (55.4%) was the initial antipsychotic of choice for the treatment of acute mania. For the treatment of acute bipolar depression, 27% choose Lamotrigineas their first choice. Most of the psychiatrists (74.8%) prescribe antidepressants for the treatment of bipolar depression. For maintenance treatment of bipolar depression most psychiatrists first choice would be Lamotrigine (50.3%). Most of the psychiatrists (89.1%) prescribed two or more psychotropic drugs for the maintenance treatment of their bipolar patients. There were some similarities with the studies previously done in the US. It seems that for the most part the Latin-American psychiatrists don't strictly follow the literature guidelines that are published, but rather adapt the treatment to the specific case. More longitudinal studies of prescribing patterns in bipolar disorder are needed to corroborate these findings. Copyright © 2011 SEP y SEPB. Published by Elsevier Espana. All rights reserved.

  19. Sex differences in the psychopharmacological treatment of depression

    PubMed Central

    Sramek, John J.; Murphy, Michael F.; Cutler, Neal R.

    2016-01-01

    Although a number of studies have observed that females respond better to serotonergic antidepressants than males and that postmenopausal females have a diminished response to antidepressants compared with younger females, there are also studies that conflict with both of these findings, making any generalizations regarding sex differences difficult to make. Sex variance in antidepressant efficacy and pharmacokinetics profiles have been attributed to sex-based physiological differences, behavioral differences, related disorders, and sex-specific conditions, including pregnancy and menopause. This paper will review the history and current research on sex effects of antidepressant treatment. PMID:28179816

  20. The psychopharmacology of European herbs with cognition-enhancing properties.

    PubMed

    Kennedy, David O; Scholey, Andrew B

    2006-01-01

    Extensive research suggests that a number of plant-derived chemicals and traditional Oriental herbal remedies possess cognition-enhancing properties. Widely used current treatments for dementia include extracts of Ginkgo biloba and several alkaloidal, and therefore toxic, plant-derived cholinergic agents. Several non-toxic, European herbal species have pan-cultural traditions as treatments for cognitive deficits, including those associated with ageing. To date they have not received research interest commensurate with their potential utility. Particularly promising candidate species include sage (Salvia lavandulaefolia/officinalis), Lemon balm (Melissa officinalis) and rosemary (Rosmarinus officinalis). In the case of sage, extracts possess anti-oxidant, estrogenic, and anti-inflammatory properties, and specifically inhibit butyryl- and acetyl-cholinesterase. Acute administration has also been found to reliably improve mnemonic performance in healthy young and elderly cohorts, whilst a chronic regime has been shown to attenuate cognitive declines in sufferers from Alzheimer's disease. In the case of Melissa officinalis, extracts have, most notably, been shown to bind directly to both nicotinic and muscarinic receptors in human brain tissue. This property has been shown to vary with extraction method and strain. Robust anxiolytic effects have also been demonstrated following acute administration to healthy humans, with mnemonic enhancement restricted to an extract with high cholinergic binding properties. Chronic regimes of aromatherapy and essential oil respectively have also been shown to reduce agitation and attenuate cognitive declines in sufferers from dementia. Given the side effect profile of prescribed cholinesterase inhibitors, and a current lack of a well tolerated nicotinic receptor agonist, these herbal treatments may well provide effective and well-tolerated treatments for dementia, either alone, in combination, or as an adjunct to conventional treatments.

  1. Current status and future prospects for epigenetic psychopharmacology

    PubMed Central

    Boks, Marco P.; de Jong, Noëlle M.; Kas, Martien J.H.; Vinkers, Christiaan H.; Fernandes, Cathy; Kahn, René S.; Mill, Jonathan; Ophoff, Roel A.

    2012-01-01

    Mounting evidence suggest that epigenetic regulation of brain functions is important in the etiology of psychiatric disorders. These epigenetic regulatory mechanisms, such as DNA methylation and histone acetylation, are influenced by many pharmaceutical compounds including psychiatric drugs. It is therefore of interest to investigate how psychiatric drugs are of influence and what the potential is of new epigenetic drugs for psychiatric disorders. With this targeted review we summarize the current state of knowledge in order to provide insight in this developing field. Several traditional psychiatric drugs have been found to alter the epigenome and in a variety of animal studies, experimental compounds with epigenetic targets have been investigated as potential psychiatric drugs. After discussion of the most relevant epigenetic mechanisms we present the evidence for epigenetic effects for the most relevant classes of drugs. PMID:22207355

  2. Inpatient clinical research: its importance in psychiatry and psychopharmacology.

    PubMed

    Reiss, A L; Stahl, S M

    1986-01-01

    We have outlined the essential components found in an inpatient psychiatry research unit from the point of patient recruitment through discharge. In virtually every phase of a patient's hospitalization on the unit, there is the potential for significant tension between research and clinical goals. We conclude that, as Braff and associates have suggested, clinical and research interests are compatible when both receive appropriate support. We have also discussed the potential advantages of an inpatient research setting for patient care. Because of the washout period, there is greater opportunity for an extended diagnostic assessment and response to the therapeutic milieu alone. The attention and priority patients receive during the research phase can be of significant therapeutic benefit. Findings from research protocols can be used to help with diagnosis and clinical care. Working on an inpatient research unit provides residents and other trainees with special learning experiences. In particular, observational and diagnostic skills are sharpened. Techniques of non-pharmacologic behavioral management are added to the trainees' repertoire of therapeutic interventions. By nature, the research experience promotes creative thinking and problem solving. In this era of fiscal restrictions and cost accountability in medicine, potential advantages for immediate patient care and for staff training are only secondary reasons which justify the existence of inpatient research centers in psychiatry. We must also ask what specific and unique research information an inpatient research setting offers compared to less expensive outpatient research environments. The first factor to be considered is the ability to study individuals whose illness is so severe as to make outpatient management difficult or impossible. It is becoming increasingly clear that for many categories of psychiatric disorders, there is a spectrum of severity of possible behavioral manifestations seen in affected individuals. In depressive illness, for example, the spectrum of expression appears to range from dysthymic disorder to major depressive disorder with psychotic features. Individuals with more severe symptomatology tend to create the greater cost to society because of their correspondingly greater degree of dysfunctional behavior, need for repeated and extended hospitalization, requirement for social services, etc. Such individuals, therefore, need to be studied in a research setting at least as much as patients with milder manifestations of psychiatric illness. This would not be possible without the control, structure, and staffing found in an inpatient setting.(ABSTRACT TRUNCATED AT 400 WORDS)

  3. Applying the principles of adult learning to the teaching of psychopharmacology: audience response systems.

    PubMed

    Stahl, Stephen M; Davis, Richard L

    2009-08-01

    Medical presentations can be enhanced by systematically collecting audience feedback. This is readily accomplished with polling systems, called audience response systems. Several systems are now available that are small, inexpensive, and can be readily integrated into standard powerpoint presentations without the need for a technician. Use of audience response systems has several advantages. These include improving attentiveness, increasing learning, polling anonymously, tracking individual and group responses, gauging audience understanding, adding interactivity and fun, and evaluating both participant learning and instructor teaching. Tips for how to write questions for audience response systems are also included.

  4. The burden of mood-disorder/cerebrovascular disease comorbidity: essential neurobiology, psychopharmacology, and physical activity interventions.

    PubMed

    Fornaro, Michele; Solmi, Marco; Veronese, Nicola; De Berardis, Domenico; Buonaguro, Elisabetta Filomena; Tomasetti, Carmine; Perna, Giampaolo; Preti, Antonio; Carta, Mauro Giovanni

    2017-10-01

    Cardio-vascular diseases (CVDs) and CVD-related disorders (including cerebrovascular diseases; CBVDs) are a major public health concern as they represent the leading cause of mortality and morbidity in developed countries. Patients with CVDs and CBVDs co-morbid with mood disorders, especially bipolar disorder (BD) and major depressive disorder (MDD), suffer reduced quality-of-life and significant disability adjusted for years of life and mortality. The relationship between CVDs/CBVDs and mood disorders is likely to be bidirectional. Evidence for shared genetic risk of pathways involved in stress reaction, serotonin or dopamine signalling, circadian rhythms, and energy balance was reported in genome-wide association studies. There is some evidence of a neuroprotective effect of various antidepressants, which may be boosted by physical exercise, especially by aerobic ones. Patients with CVDs/CBVDs should be routinely attentively evaluated for the presence of mood disorders, with tools aimed at detecting both symptoms of depression and of hypomania/mania. Behavioural lifestyle interventions targeting nutrition and exercise, coping strategies, and attitudes towards health should be routinely provided to patients with mood disorders, to prevent the risk of CVDs/CBVDs. A narrative review of the evidence is herein provided, focusing on pharmacological and physical therapy interventions.

  5. Separate and combined psychopharmacological effects of alprazolam and oxycodone in healthy volunteers

    PubMed Central

    Zacny, James P.; Paice, Judith A.; Coalson, Dennis W.

    2013-01-01

    Background There are epidemiological data indicating that medical and/or nonmedical use of prescription opioids oftentimes involves concurrent use of other substances. One of those substances is benzodiazepines. It would be of relevance to characterize the effects of an opioid and a benzodiazepine when taken together to determine if measures related to abuse liability-related effects and psychomotor performance impairment are increased compared to when the drugs are taken alone. Methods Twenty volunteers participated in a crossover, randomized, double-blind study in which they received placebo, 0.5 mg alprazolam, 10mg oxycodone, and 0.5 mg alprazolam combined with 10mg oxycodone, all p.o. Subjective, psychomotor, and physiological measures were assessed during each of the four sessions. Results Oxycodone by itself increased drug liking and “take again” ratings relative to placebo, but these ratings were not increased when oxycodone was taken with alprazolam, which by itself did not increase either of these ratings. The two drugs in combination produced stronger effects (larger in magnitude or longer lasting) than when either was taken alone on a number of measures, including psychomotor performance impairment. Conclusions In healthy volunteers, abuse liability-related subjective effects of oxycodone were not enhanced by alprazolam. There was enhanced behavioral toxicity when the drugs were taken together, and thus, this is of significant concern from a public safety standpoint. PMID:22365897

  6. Great apes and rhesus monkeys as subjects for psychopharmacological studies of stimulants and depressants.

    PubMed

    Pieper, W A

    1976-09-01

    A group of experiments is described in which chimpanzees and orangutans are utilized as subjects in research projects designed to evaluate the effects of stimulant and depressant drugs on learning and performance. Efficiency of performance on a task which measures spaced responding was impaired when subjects smoked cigarettes containing delta9-tetrahydrocannabinol prior to testing. In a sequential learning task, these subjects also demonstrated reduced performance when stimulatn drugs were orally administered before testing. Depressant drugs did not produce comparable decrements in sequential learning performance. Physical and behavioral tolerance and dependence on ethanol were investigated in rhesus monkey subjects using a variety of experimental procedures, including forced oral acceptance, intragastric intubation, intravenous infusion, and conditioned voluntary oral acceptance.

  7. Pediatric psychopharmacology and local anesthesia: potential adverse drug reactions with vasoconstrictor use in dental practice.

    PubMed

    Waits, Joe; Cretton-Scott, Erika; Childers, Noel K; Sims, Pamela J

    2014-01-01

    Pain management is important when dealing with pediatric dental patients. The use of local anesthetics can be especially challenging for children taking psychotropic medications. The purpose of this paper was to identify pertinent information regarding drug interactions between vasoconstrictor/local anesthetic combinations and medications for the management of psychiatric or behavior disorders in children. Many of the reported interactions are controversial, largely theoretical with very limited clinical evidence, and not well defined. However, when considering the potential for significant increased blood pressure when local anesthesia containing a vasoconstrictor is used, a thorough under standing of the pharmacological actions of medications used to treat psychiatric or behavioral disorders and vasoconstrictors can help dental professionals minimize the potential risk of drug interactions in their practice.

  8. Mechanisms of action of estrogen in the brain: insights from human neuroimaging and psychopharmacologic studies.

    PubMed

    Maki, Pauline M; Dumas, Julie

    2009-05-01

    Use of estrogen therapy in the perimenopausal and postmenopausal periods has been shown in several clinical trials to help women maintain a premenopausal level of cognitive function. What is not yet fully understood is how the neurobiological effects of estrogen contribute to these cognitive effects. This review explores data from two related bodies of human literature that provide compelling evidence in support of the biological plausibility that estrogen treatment can benefit cognition. The first half of the literature review focuses on studies from the estrogen neuroimaging literature, and the second half focuses on pharmacologic challenge studies assessing estrogen-neurotransmitter interactions. We integrate these two bodies of literature by focusing on the neurophysiologic underpinnings of estrogen effects on cognition and linking these clinical studies to preclinical studies. The focus on verbal memory is important because it is a cognitive function that has been shown to change with estrogen treatment and predict Alzheimer's disease risk but is not addressed by preclinical studies. Overall, we conclude that estrogen interacts with cholinergic and serotonergic systems to affect hippocampal and frontal cortical brain areas and thereby enhance memory, particularly at the retrieval stage.

  9. Neurobiological and psychopharmacological basis in the therapy of bulimia and anorexia.

    PubMed

    Mauri, M C; Rudelli, R; Somaschini, E; Roncoroni, L; Papa, R; Mantero, M; Longhini, M; Penati, G

    1996-02-01

    1. Eating disorders can be found in several psychiatric pathologies: schizophrenia, delusional disorder (somatic type), bipolar disorders, major depressive disorder, borderline personality disorder, generalized anxiety disorder, body dysmorphic disorder, somatization disorder and conversion disorder. 2. Although their clinical features have been defined, relatively little is known about the role of neurobiological patterns in the pathogenesis of these disorders. Several CNS neurotransmitters and neuromodulators are involved in the regulation of eating behavior in animals and have been implicated in symptoms such as depression and anxiety often observed in patients with eating disorders. The authors will review some studies on NA, DA, 5-HT, beta-endorphins, CRH, VP, OT, CCK, NPY and PYY involved in eating disorders. Furthermore, we will highlight some of the studies on drug therapy of eating disorders taking into account the effects of these agents on neurotransmitters and neuromodulators. 3. Antidepressant drugs have long been used for anorexia nervosa and bulimia, these disorders been claimed to be affective equivalent. Antidepressant agents seem to be effective in reducing the frequency of binge-eating episodes, purging behavior and depressive symptomatology. It is notable that antidepressant agents have been proved to be effective in patients with chronic bulimic symptoms, even in cases persisting for many years and in patients who had repeatedly failed courses of alternative therapeutic approaches. In all of the positive studies, antidepressant agents appeared effective even in bulimic subjects who did not display concomitant depression. 4. Few controlled studies on use of medications for anorexia nervosa have been published. Central serotonergic receptor-blocking compounds such as cyproheptadine cause marked increase in appetite and body weight. Zinc supplementation or cisapride could be a therapeutic option in addition to psychological and other approaches in anorexia nervosa. 5. There is no therapy as yet which is fully effective in alimentary disorders. Psychotropic drugs give some relief from symptoms, but they cannot cure the disorders. An integrated approach, either pharmacological or psychological, is still recommendable.

  10. The use of magnetoencephalography in the study of psychopharmacology (pharmaco-MEG).

    PubMed

    Muthukumaraswamy, Suresh D

    2014-09-01

    Magnetoencephalography (MEG) is a neuroimaging technique that allows direct measurement of the magnetic fields generated by synchronised ionic neural currents in the brain with moderately good spatial resolution and high temporal resolution. Because chemical neuromodulation can cause changes in neuronal processing on the millisecond time-scale, the combination of MEG with pharmacological interventions (pharmaco-MEG) is a powerful tool for measuring the effects of experimental modulations of neurotransmission in the living human brain. Importantly, pharmaco-MEG can be used in both healthy humans to understand normal brain function and in patients to understand brain pathologies and drug-treatment effects. In this paper, the physiological and technical basis of pharmaco-MEG is introduced and contrasted with other pharmacological neuroimaging techniques. Ongoing developments in MEG analysis techniques such as source-localisation, functional and effective connectivity analyses, which have allowed for more powerful inferences to be made with recent pharmaco-MEG data, are described. Studies which have utilised pharmaco-MEG across a range of neurotransmitter systems (GABA, glutamate, acetylcholine, dopamine and serotonin) are reviewed.

  11. Current Practice in Psychopharmacology for Children and Adolescents with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Floyd, Elizabeth Freeman; McIntosh, David E.

    2009-01-01

    Autism spectrum disorders (ASDs) are a complex group of neurodevelopmental conditions that develop in early childhood and involve a range of impairments in core areas of social interaction, communication, and restricted behavior and interests. Associated behavioral problems such as tantrums, aggression, and self-injury frequently compound the core…

  12. [Psychopharmacology of anxiety and depression: Historical aspects, current treatments and perspectives].

    PubMed

    Javelot, H

    2016-03-01

    Pharmacological treatment of acute anxiety still relies on benzodiazepines, while chronic anxiety disorders and depression are treated with different antidepressants, according to specific indications. The monoaminergic axis is represented by two families which are being developed: (i) serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRI), also called triple reuptake inhibitors (TRI), for the treatment of depression (amitifadine), (ii) multimodal antidepressants for depression and anxiety disorders (generalized anxiety disorder mainly) (tedatioxetine, vortioxetine and vilazodone). Third-generation antipsychotics (aripiprazole, lurasidone, brexpiprazole, cariprazine) appear relevant in the treatment of resistant depression and some anxiety disorders. Among the modulators of the glutamatergic axis, promising compounds include: (i) ionotropic regulators of NMDA receptors: esketamine, AVP-923 and AVP-786, CERC-301, rapastinel (Glyx-13), NRX-1074 developed for depression, rapastinel and bitopertine developed for obsessive compulsive disorder, (ii) metabotropic glutamate receptors modulators: decoglurant and basimglurant developed for depression and mavoglurant developed for obsessive compulsive disorder.

  13. Future Trends in the Application and Impact of Psychopharmacology within the School Setting

    ERIC Educational Resources Information Center

    Noggle, Chad A.

    2009-01-01

    The number of children and adolescents using prescription medications is continually climbing. The preceding articles have offered discussions on a multitude of areas within this subject matter. This article will serve to summarize some of those points raised with particular emphasis on where we go from here in terms of training and professional…

  14. Psychopharmacology of the negative symptoms: current status and prospects for progress.

    PubMed

    Davis, Michael C; Horan, William P; Marder, Stephen R

    2014-05-01

    The past decade has witnessed a resurgence of interest in the development of novel pharmacological agents to treat the negative symptoms of schizophrenia. This review provides an overview of pharmacological approaches that have been evaluated as potential treatments and describes the emergence of several promising new approaches. First, we briefly describe recent methodological developments, including consensus-based clinical trial guidelines for patient selection criteria, symptom assessment, and trial duration. Next, we overview mono- and adjunctive-therapies that have been evaluated, including first- and second-generation antipsychotics, antidepressants, psychostimulants, molecules targeting cholinergic and glutamatergic systems, and hormones. We highlight the most promising pharmacological agents on the horizon, including glycine transporter-1 inhibitors, α7-nicotinic receptor positive allosteric modulators, and oxytocin, as well as non-pharmacological electromagnetic stimulation approaches. Further investigations, using optimal clinical trial design, hold considerable promise for discovering effective treatments for these functionally disabling symptoms in the near future.

  15. Aacap 2002 Research Forum: Placebo and Alternatives to Placebo in Randomized Controlled Trials in Pediatric Psychopharmacology

    ERIC Educational Resources Information Center

    March, John; Kratochvil, Christopher; Clarke, Gregory; Beardslee, William; Derivan, Albert; Emslie, Graham; Green, Evelyn P.; Heiligenstein, John; Hinshaw, Stephen; Hoagwood, Kimberly; Jensen, Peter; Lavori, Philip; Leonard, Henrietta; McNulty, James; Michaels, M. Alex; Mossholder, Andrew; Osher, Trina; Petti, Theodore; Prentice, Ernest; Vitiello, Benedetto; Wells, Karen

    2004-01-01

    Objective: The use of placebo in the pediatric age group has come under increasing scrutiny. At the 2002 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Academy's Workgroup on Research conducted a research forum. The purpose was to identify challenges and their solutions regarding the use of placebo in randomized…

  16. Psychopharmacology of Attention-Deficit Hyperactivity Disorder: Effects and Side Effects.

    PubMed

    Golmirzaei, Javad; Mahboobi, Hamidreza; Yazdanparast, Maryam; Mushtaq, Gohar; Kamal, Mohammad A; Hamzei, Enayatollah

    2016-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children which manifests with hyperactivity, impulsivity, and/or inattention. Several drugs are used in treatment of ADHD. Stimulants, atomoxetine, anti-depressants, and bupropion are common medications used in the treatment of ADHD. Stimulants are widely used as the first line treatment in children with ADHD. Their mechanism of action is the release of dopamine and norepinephrine in central nervous system. Methylphenidate is the most common stimulant used for the treatment of ADHD. Methylphenidate significantly reduces ADHD symptoms in children both at home and school and improves their social skills. Methylphenidate is safe in healthy children and has shown to have no cardiac side effects in these patients. Other medications include: Atomoxetine, Amphetamines, Clonidine, Melatonin, and anti-depressants. Effects, side effects, and mechanism of action these drugs have been discussed in this paper.

  17. Metabolic syndrome and obesity among users of second generation antipsychotics: A global challenge for modern psychopharmacology.

    PubMed

    Rojo, Leonel E; Gaspar, Pablo A; Silva, H; Risco, L; Arena, Pamela; Cubillos-Robles, Karen; Jara, Belen

    2015-11-01

    Second generation antipsychotics (SGAs), such as clozapine, olanzapine, risperidone and quetiapine, are among the most effective therapies to stabilize symptoms schizophrenia (SZ) spectrum disorders. In fact, clozapine, olanzapine and risperidone have improved the quality of life of billions SZ patients worldwide. Based on the broad spectrum of efficacy and low risk of extrapyramidal symptoms displayed by SGAs, some regulatory agencies approved the use of SGAs in non-schizophrenic adults, children and adolescents suffering from a range of neuropsychiatric disorders. However, increasing number of reports have shown that SGAs are strongly associated with accelerated weight gain, insulin resistance, diabetes, dyslipidemia, and increased cardiovascular risk. These metabolic alterations can develop in as short as six months after the initiation of pharmacotherapy, which is now a controversial fact in public disclosure. Although the percentage of schizophrenic patients, the main target group of SGAs, is estimated in only 1% of the population, during the past ten years there was an exponential increase in the number of SGAs users, including millions of non-SZ patients. The scientific bases of SGAs metabolic side effects are not yet elucidated, but the evidence shows that the activation of transcriptional factor SRBP1c, the D1/D2 dopamine, GABA2 and 5HT neurotransmitions are implicated in the SGAs cardiovascular toxicity. Polypharmacological interventions are either non- or modestly effective in maintaining low cardiovascular risk in SGAs users. In this review we critically discuss the clinical and molecular evidence on metabolic alterations induced by SGAs, the evidence on the efficacy of classical antidiabetic drugs and the emerging concept of antidiabetic polyphenols as potential coadjutants in SGA-induced metabolic disorders.

  18. Memory Encoding and Dopamine in the Aging Brain: A Psychopharmacological Neuroimaging Study

    PubMed Central

    Bullmore, Edward T.; Huppert, Felicia A.; Lennox, Belinda; Praseedom, Asha; Linnington, Helen; Fletcher, Paul C.

    2010-01-01

    Normal aging brings with it changes in dopaminergic and memory functions. However, little is known about how these 2 changes are related. In this study, we identify a link between dopamine, episodic memory networks, and aging, using pharmacological functional magnetic resonance imaging. Young and older adults received a D2-like agonist (Bromocriptine, 1.25 mg), a D2-like antagonist (Sulpiride, 400 mg), and Placebo, in a double-blind crossover procedure. We observed group differences, during memory encoding, in medial temporal, frontal, and striatal regions and moreover, these regions were differentially sensitive across groups to dopaminergic perturbation. These findings suggest that brain systems underlying memory show age-related changes and that dopaminergic function may be key in understanding these changes. That these changes have behavioral consequences was suggested by the observation that drug modulations were most pronounced in older subjects with poorer recognition memory. Our findings provide direct evidence linking ageing, memory, and dopaminergic change. PMID:19625385

  19. Clinical Psychopharmacology Update: What's in a Name? Confusion Prompts Change for Vortioxetine's Brand Name.

    PubMed

    Tobin, Thomas J; Tobin, Mary L

    2016-09-01

    Similar names between two unrelated drugs have led the FDA to issue warnings about and now approve a name change for vortioxetine, which was branded as Brintellix® until recently. While the trade name had been screened prior to the product's launch, the FDA received numerous reports of prescribing and dispensing errors, specifically with regard to the anti-coagulant drug Brilinta® (ticagrelor). Starting 1 June 2016, vortioxetine will be marketed under the name Trintellix™ in an effort to reduce confusion. Clinicians are advised that while the name and National Drug Code number with this product will change, it will retain the same formulation, indication, and dosage information. To the extent possible, clinicians can and should take actions to identify and reduce potential medication errors in prescriptions, especially when using electronic records and e-prescription systems.

  20. Positive Attitude Change toward Psychiatry in Pharmacy Students Following an Active Learning Psychopharmacology Course

    ERIC Educational Resources Information Center

    Einat, Haim; George, Angela

    2008-01-01

    Objective: Psychiatric care in many rural communities has been demonstrated to be less adequate compared with urban environments partially because of attitudes and stigmatization issues. Educated pharmacists with professional attitudes can have a major impact in helping mental health patients receive more accurate diagnostic assessments and safe…

  1. The TNF-α System: Functional Aspects in Depression, Narcolepsy and Psychopharmacology

    PubMed Central

    Berthold-Losleben, Mark; Himmerich, Hubertus

    2008-01-01

    Changes of the tumor necrosis factor-alpha (TNF-α) system have been shown to be involved in the development of psychiatric disorders and are additionally associated with changes in body weight as well as endocrine and metabolic changes in psychiatric patients. TNF-α might, for example, contribute to the pathogenesis of depression by an activation of the hypothalamo-pituitary-adrenocortical (HPA) axis, an activation of neuronal serotonin transporters and the stimulation of the indoleamine 2,3-dioxygenase which leads to tryptophan depletion. On the other hand, during an acute depressive episode, an elevated HPA axis activity may suppress TNF-α system activity, while after remission, when HPA axis activity has normalized the suppression of the TNF-α system has been shown not to be apparent any more. In narcoleptic patients, soluble TNF receptor (sTNF-R) p75 plasma levels have been shown to be elevated, suggesting a functional role of the TNF-α system in the development of this disorder. Additionally, psychotropic drugs influence the TNF-α system as well as the secretion and the effect of hormones which counteract or interact with the TNF-α system such as the intestinal hormone ghrelin. However, only preliminary studies with restricted sample sizes exist on these issues, and many open questions remain. PMID:19506720

  2. Salvia divinorum: a psychopharmacological riddle and a mind-body prospect.

    PubMed

    Diaz, Jose-Luis

    2013-03-01

    The multidisciplinary research on Salvia divinorum and its chemical principles is analyzed concerning whether the ethnobotany, phytochemistry, mental effects, and neuropharmacology of this sacred psychoactive plant and main principle clarify its experienced effects and divinatory uses. The scientific pursuit spans from the traditional practices, continues with the botanical identification, isolation of active molecules, characterization of mental and neural effects, possible therapeutic applications, and impinges upon the mind-body problem. The departure point is ethnopharmacology and therefore the traditional beliefs, ritual uses, and mental effects of this Mazatec sacred mint recorded during a 1973- 1983 field research project are described. A water potion of crushed leaves produced short-lasting light-headedness, dysphoria, tactile and proprioceptive sensations, a sense of depersonalization, amplified sound perception, and an increase visual and auditory imagery, but not actual hallucinations. Similar effects were described using questionnaires and are attributable to salvinorin A, but cannot be explained solely by its specific and potent brain kappa-opioid receptor agonist activity. Some requirements for a feasible classification and mechanism of action of consciousness-altering products are proposed and include the activation of neural networks comprising several neurochemical systems. Top-down analyses should be undertaken in order to characterize such neural networks and eventually allowing to explore the differential ethnic effects. As is the case for other consciousness-altering preparations, a careful and encompassing research on this plant and principle can be consequential to endeavors ranging from the mind-body problem, a better understanding of shamanic ecstasy, to the potential generation of analgesic, antidepressant, and drug-abuse attenuating products.

  3. The alarm pheromone in male rats as a unique anxiety model: psychopharmacological evidence using anxiolytics.

    PubMed

    Inagaki, Hideaki; Kiyokawa, Yasushi; Takeuchi, Yukari; Mori, Yuji

    2010-02-01

    Previously, we demonstrated that an alarm pheromone released from male donor Wistar rats evoked anxiety-related physiological and behavioral responses in recipient rats. Thus, we believe that this pheromone may increase anxiety levels in rats. In the current study, we evaluated the predictive validity of this alarm pheromone-induced anxiogenic effect in detail by investigating whether six types of human anxiolytics, each of which has a different mechanism of action, were efficacious in reducing anxiety, using changes in the acoustic startle reflex (ASR) as an index. The alarm pheromone-enhanced ASR was not affected by vehicle pretreatment but was dose-dependently attenuated by pretreatment with midazolam, phenelzine, propranolol, clonidine, and CP-154,526-although not buspirone. These results may reflect some aspects of the predictive validity of the alarm pheromone-induced anxiety in rats as an animal model of human anxiety.

  4. Psychopharmacological investigation of the monoamine oxidase inhibitory activity of molindone, a dihydroindolone neuroleptic.

    PubMed

    Balsara, J J; Gada, V P; Nandal, N V; Chandorkar, A G

    1984-09-01

    24 h pretreatment with molindone enhanced the behavioural effects of L-dopa and 5-HTP, precursors of biogenic amines (catecholamines and 5-HT respectively) preferentially deaminated by MAO-A, confirming that a metabolite of molindone inhibits MAO-A. 24 h pretreatment with molindone enhanced the behavioural effects of tryptamine and antagonized reserpine-induced ptosis, and in molindone-pretreated rats L-tryptophan induced behavioural effects, probably because of the MAO-A inhibitory activity exerted by a metabolite of molindone. Since 24 h pretreatment with molindone, unlike 30 min pretreatment with clomipramine, failed to antagonize fenfluramine and p-chloramphetamine-induced behavioural syndromes, it suggests that molindone and/or its metabolites most probably do not exert 5-HT neuronal uptake blocking activity and the potentiation of 5-HTP-induced behavioural syndrome is due to a metabolite's MAO-A inhibitory activity. As 2 h pretreatment with molindone induced catalepsy and antagonized apomorphine-induced climbing behaviour in mice and stereotypy in rats, while 24 h pretreatment failed to induce catalepsy and to antagonize apomorphine-induced behaviour, it appears that, at 24 h, the tissue levels of molindone are inadequate to block postsynaptic striatal and mesolimbic DA receptors and that, though a metabolite of molindone is biologically active so far as inhibition of MAO-A is concerned, the metabolites are devoid of neuroleptic activity. Further, since 2 h pretreatment with molindone failed to enhance the behavioural effects of L-dopa, it suggests that at 2 h the degree of MAO-A inhibition induced by molindone and/or the metabolite is not sufficient to counteract the neuroleptic activity of the parent compound.

  5. Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options

    PubMed Central

    Oluwabusi, Olumide O; Parke, Susan; Ambrosini, Paul J

    2016-01-01

    Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder (ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments. PMID:26862512

  6. Sex Hormones, Neurotransmitters, and Psychopharmacological Treatments in Men with Paraphilic Disorders

    ERIC Educational Resources Information Center

    Saleh, Fabian M.; Berlin, Fred S.

    2003-01-01

    Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social…

  7. More questions than answers! Clinical dilemmas in psychopharmacology in pregnancy and lactation

    PubMed Central

    Desai, Geetha; Babu, Girish N.; Rajkumar, Ravi P.; Chandra, Prabha S.

    2009-01-01

    Women in childbearing age frequently suffer from mental illness. Maternal psychiatric disorders may have a devastating impact on the fetus and the newborn. Thus treating or preventing relapse of these disorders during pregnancy and puerperium is a clinical and ethical duty with the necessity to avoid or minimize fetal or neonatal drug exposure. Though there are many guidelines and comprehensive reviews regarding drug safety in pregnancy and lactation, the application of these recommendations into clinical practice appears to be complex. Hence, we present some clinical questions with answers considering the available literature on safety of psychotropics in pregnancy and lactation. PMID:19742205

  8. Empirical Approach to Psychopharmacology for Institutionalized Individuals with Severe or Profound Mental Retardation.

    ERIC Educational Resources Information Center

    Bishop, Andrew C.

    1992-01-01

    A six-point program of diagnostic inquiry and treatment strategy for individuals with behavior disorders in addition to severe or profound mental retardation is presented, which allows alternate etiological hypotheses to be tested in a clinical setting. This format is intended to unify psychopharmacy practice in mental retardation and in general…

  9. Psychopharmacology of atypical antipsychotic drugs: From the receptor binding profile to neuroprotection and neurogenesis.

    PubMed

    Kusumi, Ichiro; Boku, Shuken; Takahashi, Yoshito

    2015-05-01

    The original definition of atypical antipsychotic drugs (APD) was drugs that are effective against positive symptoms in schizophrenia with no or little extrapyramidal symptoms (EPS). However, atypical APD have been reported to be more effective for cognitive dysfunction and negative symptoms in schizophrenia than typical APD, which expands the definition of 'atypicality'. This article provides a critical review of the pharmacology of atypical APD, especially from the viewpoint of receptor binding profiles and neurotransmitter regulations as well as neuroprotection and neurogenesis. A variety of serotonin (5-HT) receptors, such as 5-HT2A / 2C , 5-HT1A , 5-HT6 and 5-HT7 receptors, may contribute to the mechanisms of action of 'atypicality'. The dopaminergic modulations, including a low affinity for dopamine D2 receptors and a partial D2 receptor agonistic action, and glutamatergic regulations may also be involved in the pharmacological backgrounds of 'atypicality'. Atypical APD, but not typical APD, may facilitate cortical neuroprotection and hippocampal neurogenesis, which might be a part of the action mechanisms of atypical APD. The facilitation of cortical neuroprotection and hippocampal neurogenesis induced by atypical APD might be mediated by an increase in the Ser9 phosphorylation of glycogen synthase kinase-3β (GSK-3β). The stimulation of 5-HT1A receptors and/or the blockade of 5-HT2 receptors, which is characteristic of atypical APD, might increase Ser9 phosphorylation of GSK-3β. Moreover, atypical APD increase brain-derived neurotrophic factor (BDNF) levels. BDNF increases Ser9 phosphorylation of GSK-3β and has neuroprotective and neurogenic effects, as in the case of atypical APD. These findings suggest that GSK-3β might play a role in the action mechanisms of atypical APD, in both the 5-HT-dependent and BDNF-dependent mechanisms.

  10. Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options.

    PubMed

    Oluwabusi, Olumide O; Parke, Susan; Ambrosini, Paul J

    2016-02-08

    Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder (ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.

  11. Psychopharmacologic treatment of acquired attention disorders in children with brain injury.

    PubMed

    Mahalick, D M; Carmel, P W; Greenberg, J P; Molofsky, W; Brown, J A; Heary, R F; Marks, D; Zampella, E; Hodosh, R; von der Schmidt, E

    1998-09-01

    This investigation examined the efficacy of psychostimulant therapy in alleviating neurobehavioral dysfunction attendant to pediatric brain injury. The most commonly reported neurobehavioral sequelae associated with head injury in the pediatric population involve deficits along the attentional matrix. This is also the most common objectively documented neurobehavioral finding among children as well as adults. There are several investigations in the adult literature which have employed the use of psychostimulants in treating both psychiatric and neuropsychological residua associated with head injury. Overall, the results of these studies are equivocal, but suggest a beneficial impact on general functioning. The present prospective investigation utilized a double-blind, placebo-controlled, cross-over experimental design to examine the efficacy of methylphenidate in treating children with acquired attentional disorders secondary to brain injury. A cohort of 14 children with varying degrees of head injury were recruited for participation. As expected, differences between drug and placebo conditions uniformly achieved statistical significance. Additionally, there were no differences in performance between baseline and placebo conditions on neurobehavioral tasks of attention and concentration. Current findings suggest that methylphenidate (and probably other psychostimulants such as Cylert, Adderal, Wellbutrin and dextroamphetamine sulfate) is an extremely effective agent in treating attentional disorders secondary to brain injury in children.

  12. Sex hormones, neurotransmitters, and psychopharmacological treatments in men with paraphilic disorders.

    PubMed

    Saleh, Fabian M; Berlin, Fred S

    2003-01-01

    Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social embarrassment to the afflicted patient but also to the targets of their paraphilic focus. The primary objective of this article is to examine and review data on the efficacy and tolerability of the testosterone-lowering agents medroxprogesterone acetate, cyproterone acetate, and leuprolide acetate. The secondary goal is to review data on less conventional and more innovative pharmacological treatments, particularly the serotonin-specific reuptake inhibitors.

  13. Set and setting, psychedelics and the placebo response: An extra-pharmacological perspective on psychopharmacology.

    PubMed

    Hartogsohn, Ido

    2016-12-01

    Placebo response theory and set and setting theory are two fields which examine how non-biological factors shape the response to therapy. Both consider factors such as expectancy, preparation and beliefs to be crucial for understanding the extra-pharmacological processes which shape the response to drugs. Yet there are also fundamental differences between the two theories. Set and setting concerns itself with response to psychoactive drugs only; placebo theory relates to all therapeutic interventions. Placebo theory is aimed at medical professionals; set and setting theory is aimed at professionals and drug users alike. Placebo theory is primarily descriptive, describing how placebo acts; set and setting theory is primarily prescriptive, educating therapists and users on how to control and optimize the effects of drugs. This paper examines how placebo theory and set and setting theory can complement and benefit each other, broadening our understanding of how non-biological factors shape response to drugs and other treatment interventions. © The Author(s) 2016.

  14. Current Practice in Psychopharmacology for Children and Adolescents with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Floyd, Elizabeth Freeman; McIntosh, David E.

    2009-01-01

    Autism spectrum disorders (ASDs) are a complex group of neurodevelopmental conditions that develop in early childhood and involve a range of impairments in core areas of social interaction, communication, and restricted behavior and interests. Associated behavioral problems such as tantrums, aggression, and self-injury frequently compound the core…

  15. Aacap 2002 Research Forum: Placebo and Alternatives to Placebo in Randomized Controlled Trials in Pediatric Psychopharmacology

    ERIC Educational Resources Information Center

    March, John; Kratochvil, Christopher; Clarke, Gregory; Beardslee, William; Derivan, Albert; Emslie, Graham; Green, Evelyn P.; Heiligenstein, John; Hinshaw, Stephen; Hoagwood, Kimberly; Jensen, Peter; Lavori, Philip; Leonard, Henrietta; McNulty, James; Michaels, M. Alex; Mossholder, Andrew; Osher, Trina; Petti, Theodore; Prentice, Ernest; Vitiello, Benedetto; Wells, Karen

    2004-01-01

    Objective: The use of placebo in the pediatric age group has come under increasing scrutiny. At the 2002 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Academy's Workgroup on Research conducted a research forum. The purpose was to identify challenges and their solutions regarding the use of placebo in randomized…

  16. Future Trends in the Application and Impact of Psychopharmacology within the School Setting

    ERIC Educational Resources Information Center

    Noggle, Chad A.

    2009-01-01

    The number of children and adolescents using prescription medications is continually climbing. The preceding articles have offered discussions on a multitude of areas within this subject matter. This article will serve to summarize some of those points raised with particular emphasis on where we go from here in terms of training and professional…

  17. Positive Attitude Change toward Psychiatry in Pharmacy Students Following an Active Learning Psychopharmacology Course

    ERIC Educational Resources Information Center

    Einat, Haim; George, Angela

    2008-01-01

    Objective: Psychiatric care in many rural communities has been demonstrated to be less adequate compared with urban environments partially because of attitudes and stigmatization issues. Educated pharmacists with professional attitudes can have a major impact in helping mental health patients receive more accurate diagnostic assessments and safe…

  18. Psychopharmacology of child and adolescent major depression: present status and future directions.

    PubMed

    Jensen, P S; Ryan, N D; Prien, R

    1992-01-01

    ABSTRACT Current concerns about antidepressant efficacy in children and adolescents are reminiscent of the history of adult studies. Such awareness should temper these concerns, especially in view of the enormous progress in the last two decades of studies of adult depression. A number of methodologie, nosologie, developmental, and validity considerations may have hampered the child and adolescent studies to date; thus, with more careful consideration of past problem areas, future studies may yield more promising results. The next generation of treatment research in child and adolescent depression may require innovative, multisite, longitudinal treatment designs which allow the simultaneous possibility for the continuing clarification and validation of depressive syndromes and treatment-responsive subgroups.

  19. Sex Hormones, Neurotransmitters, and Psychopharmacological Treatments in Men with Paraphilic Disorders

    ERIC Educational Resources Information Center

    Saleh, Fabian M.; Berlin, Fred S.

    2003-01-01

    Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social…

  20. Cardiometabolic Risks in Schizophrenia and Directions for Intervention, 3: Psychopharmacological Interventions.

    PubMed

    Andrade, Chittaranjan

    2016-09-01

    Patients with schizophrenia have increased prevalence rates for many cardiometabolic risk factors; the prevalence and severity of these risks increase after the institution of antipsychotic medication. Nearly 2 dozen different pharmacologic interventions have been trialed to prevent or attenuate antipsychotic-related cardiometabolic changes. Metformin (usually 1,000-1,500 mg/d) has emerged as the best-studied intervention; in short- and intermediate-duration randomized controlled trials, it has been shown to bring about improvements in weight and other anthropometric indices, in fasting sugar and other glycemic control indices, and in total cholesterol and other lipid metabolism indices. Topiramate and aripiprazole are other possible interventions with support in literature; besides improving metabolic outcomes, these drugs may improve indices of psychopathology, as well. Encouraging though the findings are, there are many unanswered questions that require attention in future research.

  1. The psychopharmacological effects of premazepam, diazepam and placebo in healthy human subjects.

    PubMed Central

    Golombok, S; Lader, M

    1984-01-01

    Pharmacological studies of premazepam in animals predicted antianxiety activity without sedation and, in combination with diazepam, a reduction in the sedative effects of the latter. The effects of single doses of premazepam (25 and 50 mg), diazepam (10 mg), premazepam (25 mg) plus diazepam (10 mg), and a placebo on subjective feelings, psychological tests and the EEG were studied in a double-blind cross-over study in 10 healthy subjects. In a repeated dose study in eight subjects, the effects on subjective feelings, psychological tests and the EEG of premazepam (5 and 10 mg twice-daily), diazepam (5mg twice-daily) and a placebo were compared. Premazepam had a different EEG profile from diazepam, producing more slow and less fast wave activity. In the single dose study its effects were similar to diazepam for sedative action and most of the psychological tests, with a tendency towards greater psychomotor impairment. In the repeated dose study, however, premazepam caused less sedation and also tended to produce less psychomotor impairment. The combination dose of premazepam (25 mg) plus diazepam (10 mg) in the single dose study indicated an additive effect rather than an antagonistic one. PMID:6148956

  2. Psychopharmacological assessment of Pfaffia glomerata roots (extract BNT-08) in rodents.

    PubMed

    Marques, Luís Carlos; Galvão, Suzana Maria Pereira; Espínola, Eduardo; Dias, Rosângela Fernandes; Mattei, Rita; Oliveira, Maria Gabriela Menezes; De Araújo Carlini, Elisaldo Luiz

    2004-07-01

    A pharmacological assessment of the standardized extract (BNT-08) of Pfaffia glomerata roots was performed in young mice submitted to acute treatment with several doses (i.p.), in young and old mice submitted to chronic oral treatment for 150 days or with water (control groups) and in old mice at a dose of 100 mg/kg of extract. Acute tests involved an initial screening, spontaneous movements, rota-rod, barbiturate sleeping time and passive avoidance were carried out. The chronic test involved mortality assessment, body weight and learning and memory in a T-maze left/right discrimination test and in the passive avoidance model. Of the acute tests only the sleeping time test showed relevant differences between the groups. With the chronic treatment, a relevant decrease of the number of sessions necessary for learning in the group of old mice treated with the extract was evident. A partial reversal of the memory de fi cit induced by age in the old mice treated with the extract was found in the passive avoidance test. The results suggest that the standardized extract from Pfaffia glomerata roots promoted an increase in both learning and memory of old mice treated in the chronic test.

  3. Towards a Better Understanding of the Psychopharmacology of Nutmeg: Activities in the Mouse Tetrad Assay

    PubMed Central

    El-Alfy, Abir; Wilson, Lisa; ElSohly, Mahmoud A.; Abourashed, Ehab A.

    2009-01-01

    Ethnopharmacological relevance Nutmeg, the seeds of Myritica fragrans (family Myristicaceae), is a well known kitchen spice with a long-standing reputation as a psychoactive herb. Nutmeg at high doses is considered a cheap substitute to several drugs of abuse. Earlier reports have attributed amphetamine-like activities to nutmeg. Aim of the study To characterize the neuropharmacological effects of different nutmeg extracts, administered orally and intraperitoneally, in comparison to Δ9-terahydrocannabinol, amphetamine, and morphine. Materials and methods Methanolic (ME), dichloromethane (DE), and hexane (HE) extracts were obtained from a chromatographically fingerprinted batch of nutmeg. Biological evaluation was conducted in sets of 6–8 mice in the tetrad assay at doses ranging from 100–500 and 500–1000 mg/kg for i.p. and oral administration, respectively. Results While oral administration of all the nutmeg extracts at 500 mg/kg caused a significant increase in locomotor activity, the i.p. administration of DE showed significant reduction in rectal temperature along with a significant increase in tail flick latency at 300 mg/kg. A significant decrease in core body temperature was observed with HE at 100 mg/kg, while higher doses caused significant increases in hot plate latency. Conclusion Different behavioral effects were observed that varied by the type of extract as well as by the route of administration. PMID:19703539

  4. Towards a better understanding of the psychopharmacology of nutmeg: Activities in the mouse tetrad assay.

    PubMed

    El-Alfy, Abir T; Wilson, Lisa; ElSohly, Mahmoud A; Abourashed, Ehab A

    2009-11-12

    Nutmeg, the seeds of Myritica fragrans (family Myristicaceae), is a well known kitchen spice with a long-standing reputation as a psychoactive herb. Nutmeg at high doses is considered a cheap substitute to several drugs of abuse. Earlier reports have attributed amphetamine-like activities to nutmeg. To characterize the neuropharmacological effects of different nutmeg extracts, administered orally and intraperitoneally, in comparison to Delta(9)-terahydrocannabinol, amphetamine, and morphine. Methanolic (ME), dichloromethane (DE), and hexane (HE) extracts were obtained from a chromatographically fingerprinted batch of nutmeg. Biological evaluation was conducted in sets of 6-8 mice in the tetrad assay at doses ranging from 100 to 500 and 500 to 1000 mg/kg for i.p. and oral administration, respectively. While oral administration of all the nutmeg extracts at 500 mg/kg caused a significant increase in locomotor activity, the i.p. administration of DE showed significant reduction in rectal temperature along with a significant increase in tail flick latency at 300 mg/kg. A significant decrease in core body temperature was observed with HE at 100 mg/kg, while higher doses caused significant increases in hot plate latency. Different behavioral effects were observed that varied by the type of extract as well as by the route of administration.

  5. Herbal Insomnia Medications that Target GABAergic Systems: A Review of the Psychopharmacological Evidence

    PubMed Central

    Shi, Yuan; Dong, Jing-Wen; Zhao, Jiang-He; Tang, Li-Na; Zhang, Jian-Jun

    2014-01-01

    Insomnia is a common sleep disorder which is prevalent in women and the elderly. Current insomnia drugs mainly target the γ-aminobutyric acid (GABA) receptor, melatonin receptor, histamine receptor, orexin, and serotonin receptor. GABAA receptor modulators are ordinarily used to manage insomnia, but they are known to affect sleep maintenance, including residual effects, tolerance, and dependence. In an effort to discover new drugs that relieve insomnia symptoms while avoiding side effects, numerous studies focusing on the neurotransmitter GABA and herbal medicines have been conducted. Traditional herbal medicines, such as Piper methysticum and the seed of Zizyphus jujuba Mill var. spinosa, have been widely reported to improve sleep and other mental disorders. These herbal medicines have been applied for many years in folk medicine, and extracts of these medicines have been used to study their pharmacological actions and mechanisms. Although effective and relatively safe, natural plant products have some side effects, such as hepatotoxicity and skin reactions effects of Piper methysticum. In addition, there are insufficient evidences to certify the safety of most traditional herbal medicine. In this review, we provide an overview of the current state of knowledge regarding a variety of natural plant products that are commonly used to treat insomnia to facilitate future studies. PMID:24851093

  6. The psychopharmacological and electrophysiological effects of single doses of caffeine in healthy human subjects.

    PubMed Central

    Bruce, M; Scott, N; Lader, M; Marks, V

    1986-01-01

    The effects of single doses of anhydrous caffeine (250 mg and 500 mg) and placebo on physiological, psychological measures and subjective feelings were studied in a double-blind, cross-over study in nine healthy subjects who had abstained from caffeine-containing beverages for 24 h before each occasion. Caffeine and caffeine metabolites in plasma and urine were assayed. Peak plasma concentrations were observed at 1 to 2 h with an approximate half-life of 5 h. The concentrations of the metabolite 1,7-dimethylxanthine increased during the 5 h. The major urine metabolite was 1-methyluric acid. The EEG showed a dose-related decrease in log 'theta' power and a decrease in log 'alpha' power. Other dose-related effects were an increase in skin conductance level (sweat-gland activity) and self rating of alertness. Ratings of headache and tiredness were decreased by the caffeine. The study illustrates the complexities of studying a drug which is widely taken and which is often associated with withdrawal effects. PMID:3741730

  7. Psychopharmacology of chronic pain: a focus on antidepressants and atypical antipsychotics.

    PubMed

    Khouzam, Hani Raoul

    2016-01-01

    Chronic pain is considered one of the most prevalent causes of costly and disabling medical conditions. This review will define chronic pain and its categories and then will summarize the effectiveness and side effects associated with the use of various antidepressants, including the tricyclics, the selective serotonin reuptake inhibitors, the serotonin norepinephrine reuptake inhibitors, other miscellaneous antidepressants and the atypical antipsychotics in the treatment of chronic pain.

  8. Integrating psychoanalysis and psychopharmacology: a review of the literature of combined treatment for affective disorders.

    PubMed

    Lebovitz, Phil S

    2004-01-01

    Affective distress has been a double-edged sword in psychoanalytic treatment. Motivation for treatment develops when emotional discomfort reaches a threshold of intolerable pain. When distress rises above a certain limit, the patient becomes flooded and overwhelmed by affects that severely compromise his/her capability of utilizing psychoanalytic treatment. The psychoanalytic therapist's dilemma has been whether prescribing medication facilitates treatment or undermines and/or distorts treatment with destructive consequences. The efficacy of combining pharmacotherapy and psychoanalytic therapy is more firmly validated by recent studies. The focus shifts now toward the indications, and contraindications, for integrated treatment. An essential issue remaining is whether, and when, the treating analyst should be the prescribing analyst.

  9. Commentary on N. Ghaemi's "Hippocratic Psychopharmacology of Bipolar Disorder" Maintenance Treatment in Bipolar Disorder.

    PubMed

    Tohen, Mauricio; Lin, Daniel

    2006-06-01

    Bipolar disorder is a chronic recurring condition that is associated with high mortality and severe functional and psychosocial impairments. Treatment strategies that prolong recovery from a mood episode and delay relapse into a new mood episode are essential for long-term improvements in outcomes. Maintenance treatments for bipolar disorder should be evaluated on the strength of the empirical evidence and with the recognition that some treatments may be more effective in preventing relapse into manic, depressive, or mixed episodes.

  10. Drugs Are Not Enough: Some Principles of Psychopharmacology for General Medical Practice

    PubMed Central

    Ross, W. Donald

    1963-01-01

    There is no necessary antagonism between the judicious use of drugs and a psychotherapeutic approach to patients in general medical practice. A table is presented with a simple pragmatic classification of types of drugs for altering emotional and mental states. Three general principles are given for the use of such drugs, illustrated by examples of the use and misuse of tranquillizers. Some differentiation is made between sedatives and tranquillizers and between different types of tranquillizers, particularly with reference to the need to consider depressive features in patients. Suggestions are made for the use of drugs for mild depressions and for depressions accompanying organic disease. One may have to take an “experimental” approach to new drugs to determine which to them are of value in relation to the particular emotional states of one's own patients. ImagesFig. 1 PMID:14060167

  11. Psychopharmacological profile of Chamomile (Matricaria recutita L.) essential oil in mice.

    PubMed

    Can, Ozgür Devrim; Demir Özkay, Umide; Kıyan, Hülya Tuba; Demirci, Betül

    2012-02-15

    In this study, the effect of Matricaria recutita L. essential oil (MEO) on the central nervous system (CNS) of mice was investigated using some behavioral methods. Chemical profiling both by GC and GC-MS analyses of the hydrodistilled essential oil of M. recutita revealed α-bisabolol oxide A (28%), α-bisabolol oxide B (17.1%), (Z)-β-Farnesene (15.9%) and α-bisabolol (6.8%) as the main components. Changes induced by MEO (25, 50 and 100 mg/kg) and reference drug caffeine (25 mg/kg) in spontaneous locomotor activities and motor coordinations of mice were investigated by activity cage measurements and Rota-Rod tests, respectively. Open field, social interaction and elevated plus-maze tests were applied to assess the emotional state of the animals. Further, tail-suspension test was performed for evaluating the effect of MEO on depression levels of mice. As a result, at 50 and 100 mg/kg, MEO significantly increased the numbers of spontaneous locomotor activities, exhibited anxiogenic effect in the open field, elevated plus-maze and social interaction tests and decreased the immobility times of animals in tail suspension tests. The falling latencies in Rota-Rod tests did not change. This activity profile of MEO was similar to the typical psychostimulant caffeine. The exact mechanism of action underlying this stimulant-like effect should be clarified with further detailed studies. Copyright © 2011 Elsevier GmbH. All rights reserved.

  12. [The psychopharmacology of the comorbid disorders associated with attention deficit hyperactivity disorder].

    PubMed

    de la Osa-Langreo, A; Mulas, F; Téllez de Meneses, M; Gandía, R; Mattos, L

    2007-03-02

    The pharmacological treatment most commonly used in attention deficit hyperactivity disorder (ADHD) has traditionally consisted in the administration of psychostimulants. The particular association with comorbid disorders makes it essential to utilise different therapeutic approaches and this accounts for the growing therapeutic arsenal currently available for use in this condition. It is important to be familiar with the different comorbidities because they are especially frequent and also because of their effect on the prognosis. Thus, it is necessary to reach a good diagnosis as early as possible in order to implement a therapy that allows the problem to be curbed. To do so, we need to know about the different pharmaceuticals that have to some extent or other proved to be effective. This paper aims to offer a global view of the problem by analysing the characteristics of the comorbid disorders associated with ADHD and the pharmacological tools that enable us to modify their deleterious effects.

  13. Psychopharmacology Today: Where are We and Where Do We Go From Here?

    PubMed Central

    Schwartz, Thomas L.

    2010-01-01

    Since the 1950s we have had the same three neurotransmitters to work with to treat depression, one transmitter for psychoses, three for anxiety. We have developed newer drugs that are more tolerable, but we have not developed drugs that are better in efficacy. The last 50-60 years should be considered the decades that allowed us to treat a greater number of patients with safer and more tolerable drugs. We have also decreased stigma and allowed primary care clinicians to become more comfortable treating the mentally ill. We clearly treat more patients than before, and sometimes are now accused of over-prescribing wantonly as our drugs are safer. Without any clear blockbuster new drug ready to be added to our armamentarium, what can we do as psychopharmacologists today, and tomorrow, to obtain better results? This introductory manuscript will attempt to provide an overview of ideas so that an adept, well-rounded clinician might be able to obtain better outcomes despite using neurotransmitter pharmacodynamics that have been around since the 1950s. Finally, I will comment on the psychotropic pipeline, which may be added to our armamentarium in the future. PMID:21327167

  14. Neuroleptics related to butaclamol. Synthesis and some psychopharmacological effects of a series of 3-aryl analogues.

    PubMed

    Voith, K; Bruderlein, F T; Humber, L G

    1978-07-01

    The synthesis and some pharmacological effects of 16 3-aryl analogues of butaclamol, a new antipsychotic drug, are described. The animal models were predictive of neuroleptic activity as well as side effects commonly associated with neuroleptic therapy. The results indicate that the 3-substituent plays a critical role with regard to the potency of the compounds as well as to their tendencies to induce extrapyramidal side effects and/or hypotension.

  15. Psychopharmacology Decision-Making Among Pregnant and Postpartum Women and Health Providers: Informing Compassionate and Collaborative Care Women's Health

    PubMed Central

    Price, Sarah Kye; Bentley, Kia J.

    2013-01-01

    Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision–making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 3) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity. PMID:23517513

  16. Psychopharmacological evidences for the involvement of muscarinic and nicotinic cholinergic receptors on sweet substance-induced analgesia in Rattus norvegicus.

    PubMed

    Irusta, A E; Savoldi, M; Kishi, R; Resende, G C; Freitas, R L; Carvalho, A D; Coimbra, N C

    2001-06-08

    In order to investigate the effects of sweet substance intake on pain modulation, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l) for 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex) were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The index (mean +/- SEM, N = 8) for the groups receiving sucrose solution plus saline (NaCl; 0.9%) for 14 days was 0.70 +/- 0.01. Atropine (1 and 2 mg/kg)-treated rats (N = 8) after intake of sucrose exhibited an analgesia index of 0.39 +/- 0.09 and 0.39 +/- 0.08, respectively, while mecamylamine (1 and 2 mg/kg)-treated rats (N = 10) after intake of sucrose had an index of -0.02 +/- 0.07 and 0.03 +/- 0.07, respectively. These results indicate that the effect of sucrose intake on nociceptive thresholds is controlled by neurotransmission of acetylcholine and depends on the nicotinic cholinergic receptors for its major analgesic effect, although muscarinic receptors were also involved in this antinociceptive process.

  17. The Role of the Noradrenergic System in the Exploration–Exploitation Trade-Off: A Psychopharmacological Study

    PubMed Central

    Jepma, Marieke; te Beek, Erik T.; Wagenmakers, Eric-Jan; van Gerven, Joop M.A.; Nieuwenhuis, Sander

    2010-01-01

    Animal research and computational modeling have indicated an important role for the neuromodulatory locus coeruleus–norepinephrine (LC–NE) system in the control of behavior. According to the adaptive gain theory, the LC–NE system is critical for optimizing behavioral performance by regulating the balance between exploitative and exploratory control states. However, crucial direct empirical tests of this theory in human subjects have been lacking. We used a pharmacological manipulation of the LC–NE system to test predictions of this theory in humans. In a double-blind parallel-groups design (N = 52), participants received 4 mg reboxetine (a selective norepinephrine reuptake inhibitor), 30 mg citalopram (a selective serotonin reuptake inhibitor), or placebo. The adaptive gain theory predicted that the increased tonic NE levels induced by reboxetine would promote task disengagement and exploratory behavior. We assessed the effects of reboxetine on performance in two cognitive tasks designed to examine task (dis)engagement and exploitative versus exploratory behavior: a diminishing-utility task and a gambling task with a non-stationary pay-off structure. In contrast to predictions of the adaptive gain theory, we did not find differences in task (dis)engagement or exploratory behavior between the three experimental groups, despite demonstrable effects of the two drugs on non-specific central and autonomic nervous system parameters. Our findings suggest that the LC–NE system may not be involved in the regulation of the exploration–exploitation trade-off in humans, at least not within the context of a single task. It remains to be examined whether the LC–NE system is involved in random exploration exceeding the current task context. PMID:21206527

  18. An archetype of the collaborative efforts of psychotherapy and psychopharmacology in successfully treating dissociative identity disorder with comorbid bipolar disorder.

    PubMed

    Lakshmanan, Manu N; Meier, Stacey L Colton; Meier, Robert S; Lakshmanan, Ramaswamy

    2010-07-01

    We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.

  19. An Archetype of the Collaborative Efforts of Psychotherapy and Psychopharmacology in Successfully Treating Dissociative Identity Disorder with Comorbid Bipolar Disorder

    PubMed Central

    Lakshmanan, Manu N.; Meier, Stacey L. Colton; Meier, Robert S.

    2010-01-01

    We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient’s comorbid bipolar disorder contributed to the patient’s instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method. PMID:20805917

  20. Psychopharmacological treatment of 2195 in-patients with borderline personality disorder: A comparison with other psychiatric disorders.

    PubMed

    Bridler, René; Häberle, Anne; Müller, Sabrina T; Cattapan, Katja; Grohmann, Renate; Toto, Sermin; Kasper, Siegfried; Greil, Waldemar

    2015-06-01

    Patients with borderline personality disorder (BPD) are usually prescribed a variety of psychotropic drugs; however, none is recommended in the guidelines nor has any been approved for this indication. As data on drug prescriptions for BPD are sparse, cross-sectional data from the European Drug Safety Project AMSP were used to analyse drug prescriptions of 2195 in-patients with BPD between 2001 and 2011, and the mean values, confidence intervals and regression analyses were calculated. 70% of all BPD patients were medicated with antipsychotics and/or antidepressants, 33% with anticonvulsants, 30% with benzodiazepines, and 4% with lithium; 90% received at least one, 80%≥2, and 54%≥3 psychotropic drugs concomitantly (mean: 2.8). Prescription rates for quetiapine, the single drug most often used in BPD (22%), increased significantly over time. In view of the high percentage of young females with BPD, 18-40 year-old female patients with BPD were compared with patients of the same age but with depression (unipolar and bipolar) and schizophrenia. Typical sedative antipsychotics and anticonvulsants were prescribed more often in BPD than in the other diagnostic groups, with the exception of bipolar depression; this was true for the single substances quetiapine, levomepromazine, chlorprothixene, carbamazepine, and valproate. A limitation of the study was the use of clinical data without verifying the diagnoses by structured interviews. Contrary to the guidelines, about 90% of in-patients with BPD received psychotropic drugs. Polypharmacy was common, and antipsychotics with sedative profiles such as quetiapine and mood-stabilizing anticonvulsants such as valproate appear to be preferred. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

  1. Psychopharmacology of aggression in children and adolescents with primary neuropsychiatric disorders: a review of current and potentially promising treatment options.

    PubMed

    Nevels, Robert M; Dehon, Erin E; Alexander, Katrina; Gontkovsky, Samuel T

    2010-04-01

    Research examining the role of pharmacological therapy in the treatment of children and adolescents with clinical disorders is growing. Clinical disorders that present with comorbid aggression can add a challenge to treatment. Child and adolescent neuropsychiatric disorders associated with aggression include attention-deficit hyperactivity disorder, various mood disorders and in particular bipolar disorders/pediatric mania, schizophrenia, mental retardation, oppositional defiant disorder, conduct disorder, and autism spectrum disorders. This review describes the psychopharmacy to treat these disorders and the aggression that often appears comorbidly. Existing literature regarding the efficacy and safety of psychotropics for youth with neuropsychiatric disorders also is discussed. In addition, general guidelines for psychopharmacy of aggression in children and adolescents are presented. Studies reviewed in this article provide evidence for the use of psychostimulants, alpha-2 agonists, beta blockers, lithium, anticonvulsant mood-stabilizers, atypical antipsychotics, traditional antipsychotics, and selective serotonin reuptake inhibitors in treating pediatric aggression with the choice of medication dependent on symptomology. Despite increased support for pediatric psychotropic use, there is a need for more long-term safety and efficacy studies of existing medications and newer, safer, and more effective agents with fewer side effects for the pharmacological treatment of all childhood disorders in which aggression is prominent.

  2. The Application of Child Analytic Principles to Educational Models, School Consultations, and Psychopharmacology: Introduction to the Section.

    PubMed

    Whitman, Laura

    2015-01-01

    In this collection of papers, psychoanalytic principles come to life in a variety of settings: in a therapeutic nursery, in two schools serving children with special needs, in mainstream schools, and in a psychiatric practice. From dyadic work with a two-year-old's tantrums, to play therapy using deep-sea symbolism with a five-year-old; from the interchange with parents and school administrators in a middle school regarding "sexting, " to the in-depth assessment of children upon entry to a special school, these papers illustrate enriching exchanges between psychoanalysts, educators, children, and their communities.

  3. Brief Report: Social Disability in Autism Spectrum Disorder--Results from Research Units on Pediatric Psychopharmacology (RUPP) Autism Network Trials

    ERIC Educational Resources Information Center

    Scahill, Lawrence; Hallett, Victoria; Aman, Michael G.; McDougle, Christopher J.; Arnold, L. Eugene; McCracken, James T.; Tierney, Elaine; Deng, Yanhong; Dziura, James; Vitiello, Benedetto

    2013-01-01

    There is growing interest in measuring social disability as a core element of autism spectrum disorders in medication trials. We conducted a secondary analysis on the Aberrant Behavior Checklist Social Withdrawal subscale using data from two federally-funded, multi-site, randomized trials with risperidone. Study 1 included 52 subjects assigned to…

  4. Vigilance decrement during the on-the-road driving tests: the importance of time-on-task in psychopharmacological research.

    PubMed

    Verster, Joris C; Roth, Thomas

    2013-09-01

    Time dependent decrements in performance are characteristic of activities that are monotonous and require focused attention for an extended period of time. A vigilance task is a task that participants can perform without difficulty for a short period of time, but with time their performance becomes impaired. A real world example of such a vigilance task is prolonged highway driving. The on-the-road driving test in normal traffic was specifically designed to measure the effects of vigilance decrement associated with driving. The primary parameter of this test is the Standard Deviation of Lateral Position (SDLP), i.e. the weaving of the car. This methodological paper explains the typical vigilance decrement seen in the on-the-road driving test and discusses the importance of sufficient time-on-task to elucidate potential adverse drug effects on driving. Performance decrements (SDLP increment) as a function of time are seen after both drug and placebo treatment, following a similar pattern over distance/time traveled. However, whereas for some drugs SDLP differences between drug and placebo are constant, other drugs produce additional performance decrement that increases over distance traveled. It is concluded that driving tests of short duration (e.g. less than half an hour) may fail to detect drug-related impairment, because participants are capable of, at least in part, counteracting the impairment by increased effort and motivation to perform the test. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Treatment of Generalized Anxiety Disorder: A Comprehensive Review of the Literature for Psychopharmacologic Alternatives to Newer Antidepressants and Benzodiazepines

    PubMed Central

    Goebert, Deborah; Takeshita, Junji; Lu, Brett Y.; Kang, Mark

    2011-01-01

    Objective: Generalized anxiety disorder (GAD) is common, chronic, and debilitating. Treatment with benzodiazepines and newer antidepressants is often inadequate. This article reviews the effectiveness of alternative and augmenting medications, such as older antidepressants, antipsychotics, anticonvulsants, and β-blockers. Data Sources: A search using MEDLINE (1980 to week 4 of May 2010) with the key words generalized anxiety disorder or GAD and therapeutics or treatment was conducted. Articles included adult patients with a GAD diagnosis that established chronicity of illness. These included a small number of studies that used DSM-III criteria but added a chronicity of symptoms and included all studies that used DSM-III-R and DSM-IV criteria. Articles that did not include medications or that exclusively focused on newer antidepressants (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, bupropion, and mirtazapine), buspirone, benzodiazepines, or herbal or investigational medications were excluded. Review articles and non–English-language articles were also excluded. Results: Thirty-six studies were reviewed. All of the references were then analyzed, and key portions were extracted. Many studies were open trials. Double-blind, placebo-controlled studies with imipramine, risperidone, olanzapine, hydroxyzine, ondansetron, tiagabine, valproate, and pregabalin had been conducted. Imipramine, hydroxyzine, valproate, and pregabalin were the most effective, although risperidone, olanzapine, ziprasidone, and aripiprazole may also reduce symptoms. Conclusions: Several medication strategies can be considered as promising alternatives or augmenting to antidepressant or benzodiazepine therapy in GAD. PMID:21977338

  6. Human psychopharmacology and dose-effects of salvinorin A, a kappa opioid agonist hallucinogen present in the plant Salvia divinorum.

    PubMed

    Johnson, Matthew W; MacLean, Katherine A; Reissig, Chad J; Prisinzano, Thomas E; Griffiths, Roland R

    2011-05-01

    Salvinorin A is a potent, selective nonnitrogenous kappa opioid agonist and the known psychoactive constituent of Salvia divinorum, a member of the mint family that has been used for centuries by Mazatec shamans of Mexico for divination and spiritual healing. S. divinorum has over the last several years gained increased popularity as a recreational drug. This is a double-blind, placebo controlled study of salvinorin A in 4 psychologically and physically healthy hallucinogen-using adults. Across sessions, participants inhaled 16 ascending doses of salvinorin A and 4 intermixed placebo doses under comfortable and supportive conditions. Doses ranged from 0.375 μg/kg to 21 μg/kg. Subject-rated drug strength was assessed every 2 min for 60 min after inhalation. Orderly time- and dose-related effects were observed. Drug strength ratings peaked at 2 min (first time point) and definite subjective effects were no longer present at approximately 20 min after inhalation. Dose-related increases were observed on questionnaire measures of mystical-type experience (Mysticism Scale) and subjective effects associated with classic serotonergic (5-HT2(A)) hallucinogens (Hallucinogen Rating Scale). Salvinorin A did not significantly increase heart rate or blood pressure. Participant narratives indicated intense experiences characterized by disruptions in vestibular and interoceptive signals (e.g., change in spatial orientation, pressure on the body) and unusual and sometimes recurring themes across sessions such as revisiting childhood memories, cartoon-like imagery, and contact with entities. Under these prepared and supportive conditions, salvinorin A occasioned a unique profile of subjective effects having similarities to classic hallucinogens, including mystical-type effects.

  7. Psychopharmacological Treatment in the RAISE-ETP Study: Outcomes of a Manual and Computer Decision Support System Based Intervention.

    PubMed

    Robinson, Delbert G; Schooler, Nina R; Correll, Christoph U; John, Majnu; Kurian, Benji T; Marcy, Patricia; Miller, Alexander L; Pipes, Ronny; Trivedi, Madhukar H; Kane, John M

    2017-09-15

    The Recovery After an Initial Schizophrenia Episode-Early Treatment Program compared NAVIGATE, a comprehensive program for first-episode psychosis, to clinician-choice community care over 2 years. Quality of life and psychotic and depressive symptom outcomes were found to be better with NAVIGATE. Compared with previous comprehensive first-episode psychosis interventions, NAVIGATE medication treatment included unique elements of detailed first-episode-specific psychotropic medication guidelines and a computerized decision support system to facilitate shared decision making regarding prescriptions. In the present study, the authors compared NAVIGATE and community care on the psychotropic medications prescribed, side effects experienced, metabolic outcomes, and scores on the Adherence Estimator scale, which assesses beliefs related to nonadherence. Prescription data were obtained monthly. At baseline and at 3, 6, 12, 18, and 24 months, participants reported whether they were experiencing any of 21 common antipsychotic side effects, vital signs were obtained, fasting blood samples were collected, and the Adherence Estimator scale was completed. Over the 2-year study period, compared with the 181 community care participants, the 223 NAVIGATE participants had more medication visits, were more likely to receive a prescription for an antipsychotic and more likely to receive one conforming to NAVIGATE prescribing principles, and were less likely to receive a prescription for an antidepressant. NAVIGATE participants experienced fewer side effects and gained less weight; other vital signs and cardiometabolic laboratory findings did not differ between groups. Adherence Estimator scores improved in the NAVIGATE group but not in the community care group. As part of comprehensive care services, medication prescription can be optimized for first-episode psychosis, contributing to better outcomes with a lower side effect burden than standard care.

  8. Psychopharmacologic Services for Homeless Veterans: Comparing Psychotropic Prescription Fills Among Homeless and Non-Homeless Veterans with Serious Mental Illness.

    PubMed

    Hermes, Eric; Rosenheck, Robert

    2016-02-01

    Using national Veterans Health Administration (VHA) administrative data, this study evaluated differences in psychotropic medication use between homeless and non-homeless adults with serious mental illness (SMI) who used VHA services in 2010. The adjusted mean number of psychotropic prescription fills associated with homeless individuals were identified using regression models adjusted for socio-demographics, diagnoses, and use of health services. Of the 876,989 individuals with SMI using VHA services, 7.2 % were homeless at some time during 2010. In bivariate analysis, homeless individuals filled more psychotropic medication prescriptions compared with non-homeless individuals. However, after adjusting for potentially confounding variables, homeless individuals were found to have filled 16.2 % fewer prescriptions than non-homeless individuals when all psychotropics were analyzed together (F = 6947.1, p < .001) and for most individual classes of psychotropics. Greater use of residential/inpatient mental health services by the homeless was the most important single factor associated with filling more psychotropic prescriptions than non-homeless individuals.

  9. Psychopharmacological and Other Treatments in Preschool Children with Attention-Deficit/Hyperactivity Disorder: Current Evidence and Practice

    PubMed Central

    Arnold, L. Eugene; Anthony, Bruno J.

    2008-01-01

    Abstract Objective This article reviews rational approaches to treating attention-deficit/hyperactivity disorder (ADHD) in preschool children, including pharmacological and nonpharmacological treatments. Implications for clinical practice are discussed. Data Sources We searched MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health, Educational Resources Information Center, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects for relevant literature published in English from 1967 to 2007 on preschool ADHD. We also reviewed the references cited in identified reports. Study Selection Studies were reviewed if the sample included at least some children younger than 6 years of age or attending kindergarten, the study participants had a diagnosis of ADHD or equivalent symptoms, received intervention aimed at ADHD symptoms, and included a relevant outcome measure. Data Extraction Studies were reviewed for type of intervention and outcome relevant to ADHD and were rated for the level of evidence for adequacy of the data to inform clinical practice. Conclusions The current level of evidence for adequacy of empirical data to inform clinical practice for short-term treatment of ADHD in preschool children is Level A for methylphenidate and Level B for parent behavior training, child training, and additive-free elimination diet. PMID:18844482

  10. Brain Functional Effects of Psychopharmacological Treatment in Major Depression: a Focus on Neural Circuitry of Affective Processing.

    PubMed

    Wessa, Michèle; Lois, Giannis

    2015-01-01

    In the last two decades, neuroimaging research has reached a much deeper understanding of the neurobiological underpinnings of major depression (MD) and has converged on functional alterations in limbic and prefrontal neural networks, which are mainly linked to altered emotional processing observed in MD patients. To date, a considerable number of studies have sought to investigate how these neural networks change with pharmacological antidepressant treatment. In the current review, we therefore discuss results from a) pharmacological functional magnetic resonance imaging (fMRI) studies investigating the effects of selective serotonin or noradrenalin reuptake inhibitors on neural activation patterns in relation to emotional processing in healthy individuals, b) treatment studies in patients with unipolar depression assessing changes in neural activation patterns before and after antidepressant pharmacotherapy, and c) predictive neural biomarkers of clinical response in depression. Comparing results from pharmacological fMRI studies in healthy individuals and treatment studies in depressed patients nicely showed parallel findings, mainly for a reduction of limbic activation in response to negative stimuli. A thorough investigation of the empirical findings highlights the importance of the specific paradigm employed in every study which may account for some of the discrepant findings reported in treatment studies in depressed patients.

  11. The role of the noradrenergic system in the exploration-exploitation trade-off: a psychopharmacological study.

    PubMed

    Jepma, Marieke; Te Beek, Erik T; Wagenmakers, Eric-Jan; van Gerven, Joop M A; Nieuwenhuis, Sander

    2010-01-01

    Animal research and computational modeling have indicated an important role for the neuromodulatory locus coeruleus-norepinephrine (LC-NE) system in the control of behavior. According to the adaptive gain theory, the LC-NE system is critical for optimizing behavioral performance by regulating the balance between exploitative and exploratory control states. However, crucial direct empirical tests of this theory in human subjects have been lacking. We used a pharmacological manipulation of the LC-NE system to test predictions of this theory in humans. In a double-blind parallel-groups design (N = 52), participants received 4 mg reboxetine (a selective norepinephrine reuptake inhibitor), 30 mg citalopram (a selective serotonin reuptake inhibitor), or placebo. The adaptive gain theory predicted that the increased tonic NE levels induced by reboxetine would promote task disengagement and exploratory behavior. We assessed the effects of reboxetine on performance in two cognitive tasks designed to examine task (dis)engagement and exploitative versus exploratory behavior: a diminishing-utility task and a gambling task with a non-stationary pay-off structure. In contrast to predictions of the adaptive gain theory, we did not find differences in task (dis)engagement or exploratory behavior between the three experimental groups, despite demonstrable effects of the two drugs on non-specific central and autonomic nervous system parameters. Our findings suggest that the LC-NE system may not be involved in the regulation of the exploration-exploitation trade-off in humans, at least not within the context of a single task. It remains to be examined whether the LC-NE system is involved in random exploration exceeding the current task context.

  12. Brief Report: Social Disability in Autism Spectrum Disorder--Results from Research Units on Pediatric Psychopharmacology (RUPP) Autism Network Trials

    ERIC Educational Resources Information Center

    Scahill, Lawrence; Hallett, Victoria; Aman, Michael G.; McDougle, Christopher J.; Arnold, L. Eugene; McCracken, James T.; Tierney, Elaine; Deng, Yanhong; Dziura, James; Vitiello, Benedetto

    2013-01-01

    There is growing interest in measuring social disability as a core element of autism spectrum disorders in medication trials. We conducted a secondary analysis on the Aberrant Behavior Checklist Social Withdrawal subscale using data from two federally-funded, multi-site, randomized trials with risperidone. Study 1 included 52 subjects assigned to…

  13. Brief Report: social disability in autism spectrum disorder: results from Research Units on Pediatric Psychopharmacology (RUPP) Autism Network trials.

    PubMed

    Scahill, Lawrence; Hallett, Victoria; Aman, Michael G; McDougle, Christopher J; Eugene Arnold, L; McCracken, James T; Tierney, Elaine; Deng, Yanhong; Dziura, James; Vitiello, Benedetto

    2013-03-01

    There is growing interest in measuring social disability as a core element of autism spectrum disorders in medication trials. We conducted a secondary analysis on the Aberrant Behavior Checklist Social Withdrawal subscale using data from two federally-funded, multi-site, randomized trials with risperidone. Study 1 included 52 subjects assigned to placebo and 49 subjects to risperidone under double-blind conditions. Study 2 included 49 subjects assigned to risperidone only and 75 subjects assigned to risperidone plus parent training. After 8 weeks of treatment, all active treatments were superior to placebo (effect sizes ranging from 0.42 to 0.65). The findings suggest that the Social Withdrawal subscale may be a useful measure of social disability in acute treatment trials.

  14. Psychopharmacology and psychotherapy for the treatment of adults with ADHD-a systematic review of available meta-analyses.

    PubMed

    Moriyama, Tais S; Polanczyk, Guilherme V; Terzi, Fernanda S; Faria, Kauy M; Rohde, Luis A

    2013-12-01

    OBJECTIVE/INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) in adult life is a prevalent condition. We systematically reviewed the literature available by searching for meta-analyses assessing pharmacological and psychosocial interventions for adults with ADHD. Using wide-ranging search terms, we retrieved 191 titles from the PubMed and Cochrane databases. Two independent evaluators judged all abstracts. Only meta-analyses about the treatment of adults with ADHD were included. Information from meta-analyses found was systematically extracted by 3 independent evaluators. Eight meta-analyses were identified. Results from those meta-analyses suggest that stimulants are effective in decreasing ADHD symptoms on a short-term basis with a medium to large effect size (ES). Short-acting stimulants might be superior to long-acting stimulants, but no data on difference in adherence are available for the comparison of these two types of formulation. Bupropion is superior to placebo but less effective than stimulants. No conclusions about the impact of psychosocial interventions can be drawn based on meta-analyses so far. Discussion The efficacy of stimulants in reducing ADHD symptoms for adults is well documented in meta-analyses, but there is a concerning lack of meta-analysis about other treatment interventions. The available meta-analytic literature does not cover questions of essential clinical relevance for adults with ADHD.

  15. A Systematic Review of Treatments for Anxiety in Youth with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Vasa, Roma A.; Carroll, Laura M.; Nozzolillo, Alixandra A.; Mahajan, Rajneesh; Mazurek, Micah O.; Bennett, Amanda E.; Wink, Logan K.; Bernal, Maria Pilar

    2014-01-01

    This study systematically examined the efficacy and safety of psychopharmacological and non-psychopharmacological treatments for anxiety in youth with autism spectrum disorders (ASD). Four psychopharmacological, nine cognitive behavioral therapy (CBT), and two alternative treatment studies met inclusion criteria. Psychopharmacological studies were…

  16. A Systematic Review of Treatments for Anxiety in Youth with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Vasa, Roma A.; Carroll, Laura M.; Nozzolillo, Alixandra A.; Mahajan, Rajneesh; Mazurek, Micah O.; Bennett, Amanda E.; Wink, Logan K.; Bernal, Maria Pilar

    2014-01-01

    This study systematically examined the efficacy and safety of psychopharmacological and non-psychopharmacological treatments for anxiety in youth with autism spectrum disorders (ASD). Four psychopharmacological, nine cognitive behavioral therapy (CBT), and two alternative treatment studies met inclusion criteria. Psychopharmacological studies were…

  17. Chemical neuroanatomical and psychopharmacological evidence that κ receptor-mediated endogenous opioid peptide neurotransmission in the dorsal and ventral mesencephalon modulates panic-like behaviour.

    PubMed

    da Silva, Juliana Almeida; de Freitas, Renato Leonardo; Eichenberger, Gustavo Cavalcanti Dutra; Padovan, Cláudia Maria; Coimbra, Norberto Cysne

    2013-01-05

    The chemical neuroanatomy and the effects of central administration of opioid antagonists on the innate fear-induced responses elicited by electrical (at escape behaviour threshold) stimulation of the midbrain tectum were determined. The aim of the present work was to investigate the interaction between the tecto-nigral endogenous opioid peptide-mediated disinhibitory pathways and nigro-tectal inhibitory links in the control of panic-like behaviour and their organisation in the continuum comprised by the deep layers of the superior colliculus (dlSC) and the dorsolateral columns of the periaqueductal grey matter (dlPAG). Beta-endorphin-labelled neurons and fibres were found in the dorsal midbrain and also in the substantia nigra. Opioid varicose fibres and terminal buttons were widely distributed in PAG columns and in all substantia nigra subdivisions. Microinjections of naltrexone (a non-selective opioid receptor antagonist; 5.0 μg/0.2 μl) or nor-binaltorphimine (a selective κ-opioid receptor antagonist; 5.0 μg/0.2 μl) in the dlSC/dlPAG continuum, in independent groups of animals, induced significant increases in the escape thresholds for midbrain tectum electrical stimulation. The microinjection of naltrexone or nor-binaltorphimine into the SNpr also increased the escape behaviour threshold for electrical stimulation of dlSC/dlPAG. These morphological and neuropharmacological findings support previous evidence from our team for the role played by the interaction between opioidergic and GABAergic mechanisms in the modulation of innate fear-induced responses. The present data offer a neuroanatomical basis for both intratectal axo-axonic/pre-synaptic and tecto-nigral axo-somatic opioid inhibition of GABAergic nigro-tectal neurons that modulate the dorsal midbrain neurons related to the organisation of fear-related emotional responses.

  18. Effects of propranolol on conversational reciprocity in autism spectrum disorder: a pilot, double-blind, single-dose psychopharmacological challenge study.

    PubMed

    Zamzow, Rachel M; Ferguson, Bradley J; Stichter, Janine P; Porges, Eric C; Ragsdale, Alexandra S; Lewis, Morgan L; Beversdorf, David Q

    2016-04-01

    Pharmacological intervention for autism spectrum disorder (ASD) is an important addition to treatment, yet currently available agents target co-morbid psychiatric concerns, such as aggression and irritability. Propranolol, a beta-adrenergic antagonist with anxiolytic effects, has been shown to improve verbal fluency and working memory in adults and adolescents with ASD in single-dose challenges. The present pilot study explores the acute effects of propranolol on a measure of conversational reciprocity in this population. We also examined whether autonomic activity and anxiety moderate or mediate response to the drug, given relationships between these variables and ASD, as well as the drug's effects. In a within-subject crossover design, 20 individuals with ASD received a single dose of propranolol or placebo during two sessions in a double-blinded, counterbalanced manner. After drug administration, participants performed a conversational reciprocity task by engaging in a short conversation with the researcher. Measurements of autonomic activity and anxiety were obtained before and after drug administration. Propranolol significantly improved performance on the conversational reciprocity task total [d = 0.40] and nonverbal communication domain scores when compared to the placebo condition. However, neither autonomic activity nor anxiety was significantly associated with drug response. Acute propranolol administration improved conversational reciprocity in ASD. Further exploration of these preliminary findings, as well as other potential treatment response predictors, with serial doses is warranted.

  19. A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments.

    PubMed

    van Balkom, A J; Bakker, A; Spinhoven, P; Blaauw, B M; Smeenk, S; Ruesink, B

    1997-08-01

    To compare short-term efficacy of benzodiazepines, antidepressants, psychological panic management, exposure in vivo, and combination treatments in panic disorder with or without agoraphobia (PA), a meta-analysis was conducted. Included were 106 studies, pertaining to 222 treatment conditions, 5,011 patients at pretest and 4,016 at posttest. Pre/post effect sizes Cohen's d were calculated within the treatment conditions for four clinical variables: panic, agoraphobia, depression, and general anxiety. Seven large treatment conditions were used in the main analyses: high-potency benzodiazepines, antidepressants, psychological panic management, exposure in vivo, pill-placebo combined with exposure, antidepressants combined with exposure, and psychological panic management combined with exposure in vivo. First, these treatments were compared with a control condition, consisting of pill-placebo, attention placebo, and waiting list. Next, a comparison was made between the treatments. Antidepressants, psychological panic management, high-potency benzodiazepines, and antidepressants combined with exposure in vivo were superior to the control condition for panic attacks. Exposure in vivo alone was not effective for panic attacks. With regard to agoraphobic avoidance, all seven treatments were superior to the control condition. When comparing the various treatment conditions, no differences concerning panic attacks were found. For agoraphobic avoidance, the combination of antidepressants with exposure in vivo was superior to the other conditions. The combination of antidepressants with exposure in vivo is the most potent short-term treatment of PA.

  20. Recreational 3,4-methylenedioxy-N-methylamphetamine (MDMA) or 'ecstasy' and self-focused compassion: Preliminary steps in the development of a therapeutic psychopharmacology of contemplative practices.

    PubMed

    Kamboj, Sunjeev K; Kilford, Emma J; Minchin, Stephanie; Moss, Abigail; Lawn, Will; Das, Ravi K; Falconer, Caroline J; Gilbert, Paul; Curran, H Valerie; Freeman, Tom P

    2015-09-01

    3,4-methylenedioxy-N-methylamphetamine (MDMA) produces diverse pro-social effects. Cognitive training methods rooted in Eastern contemplative practices also produce these effects through the development of a compassionate mindset. Given this similarity, we propose that one potential mechanism of action of MDMA in psychotherapy is through enhancing effects on intrapersonal attitudes (i.e. pro-social attitudes towards the self). We provide a preliminary test of this idea. Recreational MDMA (ecstasy) users were tested on two occasions, having consumed or not consumed ecstasy. Self-critical and self-compassionate responses to self-threatening scenarios were assessed before (T1) and after (T2) ecstasy use (or non-use), and then after compassionate imagery (T3). Moderating roles of dispositional self-criticism and avoidant attachment were examined. Separately, compassionate imagery and ecstasy produced similar sociotropic effects, as well as increases in self-compassion and reductions in self-criticism. Higher attachment-related avoidance was associated with additive effects of compassionate imagery and ecstasy on self-compassion. Findings were in line with MDMA's neuropharmacological profile, its phenomenological effects and its proposed adjunctive use in psychotherapy. However, although conditions were balanced, the experiment was non-blind and MDMA dose/purity was not determined. Controlled studies with pharmaceutically pure MDMA are still needed to test these effects rigorously.

  1. Research Units of Pediatric Psychopharmacology (RUPP) Autism Network Randomized Clinical Trial of Parent Training and Medication: One-Year Follow-Up

    ERIC Educational Resources Information Center

    Arnold, L. Eugene; Aman, Michael G.; Li, Xiaobai; Butter, Eric; Humphries, Kristina; Scahill, Lawrence; Lecavalier, Luc; McDougle, Christopher J.; Swiezy, Naomi B.; Handen, Benjamin; Wilson, Krystina; Stigler, Kimberly A.

    2012-01-01

    Objective: To follow up on a three-site, 24-week randomized clinical trial (N = 124) comparing antipsychotic medication alone (MED) with antipsychotic medication plus parent training in the behavior management (COMB) of children with autism spectrum disorders and severe behavior problems. The COMB treatment had shown a significant advantage for…

  2. Moclobemide as add-on therapy to agomelatine in a patient with treatment-resistant major depressive disorder: a psychopharmacological case.

    PubMed

    Stuhec, Matej; Oravecz, Robert

    2016-04-01

    Treatment-resistant depression is a major depressive disorder that does not respond to adequate treatment of at least two antidepressants and is one of the major clinical challenges for clinicians and clinical pharmacists. One treatment option is to switch the patient to a different medication. Another option is to add a medication to the patient's current pharmacotherapy. This article presents an improvement of symptoms induced by a combination of moclobemide (MOC) and agomelatine (AG) treatment in a 48-year-old Caucasian woman with treatment-resistant major depressive disorder (MDD). The patient had been treated with numerous antidepressants in the last 2 years that had not been effective or had caused serious adverse effects. When MOC 300 mg daily was added to AG 25 mg daily, the patient recovered progressively without any adverse effects. Her functional status also appeared stable. No other drugs known to interact with AG were administered. The MOC dose was subsequently increased to 600 mg daily and was taken with AG 25 mg daily and zolpidem 5 mg daily. The positive effects of AG or MOC on MDD have been widely reported, but there have not been reports of a combined treatment with MOG and AG improving symptoms of treatment-resistant MDD. The exact mechanism of this effect on the central nervous system is unknown. The additive activity could have been caused by a broader spectrum activity of AG and MOC. In this report, we identified a case with positive evidence of this antidepressant combination relieving the symptoms of treatment-resistant MDD, which is otherwise difficult to manage. This case report may serve to help clinicians and clinical pharmacists as a new treatment option for treatment-resistant MDD, although further research is needed to confirm this practice.

  3. Human psychopharmacology and dose-effects of salvinorin A, a kappa-opioid agonist hallucinogen present in the plant Salvia divinorum

    PubMed Central

    Johnson, Matthew W.; MacLean, Katherine A.; Reissig, Chad J.; Prisinzano, Thomas E.; Griffiths, Roland R.

    2010-01-01

    Salvinorin A is a potent, selective nonnitrogenous kappa opioid agonist and the known psychoactive constituent of Salvia divinorum, a member of the mint family that has been used for centuries by Mazatec shamans of Mexico for divination and spiritual healing. Salvia divinorum has over the last several years gained increased popularity as a recreational drug. This is a double-blind, placebo controlled study of salvinorin A in 4 psychologically and physically healthy hallucinogen-using adults. Across sessions, participants inhaled 16 ascending doses of salvinorin A and 4 intermixed placebo doses under comfortable and supportive conditions. Doses ranged from 0.375 μg/kg to 21 μg/kg. Subject-rated drug strength was assessed every 2 minutes for 60 minutes after inhalation. Orderly time- and dose-related effects were observed. Drug strength ratings peaked at 2 minutes (first time point) and definite subjective effects were no longer present at approximately 20 minutes after inhalation. Dose-related increases were observed on questionnaire measures of mystical-type experience (Mysticism Scale) and subjective effects associated with classic serotonergic (5-HT2A) hallucinogens (Hallucinogen Rating Scale). Salvinorin A did not significantly increase heart rate or blood pressure. Participant narratives indicated intense experiences characterized by disruptions in vestibular and interoceptive signals (e.g., change in spatial orientation, pressure on the body) and unusual and sometimes recurring themes across sessions such as revisiting childhood memories, cartoon-like imagery, and contact with entities. Under these prepared and supportive conditions, salvinorin A occasioned a unique profile of subjective effects having similarities to classic hallucinogens, including mystical-type effects. PMID:21131142

  4. Sex Differences and the Effects of Stress on Subsequent Opioid Consumption in Adult Rats Following Adolescent Nicotine Exposure: A Psychopharmacologic Examination of the Gateway Hypothesis

    DTIC Science & Technology

    1997-07-18

    nicotine should include more dosages, particularly more low dosages ofnicotine. Inclusion ofadditional dosages is necessary to reveal the shape ofthe dose ...distal extremities; (3) skeletal muscle relaxation and constriction; (4) respiratory enhancement or failure (at toxic doses ); and (5) increases in...Kozlowski, 1980). Therefore, women actually may smoke more when nicotine yields are low and they may smoke less when the yields are high (Kozlowski et al

  5. Psychopharmacology and Aggression: II. A Meta-Analysis of Nonstimulant Medication Effects on Overt Aggression-Related Behaviors in Youth with SED.

    ERIC Educational Resources Information Center

    Connor, Daniel R.; Boone, R. Thomas; Steingard, Ronald J.; Lopez, Ivan D.; Melloni, Richard H., Jr.

    2003-01-01

    Meta-analysis of 33 studies examined effect size for nonstimulant medications on symptoms of overt aggression-related behaviors in children and adolescents with serious emotional and behavioral disturbances. Thirty-seven independent effects were found for neuroleptic, atypical antipsychotic, mood stabilizer, antidepressant, and adrenergic agents…

  6. Research Units of Pediatric Psychopharmacology (RUPP) Autism Network Randomized Clinical Trial of Parent Training and Medication: One-Year Follow-Up

    ERIC Educational Resources Information Center

    Arnold, L. Eugene; Aman, Michael G.; Li, Xiaobai; Butter, Eric; Humphries, Kristina; Scahill, Lawrence; Lecavalier, Luc; McDougle, Christopher J.; Swiezy, Naomi B.; Handen, Benjamin; Wilson, Krystina; Stigler, Kimberly A.

    2012-01-01

    Objective: To follow up on a three-site, 24-week randomized clinical trial (N = 124) comparing antipsychotic medication alone (MED) with antipsychotic medication plus parent training in the behavior management (COMB) of children with autism spectrum disorders and severe behavior problems. The COMB treatment had shown a significant advantage for…

  7. Naval Health Research Center 1985 Annual Report

    DTIC Science & Technology

    1985-01-01

    Partial contents: Environmental Physiology; Environmental Medicine; Behavioral Psychopharmacology; Health Psychology ; Research Supports. Keywords: Naval Health Research; Naval laboratories; Abstracts.

  8. 76 FR 71573 - Medicare Program; Request for Nominations for Members for the Medicare Evidence Development...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... hematology; genomics; Bayesian statistics; clinical epidemiology; clinical trial methodology; knee, hip, and other joint replacement surgery; ophthalmology; psychopharmacology; rheumatology; screening...

  9. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

    PubMed Central

    Yatham, Lakshmi; Grunze, Heinz; Vieta, Eduard; Young, Allan; Blier, Pierre; Kasper, Siegfried; Moeller, Hans Jurgen

    2017-01-01

    Abstract Background: The current paper includes a systematic search of the literature, a detailed presentation of the results, and a grading of treatment options in terms of efficacy and tolerability/safety. Material and Methods: The PRISMA method was used in the literature search with the combination of the words ‘bipolar,’ ‘manic,’ ‘mania,’ ‘manic depression,’ and ‘manic depressive’ with ‘randomized,’ and ‘algorithms’ with ‘mania,’ ‘manic,’ ‘bipolar,’ ‘manic-depressive,’ or ‘manic depression.’ Relevant web pages and review articles were also reviewed. Results: The current report is based on the analysis of 57 guideline papers and 531 published papers related to RCTs, reviews, posthoc, or meta-analysis papers to March 25, 2016. The specific treatment options for acute mania, mixed episodes, acute bipolar depression, maintenance phase, psychotic and mixed features, anxiety, and rapid cycling were evaluated with regards to efficacy. Existing treatment guidelines were also reviewed. Finally, Tables reflecting efficacy and recommendation levels were created that led to the development of a precise algorithm that still has to prove its feasibility in everyday clinical practice. Conclusions: A systematic literature search was conducted on the pharmacological treatment of bipolar disorder to identify all relevant random controlled trials pertaining to all aspects of bipolar disorder and graded the data according to a predetermined method to develop a precise treatment algorithm for management of various phases of bipolar disorder. It is important to note that the some of the recommendations in the treatment algorithm were based on the secondary outcome data from posthoc analyses. PMID:27816941

  10. Identifying Molecular Targets For PTSD Treatment Using Single Prolonged Stress

    DTIC Science & Technology

    2014-10-01

    medial prefrontal cortex”, that was recently accepted for publication in the Psychopharmacology DOI: 10.1007/s00213-014-3635-x. Fig. 1 Single...peer-reviewed journals (Biology of Mood and Anxiety Disorders, 2013, 3,22; Psychopharmacology , 2014, DOI:10.1007/s00213-014-3635-x). Dr. George has...extinction retention deficits and glucocorticoid upregulation in the medial prefrontal cortex. Psychopharmacology . DOI: 10.1007/s00213-014-3635-x

  11. 75 FR 78705 - Medicare Program; Request for Nominations for Members for the Medicare Evidence Development...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-16

    ... trial methodology; knee, hip, and other joint replacement surgery; ophthalmology; psychopharmacology; registries; rheumatology; screening and diagnostic testing analysis; and vascular surgery. We also...

  12. Psychotherapists' Perceptions and Understanding of Pharmacotherapy.

    ERIC Educational Resources Information Center

    Brammer, Robert; Haller, Katherine; Roberson, Janice

    Attendees at the 1998 Texas Counseling Association's annual convention were given a brief survey and short test on psychopharmacology. Analysis was performed to examine the effects of demographic and ideological variables. The model moderately explained the variance on the psychopharmacology test with only 2.5% of the adjusted variance explained…

  13. A Catalog of Psychiatric Medications Used in the Treatment of Child and Adolescent Mental Disorders.

    ERIC Educational Resources Information Center

    James, Susan Hackbarth; Nims, Donald R.

    1996-01-01

    Although school counselors are increasingly involved in administering medications to students with emotional, conduct, and behavioral problems, few counselors have training in psychopharmacology. Gives a brief history of psychopharmacological interventions, and describes usage and side effects of drugs for psychosis, depression, anxiety, and…

  14. A Catalog of Psychiatric Medications Used in the Treatment of Child and Adolescent Mental Disorders.

    ERIC Educational Resources Information Center

    James, Susan Hackbarth; Nims, Donald R.

    1996-01-01

    Although school counselors are increasingly involved in administering medications to students with emotional, conduct, and behavioral problems, few counselors have training in psychopharmacology. Gives a brief history of psychopharmacological interventions, and describes usage and side effects of drugs for psychosis, depression, anxiety, and…

  15. Diagnosis, assessment, and treatment of hypersexuality.

    PubMed

    Kaplan, Meg S; Krueger, Richard B

    2010-03-01

    This article reviews the current evidence base for the diagnosis, assessment, and treatment of hypersexual conditions. Controversy concerning this diagnosis is discussed. Terminology and diagnostic criteria, as well as psychological, psychopharmacological, and other treatment approaches, are presented.

  16. Treatment for Panic Disorder: Practical Guidelines.

    ERIC Educational Resources Information Center

    Beamish, Patricia M.; Granello, Darcy Haag; Belcastro, Amy L.

    2002-01-01

    This article presents current research information on the treatment of panic disorder. Specific guidelines are presented to guide the mental health counselor in the delivery of effective psychopharmacological and cognitive-behavioral treatment. (Contains 81 references.) (Author)

  17. The pharmacologic approach to the critically ill patient

    SciTech Connect

    Chernow, B. )

    1988-01-01

    This book contains papers addressing the pharmacologic approach to the critically ill patient. Chapter topics include: Radiation injury; Red cell substitutes: a current appraisal; and Psychopharmacology in the ICU.

  18. Summary from the 153rd meeting of the American Psychiatric Association. 13-18 May 2000, Chicago, Illinois, USA.

    PubMed

    Goodnick, P J

    2000-07-01

    The annual meeting of the American Psychiatric Association focuses on a variety of topics, including those on psychopharmacology. The latest developments are typically those found in the New Research sections, which is where this summary will focus.

  19. Predisposition Factors in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Nagel, K. L.; Jones, Karen H.

    1992-01-01

    Reviews literature concerned with investigating psychiatric disturbances and genetic variables hypothesized as predisposing factors in etiology of anorexia nervosa. Gives particular emphasis to research which discusses association between anorexia nervosa and depression. Reviews psychopharmacological evidence and family genetics studies. Offers…

  20. Predisposition Factors in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Nagel, K. L.; Jones, Karen H.

    1992-01-01

    Reviews literature concerned with investigating psychiatric disturbances and genetic variables hypothesized as predisposing factors in etiology of anorexia nervosa. Gives particular emphasis to research which discusses association between anorexia nervosa and depression. Reviews psychopharmacological evidence and family genetics studies. Offers…

  1. 78 FR 63986 - Medicare Program; Request for Nominations for Members for the Medicare Evidence Development...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... medicine, public health, biological and physical sciences, epidemiology and biostatistics, clinical trial... Administrative medicine Public health Biological and physical sciences Epidemiology and biostatistics Clinical... include cancer screening, genetic testing, clinical epidemiology; psychopharmacology; screening and...

  2. Outcome Studies in the Treatment of Panic Disorder: A Review.

    ERIC Educational Resources Information Center

    Beamish, Patricia M.; And Others

    1996-01-01

    Reviews outcome studies in the treatment of panic disorder without agoraphobia for adults. Presents evidence supporting the efficacy of psychopharmacological and cognitive-behavioral interventions. Addresses the need for standards of care in counseling persons with panic disorder. (RB)

  3. Treatment for Panic Disorder: Practical Guidelines.

    ERIC Educational Resources Information Center

    Beamish, Patricia M.; Granello, Darcy Haag; Belcastro, Amy L.

    2002-01-01

    This article presents current research information on the treatment of panic disorder. Specific guidelines are presented to guide the mental health counselor in the delivery of effective psychopharmacological and cognitive-behavioral treatment. (Contains 81 references.) (Author)

  4. Celebrating the decade of behavior: introduction to special issue.

    PubMed

    Higgins, S T; Bickel, W K

    2000-08-01

    This special issue represents a joint effort by the journal Experimental and Clinical Psychopharmacology and the American Psychological Association's Division of Psychopharmacology and Substance Abuse to celebrate the "Decade of Behavior: 2000-2100" initiative. The Decade of Behavior initiative seeks to underscore the importance of behavioral science to broadening understanding and offering solutions to many of society's most challenging problems. Contained in this special issue are commentaries by 3 Institute directors from the National Institutes of Health, 4 excellent critical reviews of various aspects of contemporary psychopharmacology research, and a series of 9 excellent original research reports. This series of articles bodes well for the health of psychopharmacology and substance abuse research and offers a fitting salute to this important initiative.

  5. Children and Grief

    MedlinePlus

    ... 2018 Annual Review Course 2016 Annual Meeting 2018 Psychopharmacology Update Institute Maintenance of Certification and Lifelong Learning ... or freely. The person who has died was essential to the stability of the child's world, and ...

  6. Locus Coeruleus, Vigilance and Stress: Brain Mechanisms of Adaptive Behavioral Responsiveness

    DTIC Science & Technology

    1993-05-13

    anxiety in cocaine and morphine dependent rats. Psychopharmacology (in press). 34. Shiekhattar. R. and Aston-Jones. G., Sensory responsiveness of brain...aversive signs of opiate withdrawal (in preparation for Scec). 43. Aston-Jones, G. and Siggins. G.R., Electrophysiology. In: Psychopharmacology : The...that the essential property of stimuli to elicit LC responses was W0So. meaningfulness, so that intense stimuli elicited C1 ! responses because their

  7. [The new biological revolution in psychiatry: a Latin American point of view (2)].

    PubMed

    Alarcón, R D

    1985-09-01

    The new clinical psychopharmacology has helped to expand six areas: new drugs, prediction of response, side effects, therapeutic combinations and new uses for old drugs. Basic research (theoretical and experimental) has focused primarily on schizophrenia, affective disorders and anxiety. The Latin American psychiatrist must adopt neither a dependent nor a hyper-critical attitude toward this revolution. He can successfully contribute in the areas of nosology, laboratory tests and clinical psychopharmacology. He must selectively accept or critically screen the contributions of the new neuro-radiology and basic research. Finally, he must be pragmatic and never lose sight of his unique socio-cultural perspective.

  8. Intervening in the psychopath's brain.

    PubMed

    Glannon, Walter

    2014-02-01

    Psychopathy is a disorder involving personality and behavioral features associated with a high rate of violent aggression and recidivism. This paper explores potential psychopharmacological therapies to modulate dysfunctional neural pathways in psychopaths and reduce the incidence of their harmful behavior, as well as the ethical and legal implications of offering these therapies as an alternative to incarceration. It also considers whether forced psychopharmacological intervention in adults and children with psychopathic traits manifesting in violent behavior can be justified. More generally, the paper addresses the question of how to weigh the psychopath's presumptive right to non-interference in his brain and mind against the public interest in avoiding harm.

  9. [Use of psychotropic drugs in children].

    PubMed

    Purper-Ouakil, D

    2008-12-01

    The need for specific psychopharmacology trials in the pediatric population has been recognized and promoted by clinicians and regulatory instances. There are indeed specificities in symptom expression and pharmacological characteristics in this population, and recent studies showed that extrapolation from adult data is not always possible. Available results are insufficient to provide effective guidance for prescription and long-term evaluation of risk/benefit ratio in most indications. The aim of this article is to give an overview of efficacy and safety data in pediatric psychopharmacology.

  10. Medication development and testing in children and adolescents. Current problems, future directions.

    PubMed

    Vitiello, B; Jensen, P S

    1997-09-01

    Progress in pediatric psychopharmacological research has suffered notable delay, especially compared with the achievements in adult psychopharmacology. Although safety and efficacy of the use of many psychotropic agents in children remain largely unproved, their pediatric use has been increasing and their widespread off-label prescribing by practitioners has raised some important concerns. The National Institute of Mental Health, in cooperation with the Food and Drug Administration and leading researchers, has coordinated systematic efforts to identify the major obstacles to research in pediatric psychopharmacology and to propose feasible solutions. In 1995, a conference cosponsored by the national Institute of Mental Health and the Food and Drug Administration gathered more than 100 research experts, family and patient advocates, and representatives of mental health professional associations. Participants met in working groups focused on specific aspects of child research and reached consensus on various recommendations. Each of the various aspects relevant to conducting research in this area (methodological, ethical, legal, regulatory, financial, and family or community context) presents specific challenges, which are herein outlined. Recommendations for possible solutions are presented, some of which are being implemented. Because data about drug safety and efficacy in adults can rarely be extrapolated to children, there is no substitute for pediatric psychopharmacological research. Successful strategies for overcoming the many obstacles with which this research has to contend must enlist the concerted efforts of all the relevant parties (investigators, clinicians, industry, federal agencies, ethicists, families, and community representatives).

  11. Bibliography on the Hyperkinetic Behavior Syndrome.

    ERIC Educational Resources Information Center

    Kirson, Tamara; And Others

    The bibliography on the hyperkinetic behavior syndrome focuses on the behavior characteristics of and treatment for hyperactivity. Entries are divided into the following sections (sample subsections are in parentheses): general review of pediatric psychopharmacology; the hyperkinetic behavior syndrome (overview, diagnosis and evaluation,…

  12. Research on Disorders of the Mind. Progress & Prospects.

    ERIC Educational Resources Information Center

    National Inst. of Mental Health (DHEW), Rockville, MD.

    The 14 conference papers on mental illness focus on the biological, genetic, psychopharmacological, psychopathological, and epidemiological and social factors related to psychoses. Divided into five sections each preceded by a brief introduction, entries include the following titles and authors: "The Biological Substrates of Schizophrenia" (S.…

  13. Book Review: ADHD with Comorbid Disorders: Clinical Assessment and Management.

    ERIC Educational Resources Information Center

    Kirkpatrick, Michael A.

    2001-01-01

    This article reviews "ADHD with Comorbid Disorders: Clinical Assessment and Management" by Steven R. Pliszka, Caryn L. Carlson, and James M. Swanson, a book that provides information on children displaying both attention-deficit/hyperactivity disorder and other comorbid psychiatric conditions, complex psychopharmacological interventions that may…

  14. Opioid Abuse After Traumatic Brain Injury: Evaluation Using Rodet Models

    DTIC Science & Technology

    2014-07-01

    Psychopharmacology (Berl). 2003 Jul;168(1-2):3- 20. Smith RJ, Aston-Jones G. Orexin/hypocretin 1 receptor antagonist reduces heroin self- administration...and cue-induced heroin seeking. Eur J Neurosci. 2012 Mar;35(5):798-804.   55 Stafford D, LeSage MG, Glowa JR. Progressive-ratio schedules of drug

  15. Improving Healthcare Transition Planning and Health-Related Independence for Youth with ASD and their Families

    DTIC Science & Technology

    2015-10-01

    2008) Mirtazapine treatment in a subject with autistic disorder and fetishism . Journal of child and adolescent psychopharmacology 18: 206-209...3483. Dozier CL, Iwata BA and Worsdell AS. (2011) ASSESSMENT AND TREATMENT OF FOOT—SHOE FETISH DISPLAYED BY A MAN WITH AUTISM. Journal of Applied

  16. Gastrointestinal Symptoms in a Sample of Children with Pervasive Developmental Disorders

    ERIC Educational Resources Information Center

    Nikolov, Roumen N.; Bearss, Karen E.; Lettinga, Jelle; Erickson, Craig; Rodowski, Maria; Aman, Michael G.; McCracken, James T.; McDougle, Christopher J.; Tierney, Elaine; Vitiello, Benedetto; Arnold, L. Eugene; Shah, Bhavik; Posey, David J.; Ritz, Louise; Scahill, Lawrence

    2009-01-01

    Objective: To evaluate gastrointestinal (GI) problems in a large, well-characterized sample of children with pervasive developmental disorders (PDDs). Methods: One hundred seventy two children entering one of two trials conducted by the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were assessed comprehensively prior to…

  17. Tertiary Oximes on Brain Acetylcholinesterase and Central Excitatory Effects of Nerve Agents

    DTIC Science & Technology

    2012-01-01

    2-PAM), obidoxime (Toxogonin®), or HI-6 to reactivate any unaged, inhibited enzyme, and an anticonvulsant such as diazepam or midazolam to control...sulfate and a benzodiazepine such as diazepam or midazolam [1-4, 28, 31]. These drugs themselves also cause psycho-pharmacological and sedative

  18. Guidelines for the Clinical Evaluation of Psychoactive Drugs in Infants and Children.

    ERIC Educational Resources Information Center

    Food and Drug Administration (DHEW), Washington, DC.

    These guidelines are intended to help those who design and conduct investigations of psychopharmacologic agents in children. A progression of studies in four phases is advocated. First, early short term studies should establish single and multiple dose safety baselines. Second, early pilot efficacy studies may be initiated jointly with longer…

  19. The Current State of Empirical Support for the Pharmacological Treatment of Selective Mutism

    ERIC Educational Resources Information Center

    Carlson, John S.; Mitchell, Angela D.; Segool, Natasha

    2008-01-01

    This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice,…

  20. Brief Report: Effects of Clozapine on Self-Injurious Behavior of Two Risperidone Nonresponders with Mental Retardation.

    ERIC Educational Resources Information Center

    Hammock, Ron; Levine, William R.; Schroeder, Stephen R.

    2001-01-01

    This study reports marked reductions in self-injurious behavior and aggression of two adults with profound mental retardation treated with clozapine, who were non-responsive to all other behavioral and psychopharmacological interventions, including risperidone. The most effective dose was 200mg/day. Side effects were mild and the drug was…

  1. Evaluating Psychotropic Drugs in People with Mental Retardation: Where Are the Social Validity Data?

    ERIC Educational Resources Information Center

    Poling, Alan; LeSage, Mark

    1995-01-01

    Journal articles dealing with drug treatment of individuals with mental retardation were examined to determine treatment goals and outcomes of treating behavior problems. Analysis of articles published from 1987 to 1993 in 5 major journals revealed that none of the 68 articles concerned with the psychopharmacology of mental retardation reported…

  2. Psychotropic Medication Consultation in Schools: An Ethical and Legal Dilemma for School Psychologists

    ERIC Educational Resources Information Center

    Carlson, John S.; Thaler, Cara L.; Hirsch, Amanda J.

    2006-01-01

    Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the…

  3. Use and Management of Medications for Children Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

    ERIC Educational Resources Information Center

    Kollins, Scott H.; Barkley, Russell A.; DuPaul, George J.

    2001-01-01

    This article provides information and guidelines for the effective use of medication in treating attention deficit hyperactivity disorder (ADHD). Basic principles of psychopharmacology, different types of medications that have been used successfully to treat ADHD, and best practices for assessing the effects of medication in children with ADHD are…

  4. On the Difference between Designing Children and Raising Them: Ethics and the Use of Educationally Oriented Biotechnology

    ERIC Educational Resources Information Center

    Stein, Zachary

    2010-01-01

    The use of educationally oriented biotechnology has grown drastically in recent decades and is likely to continue to grow. Advances in both the neurosciences and genetics have opened up important areas of application and industry, from psychopharmacology to gene-chip technologies. This article reviews the current state of educationally oriented…

  5. Review of Research for People with ID and Mental Health Problems: A View from the United Kingdom

    ERIC Educational Resources Information Center

    Hemmings, Colin; Deb, Shoumitro; Chaplin, Eddie; Hardy, Steve; Mukherjee, Rittick

    2013-01-01

    This review of research into mental disorders in people with intellectual disabilities (ID) focuses on research in this field that has originated from the United Kingdom in the last 2 decades. It considers research developments into the epidemiology of mental disorders and problem behaviors, psychopharmacology, psychosocial interventions, and…

  6. Mind Altering Drugs and the Future

    ERIC Educational Resources Information Center

    Evans, Wayne O.

    1971-01-01

    A researcher in psychopharmacology foresees a flood of new drugs that will make man feel happy, cause him to forget his past, and arouse his sexual desires. Man may actually have the possibility of attaining sustained happiness, or something like it, through drugs, and so must ask the question, Is happiness what I most want?" (Author)

  7. Children's Yale-Brown Obsessive Compulsive Scale Modified for Pervasive Developmental Disorders

    ERIC Educational Resources Information Center

    Scahill, Lawrence; McDougle, Christopher J.; Williams, Susan K.; Dimitropoulos, Anastasia; Aman, Michael G.; McCracken, James T.; Tierney, Elaine; Arnold, L. Eugene; Cronin, Pegeen; Grados, Marco; Ghuman, Jaswinder; Koenig, Kathleen; Lam, Kristen S. L.; McGough, James; Posey, David J.; Ritz, Louise; Swiezy, Naomi B.; Vitiello, Benedetto

    2006-01-01

    Objective: To examine the psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scales (CYBOCS) modified for pervasive developmental disorders (PDDs). Method: Raters from five Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were trained to reliability. The modified scale (CYBOCS-PDD), which contains only…

  8. Assessment in Multisite Randomized Clinical Trials of Patients with Autistic Disorder: The Autism RUPP Network.

    ERIC Educational Resources Information Center

    Arnold, L. Eugene; Aman, Michael G.; Martin, Andres; Collier-Crespin, Angie; Vitiello, Benedetto; Tierney, Elaine; Asarnow, Robert; Bell-Bradshaw, Felicia; Freeman, Betty Jo; Gates-Ulanet, Patricia; Klin, Ami; McCracken, James T.; McDougle, Christopher J.; McGough, James J.; Posey, David J.; Scahill, Lawrence; Swiezy, Naomi B.; Ritz, Louise; Volkmar, Fred

    2000-01-01

    This paper explains how the Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved common assessment problems including communication problems compromising use of the patient as informant, broad subject heterogeneity, difficulties in assessing low-end IQs, scarcity of autism-adapted cognitive and neuropsychological…

  9. Gastrointestinal Symptoms in a Sample of Children with Pervasive Developmental Disorders

    ERIC Educational Resources Information Center

    Nikolov, Roumen N.; Bearss, Karen E.; Lettinga, Jelle; Erickson, Craig; Rodowski, Maria; Aman, Michael G.; McCracken, James T.; McDougle, Christopher J.; Tierney, Elaine; Vitiello, Benedetto; Arnold, L. Eugene; Shah, Bhavik; Posey, David J.; Ritz, Louise; Scahill, Lawrence

    2009-01-01

    Objective: To evaluate gastrointestinal (GI) problems in a large, well-characterized sample of children with pervasive developmental disorders (PDDs). Methods: One hundred seventy two children entering one of two trials conducted by the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were assessed comprehensively prior to…

  10. Panic Disorder in Clinically Referred Children and Adolescents

    ERIC Educational Resources Information Center

    Doerfler, Leonard A.; Connor, Daniel F.; Volungis, Adam M.; Toscano, Peter F., Jr.

    2007-01-01

    The present study examined the frequency and characteristics of panic disorder in children and adolescents who had been referred to a pediatric psychopharmacology clinic. Of the 280 children and adolescents evaluated in this clinic, 35 were diagnosed with panic disorder using a semi-structured clinical interview (K-SADS) and other objective…

  11. Therapeutic Implications of Pharmacotherapy: Current Trends and Ethical Issues.(practice & Theory)

    ERIC Educational Resources Information Center

    King, Jason H.; Anderson, Shannon M.

    2004-01-01

    The use of psychotropic medications (pharmacotherapy) in conjunction with psychotherapy is regarded as the standard of care for many mental health disorders. Counselors, therefore, need to be knowledgeable about psychopharmacology to monitor its impact on the therapeutic relationship and on client outcome. Discussed are potential ethical dilemmas…

  12. Predictors and Moderators of Parent Training Efficacy in a Sample of Children with Autism Spectrum Disorders and Serious Behavioral Problems

    ERIC Educational Resources Information Center

    Farmer, Cristan; Lecavalier, Luc; Yu, Sunkyung; Arnold, L. Eugene; McDougle, Christopher J.; Scahill, Lawrence; Handen, Benjamin; Johnson, Cynthia R.; Stigler, Kimberly A.; Bearss, Karen; Swiezy, Naomi B.; Aman, Michael G.

    2012-01-01

    The Research Units on Pediatric Psychopharmacology-Autism Network reported additional benefit when adding parent training (PT) to antipsychotic medication in children with autism spectrum disorders and serious behavior problems. The intent-to-treat analyses were rerun with putative predictors and moderators. The "Home Situations…

  13. Criminal Offenders and "Mainstream" Outpatient Mental Health Care: Emerging Perspectives.

    ERIC Educational Resources Information Center

    Pallone, Nathaniel J.

    1990-01-01

    Discusses inconsistencies in societal responses to criminal behavior. Maintains that some offenders who are both guilty of criminal behavior and psychiatrically (or biochemically) disordered are being diverted from the criminal justice system into the mental health system. Suggests that clinical neuropsychology and psychopharmacology can…

  14. The Texas Children's Medication Algorithm Project: Revision of the Algorithm for Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder

    ERIC Educational Resources Information Center

    Pliszka, Steven R.; Crismon, M. Lynn; Hughes, Carroll W.; Corners, C. Keith; Emslie, Graham J.; Jensen, Peter S.; McCracken, James T.; Swanson, James M.; Lopez, Molly

    2006-01-01

    Objective: In 1998, the Texas Department of Mental Health and Mental Retardation developed algorithms for medication treatment of attention-deficit/hyperactivity disorder (ADHD). Advances in the psychopharmacology of ADHD and results of a feasibility study of algorithm use in community mental health centers caused the algorithm to be modified and…

  15. Developmental Pharmacology

    ERIC Educational Resources Information Center

    van den Anker, Johannes N.

    2010-01-01

    Understanding the pharmacokinetics and pharmacodynamics of drugs used in psychopharmacology across the pediatric age spectrum from infants to adolescents represents a major challenge for clinicians. In pediatrics, treatment protocols use either standard dose reductions for these drugs for children below a certain age or use less conventional…

  16. Teaching Medication Compliance to Psychiatric Residents: Placing an Orphan Topic into a Training Curriculum

    ERIC Educational Resources Information Center

    Weiden, Peter J.; Rao, Nyapati

    2005-01-01

    OBJECTIVE: Medication compliance is an orphan topic. Training in the understanding and management of noncompliance does not neatly fall within the domain of psychopharmacology, nor does it clearly fit into other core curricula areas, such as clinical interviewing or psychotherapy training. The objective of this article is to increase awareness…

  17. The Heavy Burden of Psychiatric Comorbidity in Youth with Autism Spectrum Disorders: A Large Comparative Study of a Psychiatrically Referred Population

    ERIC Educational Resources Information Center

    Joshi, Gagan; Petty, Carter; Wozniak, Janet; Henin, Aude; Fried, Ronna; Galdo, Maribel; Kotarski, Meghan; Walls, Sarah; Biederman, Joseph

    2010-01-01

    The objective of the study was to systematically examine patterns of psychiatric comorbidity in referred youth with autism spectrum disorders (ASD) including autistic disorder and pervasive developmental disorder not otherwise specified. Consecutively referred children and adolescents to a pediatric psychopharmacology program were assessed with…

  18. The Control of Responsiveness in ADHD by Catecholamines: Evidence for Dopaminergic, Noradrenergic and Interactive Roles

    ERIC Educational Resources Information Center

    Oades, Robert D.; Sadile, Adolfo G.; Sagvolden, Terje; Viggiano, Davide; Zuddas, Alessandro; Devoto, Paola; Aase, Heidi; Johansen, Espen B.; Ruocco, Lucia A.; Russell, Vivienne A.

    2005-01-01

    We explore the neurobiological bases of attention deficit hyperactivity disorder (ADHD) from the viewpoint of the neurochemistry and psychopharmacology of the catecholamine-based behavioural systems. The contributions of dopamine (DA) and noradrenaline (NA) neurotransmission to the motor and cognitive symptoms of ADHD (e.g. hyperactivity, variable…

  19. Factor Structure and Differential Validity of the Expanded Brief Psychiatric Rating Scale

    ERIC Educational Resources Information Center

    Thomas, Adrian; Donnell, Alison J.; Young, Tony R.

    2004-01-01

    The Brief Psychiatric Rating Scale (BPRS) is one of the most widely used measures in psychiatric outcome and clinical psychopharmacology research. To date, however, research on the psychometric properties of the expanded version of the BPRS (BPRS-E) has been limited. An exploratory factor analysis (n = 360) using maximum likelihood extraction with…

  20. A Model for Psychiatric Consultation in Systemic Therapy.

    ERIC Educational Resources Information Center

    Griffith, James L.; And Others

    1991-01-01

    Discusses metaphors used to describe problems when family therapy and psychopharmacology are employed together. Identifies coupling metaphors that support both therapies as valid treatments and exclusionary metaphors that invalidate one approach. Presents consultation model for psychiatrists consulting to family therapists wherein the psychiatrist…

  1. Parting Reflections on Education of Children with Emotional or Behavioral Disorders.

    ERIC Educational Resources Information Center

    Forness, Steven R.

    2003-01-01

    The author urges the field of education for children with emotional or behavioral disorders to address three critical areas: (1) developmental psychopathology (to improve early identification and prevention); (2) psychiatric comorbidity (e.g., disruptive disorders present with depression or anxiety disorder); and (3) psychopharmacology (especially…

  2. Childhood Depression: Implications for Teachers.

    ERIC Educational Resources Information Center

    Walker, Margaret

    1988-01-01

    The article discusses the following conceptual models of depression, noting their related treatment approaches: (1) biological model (psychopharmacology); (2) behavioral model (behavior modification, social skills training, problem-solving skills); (3) cognitive model (cognitive therapy); (4) life stress model (focusing on environmental stresses…

  3. Psychotropic Medications: An Investigation of the Knowledge of Counseling Graduate Students and Attitudes toward Coursework of Counselor Educators.

    ERIC Educational Resources Information Center

    Escobedo, Pedro Sanchez; Beamish, Patricia M.; Stump, Earl; Krause, Naomi

    Counselors working in clinical settings are frequently confronted with clients taking psychotropic medications. Counselors working in non-clinical school and industrial settings are often required to identify clients who need referral for psychopharmacological support. If counselors are to assist their clients in exploring treatment options, it is…

  4. The Effectiveness of Parent-Child Interaction Therapy for Families of Children on the Autism Spectrum

    ERIC Educational Resources Information Center

    Solomon, Marjorie; Ono, Michele; Timmer, Susan; Goodlin-Jones, Beth

    2008-01-01

    We report the results of a pilot trial of an evidence-based treatment--Parent-Child Interaction Therapy (PCIT; Eyberg et al. "Psychopharmacology Bulletin", 31(1), 83-91, 1995) for boys aged 5-12 with high functioning autism spectrum disorders and clinically significant behavioral problems. The study also included an investigation of the role of…

  5. Sensitivity of the Modified Children's Yale-Brown Obsessive Compulsive Scale to Detect Change: Results from Two Multi-Site Trials

    ERIC Educational Resources Information Center

    Scahill, Lawrence; Sukhodolsky, Denis G.; Anderberg, Emily; Dimitropoulos, Anastasia; Dziura, James; Aman, Michael G.; McCracken, James; Tierney, Elaine; Hallett, Victoria; Katz, Karol; Vitiello, Benedetto; McDougle, Christopher

    2016-01-01

    Repetitive behavior is a core feature of autism spectrum disorder. We used 8-week data from two federally funded, multi-site, randomized trials with risperidone conducted by the Research Units on Pediatric Psychopharmacology Autism Network to evaluate the sensitivity of the Children's Yale-Brown Obsessive Compulsive Scale modified for autism…

  6. Selecting an Antidepressant for the Treatment of Pediatric Depression

    ERIC Educational Resources Information Center

    Kratochvil, Christopher J.; Vitiello, Benedetto; Brent, David; Bostic, Jeff Q.; Naylor, Michael W.

    2006-01-01

    This column aims to discuss practical approaches to everyday issues in pediatric pharmacotherapy. The cases and discussions specifically target aspects of clinical care related to psychopharmacology for which there are no adequate applicable controlled trials. Given the need to address symptoms in youths with complex, severe, and comorbid…

  7. Parting Reflections on Education of Children with Emotional or Behavioral Disorders [and] Response to Forness.

    ERIC Educational Resources Information Center

    Forness, Steven R.; Oswald, Donald

    2003-01-01

    This article discusses the need to incorporate research findings in developmental psychopathology, psychiatric comorbidity, and psychopharmacology in school mental health programs to enable early detection and primary prevention of emotional and behavioral disorders in students. A response stresses the need for a multidisciplinary approach.…

  8. Antipsychotics, Lithium, Benzodiazepines, Beta-Blockers.

    ERIC Educational Resources Information Center

    Karper, Laurence P.; And Others

    1994-01-01

    The psychopharmacologic treatment of aggression is a critical component of the treatment of psychiatric patients. The diagnostic assessment of aggressive patients is reviewed and relevant literature is presented to help clinicians select appropriate medication. Side-effects, dosages, and methods of administration are highlighted. (JPS)

  9. Early Intensive Behavioral Intervention (EIBI) for Young Children with Autism Spectrum Disorders (ASD): A Systematic Review. Campbell Systematic Reviews 2014:9

    ERIC Educational Resources Information Center

    Reichow, Brian; Barton, Erin E.; Boyd, Brian A.; Hume, Kara

    2014-01-01

    Background: The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorder. Early intensive behavioral intervention…

  10. Antidepressants and Suicidal Ideation in Adolescence: A Paradoxical Effect

    ERIC Educational Resources Information Center

    Pierson, Eric E.

    2009-01-01

    The past two decades have seen a rapid increase in the number and types of psychopharmacological medications that are available for the treatment of depression in children and adolescents. Parents and adolescents often raise questions as to the potential increase in suicidal ideation associated with the use of primarily selective serotonin…

  11. [Mood disorders in HIV patients: a challenge for liaison psychiatry consultation].

    PubMed

    Maccaferri, G E; Cavassini, M; Berney, A

    2012-02-15

    Mood disorders represent the most prevalent psychiatric condition in patients infected by HIV virus. Screening and treatment of depression as well as the evaluation of the risk suicide is of the utmost importance. When psychopharmacological treatment is required, interaction with antiretroviral treatment must be carefully considered. More generally a close collaboration between the physician and the psychiatrist is recommended.

  12. Current Directions in ADHD and Its Treatment

    ERIC Educational Resources Information Center

    Norvilitis, Jill M., Ed.

    2012-01-01

    The treatment of Attention Deficit Hyperactivity Disorder is a matter of ongoing research and debate, with considerable data supporting both psychopharmacological and behavioral approaches. Researchers continue to search for new interventions to be used in conjunction with or in place of the more traditional approaches. These interventions run the…

  13. Psychotropic Medication Consultation in Schools: An Ethical and Legal Dilemma for School Psychologists

    ERIC Educational Resources Information Center

    Carlson, John S.; Thaler, Cara L.; Hirsch, Amanda J.

    2006-01-01

    Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the…

  14. The Effectiveness of Antipsychotic Medication in the Management of Behaviour Problems in Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Deb, S.; Sohanpal, S. K.; Soni, R.; Lenotre, L.; Unwin, G.

    2007-01-01

    Background: Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use. Methods: A comprehensive…

  15. The Effectiveness of Antipsychotic Medication in the Management of Behaviour Problems in Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Deb, S.; Sohanpal, S. K.; Soni, R.; Lenotre, L.; Unwin, G.

    2007-01-01

    Background: Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use. Methods: A comprehensive…

  16. Review of Research for People with ID and Mental Health Problems: A View from the United Kingdom

    ERIC Educational Resources Information Center

    Hemmings, Colin; Deb, Shoumitro; Chaplin, Eddie; Hardy, Steve; Mukherjee, Rittick

    2013-01-01

    This review of research into mental disorders in people with intellectual disabilities (ID) focuses on research in this field that has originated from the United Kingdom in the last 2 decades. It considers research developments into the epidemiology of mental disorders and problem behaviors, psychopharmacology, psychosocial interventions, and…

  17. Factor Structure and Differential Validity of the Expanded Brief Psychiatric Rating Scale

    ERIC Educational Resources Information Center

    Thomas, Adrian; Donnell, Alison J.; Young, Tony R.

    2004-01-01

    The Brief Psychiatric Rating Scale (BPRS) is one of the most widely used measures in psychiatric outcome and clinical psychopharmacology research. To date, however, research on the psychometric properties of the expanded version of the BPRS (BPRS-E) has been limited. An exploratory factor analysis (n = 360) using maximum likelihood extraction with…

  18. Criminal Offenders and "Mainstream" Outpatient Mental Health Care: Emerging Perspectives.

    ERIC Educational Resources Information Center

    Pallone, Nathaniel J.

    1990-01-01

    Discusses inconsistencies in societal responses to criminal behavior. Maintains that some offenders who are both guilty of criminal behavior and psychiatrically (or biochemically) disordered are being diverted from the criminal justice system into the mental health system. Suggests that clinical neuropsychology and psychopharmacology can…

  19. A Model for Psychiatric Consultation in Systemic Therapy.

    ERIC Educational Resources Information Center

    Griffith, James L.; And Others

    1991-01-01

    Discusses metaphors used to describe problems when family therapy and psychopharmacology are employed together. Identifies coupling metaphors that support both therapies as valid treatments and exclusionary metaphors that invalidate one approach. Presents consultation model for psychiatrists consulting to family therapists wherein the psychiatrist…

  20. Parting Reflections on Education of Children with Emotional or Behavioral Disorders.

    ERIC Educational Resources Information Center

    Forness, Steven R.

    2003-01-01

    The author urges the field of education for children with emotional or behavioral disorders to address three critical areas: (1) developmental psychopathology (to improve early identification and prevention); (2) psychiatric comorbidity (e.g., disruptive disorders present with depression or anxiety disorder); and (3) psychopharmacology (especially…