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  1. Home
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  3. Essential Evidence-Based Psychopharmacology
  • Cited by 2
Publisher:
Cambridge University Press
Online publication date:
August 2012
Print publication year:
2012
Online ISBN:
9780511910395
DOI:
https://doi.org/10.1017/CBO9780511910395
Subjects:
Psychiatry and Clinical Psychology, Medicine, Psychiatry
Information

Book description

This volume presents up-to-date, comprehensive and high quality reviews of the psychopharmacological evidence-base for each of the major psychiatric disorders, written by expert psychopharmacologists from around the world. Building on the success of the first edition, the volume summarizes the wealth of new developments in the field and sets them within the context of day-to-day clinical practice. All chapters have been fully updated and new contributions on personality disorders and substance dependence added. Each chapter provides information about optimal first line pharmacological interventions, maintenance pharmacotherapy and the management of treatment-refractory patients. The content is organized according to the DSM-V listing of psychiatric disorders, and covers all major conditions including schizophrenia, mood disorders, anxiety disorders, eating disorders and Alzheimer's disorder. These issues lie at the heart of clinical psychopharmacology, making this book invaluable to all practising and trainee clinicians, in a mental health setting or a less specialised environment.

Reviews

'Essential Evidence-Based Psychopharmacology would be a very good text for psychiatrists in practice and especially those who have recently graduated from a residency training program and are beginning their practice.'

David L. Dunner Source: Journal of Clinical Psychiatry

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Contents

Contents
  • 8 - Evidence-based pharmacotherapy of obsessive–compulsive disorder
    pp 128-170
  • View abstract

    Summary

    Neuropsychological, neuroimaging, and genetic studies have demonstrated the biological underpinnings of attention deficits hyperactivity disorder (ADHD). These studies have correlated deficits in executive functioning, response inhibition and planning with specific regions of the brain. The multimodal treatment study (MTA) study randomized participants to intensive behavioral therapy, pharmacotherapy with systematically delivered methylphenidate, a combination of the two, or standard community care. The American Academy of Child & Adolescent Psychiatry (AACAP) Practice Parameters for ADHD published in 2007 combine short- and long-term empirical evidence with expert opinion from pediatric mental health researchers and clinicians. A meta-analysis of atomoxetine and stimulant studies revealed a robust effect size for atomoxetine and the stimulants, both of which are currently approved by the food and drug administration (FDA) for the treatment of ADHD. In the interim, appropriate diagnosis, informed prescribing, clinical monitoring, and collaborative treatment planning can all help to optimize outcomes in ADHD management.
  • 9 - Evidence-based pharmacotherapy of post-traumatic stress disorder
    pp 171-189
  • View abstract

    Summary

    This chapter presents the authors' interpretation of the core evidence about the pharmacological treatment of schizophrenia. It summarizes the interpretation of the discussion about second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs), and which is the best SGA, mainly based on recent systematic reviews and effectiveness studies CATIE. The author interprets the meta-analyses such that overall clozapine, amisulpride, olanzapine and risperidonemay be somewhat more efficacious than FGAs and other SGAs. Depressive symptoms are frequently present in acutely ill patients with schizophrenia and may first improve with antipsychotics alone. Neuroleptic-induced depressive symptoms might be ruled out by anti-parkinson medication or switching to a drug with fewer extrapyramidal side-effects (EPS). Post-psychotic depression may be treated with an antidepressant. Electroconvulsive therapy (ECT) is recommended only as a last resort, but advantageously compared with the other augmentation strategies, it is effective as monotherapy and has a different mechanism of action than antipsychotics.
  • 10 - Evidence-based pharmacotherapy of eating disorders
    pp 190-213
  • View abstract

    Summary

    Bipolar disorder is commonly accompanied by substantial comorbidity, including high rates of anxiety disorders and also of substance and alcohol-use disorders. This chapter considers evidence-based pharmacotherapy for the three main clinical scenarios-episodes of bipolar depression, manic or mixed episodes, and the prevention of relapse. In new episodes of bipolar depression, the three approaches with the strongest evidence base at present are the use of quetiapine, lamotrigine, and the optimization of existing long-term treatments. The evidence for the use of conventional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), in bipolar depression has weakened in recent years. Studies in bipolar disorder have for the most part employed valproate in the form of divalproex. A recentmeta-analysis identified four small randomized placebo-controlled trials of valproate in bipolar I or bipolar II depression. Strong evidence guides first-line choices for episodes of bipolar depression, manic or mixed episodes, and for relapse prevention.
  • 11 - Evidence-based pharmacotherapy of nicotine and alcohol dependence
    pp 214-234
  • View abstract

    Summary

    This chapter reviews the evidence for first-line treatment of major depressive disorder (MDD), and strategies for patients with treatment-resistant depression. Many trials have investigated the efficacy of selective serotonin reuptake inhibitors (SSRIs) compared with other antidepressants. Patients with MDD are at higher risk of suicide, and guidelines indicate that patients should be assessed for suicide at the start of treatment and regularly over the course of treatment. As augmenting agents, atypical antipsychotics, lithium, and triiodothyronine (T3) have been studied the most extensively, and shown to have benefit. However, their risks and side-effect profiles may make them less attractive to patients, and patient preference and safety should determine treatment decisions for refractory or chronic MDD. The use of biomarkers, including pharmacogenetic testing, may one day provide more accurate predictors of response or adverse outcomes, allowing targeted treatments and the promise of personalized medicine.
  • 12 - Evidence-based pharmacotherapy of illicit substance use disorders
    pp 235-261
  • View abstract

    Summary

    This chapter emphasizes the importance of adequate care of pharmacological evidence on treating panic disorder. It focuses on the optimal first-line pharmacotherapy of panic disorder. The chapter discusses the optimal duration of maintenance therapy, and describes the optimal approach to pharmacotherapy in the treatment-refractory patient. It reviews the antidepressants and benzodiazepines with regard to efficacy in acute and long-term treatment, the side-effects and risks involved, drop-out rates, onset of action and efficacy in comorbid conditions. Given the comparable efficacy of the pharmacological classes described in acute phase treatment and the efficacy in long-term treatment, other considerations determine which agent should be considered the first-line pharmacotherapy of panic disorder. The first-line pharmacotherapy for panic disorder has been selective serotonin reuptake inhibitor (SSRIs) for some time, and there is now sufficient evidence to indicate that the SNRI venlafaxine should also be considered as a first-line agent.
  • 13 - Evidence-based pharmacotherapy of Alzheimer's disease
    pp 262-277
  • View abstract

    Summary

    This chapter summarizes the available evidence for the pharmacological management of social anxiety disorder (SAD). Monoamine oxidase inhibitors (MAOIs) were the first medications to be widely studied as a treatment for SAD. Six double-blind, placebo-controlled trials have consistently demonstrated the efficacy of phenelzine in the treatment of SAD, resulting in symptomatic and functional improvement. Compared with non-reversible MAOIs, reversible inhibitors of monoamine oxidase-A (RIMAs) have a significantly lower risk of potentiating the dangerous pressor effect of tyramine, which allows for relaxation or total elimination of dietary restrictions. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have been studied widely because of their efficacy, safety, and tolerability compared with earlier medications. The evidence from the reviewed clinical trials and meta-analyses suggests that a number of medications are efficacious in the treat.
  • 14 - Evidence-based pharmacotherapy of personality disorders
    pp 278-315
  • View abstract

    Summary

    Patients with comorbid major depression and generalized anxiety disorder (GAD) tend to have a more severe and prolonged course of illness and greater functional impairment. GAD is one of the most common mental disorders in primary medical-care settings, and is associated with increased use of health services. Current theories on pathological anxiety fit a multifactorial epigenetic model that integrates early stressors, inherited and acquired vulnerabilities, and the risks of developing interrelated or coincidental somatic diseases. The tolerability profile of prescribed medication is an important consideration, particularly when long-term treatment is recommended. Distressing symptoms on stopping treatment are common with many classes of psychotropic drug, including selective serotonin reuptake inhibitor (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines. There is clearly room for improvement in the development of more efficacious and more acceptable pharmacological approaches to the management of this common, distressing, typically disabling, and often persistent anxiety disorder.

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