Psychiatric Pharmacotherapy Update

Psychiatric disorders are highly prevalent and frequently comorbid with each other, but most of those afflicted in the United States are never treated by a professional. ¹ The World Health Organization (WHO) reports that neuropsychiatric disorders account globally for one-third of the years lost due to disability for individuals aged 15 or older and that 7 of the top 20 diagnoses are for mental health conditions. ² The economic cost of psychiatric disorders is also immense, with the burden of depression alone being estimated in one study at 83.1 billion dollars in the year 2000 for the United States. ³ However, psychiatric disorders and specialties have also been considered to be “lower prestige” illnesses and practice areas. ⁴ Yet, these disorders are eminently treatable, with the numbers needing to treat varying from 3 for major depression and bipolar affective disorder to 9 for bulimia nervosa. ⁵

It is my privilege to introduce this special double issue of the Journal of Pharmacy Practice dedicated to covering some of the more exciting recent developments in psychiatric pharmacotherapy. These articles represent both varied topics and approaches to treating psychiatric disorders. Some topics are inspired by the daily clinical experience of the authors, such as the intriguing description of the application of clinically available genomic testing to difficult to treat patients by Dr Caley. Similarly, Drs Brahm and Washington show us how something as simple as insufficient needle length can lead to prolonged suffering due to lack of response in a severely ill schizophrenic patient.

Clinicians will be brought up to date on the nuances of how to best use the new atypical antipsychotic asenapine and its role in our toolbox of agents to manage schizophrenia and bipolar disorder. While a thorough review by Drs Mathys and Mitchell of the varied options in remedying treatment-resistant depression is a help to all of us involved in the care of these patients, the article by Dr Goren and Ms Tewksbury also enlighten us with a discussion of an increasingly popular alternative “natural” approach concerning the possibility of ameliorating depressive symptomatology using omega-3 fatty acids. Dr Friedman, a neurologist who was one of the first to report the potential utility of clozapine in treating psychosis in Parkinson’s disease, discusses what we have learned about the newer agents and how to approach this problematic pharmacotherapeutic dilemma.

Our remaining articles deal with two increasingly prevalent and problematic behaviors, the abuse of amphetamine derivatives and the complex problem of nonsuicidal self-injurious behaviors such as “cutting.” Two articles discuss the abuse of amphetamine and its derivatives. Sepúlveda and associates examines the issue of the misuse of prescription stimulants obtained for use in treating attention-deficit hyperactivity disorder (ADHD) in a college population, while Drs Brackins, Brahm, and Kissack discuss how we can best treat patients who have become addicted to agents such as methamphetamine and require treatment of this debilitating affliction. While there are many theories which attempt to explain the mechanisms that may be potentially exploited to manage self-injurious behavior, there is a lack of sound clinical information informing us on how to best manage this disorder and a lack of animal models in which we could even begin to test for new treatments. Drs Bloom and Holly examine the difficulties in developing a treatment paradigm for these disorders and some promising programmatic research which may help us screen various behavioral and psychopharmacological approaches to see what may be of help to these individuals.

I wish to express my gratitude and respect for the hard work and dedication of all the fine authors who contributed to this psychiatric pharmacotherapy edition. Moreover, it is very important to acknowledge the skill and diligence of my 2 associate editors, Drs Stanley S. Weber and Michael Biglow, who aided me in reviewing these manuscripts through many revisions to yield a polished and impressive body of work. The resulting collection of articles contained herein represents an important piece of a growing body of psychiatric pharmacotherapy literature as discussed by varied eminent scholars and clinicians.