The art of psychopharmacology
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Ira D. Glick, M.D. Stanford University School of Medicine Richard Balon, M.D. Wayne State University School of Medicine. The Art of Psychopharmacology. Introduction. Clinical Practice of Psychopharmacology based on: Training Knowledge Experience

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The art of psychopharmacology

Ira D. Glick, M.D.

Stanford University School of Medicine

Richard Balon, M.D.

Wayne State University School of Medicine

The Art of Psychopharmacology


Introduction
Introduction

Clinical Practice of Psychopharmacology based on:

  • Training

  • Knowledge

  • Experience

  • The “art” (i.e. clinical pearls) combined with the science


Pearls
Pearls

  • If you use meds, give a balanced presentation of pros & cons but be positive

  • Have “real” relationship with patient (vs. being neutral)

  • Combining psychotherapy is “complex,” supportive psychotherapy is best

  • Get story from patient (in addition to other sources)

  • Get information in detail re: S & Sx


Pearls1
Pearls

  • Use meds earlier rather than later

  • In acute phase, don’t discuss “lifetime use”

  • Don’t do emergency treatment on Fridays

  • There are limits to what you do in “office”

  • There are limits to who you see at home, re: aggression, or the phone, re: clarity with pts and family


Pearls2
Pearls

  • Explore and consider patient’s views of medication

  • Information provided by therapist is useful, but only as component of the complete picture

  • Don’t get seduced by marketing and advertisement

  • Do not make unrealistic promises to patients and families


Pearls3
Pearls

  • Medication levels could be useful

  • However, don’t treat labs, treat patients

  • Even very low doses could be effective in some patients (especially in the elderly)

  • Always consider lack of adherence, but be careful how you ask about it

  • Not all side effects are side effects (consider baseline, timing, sequence)


Pearls4
Pearls

  • The patient comes first (vs other concerned parties)

  • “Do the right thing”(vs compromising Rx guidelines for “wrong” reasons)

  • Less is usually more

  • Do one medication change at a time

  • If you are in a hole, don’t dig deeper (re-evaluate progress & change what you are doing)

  • Clinical experience - defined as “making same mistake for 30 years” (use data with clinical experience)


Pearls5
Pearls

  • Data takes precedence over “gut feeling”

  • Always explain what you are doing

  • Always involve the family/sig. others

  • An M.D. by him/herself usually can’t adequately manage one psychotic patient (need family, sos)

  • Always give patient/family “hope”


Pearls6
Pearls

  • Try to do treatment changes slowly

  • Aim to do “differential psychopharmacology” vs. “shotgun polypharmacy” in hopes something will work

  • If patient resistant/ambivalent - (it’s usually the illness, not a character flaw)

  • Warn patient about major SE & controversies

  • Be patient but consistent and persistent in long term management


Summary conclusion
Summary & Conclusion

  • Know the literature

  • Be compassionate, but firm & prescriptive

  • Good psychopharmacology practice is a combination of “art plus science”


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