BMJ 2002;324:698 ( 23 March )News extraPsychologists allowed to prescribe drugs for mental illnessDeborah 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.

Louisiana also allows psychologists (2004)

Some general points to begin…… A bit of history

1. The focus of this course is pharmacotherapy

2. The practice of pharmacotherapy cannot be oversimplified (ie one illness - one type of pill)

3. Many variables impinge on adherence/ compliance and prescriptions can have tremendous variation for individuals

4. Ways to characterize drugsa. chemical structure

b. chemical name -

N-(-4-hydroxyphenyl) acetamide

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

d. Trade name-

ex. Luvox fluvoxaminePaxil paroxetineNamenda memantineAricept donepazilLunesta eszopiclone

What is the trade name for acetaminophen?

active ingredients - same in trade vs generic◦ inactive ingredients may be different

e. New novel compounds -

Clinicaltrials.gov

CP 101,606 - traxoprodil

◦ stroke, ◦ dyskinesias◦ Parkinson’s Disorder◦ Postoperative disorder◦ Alcohol-induced neurotoxicity

Typical cost for a drug to reach market

Screening tests using animal models

ensures that drugs are safe and effective.

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

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

3 phases (or 4) Phase 1 – early 1800’s –

◦ isolation of morphine from opium in 1805

early 1800’s –◦ isolation of morphine from opium in 1805

1855 – invention of hypodermic needle used in agitation, aggression in psychiatric hospitals

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,

insulin-◦ introduced to psychiatry in 1920’s to stimulate

appetite and produce ◦ 1930’s – alleviating morphine withdrawal and

treating schizophrenia

development of barbiturates (first 1/2 of 20th century)

Lithium’s usefulness in treating bipolar (1949).

1950’s to current◦ introduction of more current psychotropics

introduction of new drug discovery methods◦ ability to recreate and determine genetic

components of various neurotransmitter receptor subtypes