clinical pharmacology cover

Handbook of Clinical Psychopharmacology for Psychologists

Mark Muse

and Bret A. Moore Editors

Wiley, 2012

The Handbook of Clinical Psychopharmacology for Psychologists provides the foundations of knowledge that readers will want for comprehensive understanding in clinical psychopharmacology, located in the broader context of biology, psychology, and social environment. For the prescribing psychologist the book will prove a user-friendly, efficient training tool, and for consulting healthcare psychologists, an essential desk reference.

Handbook successfully combines information from neuroanatomy, nervous system structure and functions, biochemistry, and physiology, with current information on pharmacology, research, and practice. The authors place the issues firmly in a meaningful context for those who treat patients into today’s mental health and health industry.

Co-editor Dr. Mark Muse, American Board of Professional Psychology (ABPP) diplomat, and licensed Louisiana prescribing medical psychologist, along with co-editor Dr. Bret Moore, ABPP and licensed New Mexico conditional prescribing psychologist, highlight the concept of the integrative view throughout the text.

They use the term psychobiosocial to stress the need to combine psychological, biological, and social systems. They point out that research and theory, and especially treatment, must be viewed in this broad and inclusive perspective. They present a view that takes into account the multiple influences and feedback loops on and by a “living, surviving, and adapting person.”

“I worked in primary care in Maurepas at a family clinic,” Dr. Muse told the Times, “and found the experience taxing and eye-opening. I would never have found myself in primary care if it were not for the medical psychology piece. I worked with underprivileged children who had never seen a psychologist, nor had their psychotropics ever been reviewed by a prescribing mental health specialist. The family practitioner was doing the best he could, as there were no psychiatrists in sight. He was progressive and forward-looking and wanted desperately to get a mental health professional on board.”

This awareness for a comprehensive model is highlighted throughout the Handbook, and most clearly in the beginning chapters, where Muse and Moore set out the philosophical framework, defining psychopharmacology as a subset of medical psychology and medical psychology as including “… health psychology, rehabilitation psychology, pediatric psychology, neuropsychology, and clinical psychopharmacology, as well as subspecialties in pain management, primary care psychology, and hospital-based (or medical school-based) psychology.”

As an educational resource the Handbook has real muscle. Chapters are logically structured with consistent statements of theme, effective expansion into relevant subtopics, and concise summaries. The writing style is clear, fast and straightforward. An excellent use of tables and charts graphically consolidates information. Sections for “Key Terms” make it easy to scan and process information. Post-tests engage the reader and contribute to interactive learning.

The Handbook also includes a CD-ROM with practice questions based on the American Psychological Association’s Psychopharmacology Examination for Psychologists (PEP). The reader can prepare for the actual experience of the exam, with 150 questions from ten content areas, presented in a timed, 3-hour format if desired. This ingenious approach no doubt comes from Muse’s bent toward education methods, a theme mirrored in his website, MensanaPublications.

“Those preparing for the PEP never seem to get enough rehearsal questions to satisfy their hunger,” Mark explained. “There are an additional 250 questions as a Mensana CE quiz with the same title,” he said, allowing additional practice.

The Handbook easily fulfills its promise of reviewing foundations for psychologists who want to be conversant with psychopharmacology, and should also be especially useful to those who simply want to be able to help their clients ask the right questions about medications.

In a spirited Forward, “Integrating Care: A Forward on Changing Times,” Drs. Pat LeLeon and Jack Wiggins, both past APA presidents, applaud the

text and the direction. “… an excellent treatise written by psychologists for psychologists,” they write. And, “Lamentably, it has become commonplace in physicians’ offices to dispense psychotropic medications without an appropriate diagnosis and to do so by providers with little or not training in alternative psychological interventions for behavioral disorders.” LeLeon and Wiggins also point to Louisiana’s Drs. Glenn Ally and James Quillin as prominent in the prescriptive authority movement in psychology.

In Chapter 1, “Medical Psychology: Definitions, Controversies, and New Directions,” Drs. Muse and Moore explain the philosophical issues and controversies in the field, a theme repeated in many of the chapters: that the living, adapting human requires a biopsychosocial paradigm, and not the medical model.

The term Medical Psychology is an umbrella term they say, “… it encompasses the multiple specialties and make up health-care psychology, embracing the biopsychosocial paradigm of mental/physical health and extending that paradigm to clinical practice through research and the application of evidenced-based diagnostic and treatment procedures.” They explain the limitations in the Cartesian idea that mind and body are separate, the limitations of the medical model, or the idea that an individual’s social environment is irrelevant.

They object to Louisiana’s Act 251 because, they say, it “… builds upon the definition issues by the U.S. Drug Enforcement Agency (DEA) which recognizes that the term medical psychologist refers to a mid-level provider/practitioner who has prescriptive authority.”

In Chapter 2 Muse and Moore outline more of their rationale, “Integrating Clinical Psychopharmacology within the Practice of Medical Psychology.” Authors point to interesting research demonstrating the complexity and interactions in this psychobiosocial perspective, with examples such as: research on OCD that indicates behavioral therapy is more effective than medication and behavior therapy together; that phobias are better treated with CBT and provides longer- lasting effects; and that 70 percent of the response to antidepressants medications is considered to be placebo. Authors summarize the major large-scale studies such as the STAR*D, TADS, and CATIE studies.

Chapter 3, “Neuroscience,” by Drs. Ken Fogel and George Kaplka (Pediatricians and Pharmacologically Trained Psychologists: A Practitioner’s guide to Collaborative Treatment) write, “Homeostatic balance is the ‘holy grail’ of living things, …” They include sections on neurons,

neurotransmitters, central nervous system, structure and function of the brain, and peripheral nervous system.

In Chapter 4 “Nervous System Pathology” authors provide a comprehensive list of disorders including “Nuerodegenerative/cognitive disorders,” “Mental Retardation,” “Neurodevelopmental Disorders,” “Vascular Disorders.” Readers will appreciate a section on “Behavioral/Psychological disorders with a Neuropathological Basis.”

Chapter 5 reviews “Physiology and Pathophysiology,” including the functional systems of the body, including endrocrine, hormonal, cardiac, digestive systems, and others.

Dr. Robert Younger, ABPP and Navy psychologist with prescriptive authority authors Chapter 6, “Biopsychosocial and Pharmacological Assessment and Monitoring.” He writes that safe and effective use of medications requires psychologists to know “… how to assess the biomedical status of patients, including ongoing assessment of iatrogenic effects of medications in general.” He explains history taking, psychological assessment, as well as physical and neurological examinations and laboratory testing. A list of drug-drug interactions, drug overdose, and a section for adverse drug reactions, are included.

Chapter 7, “Differential Diagnosis in Medical Psychology,” includes important sections on “Medical Disorders that Present as Psychological Disorders,” and “Psychological Disorders that Present as Medical Disorders,” along with other topics that are critical for today’s psychologists.

In “Pharmacology,” Chapter 8, the author addresses how drugs interact with the body to produce effects as well as how they are metabolized and distributed.

Chapter 9, “The Practice of Clinical Psychopharmacology,” by Drs. William Burns, Lenore Walker, and Jose Rey, is one of the longer chapters and explains the “integration of psychotherapeutic and pharmacotherapeutic modalities of treatment.” An extensive table on “Drug Indications, Dosage Ranges, Side Effects, Routes of Administration, FDA Approval for Children, and Pregnancy Risk” is worth the cost of the book. Also described is drug metabolism and CYP450 (Cytochrome P-450), the enzymes involved in detoxification.

“Research in Clinical Psychopharmacology” Chapter 10, and “Professional, Legal, Ethical, and Interprofessional Issues in Clinical Psychopharmacology” Chapter 11, complete the text.

“My hope,” Dr. Muse explained to the Times, “… is that it is a true reflection of the breadth of training a medical psychologist undergoes. I would like the detractors to read it before asserting that prescribing psychologists’ training is insufficient. It is, in fact, more rigorous than psychiatry or practical nursing’s preparations for integrating psychotropics into overall mental health diagnosis and treatment …”

Handbook of Clinical Psychopharmacology for Psychologists is a valuable addition to any psychologist’s library resources, a practical guide for key knowledge bases regarding biological, pharmacological, differential diagnosis, ethical issues, and the important contributions and perspectives that psychologists can bring to the challenges of modern healthcare.

Dr. Mark Muse and Dr. Bret Moore will be presenting aspects of Handbook at the American Psychological Association Convention, on Thursday, August 2, in a presentation titled, “New Resources for Preparing for the Psychopharmacology Exam for Psychologists (PEP).”

The book is widely available from the publisher (Wiley) and distributors. Also, Mensana Publications offers a 20 percent discount on the Handbook and all other books bought through the website link to the publisher.

Dr. Muse completed his doctorate in clinical research and counseling psychology at Northern Arizona U. in 1980 and next was awarded the Licentiate degree in clinical psychology by the Universitat de Barcelone in 1984. He later completed a postdoctorate M.S. in clinical psychopharmacology. He served as full professor at the Universitat de Ramon Llull, Barclona, lecturing in Catalan and Spanish. He returned to the U.S. in 1998. He is the author of six books in the area of psychology as well as numerous articles appearing in psychology and medical professional journals.

 

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