The development of modern psychopharmacology has been associated with striking changes in the principles and practice of psychiatry. There are now numerous psychopharmacologist-psychiatrists, a continuing proliferation of new drugs, and an enormous amount of federal money for drug research. However, the authors, who together have had extensive experience in both psychopharmacological research and the private practice of psychiatry, have felt that there is a gulf between their experiences as researchers and as clinicians seeking to apply research findings to the treatment of individual patients. In order to examine carefully the factors involved in this problem, they have exhaustively reviewed the methodology and findings of controlled clinical psychopharmacological research. In presenting their analysis of the literature, they have detailed findings of practical use for the clinician, divided according to the psychopharmacologists’ categories of “drug factors” and “nondrug factors.” It was found that as far as practical applicability is concerned, clinical drug research has not added very much to what has been learned through clinical experience, which is rather striking in view of the fact that the expressed main purpose of such research is to increase our capability as practitioners using drugs. On the other hand, the heuristic value of drug research has been great in terms of opening new approaches to understanding and influencing mental functioning and psychopathology, and in the development of research methodology for the behavioral sciences. Considered in historical perspective, perhaps the greatest clinical value of the age of drug research has been that it has catalyzed the study of directive approaches to psychotherapy. From a “preventive medicine” point of view, the frequently contradictory research results, in spite of careful control of variables, encourage more caution in theoretical formulations. The authors discuss the terms “nondrug” and “nonspecific factors,” which are frequently used by psychopharmacologists to cover in blanket fashion various critical psychotherapeutic factors in patient improvement not particularly valued by their theoretical approach. The authors point out that this narrow view has prevented adequate study of simultaneous psychotherapy and pharmacotherapy and has been reflected in the lack of applicability of research findings for the practitioner. Psychotherapy variables relating to drug therapy are discussed. At the conclusion of the paper, the authors give general guidelines for the clinical use of psychotropic drugs, based on integration of current research and clinical knowledge.
ASJC Scopus subject areas
- Psychiatry and Mental health