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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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