PSY 565 – Topics in Behavioral Neuroscience Clinical Psychopharmacology

1. PSY 565 – Topics in Behavioral NeuroscienceClinical Psychopharmacology

2. Why do clinical psychologists need to understand psychopharmacology?

3. BMJ 2002;324:698 ( 23 March )News extra Psychologists allowed to prescribe drugs for mental illness Deborah Josefson Nebraska New Mexico has become the first US state to allow psychologists to prescribe drugs. The American Psychological Association has been lobbying since 1984 to gain legislative support for bills that authorize psychologists to prescribe psychiatric drugs. The association argues that it is more cost effective for patients to receive their psychotherapy and drug treatment from one practitioner. Before New Mexico’s act, only the US territory of Guam allowed psychologists to prescribe drugs. Guam lumped psychologists with physician assistants as allied healthcare specialists with prescribing privileges in 1998, but to date no psychologists there have taken advantage of the law.

4. Louisiana also allows psychologists (2004)

8. Outline for Today • Some general points to begin…… • A bit of history

9. Some general points to begin with • The focus of this course is pharmacotherapy 2. The practice of pharmacotherapy cannot be oversimplified (ie one illness - one type of pill) • Many variables impinge on adherence/ compliance and prescriptions can have tremendous variation for individuals

10. Factors that can influence adherence…..

11. Ways to characterize drugs 4. Ways to characterize drugs a. chemical structure b. chemical name - N-(-4-hydroxyphenyl) acetamide

12. c. generic name or nonproprietary name acetaminophen - can be useful sometimes because they give clue to the nature of the drug ex. bz, local anesthetics ** textbooks, scientific discussions of drug use generic name

13. d. Trade name- ex. Luvox fluvoxamine Paxil paroxetine Namenda memantine Aricept donepazil Lunesta eszopiclone What is the trade name for acetaminophen?

15. active ingredients - same in trade vs generic • inactive ingredients may be different

16. e. New novel compounds - Clinicaltrials.gov

18. CP 101,606 - traxoprodil • stroke, • dyskinesias • Parkinson’s Disorder • Postoperative disorder • Alcohol-induced neurotoxicity

19. Steps necessary to bring a new drug to market • Typical cost for a drug to reach market • Screening tests using animal models

20. Center for Drug Evaluation and Research's (CDER) • ensures that drugs are safe and effective.

22. http://www.fda.gov/cder/index.html

23. Steps necessary to bring a new drug to market • Screening tests using animal models • Phase 1 - assessment of safety and toxicity • small n, small dose • Phase 2 - tested in limited n of patients • individuals with condition ~ few hundred patients • Phase 3 - Expanded clinical trials • usually administered to thousands

24. A Bit of History • 3 phases (or 4) • Phase 1 – early 1800’s – • isolation of morphine from opium in 1805

25. A Bit of History • early 1800’s – • isolation of morphine from opium in 1805 • 1855 – invention of hypodermic needle • used in agitation, aggression in psychiatric hospitals

26. A Bit of History • 2nd phase • early 1900’s • first barbiturate synthesized in 1903 • phenobarbital in 1912 • by 1950’s – 2500 preps and 50 used clinically as anticonvulsant, sedative-hypnotic,

27. insulin- • introduced to psychiatry in 1920’s to stimulate appetite and produce • 1930’s – alleviating morphine withdrawal and treating schizophrenia

28. 2nd stage • development of barbiturates (first 1/2 of 20th century) • Lithium’s usefulness in treating bipolar (1949).

29. 3rd phase • 1950’s to current • introduction of more current psychotropics

31. 4th phase • introduction of new drug discovery methods • ability to recreate and determine genetic components of various neurotransmitter receptor subtypes