Polypharmacy in Psychiatry PDF

Preface

Polypharmacy, the use of multiple medications, has long been controversial in medicine. Conventional wisdom frowns upon it. Yet, gradually, polypharmacy has become more common in psychiatry. Whether this change is welcome is unclear, and, surprisingly, no single source addresses this question in psychiatry. Readers of this book will gain a broad view of the subject, from the historical roots of conventional medicine's antipathy to polypharmacy, to the psychopharmacological revolution and the rebirth of polypharmacy in psychiatry.

The book begins with the historical background in the 19th century, when medicine consisted of many untested treatments and limited diagnostic methods. Research was in its infancy, and little was known about disease. Physicians were too ready to prescribe for every ailment, especially given the absence of scientific knowledge about their treatments. This led to a fight against polypharmacy. With the help of such medical advances as the discovery of the bacterium and the prevention of illness by sanitary measures, polypharmacy declined in the first half of the 20th century.

In psychiatry, the situation mirrored that of medicine, with some special features. Before 1900, psychiatrists viewed most conditions as variations on one disease, labeled ‘‘insanity,'' and, like other physicians, used many untested treatments and potions, to little effect. That era of ineffective polypharmacy was replaced after Freud, with a shift toward believing that most psychiatric symptoms were attributable to childhood sources, and psychotherapy thus became the one treatment for all. The psychopharmacology revolution, inaugurated with the discovery of lithium in 1949, gradually reintroduced medications into psychiatry. By the 1970s, new medications forced psychiatrists to more carefully study and diagnose patients, resulting in progress to the DSM-III nosology, identifying many diseases, and many treatments for them. This process accelerated greatly in the 1980s with the introduction of newer, safer generations of antidepressant and antipsychotic agents.

Hence, psychiatry today practices polypharmacy once again. We review clinical aspects of contemporary polypharmacy by disease entity (depression, bipolar disorder, anxiety disorders, schizophrenia), by special populations (children, the elderly), and by drug type (alternative and herbal treatments). We also include a chapter on polypharmacy from the social work perspective, to bring in the viewpoint of non-M.D. mental health professionals on polypharmacy in psychiatry. The authors of this chapter specialize in psychopharmacology for social workers, and one of them has published a textbook on the topic. Each chapter author was instructed to focus on polypharmacy in the treatment of those conditions, with an emphasis on clinical relevance in contemporary treatment. They have reviewed the relevant literature, and also presented their own experience and views. I edited each chapter to remove redundancies and to ensure that these basic guidelines have been met.

This book is intended for practicing psychiatrists in the United States and overseas, as well as other mental health professionals, particularly psychologists, social workers, nurses, medical and graduate students, and other physicians.