The mental health clinic: a new model

The Emerging Role of Clinical Pharmacopsychology

Clinical pharmacopsychology is an area of clinical psychology that is concerned with the application of clinimetric methods to the assessment of psychotropic effects of drugs on psychological functioning, and the interaction of such drugs with specific or non-specific treatment ingredients. Clinical pharmacopsychology derives its data from observational and controlled studies on clinical populations and refers to the therapeutic use of medical drugs, not to the effects of substances used for other purposes.

Domains and operational settings of clinical pharmacopsychology are illustrated.

The domains of clinical pharmacopsychology extend over several areas of application which encompass the psychological effects of psychotropic drugs (with particular emphasis on subclinical changes), the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (i.e., side effects, behavioral toxicity, iatrogenic comorbidity), and the interactions between drug therapy and psychological variables. A service for clinical pharmacopsychology is here proposed as an example of the innovative role of clinical psychology in medical settings.

Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Its aim is to provide a comprehensive assessment of the clinical important changes that are concerned with wanted and expected treatment effects; treatment-induced unwanted side effects; and the patient's own personal experience of a change in terms of well-being and/or quality of life. It is now time to practice clinical pharmacopsychology, creating ad hoc services in Europe.

Clinical pharmacopsychology assesses the effects of medications on psychological functioning

Since clinical psychologists visit medicated patients, a comprehensive clinical evaluation is crucial

Vulnerabilities induced by psychotropic drugs are an important area of application of clinical pharmacopsychology

"Bowel obsession syndrome" in a patient with chronic constipation

OBJECTIVE

The bowel obsession syndrome (BOS) is a psychosomatic disorder which often remains at the intersection of somatic and psychological domains without being adequately diagnosed and treated.

CASE REPORT

A 32-year-old man with chronic constipation presented with restricted diet, compulsions on evacuation, social isolation and depressed mood, thus satisfying the diagnosis of BOS. Cognitive behavioral therapy led to complete remission of symptoms, and results were maintained after 1 year of follow-up.

CONCLUSION

Although BOS is not frequently diagnosed, it is probably more prevalent than thought. Clinicians should be aware of its existence in order to assess, diagnose and properly treat it.

Impact of changes in psychiatric practice on psychiatric education in the USA

The evidence base for the field of psychiatry is rapidly changing in the twenty-first century due to advances in neuroscience that are in the process of being translated into clinical interventions. The delivery systems for mental healthcare are simultaneously undergoing dramatic transformations as the field attempts to meet population needs effectively and efficiently. These changes demand a reconsideration of the content and priorities of psychiatric training programmes for both medical students and residents. This article examines the current state of psychiatric practice, as well as future challenges and potential models of practice, and discusses how these changes are impacting the present needs of trainees. Preparing today's medical students and residents to be active participants in the creation of the mental healthcare delivery system of the future is the key to the success of the specialism and to the welfare of tomorrow's patients.

New modalities of assessment and treatment planning in depression: the sequential approach

The sequential model of treatment for depression, i.e. the use of psychotherapy in patients who have remitted from a major depressive disorder after a course of pharmacotherapy, is an intensive two-stage approach that derives from the awareness that one course of treatment is unlikely to provide a solution to all the symptoms of patients. The aim of the sequential approach is to provide different types of treatment for as long as considered necessary in different phases of illness as determined by repeated assessments. The treatment strategies are chosen on the basis of the symptoms identified and not as predefined options. The sequential model emphasizes consideration of subclinical and residual symptomatology according to the organizing principles of macro-analysis (a relationship between co-occurring symptoms and problems is established on the basis of where treatment should commence in the first place). Diagnostic endpoints (i.e. DSM diagnoses), the customary guidance of treatment planning, are replaced by conceptualization of disorders as 'transfer stations', which are amenable to longitudinal verification and modification. The aim of this systematic review was to survey the literature concerned with the sequential approach to the treatment of depression. Randomized controlled trials were identified using MEDLINE and a manual search of the literature. In seven of the eight studies that were identified, the sequential use of pharmacotherapy and psychotherapy was found to improve long-term outcome after termination of treatment compared with clinical management and treatment as usual. Nevertheless, data on this approach are limited and more studies are necessary for detailing the various clinical steps associated with it. The sequential approach calls for a re-assessment of the design of comparative clinical trials. It allows randomization of patients who are already in treatment and assignment of them to treatment alternatives according to stages of development of their illness and not simply to disease classification. The model is thus more in line with the chronicity of mood disorders compared to the standard randomized controlled trial, which is based on the acute disease model.