Front Matter

Clinical Pharmacy Specialist—Psychiatry; and Clinical Assistant Professor, Departments of Pharmacy and Psychiatry, Virginia Commonwealth University Health System, Richmond, Virginia

Attending Consultation-Liaison Psychiatrist, West Los Angeles VA, Greater Los Angeles Health System, Los Angeles, CA

Associate Professor, Department of Psychiatry, Yale University School of Medicine, and VA Connecticut Health Care System, West Haven, Connecticut

Private Practice, Hematology and Oncology, Moorestown, New Jersey

Attending Psychiatrist, Memorial Sloan Kettering Cancer Center; and Associate Professor of Clinical Psychiatry, Weill Cornell Medical College, New York, New York

Consultation-Liaison Psychiatrist, Arlington, Virginia

Assistant Professor of Psychiatry, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia

Robert L. Sadoff Professor and Vice Chair of Education; and Director, Psychiatry Residency Program, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania

Chair of Psychiatry, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; and Professor of Psychiatry, Creighton University School of Medicine, Phoenix, Arizona

Emeritus Professor, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania

Associate Professor, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C.

Associate Professor, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy; and Clinical Associate Professor, Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, Virginia

Assistant Clinical Professor, Department of Psychiatry and Behavioral Science, New York Medical College at Westchester Medical Center, Valhalla, New York

Chief Psychiatry Resident, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia

Professor of Psychiatry and Professor of Surgery, Western Psychiatric Institute; and Consultation Liaison to the Liver Transplant Program, Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Postdoctoral Fellow; and Assistant in Clinical Psychiatry, Department of Psychiatry, Columbia University, New York, New York

Director, Department of Psychiatry, Westchester Medical Center Health System; and Edith Har Esh, M.D., Professor and Chairman, Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York

Professor of Psychiatry, Oregon Health & Science University, Portland, Oregon

Professor, Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada

Private Practice in Psychiatry, New York, New York

Associate Medical Director for Behavioral Health, Babylon Health; and Volunteer Faculty, Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, Texas

Clinical Pharmacy Specialist—Psychiatry, Department of Pharmacy; and Clinical Associate Professor of Psychiatry, Associate Professor of Pharmacy, Mayo Clinic College of Medicine & Science, Mayo Clinic, Rochester, Minnesota

Rhona Arenstein Professor of Psychiatry, Professor of Medicine and Surgery, Chair of the Division of Consultation-Liaison Psychiatry, and Vice-Chair, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia

Private Practice, Psychiatry, Harleysville, Pennsylvania

Professor, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Psychiatrist, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; and Associate Professor, Creighton University Arizona Health Education Alliance, Phoenix, Arizona

Assistant Professor, Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

Clinical Assistant Professor, Department of Psychiatry, Weill Cornell Medical College, New York, New York

Private Practice, Main Line Healthcare Endocrinology, Wynnewood, Pennsylvania

Assistant Professor, Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas

Professor of Psychiatry, Columbia University Medical Center, Columbia University; and Director, Consultation-Liaison Psychiatry Service, New York Presbyterian Hospital–Columbia University Irving Medical Center, New York, New York

Director, Consultation-Liaison Psychiatry Service, and Fellowship, Department of Psychiatry and Behavioral Science, New York Medical College at Westchester Medical Center, Valhalla, New York

Instructor, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C.

Professor, Department of Health Sciences, University of York, Heslington, York, United Kingdom

Professor and Chief Psychiatric Consultant, Penn Transplant Institute; and Program Director, Penn/VA Consultation-Liaison Psychiatry Fellowship, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

Pediatric Hematology/Oncology Clinical Pharmacy Specialist, Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York

The editors would collectively like to acknowledge multiple individuals for their support, encouragement, and thoughtful input during the preparation of this book. We thank our original contributors, who have undertaken to update their original contributions, and welcome our newest authors for their high-quality contributions. We continue to appreciate the wisdom and dedication of Dr. Laura Roberts, Editor-in-Chief of American Psychiatric Association (APA) Publishing, as well as the editorial staff of APA Publishing for their enthusiastic encouragement to produce a third edition.

Dr. Levenson would like to thank his wife, Janet, his family, and his colleagues for their support.

Dr. Ferrando would like to thank his wife, Maria, and his children, Luke, Nicole, Marco, and David, for all their support.

We are very happy with the publication of this third edition of the Clinical Manual of Psychopharmacology in the Medically Ill, the collective effort of many expert clinicians, including 11 new authors. The mission of this third edition is the same as that of the first two: to serve as a clinical manual and educational tool for specialist and nonspecialist clinicians for the psychopharmacological treatment of patients with medical illness. Every chapter has been thoroughly updated, with thousands of new references. Nineteen new psychiatric drugs have been approved by the U.S. FDA since the publication of the second edition, and we and the other contributors have incorporated them in the manual whenever relevant. There have also been 19 new forms or routes of administration introduced for previously approved psychiatric drugs (e.g., transdermal, intranasal, long-acting injection), which can be particularly important for patients who cannot take a pill or capsule, a common occurrence in the medically ill (see Chapter 3, “Alternative Routes of Drug Administration”). We are also pleased that many fellowship programs approved by the Accreditation Council for Graduate Medical Education have adopted this book as a core reference and text for teaching the principles and practice of prescribing psychotropic medication to psychiatrically and medically ill patients. Furthermore, physicians in other specialties of medicine, including primary care specialties, have found the manual to be useful.

Since the publication of the first two editions, the importance of the co-occurrence of psychiatric and medical illness has become even more evident (van Niekerk et al. 2022). There is increasing recognition that patients with medical and psychiatric comorbidity have more functional impairment, disability days, emergency department use, rehospitalization, and other medical care costs than do those without such comorbidity. Many studies have found that collaborative and integrated models of care that address patients’ medical and psychiatric needs together improve outcomes (Bartels et al. 2018). Health care systems are developing new and innovative models of population-based care that integrate medical and psychiatric care in an effort to increase quality and prevention while decreasing use of expensive services such as emergency department visits and hospitalizations. In this context, a broader array of physician and nonphysician practitioners will be called on to prescribe psychiatric medications to individuals with medical illness, taking into account neuropsychiatric, metabolic, and other side effects as well as drug-drug and drug-disease interactions. Of further importance is the fact that outpatient practitioners will be called on to take care of sicker patients more than ever before, making issues of safe prescribing even more critical. It is our hope that this manual will continue to fill a key need for up-to-date and practical information.