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Preface to Innovative Psychopharmacotherapy

Psychopharmacotherapy involves the manipulation of behavior and psychological functions using psychotropic agents. it implies an attempt at extended or permanent change, correcting aberrant symptomatology. This book is innovative in that it discusses the cutting edge of knowledge in the area. It involves new approaches and therefore combines areas of old knowledge with current research and accumulated clinical experience. It provides an individual perspective and suggests speculative directions for further clinical application in intractable patients.

This book deals with a variety of topics not included in other volumes. It makes no pretense as to comprehensiveness and breadth of field. instead, we have chosen special areas that are somewhat neglected at a psychopharmacological level, or involve new, special, or unusual applications.

Our approach has been to deal predominantly first with clinical features and to marry the phenomenological, symptomatological, and physical signs with underlying biochemical, electrical, and other physical facets. Thus, one major theme running through the book is the principle of psychopharmacological responsiveness, allowing to some degree an underlying indicator of tracing the abnormality with no pretenses as to whether or not the primary causal features are being treated, as opposed to biochemical expressions of even deeper psychopathology. Along with the theme of innovation, we also stress the caution that innovative psychopharmacotherapy should necessarily be applied conservatively, after taking into account the risks, benefits, and options that are available. Treatment should always be in the best interests of the patient.

In similar ways, other principles are espoused. As the patient improves, his psychological functioning changes: Management at that level is not only pharmacological, but also involves allowing the patient to cope with the change from invalidism to a reasonably functioning individual. This impinges not only at the psychological level, but also involves manipulations at family, social, and cultural levels. The system focused on may be biological, but our approach is biopsychofamiliosociocultural. Within the text are other guidelines that are more basic, such as making only one change at a time in the management of patients-this allows clearer pictures of possible causal facets of change. This book deals with three major themes. First, it examines two forms of treatment of anxiety and related conditions, through chapters on beta-adrenergic blocking agents and buspirone. Both of these areas are relatively new to psychiatry. The book then focuses more at the psychosis level, dealing first with modern approaches to schizophrenia, and follows this with a section on management of the nonresponsive psychotic patient. Two special areas of focus in this regard are carbamazepine and the antiparkinsonian agents. These chapters are clinical and then link the biochemical. The final chapter uses the opposite approach. The biochemical facets of vitamin B6 are discussed in some detail, and attempts are made to link this with the clinical. Theoretically, this should be a highly fruitful marriage of the biochemical and the clinical; however, the theme of the chapter is to emphasize how, despite the possible and sometimes obvious links of vitamin B6 biochemistry to brain functioning, this does not necessarily imply its successful use as a psychotherapeutic agent. Thus, it tempers the framework of using innovative approaches without re-examining the available research and clinical experience in the past. This book is directed towards a variety of disciplines: the psychiatrist, the psychopharmacologist, the clinician, the biochemist, the pharmacist, the general physician, and those in training in these areas. The structure of this book is such that each chapter involves some continuity with the previous one. However, repetition is kept to a minimum, but is sufficient to maintain an independence for that chapter, even in the absence of other sections.

Vernon M. Neppe

 

 


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