Ebook Prescribing mental health medication the practitioner''s guide (2nd edition): Part 1

Praise for the first
edition

This book is a MUST ADD to any practicing physician’s set of in office clinical
references. It answers virtually all the questions that come up in the day-to-day
use of psychoactive medications in primary care and other clinical settings –
the author provides pragmatic, well researched guidance coupled with loads
of practical suggestions for ways to talk with patients and improve the effectiveness of treatment.
Larry Culpepper, MD, M.P.H., Professor Chairman of Family Medicine,
Boston University Medical Center, USA
I am very impressed both with the form and content of this book. A great deal
of the discussion is drawn from clinical practice and the concerns that patients
have about medication. It has the potential to become a much referenced text.
Peter Nolan, Professor of Mental Health Nursing, University of Staffordshire
Learning psychopharmacology can represent a daunting challenge for the
non-psychiatrist. In Prescribing Mental Health Medication, Christopher Doran
MD has struck the right balance in describing patient focused technique and
“art” while detailing comprehensive and expert information in a masterful mix
of text and table.
Jerrold Rosenbaum, MD, Chief of Psychiatry, Massachusetts General Hospital,
Professor Psychiatry Harvard Medical School, USA
Although there are countless textbooks and guidelines about psychopharmacology this book, to my knowledge, is a unique guide about how to prescribe
and manage psychiatric medication. It is engaging, easy to read, intelligent
and incredibly useful to mental health practitioners.
Richard Gray, Research Fellow, Institute of Psychiatry



Prescribing Mental
Health Medication

Prescribing Mental Health Medication is a text for practitioners who treat mental disorders with medication. It is the unique text to explain the entire process of medication
assessment, management and follow up for general medical practitioners, mental health
practitioners, students, residents, prescribing nurses and others who are perfecting this
skill. Already used by providers and training institutions throughout the world, the newly
revised second edition is completely updated and focuses on the following key issues:
N
N
N
N
N
N
N

N
N

N
N

how to determine if medication is needed
how to start and stop medication
how to dose
when to change medication
dealing with “difficult” medication patients
specific mental health symptoms and appropriate medication
special populations including:
N
pregnancy
N
substance abusers

N
children and adolescents
N
the elderly
management of medication side effects
practical issues such as:
N
monitoring medication with blood levels
N
managing the misuse of medication
N
appropriate prescription of generic preparations
N
safely avoiding areas of medication risk
Internet prescription, telemedicine and electronic medical records
organizing a prescriptive office and record keeping.

Completely updated, this text includes information on all psychotropic medications in
use in the United States and the United Kingdom. It incorporates clinical tips, sample
dialogues for talking about medications to patients and information specifically relevant
for primary care settings.
Christopher M. Doran MD is a Psychiatrist and a Clinical Associate Professor at
the University of Colorado School of Medicine, USA. He has taught the principles and
practice of psychotropic medication prescription around the globe to practitioners of
all disciplines.



Prescribing Mental
Health Medication

The Practitioner’s Guide
Second Edition

Christopher M. Doran


First edition published 2003
by Routledge
This edition published 2013
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2013 Christopher M. Doran
The right of Christopher M. Doran to be identified as author of this work has been
asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and
Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilized in
any form or by any electronic, mechanical or other means, now known or hereafter
invented, including photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Doran, Christopher M., 1946–

Prescribing mental health medication : the practitioner’s guide / Christopher M. Doran. –
2nd ed.
p. ; cm.
Includes bibliographical references and index.
I. Title.
[DNLM: 1. Psychotropic Drugs–administration & dosage. 2. Drug Prescriptions–
standards. 3. Mental Disorders–drug therapy. 4. Psychopharmacology–methods.
QV 77.2]
615’.78–dc23
2012026592
ISBN: 978-0-415-53503-8 (hbk)
ISBN: 978-0-415-53609-7 (pbk)
ISBN: 978-0-203-11182-6 (ebk)
Typeset in Bembo
by Wearset Ltd, Boldon, Tyne and Wear


To my patients
whose patience, strength and perseverance
have taught me much of what is written here.



Contents

List of tables

xviii

Preface

xxii

Acknowledgments

xxiv

A note on the icons used in this book

xxv

Part I

The need for this book

1 General principles of medication management
The scope of the problem
Mental health in the spotlight
2 Myths and truths about mental health medication
Myth 1: Mental health medication is a placebo
Myth 2: Mental health medication is addictive
Myth 3: Mental health medication will change personality
Myth 4: Stopping mental health medicine as soon as possible is
competent practice
Myth 5: Mental health medication will overcome bad habits
Myth 6: If side effects occur, the medication must be working
Myth 7: Taking medication for depression means weakness
Myth 8: Antidepressants frequently cause suicidal or homicidal
thoughts
Myth 9: All antidepressants are alike

Myth 10: Alcohol is prohibited while taking psychotropic medicine
Myth 11: Mental health medication will treat alcoholism
Myth 12: A person must be substance-free to be assessed/treated
accurately for mental illness

1
3
6
7
9
10
10
11
12
13
13
14
15
17
17
18
18


x

CONTENTS

Part II

Medication management start to finish

21

3 The initial prescriptive interview
What to say after “hello”
General issues of history taking
Essentials that must be obtained for medication prescription
Mental status exam
Suicide and homicide assessment
Useful but optional information
Target symptoms
Historical information from others
The medical work-up
The next decision
Assessment and formulation
Length of an initial prescriptive interview
Sample clinician guidelines
Diagnostic and medication bias

23
24
26
28
29
29
30
31
31
32

34
34
36
38
42

4 Helping a patient decide to try medication
Shared goals
Common patient concerns about psychotropic medication
Other resistances to psychotropic medication
The use of levers
Reasons that patients take psychotropic medication
The use of metaphor

44
44
45
47
48
49
51

5 Starting medication
Monotherapy
Overlap and “indications”
What is the target of the medication?
Choosing a starting dose
Loading doses
The art of choosing a medication
Selecting medication in the previously treated patient

The liver-impaired patient
The kidney-impaired patient
How many pills to prescribe?
The five points of education about psychotropics
Other issues to be discussed
Informed consent
Involuntary medication
Education as treatment
The use of placebo

53
54
54
55
55
58
59
61
62
64
64
65
66
68
69
69
70

6 Follow-up appointments and strategies
When do I schedule follow-up?

72
72


CONTENTS

How long does it take?
Inpatient medication follow-up
Preparing for a follow-up
Goals of a follow-up
Two simple, powerful questions
The power of positive comments
What is an adequate trial?
Switching medication and side effects
When changing, gradual is best
Polypharmacy – from the doghouse to the penthouse
Feedback from others
Helping a patient stay on medication – the adherence dilemma
How and when to refer to a mental health specialist
Missed doses
Parenteral medications
Pill facts
Antipsychotics and movement disorders at follow-up

73
74
74
75
77

79
82
83
84
86
89
89
91
93
95
96
98

7 Medication, psychotherapy and adjunctive therapies
The first session dilemma
Patient’s preference
What can medication do?
Who prescribes psychotropic medication?
Other adjunctive therapies

99
100
101
102
102
104

8 Stopping medication
When to stop a psychotropic
Tapering medications

“When I stopped, I got worse”
Benzodiazepine withdrawal
Management of discontinuation syndromes
Relapse vs discontinuation syndrome
When to stop medication more quickly
New episode or relapse?
Side effects pass quickly
Unplanned stoppages of medication
Complex discontinuation

106
107
109
109
112
116
117
118
118
118
119
121

9 The long-term patient
Who should receive long-term treatment?
A symptomatic crisis in a stable patient – general principles
“The medicine stopped working” – getting back on TRACCCC
Helping the patient stay well
Missed appointments
When the patient asks for more

Inappropriate requests

122
123
125
126
129
131
133
134

xi


xii

CONTENTS

Is newer medication better?
Periodic reassessment
Concurrence for a change of medication
Conflicting advice from others

Part III

134
137
137
138

Medicating special populations

141

10 Using medication with children and adolescents
Outdated views of pediatric mental health prescription
The scope of pediatric psychopharmacology
Principles of psychotropic prescription with children and
adolescents
Diagnostic and conceptual issues in the prescriptive process
A child’s goals differ from those of adults
Parental power struggles over medication
The medical work-up prior to psychotropics
Practical issues in child/adolescent prescription

143
144
145

11 Pregnancy and psychotropics – rewards and risks
Clinician principles for prescribing to the pregnant woman
The A, B, C, D, X classification of medication in pregnancy and
lactation
Working with the fertile woman, pre-pregnancy
When the patient wishes to become pregnant
While the patient is actively trying to become pregnant
When pregnancy occurs
During pregnancy
Specific conditions and medication groups
Lithium carbonate

Carbamazepine and valproic acid
Postpartum
Lactation and psychotropics
Antidepressants
Mood stabilizers
Antipsychotics
Anti-anxiety medications
Data will change; the decision process will not

158
159

12 Prescribing psychotropics for older patients
Seniors at risk
Non-adherence – a major problem
Principles of psychotropic medication prescription in the elderly
Regular re-evaluation
Senior medication problems – general strategies
Specific psychotropic medication considerations in the elderly

183
184
185
186
187
188
190

145
147

151
152
152
153

161
162
163
165
165
166
168
169
170
172
173
175
176
176
177
177


CONTENTS

13 Medication of sleep problems
Facts and definitions
Stages of sleep
Evaluating a sleep problem
Principles of treating sleep disorders

Treatment of sleep problems
Necessity of follow-up
Sleep problems in special populations

195
195
196
198
201
201
206
207

14 Alcohol, recreational drugs and psychotropic medication
Ingesting chemicals – a human activity
Routine warnings regarding alcohol use and psychotropics in the
non-substance abusing patient
Routine warnings for other recreational drugs
Early detection of substance abuse
Signs of alcohol abuse
The CAGE assessment tool
Polysubstance abuse
Evaluation of the intoxicated and withdrawing patient
Psychotropic medications and dual diagnosis patients
Psychotropics used in the treatment of substance use disorders
Psychotropics in treatment of alcohol withdrawal
Other interventions for the prescriber with a substance abusing patient

211
212

216
218
218
218
220
220
221
222
225
229
230

15 The confused and cognitively impaired patient –
medication pitfalls
General principles of dealing with the confused patient
Cognitive disorders – delirium and dementia
Management of delirium and dementia
Medication use in delirium and dementia
Dementia of the Alzheimer’s type
Current medications for Alzheimer’s dementia
Mild cognitive impairment
Psychiatric diseases that may present with confusion

234
235
236
241
241
243
245

247
248

16 Inattention and hyperactivity – ADHD and stimulants
ADHD – a diagnosis which is increasing rapidly
What are the syndromes of ADHD and why is it confusing?
What are the causes of ADHD?
How is ADHD diagnosed in children?
ADHD in adults
Stimulant medication and its appropriate uses
Other medications used in ADHD
Additional treatments for ADHD beside medication
Other alternative/home remedies for ADHD
Abuse of stimulants

251
251
253
254
255
257
259
261
262
262
263

xiii

xiv

CONTENTS

Part IV Medication dilemmas and their clinical
management

273

17 Psychotropic medications and side effects
During the initial evaluation
Useful advice to patients
Side-effect assessment in follow up visits
How much of a problem is it?
Other issues to consider in evaluating side effects
Changing medication due to side effects
Severity of side effects
Side effects and clinical response
The novice clinician and side effects
Side effects seen most frequently
Sedation
Overactivation/anxiety
Nervousness
Akathisia
Hypomania
Sleeplessness as a side effect
Tremor
Nausea and gastrointestinal problems
Sexual interference
Weight gain

“It must be the medication . . .”
Intervention helps
Approaches to medication-induced weight gain
Headaches
Asthenia
Dry mouth
Hair loss
Skin reactions
Prolactin elevation
Hypotension
Falls
Elevation of blood sugar and lipids
Hyponatremia
Suicidality
Side effects and medication combinations

275
276
278
279
280
280
281
282
283
283
284
285
286
287

288
289
289
290
291
293
300
302
304
304
307
308
308
308
310
312
314
314
315
317
318
319

18 Danger zones – areas of risk with psychotropics
P-450 issues made easy
Serotonin syndrome
Anticholinergic intoxication
Lithium toxicity
QTc interval issues

324
325
333
336
340
343


CONTENTS

Sudden death and antipsychotics
Extrapyramidal symptoms, neuroleptic malignant syndrome and
tardive dyskinesia
Monoamine oxidase inhibitor reactions
Other potentially dangerous side effects
19 Medication allergies
Identification of allergic responses
Management of allergy symptoms
Other issues of evaluation when allergy is suspected
Stopping the offending medication
What else to do
Pills contain more than just the active ingredient
Part V

Competent clinical practice

349
350
359
364

375
375
377
377
378
379
379
381

20 Misuse of medication – taking too much and taking too
little
How medication misuse presents
Accidental and careless overutilization
Intentional overdose
Serious overdose
Minor overdose
Using too little medication
Fraud and abuse with psychotropic medications
Practitioner protections against abuse of prescription medications
The development of abuse
If abuse is suspected
The pharmacist as ally
What to do when abuse occurs

383
386
386
387
389
390

390
391
392
394
395
396
396

21 “Difficult” medication patients and how to treat them
Overriding principles of managing difficult patients
The patient who abuses the telephone
The overly anxious patient
The patient preoccupied with side effects and negative reactions
The minimal contact patient
The non-compliant patient
The patient who needs to be in charge
The information overload patient
The “naturalist”
The borderline patient
Consultation and disengagement
The patient is not always the problem

399
399
403
403
404
406
407
409

411
412
414
418
419

xv


xvi

CONTENTS

22 Prescription writing and record keeping
The written prescription
Record keeping
Elements of a clinician’s prescriptive note
Systems for note taking
Style items in a medication note
Separate medication lists
Ongoing laboratory monitoring
Confidentiality and security of records
Record every encounter, not every fact
Documenting unusual treatment

422
422
424
424
426

427
427
427
430
431
432

23 Serum blood levels of psychotropics
When blood levels help
Instructions to patients
Frequency of blood levels
Using clinical judgment
When blood levels do not help
Necessary documentation

433
433
435
436
438
438
439

24 Generic medications
Generic substitution problems
Generic change without the clinician’s knowledge
Tips for generic use
Serum blood levels and generic substitution
Mandated generics

440
442
443
443
444
444

25 The prescriber and the telephone – mainstay and
millstone
Being available by telephone
Telephone appointments
Inappropriate use of the telephone
When a patient calls too much

446
446
448
449
451

26 The digital prescriber
The Internet and the digital revolution
E-mail and the medication prescriber
A communications information sheet for patients
Electronic medical records (EMR)
Electronic prescribing and prescriptions
Tele-psychiatry – medication management via the computer
Internet-based mental health treatment modalities
Internet-based medication reference and educational information for
practitioners

Internet medication information for patients
Websites maintained by practitioners for patient information

453
453
454
457
459
460
462
464
464
467
467


CONTENTS

Data collection, protocols and oversight
Online patient access to medical records
Computer and Internet security
Social media and the prescriber – gold mine or mine field?
The nasty underside of the Internet

469
469
470
471
473

27 The pharmacist, the pharmaceutical industry and the
clinician
Interacting with the pharmacist
Preauthorization – a fact of American practice
The pharmaceutical industry
Indigent care medication programs
Media advertising and mental health medications

476
476
477
478
479
480

28 Preparing an office for mental health prescribing
Mandatory issues
Optional measures
Personal presentation
Periodic re-evaluation of image

481
481
484
486
486

29 The way forward
Practice guidelines
Genetics – the next big frontier

Lifestyle prescribing
Summary

488
488
489
490
491

Appendices

493

Index

549

xvii


List of tables

1.1
3.1
3.2
3.3
3.4
3.5
3.6
3.7

5.1
5.2
5.3
5.4
6.1
6.2
6.3
6.4
6.5
6.6
6.7
7.1
7.2
7.3

Factors that make mental health medications unique
Framework of a prescriptive interview
Important elements of history taking
Essentials to be obtained for medication prescription
Other factual information that may be useful
Depression issues checklist
Mania/bipolar issues symptoms checklist
Anxiety issues checklist
Other common mental health uses of FDA-approved drugs
The art of choosing a medication
Preferred choices of psychotropics for the hepatically impaired
patient
Recommended medications for the renally impaired patient
Recommended laboratory monitoring for psychotropic
medication

When to change antidepressants
Medication changeover sheet
Completed medication changeover sheet (dosage)
Completed medication changeover sheet (number of pills)
Factors that can increase adherence with psychotropic
medication
Using long-acting depot preparations of traditional
neuroleptics
One-stop shopping – psychiatrist or advanced practice mental
health nurse only
Non-medical psychotherapist with mental health specialist
prescribing
Non-medical psychotherapist with PCP prescribing
psychotropics

4
24
26
28
30
39–40
40
41
56–57
59
63
64
80–81
84
85

86
87
89
96
103
103
104


TABLES

7.4
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
8.10
8.11
8.12
8.13
8.14
9.1
10.1
10.2
10.3

12.1
12.2
13.1
13.2
13.3
14.1
14.2
14.3
14.4
15.1
15.2
15.3
15.4
15.5
15.6
15.7
15.8
16.1
16.2

Mental health treatments and modalities that might be
combined with medication
105
Issues related to stopping medication
107
Discontinuing medications
109
Psychotropics that may cause discontinuation syndromes
110
Psychotropics that do not cause discontinuation syndromes

110
Tips-offs that a discontinuation syndrome may be occurring
110
Symptoms of an SSRI discontinuation syndrome
111
Symptoms of a TCA discontinuation syndrome
111
Symptoms of benzodiazepine withdrawal
111
Withdrawal schedule for moderate benzodiazepine dosage
and exposure less than 1 year
112
Benzodiazepine comparison chart
113
Slow benzodiazepine taper from high dose
114–115
Symptoms of stimulant withdrawal
116
Management strategies for discontinuation syndromes
117
Possible causes of unplanned stoppages
119
Getting back on TRACCCC
126
Children and adolescents age 9–17 with mental or addictive
disorders
144
Some psychiatric disorders in children and adolescents for
which pharmacotherapy has been used
146

Child and adolescent prescriptive issues
147
Psychotropic medications to be used with caution in elderly
patients
190
Possible adverse effects of medications
192
Factors in a sleep evaluation
198
Benzodiazepine hypnotics with the recommended adult
dosage for treatment of insomnia
204
Non-benzodiazepine sedative hypnotics
204
Common drugs of abuse
213–216
The CAGE questionnaire to detect alcohol use disorders
220
Examples of diazepam and lorazepam protocols
228
The 5 A’s of brief interventions for alcohol use
231
Signs and symptoms that can alert the clinician to patient
confusion
235
Causes of confusion
235
Symptoms of delirium
237
Causes of delirium

238
Symptoms of dementia
239
Causes of dementia
240
Medical work-up for delirium and dementia
241
Dosing schedules of medication in medications used to treat
dementia of the Alzheimer’s type
246
Signs of inattention
252
Signs of hyperactivity
252

xix


xx

TABLES

16.3
16.4
16.5
16.6
16.7
16.8
16.9
16.10

16.11
16.12
17.1
17.2
17.3
17.4
17.5
17.6
17.7
17.8
17.9
17.10
17.11
17.12
17.13
17.14
17.15
17.16
18.1
18.2
18.3
18.4
18.5
18.6
18.7
18.8
18.9
18.10

Signs of impulsiveness

253
DSM-IV criteria for ADHD
253
ICD-10 wording of criteria for hyperkinetic disorders
257
Rating evaluation forms for ADHD in adults
258
List of currently available stimulant medications
260
Non-medication interventions for ADHD patients
263
ADHD therapy references
264
ADHD therapies that have some evidence-based support
265
Purported ADHD therapies that in general are not adequately
evidence based
266
Warning signs of possible stimulant misuse
267
Facts regarding psychotropics and side effects
276
Common side effects of psychotropic medications
284
Potential causes of overactivation as a side effect
287
Medications used in mental health that can cause tremor
290
Medical and surgical causes of sexual dysfunction
295

Classes of medication that may affect sexual response
296
Phase I: first responses to medication-induced sexual
interference
297
Phase II: remedies for medication-induced sexual interference
297
Drugs used to treat antidepressant-induced sexual dysfunction
299
Psychotropics and weight gain
301
Psychotropic medications causing hair loss with significant
frequency
309
Psychotropic medications with at least one case of possible
medication-related hair loss
310
Psychotropic medications with an incidence of skin rash
greater than 3 percent
311
Clinical effects of elevated prolactin
313
Metabolic effects of atypical antipsychotics
316
Monitoring protocol for patients on second generation
antipsychotics
316
Drugs with known P-450 enzyme metabolism
329–330
Symptoms associated with serotonin syndrome

334
Drugs that affect serotonin levels and have been implicated in
serotonin syndrome
335
Medications that have strong anticholinergic properties
338
Anticholinergic effect of commonly prescribed psychotropic
drugs compared with trihexyphenidyl
338
Drugs that prolong the QTc interval and/or induce torsades
de pointes
346–348
Strongly serotonergic psychotropics prohibited in conjunction
with MAOIs
361
Dietary restrictions for patients taking irreversible MAOIs
361
Drugs contraindicated for patients receiving irreversible MAOIs
362
Medications with known risk of agranulocytosis
365


TABLES

18.11
18.12
18.13
18.14
19.1

19.2
20.1
20.2
20.3
21.1
21.2
22.1
22.2
22.3
22.4
22.5
22.6
23.1
23.2
23.3
23.4
23.5
24.1
24.2
24.3
24.4
26.1
26.2
27.1
A.1
A.2

A.3
A.4
A.5

Psychotropics associated with liver toxicity
Clinical symptoms of liver toxicity
Psychotropics with a low risk of seizure
Psychotropic medications associated with higher than average
seizure risk
Common allergy symptoms
Drug allergy assessment and treatment
Misuse of medication
Methods of obtaining medication fraudulently
Reporting drug misuse in the UK
Some “difficult” medication patients
Principles of treating “difficult” medication patients
The essential elements of a prescription
Optional elements on a prescription
Elements of a prescriptive note
Sample medication list
Sample laboratory test results form
Sample laboratory test results form (filled in)
Psychotropic medications for which serum blood levels are
helpful
Therapeutic serum blood levels of commonly used
psychotropic medications
Instructions for blood level testing
Reasons to obtain more frequent serum psychotropic levels
Psychotropic medications for which serum blood levels are of
no value
Generic medications
Commonly used mental health medications that have a
generic preparation

Potential generic problems
Changes to a generic
Technological functions used by mental health prescribers and
their patients
Expected advantages of linked, computerized electronic
medical records
Services provided by pharmaceutical representatives
Mini-Mental State Examination
Commonly prescribed psychotropics by medication function
with subgroups of chemical class listed alphabetically by
generic name
Common psychotropic medicines alphabetically by generic
name
Common psychotropics available in the USA listed
alphabetically by brand name
Common psychotropics available in the UK listed
alphabetically by brand name

366
367
368
369
376
377
384
391
398
400
400
423

423
425
428
429
429
434
434
435
437
438
440
442
442
443
454
459
478
495

504
505
506
507

xxi


Preface

This is a unique book about psychopharmacology. It is written with the intent of

teaching principles and guidelines to clinicians which will result in successful,
rational and evidence-based prescribing. Step by step, it will take the reader from
the initial prescriptive evaluation for mental health medication through follow-up
sessions, to the ending of a course of medication. Special populations such as
children and adolescents, pregnant and older patients are discussed, noting the
adaptations in practice necessary for these populations. Common clinical situations in which psychotropics may be considered, such as in sleep problems, with
the cognitively impaired patient and in the treatment of alcohol abuse, are also
addressed. Other essentials of prescribing such as measuring serum blood levels,
use of generic medications, record keeping, use of the telephone and Internet are
discussed as they apply to the prescription of psychotropics.
Throughout the book there are numerous examples of suggested ways to
approach patients verbally, giving the clinician possible scripts and analogies for
clinical psychotropic prescription. These suggestions are highlighted under the
“Talking to Patients” icon. Specific remedies are detailed for potential problem
situations such as side effects and patients who are unusually difficult to treat.
This work is not intended to be a textbook of psychiatry, or to cover in depth
the issues of comprehensive psychiatric diagnosis, both of which are available in
many texts.1–6 Although many medication specifics are documented in the text
and appendices, this is much more than a compendium of drug facts, dosages or
medication side effects, which can be found in other volumes.6–13
This book is a necessary precursor and companion to using drug information
and mental health textbooks, since it helps the prescriber make sense of the facts.
It is a manual for students to learn the essentials of competent clinical practice.
The text also serves as an educational tool for current prescribers in helping to
refine their clinical practice and to organize the process of prescribing psychotropic medications.


PREFACE

References

1 Gelder M et al. (2012) The New Oxford Textbook of Psychiatry. Oxford University Press.
2 Sadock BJ and Sadock VA (2009) Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, Vol. 9. Lippincott, Williams & Wilkins.
3 Andreason NC and Black DW (2012) Introductory Textbook of Psychiatry, 5th
edn. American Psychiatric Press.
4 Hales RE et al. (eds.) (2002) The American Psychiatric Press Textbook of Psychiatry. American Psychiatric Press.
5 Henn F et al. (2001) Contemporary Psychiatry, 4th edn., Vols 1, 2, 3. SpringerVerlag.
6 Taylor D, Paton C and Kapur S (2009) The Maudsley Prescribing Guidelines,
10th edn. Informa Healthcare.
7 The Physician’s Desk Reference (2012) Medical Economics Company Inc.
8 U.S.P. Pharmacopia (2010) USP-NF.
9 Drug Facts and Comparisons (2002) Lippincott, Williams & Wilkins.
10 Arana GS and Rosenbaum JF (2004) Handbook of Psychiatric Drugs/Therapy,
4th edn. Lippincott, Williams & Wilkins.
11 Fuller MA and Sajatovic M (2005) Psychotropic Drug Information Handbook, 6th
edn. Lexi-Comp.
12 Keltner NL and Folks DG (2005) Psychotropic Drugs, 4th edn. Mosby Press.
13 British National Formulary, 62nd edn (2011) British Medical Association and
Royal Pharmaceutical Society.

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Acknowledgments

To:
My wife, Maureen O’Keefe Doran RN APRN, who is an outstanding mental
health clinician in her own right and one of the first mental health nurse prescribers in Colorado. I cannot thank you enough for your tireless first-line editing, and
your emotional support when I have needed it most.
My daughters, Alison O’Keefe Doran and Meghan Miller Macaluso. Your generation will see mental health and mental illness treatment with a clarity of vision
and freshness of spirit.

My parents, Kenneth and Kathleen Doran. Your reviews of this work brought
the wisdom of lifetimes devoted to education and the practical perspective of
healthcare consumers.