Handbook of Clinical Psychopharmacology for Psychologists

Mark Muse, Bret A. Moore, Mark Muse, Bret A. Moore

• Publisher: Wiley
• Year: 2012
• Print ISBN: 9780470907573
• eBook ISBN: 9781118235089
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Praise for Handbook of Clinical Psychopharmacology for Psychologists

" Handbook of Clinical Psychopharmacology for Psychologists is a remarkably thorough introductory textbook for integrating psychotropic drug prescribing into psychological practices. It covers basic concepts in physiology, neurology, and pharmacology in easily understood language. Not only is this book a requirement for any psychologist seeking to gain prescriptive authority, but it is also helpful for any mental health clinician who collaborates with prescribers of any discipline. I recommend it highly." —Daniel Carlat, MD, Editor in Chief of The Carlat Psychiatry Report

"An important resource for any psychologist who is preparing to become a prescribing psychologist or for any psychologist who wants to be informed about the practice of medical psychology." —Joseph E. Comaty, PhD, MP, coauthor of A Primer of Drug Action

" Handbook of Clinical Psychopharmacology for Psychologists is an excellent treatise written by psychologists for psychologists." —From the Foreword by Patrick H. DeLeon, PhD, and Jack G. Wiggins, PhD, former presidents of the American Psychological Association

An essential and practical guide to integrating psychopharmacology into clinical practice

Edited by medical psychologists with contributions by notable experts in their respective specialties, Handbook of Clinical Psychopharmacology for Psychologists covers key topics including:

• Ethics, standards of care, laws, and regulations relevant to clinical psychopharmacology
  
  

• Disorders of the nervous system, with particular relevance to psychopharmacology
  
  

• Use of comprehensive diagnostic strategies to establish differential diagnoses among possible medical and psychological symptoms
  
  

• Integration of pharmacotherapy with psychotherapy
  
  

This essential book also provides an introduction to the qualifying exam for psychologists seeking specialty training in psychopharmacology, the Psychopharmacology Exam for Psychologists (PEP). The PEP-like practice test is available on the companion CD-ROM.

Chapter 1

MEDICAL PSYCHOLOGY

Definitions, Controversies, and New Directions

What’s in a name?

—Juliet Capulet

Bret A. Moore

Mark Muse

The field of medical psychology includes the specialties of 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. Yet the term “medical psychology” is an umbrella term: it encompasses the multiple specialties that make up healthcare 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.

By adopting the biopsychosocial paradigm, the field of medical psychology has recognized that the Cartesian assumption that the body and mind are separate entities is inadequate, representing as it does an arbitrary dichotomy that works to the detriment of healthcare (Burns, Mueller, & Warren, 2010). The biopsychosocial approach reflects the concept that the psychology of an individual cannot be understood without reference to that individual’s social environment (Steele & Price, 2007). For the medical psychologist, the medical model of disease cannot in itself explain complex health concerns any more than a strict psychosocial explanation of mental and physical health can in itself be comprehensive (Miller, 2010). Rather, the specialties that constitute medical psychology strive to integrate the major components of an individual’s psychological, biological, and social functioning and are designed to contribute to that person’s well-being in a way that respects the natural interface among these components.

The biopsychosocial paradigm (Engel, 1977)—or, more aptly, the psychobiosocial paradigm (LeVine & Orabona Foster, 2010)—argues not so much for the standard, multidisciplinary division of a person into discrete parts as for the integrated care of the whole person by a professional who is trained to assess and treat all these functional components within his or her specialty area. Indeed, the whole is greater than the sum of its parts when it comes to providing comprehensive and sensible behavioral healthcare.

DEFINITION OF MEDICAL PSYCHOLOGY

The idea that psychologists should be allowed to integrate psychopharmacology and the principles of traditional behavioral science into their clinical practice has been met with considerable controversy. From the perspective of its proponents, progress toward this goal has been slow but steady. Over the past two decades, the debate over whether medication management should be within the purview of psychologists—that is, their right to have prescriptive authority—has taken place at professional conferences, in the pages of professional journals (Julien, 2011), before state boards of psychology and medicine, and within academic and legislative halls throughout the country. Although this debate has reflected mainly the opinions of organized psychiatry versus psychologists (Muse & McGrath, 2010a), it has not been exclusively so. One point of contention within professional psychology itself is how the term “medical psychology” should be defined, as well as which areas of applied psychology should have the right to adopt it. For example, Division 38 (Health Psychology) of the American Psychological Association (APA) has taken the stance that the terms “medical psychology” and “medical psychologist” should not be equated with prescriptive authority exclusively (American Psychological Association Division 38, 2010). In a position statement, Division 38 makes the case that the term medical psychology has a long history within the profession and has not been traditionally associated with the right of psychologists to prescribe medication.

In agreement with the concern raised by Division 38 about use of the term medical psychology to mean exclusively the authority to prescribe medication, the Academy of Medical Psychology supports an inclusive definition, by which medical psychology is viewed as a specialty within psychology that requires training at the postdoctoral level and utilizes the skills of professionals in clinical psychology, health psychology, behavioral medicine, psychopharmacology, and medical science. This point of view is most consistent with the definition put forth by Division 55 of the APA, the American Society for the Advancement of Pharmacotherapy, which states that “[medical psychology] is that branch of psychology that integrates somatic and psychotherapeutic modalities into the management of mental illness, substance-use disorders, and emotional, cognitive, and behavioral disorders” (American Psychological Association Division 55, 2007). This view is also in keeping with the inclusive definition offered 30 years ago by Prokop and Bradley (1981) in the first cogent treatise on the subject entitled “Medical Psychology: Contributions to Behavioral Medicine.” Although these authors believed that medical psychology in the 1980s emanated primarily from psychologists housed within schools of medicine, they also foresaw the overlapping of various emerging disciplines, such as health psychology and behavioral medicine.

Much of the concern of Division 38 and other specialties that have traditionally used the term medical psychologist stems from a recent legislative statute in the State of Louisiana in which the term refers specifically to those psychologists licensed by the Louisiana State Board of Medical Examiners to prescribe medications. This statute builds upon the definition issued 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. The DEA definition notwithstanding, the problem with legislating at a state level the exclusive use of the generic term “medical psychologist” by those psychologists who can prescribe psychotropic medication is that it makes it illegal for other medical psychologists to use the term when referring to themselves within such a jurisdiction. In our opinion, this unfortunate consequence can be avoided by writing future prescriptive authority laws in such a way as to distinguish those medical psychologists who prescribe from those who do not prescribe.

PRESCRIBING MEDICAL PSYCHOLOGY

Since the editors of this volume wish to highlight the integration of clinical psychopharmacology within the psychobiosocial paradigm of medical psychology, we will herein treat the field of medical psychology as a generic one, from which springs the discipline of prescribing medical psychology, and define it as follows:

Medical Psychology is a postdoctoral specialty within applied psychology that integrates evidence-based psychological principles with medical science for the purpose of diagnosing and treating emotional, cognitive, behavioral, and psychosomatic disorders. Pharmacologically trained medical psychologists can prescribe, in concert with psychobiosocial interventions, psychotropic medications or advise patients and other professionals about the use of such medication.

Nothing in this definition prevents health, rehabilitation, or pediatric psychologists or neuropsychologists, or any other subspecialty of psychology, such as pain management or primary care psychology, from using the term medical psychology or medical psychologist. The definition does, however, specifically identify a subgroup of medical psychologists who are competent in medication management. Such professionals are referred to here as “prescribing medical psychologists” and are understood to be engaged in the practice of prescribing medical psychology.

In the editors’ view, the term prescribing medical psychology most aptly conveys the complexities of this emerging field and captures the rigors of training and clinical practice inherent in integrating psychopharmacology within the psychobiosocial model of health and disease. To refer to individuals who have been trained to be proficient in managing psychotropic medications simply as “prescribing psychologists” does not do justice to their extensive instruction in all aspects of the psychobiosocial model. The individual chapters of this text cover each of the 10 content areas that constitute the subspecialty of prescribing medical psychology and attest to the complex integration of the sciences of psychology and medicine in the preparation of psychologists to prescribe medication.

PRESCRIBING MEDICAL PSYCHOLOGY AND THE PRESCRIPTIVE AUTHORITY MOVEMENT

Because of the broad scope of this subject and space constraints, it would not be prudent to offer a comprehensive review of the history of prescribing medical psychology and the prescriptive authority movement at this juncture.1 For our purposes here, it is more appropriate to highlight the core issues and arguments that propel prescriptive authority within the greater context of medical psychology. These essential arguments illuminate the importance of medical psychology in general and prescribing medical psychology in particular, as well as the reasons why the profession of clinical psychology hinges on the success of this branch of clinical practice.

PROFESSIONAL PSYCHOLOGY IN CRISIS

Professional psychology—that is, the practical application of the science of psychology in the clinical domain—is in danger of becoming obsolete or obviated by other burgeoning professions such as clinical social work and professional counseling. This is due to a multitude of factors, including the shorter preparation time required for the latter groups to pursue their career, preferential contracting by third-party insurance because of the inherently lower costs/reimbursement rates for their services, and effective legislative lobbying by other behavioral health providers to gain competencies that once were reserved for psychologists. Clinical psychology can no longer hold itself out to the public as the sine qua non of psychotherapy. It is, quite literally, being overrun by competitors and ignored by payers. In the eyes of any accountant, this turn of events spells trouble.

Clinical psychology has, indisputably, bona fide differences from other disciplines that offer behavioral health services; traditionally, these differences were founded on this discipline’s respect for science and evidence-based approaches, as well as on its development and practice of psychometric-based diagnostic techniques. Still, these differences are largely ignored by third-party payers whose business plan is based on reduced costs rather than on the excellence of a product or outcome. At the same time, large third-party insurers have shifted reimbursement and emphasis from psychotherapy to psychiatric treatment (i.e., psychotropic medication) for an array of conditions that have traditionally been effectively managed with psychotherapy (Olfson & Marcus, 2010).

Medical psychology, on the other hand, not only creates and applies evidence-based diagnostics and interventions, but it does so in an area of practice that is hard to replicate in disciplines with shorter career paths because of the extensive training needed to round out the practitioner in both the psychosocial realm and the biomedical arena. It is the contribution of the medical p...

Table of contents

• Cover
• Contents
• Title
• Copyright
• Dedication
• Integrating Care: A Foreword on Changing Times
• About the Editors
• About the Contributors
• List of Illustrations
• List of Tables
• Chapter 1: Medical Psychology
• Chapter 2: Integrating Clinical Psychopharmacology Within the Practice of Medical Psychology
• Chapter 3: Neuroscience
• Chapter 4: Nervous System Pathology
• Chapter 5: Physiology and Pathophysiology
• Chapter 6: Biopsychosocial and Pharmacological Assessment and Monitoring
• Chapter 7: Differential Diagnosis in Medical Psychology
• Chapter 8: Pharmacology
• Chapter 9: The Practice of Clinical Psychopharmacology
• Chapter 10: Research in Clinical Psychopharmacology
• Chapter 11: Professional, Legal, Ethical, and Interprofessional Issues in Clinical Psychopharmacology
• Epigraph
• Index
• About the CD-ROM