What psychologists need to know about psychotropic medications

Abstract

Despite the fact that today most of the patients with psychological disturbances assume some form of psychotropic drug treatment, clinical psychologists may have little familiarity with psychopharmacology and are substantially unaware of subtle and yet pervasive potential effects of medications in clinical presentations. In their training, psychologists are generally exposed, at best, to some general principles of drug action. Standard psychopharmacology textbooks tend to omit the subtle psychological changes that may occur during psychotropic drug treatment. Clinical pharmacopsychology consists of the application of clinical psychology to the full understanding of pharmacological effects. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (side effects, behavioural toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. The DSM-5 refers to a patient population that no longer exists: subjects who display various manifestations of psychological distress who do not receive any form of drug treatment for it. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug. The changes may be persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects.

Biological and Clinical Markers in Panic Disorder

“…To be also noted that biomarkers are influenced by environmental and lifestyle factors such as stress, physical activity, comorbidity, psychotropic medications [45]. Psychotropic drug treatments, particularly after long-term use, might cause or precipitate adverse effects on the course, characteristics, and responsiveness of an illness that do not necessarily subside with discontinuation of the drug or of modifying responsiveness to subsequent treatments [61,62]. Such vulnerabilities are subsumed under the rubric of iatrogenic comorbidity [61,62].…”

Iatrogenic Factors in Psychopathology

“…The concept of behavioral toxicity has recently been revisited [31, 32]. Behavioral toxicity may ensue with any type of medical drug.…”

“…First, when antidepressant drugs trigger a manic or hypomanic episode in allegedly unipolar disorders (i.e., a patient who has never had such episodes before), discontinuation of the medication is unlikely to entail a solution to the problem, which tends to persist and modify the entire course of illness in a cascade of affective episodes [32, 54-56]. …”

The Clinimetric Approach to Psychological Assessment: A Tribute to Per Bech, MD (1942–2018)

“…In other terms, the aim of the treatment consists of reaching a balance between the desired versus the undesired effects of the drug under examination by evaluating if the patient has returned to an ordinary well-being [23]. Bech’s [60] triangle anticipated developments in the appraisal of therapies [61-64], suggesting consideration of three dimensions in the process of evidence-based decision: baseline risk of poor outcomes from an index disorder without treatment, responsiveness to the treatment option, and vulnerability to the adverse effects of treatment. Evidence-based medicine is focused on the potential benefits that therapy may entail as to baseline risk, but it is likely to neglect the other two dimensions [62].…”