Introduction

Not infrequently, one of our patients will tell us the following during a follow-up office visit:

“At my last appointment, you spent a long time discussing my new medication with me. Even though you asked me several times if I had any questions about my new drug, none occurred to me at the time. However, I had many more questions about the medication once I got home than I had in your office.”
We have pondered this paradox over the years and have concluded that there are several key reasons that patients often require much more information about their psychiatric medications than they take away from their prescribing physicians—even under ideal circumstances. We believe that the following are some of the reasons for this important discrepancy:

  1. Anxiety. Despite most physicians' efforts to be supportive, empathic, communicative, and where appropriate, reassuring, many patients remain highly anxious in their doctors' offices. Specialists in internal medicine have documented that the blood pressure of many patients becomes elevated because they feel stressed by being in the medical environment—a phenomenon called “the white coat effect.” The anxiety of many patients upon being told that they require a psychiatric medication can interfere with their ability to concentrate and absorb the information being imparted their physicians. During their appointments, they may feel so nervous that they “draw blanks” when their doctors ask if they have any questions about their medications. It is only later—on the drive home or after the prescription has been filled—that many important questions and concerns occur to them.
  2. Psychiatric disorders may impair attention and concentration. The acute symptoms associated with many—if not most—psychiatric disorders impair patients' ability to absorb and process information. For example, patients with obsessive-compulsive disorder might be preoccupied by intrusive and distracting concerns or worries during the entirety of their office visits. Similarly, people with psychotic disorders might be focusing on fearful delusions or auditory hallucinations at the exact moment that their psychiatrists are explaining how to take their medications. Prototypically, major depression affects the brains of many people with this condition, and they are unable to pay attention or concentrate at their usual levels. The minds of people with mania often are racing to such a degree that they are unable to slow down sufficiently to listen to the advice and instruction of their physicians. The net result is that people with these and many other psychiatric conditions often are not in the states of mind to attend to or process their doctors' information about their medications.
  3. Learning differences. As educators, we understand that people acquire and retain new information (i.e., "learn") in different ways. Certain individuals are "auditory learners," and these individuals often do quite well during office visits in retaining important data about their medications imparted by their psychiatrists. Other patients, however, find having more visual stimuli and written information is helpful for them to learn optimally, and these patients will benefit from well-organized and succinct information about their medications.
  4. Stigma. The stigmatization of people with mental illnesses—and of those of us in the caring professions who are devoted to helping them—has important ramifications for the transmission of information about psychiatric disorders. Many people with psychiatric illnesses are reluctant to accept that they have these conditions. For these individuals, the idea that they must take a psychiatric medication is a tangible “admission” that they have a mental illness. When told by their physician that they must take a psychiatric medication, their resistance and denial may be so strong that they do not pay close attention to the specifics of the doctor's explanations and recommendations.
  5. Skepticism. Even when patients acknowledge that they do, in fact, have a mental illness, they might not believe that “something they swallow” can elevate their mood, help them think more rationally, or make them feel more like themselves. The specific symptoms of many mental illnesses may also reinforce the patients' disbelief in the benefit of psychiatric medications. For example, people with major depression often feel hopeless and are especially pessimistic that anything can change their sad feelings and self-deprecating beliefs. Individuals with paranoid disorders are often distrustful of those, such as physicians, who they believe might want to influence or control them with drugs. Often, people with mania enjoy their grandiose ideas and inflated mood and therefore, do not want medications to “bring them down.” The net result is that they do not accept what their physicians tell them about psychiatric medications and may even believe that such drugs will bring them great harm.
  6. Time. Physicians are usually very busy, and there is often limited time available (or reimbursed) to review the full range of information related to the new medication being prescribed. In addition, responding to patients' concerns about the efficacy and side effects of prescribed medications can take a great deal of professional time. Primary care physicians, in particular, commonly prescribe psychiatric medications but often have only brief periods of time to spend with each patient. Patients sense this time pressure and may feel uncomfortable asking their physicians for clarification or additional information about their medications. We have had patients tell us that they feel “stupid” because they do not understand certain scientific information conveyed to them about their psychiatric medications. Others have said that they do not want to “bother” us with their “dumb questions.” Thus patients are bereft of information that may have made them feel more confident about the safety and benefits of their medications, and they may even be confused about our prescribing information.
  7. Complexities of the human brain and psychiatric medications. The human brain is our most complex organ, and arguably, its most important functions involve regulation of mood, thinking, perceptions, impulses, and behavior. The mechanisms of action, benefits, and side effects of psychiatric medications—as they alter the brain to treat psychiatric disorders—are also difficult to describe and understand. Our patients acquire new information in many disparate ways. Some patients learn best through dialogue with physicians, whereas others are “visual learners” and may prefer to read about and think through new ideas in the quiet of their own homes.
Understanding these varying needs and differences among our patients, the authors undertook to write the first edition of What Your Patients Need to Know About Psychiatric Medications. Drs. Hales and Yudofsky have active clinical practices, and we have provided for most of our patients supplemental information from the book about the medications that we prescribe. Our patients have been uniform in their feedback to us that the information in these forms has been most helpful to them, and we believe that their compliance with medications has also improved significantly. Additionally, the information that we imparted to our patients from the first edition of What Your Patients Need to Know About Psychiatric Medications has improved our communication with our patients. For example, they are much more proactive in informing us about medication side effects. For these reasons, because so many new psychiatric medications have become available since we published the first edition of the book, and because new data have emerged about the safety, side effects, and effectiveness of psychiatric medications over this time, we have decided that it would be worthwhile to update the information in a second edition of the text.

What Your Patients Need to Know About Psychiatric Medications has been written by two psychiatrists and a pharmacist with many decades of experience as clinicians, educators, and authors. Based on this experience, we have endeavored to write a book that addresses the barriers to optimal psychopharmacological treatment as enumerated above. We have attempted to complement the work of the treating physician by writing a book that provides patients with relevant, easy-to-use, and easy-to-understand information about psychiatric medications. The book has been conceptualized and organized to answer the most common questions that patients have about their psychiatric medications—including how to take their medications and the benefits and side effects of those medications. Emphasis is placed on the clarity, accuracy, and accessibility of information offered. We have prioritized information that is evidence-based and that enhances the safe and effective use of psychiatric medications. We believe that the more informed our patients are about their psychiatric disorders and their medication-based treatments, the greater the degree of their compliance, safety, and treatment response. We hope that we have written a book that physicians will “prescribe” to their patients receiving psychiatric medications. We also hope that What Your Patients Need to Know About Psychiatric Medications will enhance patients' understanding of why they need to take medication and will increase their motivation to comply with their physicians' treatment recommendations. We believe that the book will also help improve patient–physician communication regarding psychiatric medications.

Acknowledgments

The authors would like to thank John McDuffie, Editorial Director at American Psychiatric Publishing, Inc., for his strong support of this project, and Bob Pursell and his exceptional marketing team for developing an excellent marketing plan. In addition, Greg Kuny, Managing Editor of the Books Department, completed the detailed editorial review of the manuscript in his usual meticulous fashion. Tammy Cordova, Graphic Design Manager, designed the cover, incorporating artwork by Peter Shahrokh, and Judy Castagna managed the manufacturing of the book and accompanying CD-ROM.