Not infrequently, one of our patients will tell us the following during a follow-up
“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
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.
- 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 environmenta 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 lateron
the drive home or after the prescription has been filled—that many important
questions and concerns occur to them.
- Psychiatric disorders may impair attention and concentration.
The acute symptoms associated with manyif not mostpsychiatric 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.
- 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.
- Stigma. The stigmatization of people with mental illnessesand
of those of us in the caring professions who are devoted to helping themhas
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.
- 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.
- 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.
- 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
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.
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.