Despite the lack of guidance available for practitioners, extensive polypharmacy has become the primary method of treating patients with severe and chronic mood, anxiety, psychotic or behavioral disorders. This ground-breaking new book provides an overview of psychopharmacology knowledge and decision-making strategies, integrating findings from evidence-based trials with real-world clinical presentations. It adopts the approach and mind-set of a clinical investigator and reveals how prescribers can practice 'bespoke psychopharmacology', tailoring care to the individualized needs of patients. Practitioners at all levels of expertise will enhance their ability to devise rationale-based treatments, targeting manifestations of dysfunctional neural circuitry and dimensions of psychopathology that cut across conventional psychiatric diagnoses. Presented in a user-friendly, practical, full-colour layout and incorporating summary tables, bullet points, and illustrative case vignettes, it is an invaluable guide for all healthcare professionals prescribing psychotropic medications, including psychiatry specialists, primary care physicians, and advanced practice registered nurses.
Despite the lack of guidance available for practitioners, extensive polypharmacy has become the primary method of treating patients with severe and chronic mood, anxiety, psychotic or behavioral disorders. This ground-breaking new book provides an overview of psychopharmacology knowledge and decision-making strategies, integrating findings from evidence-based trials with real-world clinical presentations. It adopts the approach and mind-set of a clinical investigator and reveals how prescribers can practice 'bespoke psychopharmacology', tailoring care to the individualized needs of patients. Practitioners at all levels of expertise will enhance their ability to devise rationale-based treatments, targeting manifestations of dysfunctional neural circuitry and dimensions of psychopathology that cut across conventional psychiatric diagnoses. Presented in a user-friendly, practical, full-colour layout and incorporating summary tables, bullet points, and illustrative case vignettes, it is an invaluable guide for all healthcare professionals prescribing psychotropic medications, including psychiatry specialists, primary care physicians, and advanced practice registered nurses.
Part I. General Principles: 1. Core concepts of good psychopharmacology; 2. Targets of treatment: categories versus dimensions of psychopathology; 3. Interpreting and using the literature: integrating evidence-based trials with real-world practice; 4. Placebo and nocebo effects; 5. Tailoring the fit: moderators and mediators of treatment outcome; 6. Complex regimens and rationale-based combination drug therapies; 7. Laboratory values and psychiatric symptoms: what to measure, what not to measure, and what to do with the results; 8. Pharmacogenetics: when relevant, when not; 9. Cross-tapering and the logistics of drug discontinuation; 10. Managing major adverse drug effects: when to avoid, switch, or treat through; 11. Novel drug therapeutics: nutraceuticals, steroids, probiotics, and other dietary supplements; 12. Human diversity and considerations in special populations; Part II. Targets of Pharmacotherapy: 13. Disordered mood and affect; 14. Disorders of impulsivity, compulsivity, and aggression; 15. Psychosis; 16. Deficit states and negative symptoms; 17. Anxiety; 18. Addiction and the reward pathway; 19. Trauma and posttraumatic stress disorder; 20. Personality disorders; 21. Cognition; 22. Putting it all together; References; Index.
A practical guide translating clinical trials findings, across major psychiatric disorders, to devise tailored, evidence-based treatments.
Joseph Goldberg is Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York. Stephen M. Stahl is Adjunct Professor of Psychiatry at the University of California, San Diego, Clinical Professor of Psychiatry and Neuroscience at the University of California, Riverside, and Honorary Visiting Senior Fellow in Psychiatry at the University of Cambridge.
'Psychopharmacology textbooks are typically either scholarly,
endlessly long and inaccessible to clinicians, or
clinician-friendly but with inadequate documentation for readers
who want more detailed information. Somehow, Goldberg and Stahl's
Practical Psychopharmacology combines the best of these two styles.
It is astonishingly comprehensive with many Tables citing every
relevant study while simultaneously providing the deep practical
wisdom and experience of the two authors, both of whom are world
class clinician-scholars. Practical Psychopharmacology also
provides a sophisticated yet accessible review of the biological
underpinnings of both psychopathology and medication effects. It
does not just inform; it teaches the reader how to think about
medications. This book will set the standard in our field for the
foreseeable future.' Michael Gitlin, Distinguished Professor of
Clinical Psychiatry, Director, Adult Division of Psychiatry,
Director, Mood Disorders Clinic, Geffen School of Medicine at
UCLA
'The translation of clinical research findings into practice is
fraught. The methodology of many trials is imperfect, complex, and
opaque and hard to generalise to real world patients. Many critical
questions are poorly answered by the extant evidence. The basic
neuroscience is extraordinarily complex. This book is a Rosetta
stone for translating this evidence into practice in providing a
critical bridge for practising clinicians in distilling and
interpreting the evidence into clear and coherent pragmatic
management and prescribing recommendations. Written by two of the
world's premier authorities, it is infused with a rare synergy of
clinical wisdom and neuroscience expertise and is an essential
resource for any practising prescriber of psychotropic agents.'
Michael Berk, NHMRC Senior Principal Research Fellow; Alfred Deakin
Professor of Psychiatry, School of Medicine, Deakin University and
Barwon Health; Director, IMPACT, the Institute for Mental and
Physical Health and Clinical Translation
'Drs. Goldberg and Stahl have reminded us that they are scientific
artisans by creating a pragmatic, patient-centered set of guiding
principles in clinical psychopharmacology. The emergence of newer
psychopharmacologic treatments and expansion of indications for
previously available agents has provided hope for identifying
therapeutic avenues for patients to improve their general
wellbeing, but also can feel daunting, overwhelming, and a source
of entropy. Consequently, it is not uncommon for clinicians at
point of care to be genuinely perplexed as to which treatments and
capabilities are 'promising rather than prime-time'. The authors
have deftly synthesized the scientific literature and have produced
a book that is comprehensive, concise, and an invaluable source of
decision support at the point of care for multidisciplinary
practitioners who provide care to persons with mental disorders.'
Roger S. McIntyre, Professor of Psychiatry and Pharmacology and
Head, Mood Disorders Psychopharmacology Unit, University of
Toronto, Canada
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