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Excerpt
We speak often these days of “evidence-based practice,” reflecting the growing database of randomized controlled treatment studies in the literature, and our obligation to be guided by these findings in our day-to-day practice. A more comprehensive term might be “science-based practice,” reflecting the growing knowledge of the molecular neuropathology of psychiatric illnesses, and the increasingly sophisticated science-based capacity to design new, targeted treatments for these disorders. In his series of columns on psychopharmacology, Preskorn has reviewed the rapidly changing science base that is accelerating the pace and specificity of new drug development in psychiatry. The human genome project represents a landmark advance in biomedical science and, as Preskorn elegantly described, this development catapults us into a new era of potential drug development, focused on the regulatory proteins as sites of actions for new drugs. In this issue, Preskorn points out that new drugs developed in this way will be less likely to have a “shotgun” variety of central and peripheral side effects, but rather may have behavioral side effects stemming from the targeted activity of the drug in the brain. This makes it even more important for the psychiatrist to know the science underlying such a new drug, in order to identify and monitor the drug’s full range of effects.
In their review of medication treatments for schizophrenia in this issue, Lauriello and Bustillo present a snapshot of our current knowledge about antipsychotic medications and review the clear progress that has been made as a result of the development of the atypical antipsychotics. In his column in our May issue, Preskorn provided a clear summary of the scientific background that led to the development of these new medications, as a demonstration of the rapidly evolving world of science-based practice.
There are many other components to “best-practice” psychiatry, whether it be evidence-based or science-based. For example, we have a growing body of evidence that psychotherapy is effective, and we now suspect that it may act, at least in part, by inducing cellular growth in the brain. While we learn more about these mechanisms of action, it is important to observe and report careful clinical observations about the use of psychotherapy. In this issue, Leigh and Verghese describe its usefulness with elderly populations, a clinical view shared by Clemens as he explained in his column on psychotherapy in our May issue. In turn, Stone, in this issue, warns us that the clinician’s voice must remain strong, advocating for the known benefits of psychotherapy in the face of the non-clinically driven market forces of managed care.
