Front Matter

The following contributor to this book has indicated a financial interest in or other affiliation with a commercial supporter, a manufacturer of a commercial product, a provider of a commercial service, a nongovernmental organization, and/or a government agency, as listed below:

Margo C. Funk, M.D., M.A., has received a speaking honorarium of less than $1,000 from Acadia Pharmaceuticals for a 4-hour Education Session for Scientific Team on QTc Prolongation (July 2021).

Most psychotropic medications are fairly safe when prescribed appropriately. However, like other medications, psychotropic medications are associated with various side effects. Although some of them are rare and paradoxical, others are quite common and even expected. Although most associated side effects are mild and require no intervention other than cautiously waiting to see whether they subside, sometimes dose adjustment or the addition of another medication is necessary.

The focus of this pocket guide is on those adverse effects that we, in consultation with our colleagues, considered to be serious and potentially life-threatening. The chapters, authored by a combination of experts and novices in the field, provide summaries of the current state of knowledge on particular topics and are not simply opinions based on personal experience.

We conceptualized this pocket guide as a simple and practical reference book with chapters listed in alphabetical order. The information contained is up to date (e.g., the management of hypertensive crisis with monoamine oxidase inhibitors). We strove to keep the structure of chapters cohesive, with an introduction followed by sections on recognition and detection, culprit medications, assessment, management, and follow-up management. The user can easily navigate through the text, choosing to read it in its entirety or to skip some chapters or section(s) when a quick decision is needed. However, this book is intended to be read and used as a whole because we believe that the information contained within is necessary for a comprehensive understanding of prescribing in psychiatry.

This pocket guide is intended to be what it is, a pocket guide. It does not cover all side effects like some complete volumes on this topic—for instance, Goldberg and Ernst’s (2019) book on managing side effects of psychotropic medications, which is an excellent reference text. Ours is a volume mostly for psychopharmacology beginners and is intended to be carried around and consulted when one suspects a serious side effect caused by a psychopharmacological agent and needs information on acute management and further steps.

The management of side effects, similar to clinical psychopharmacology itself, is at the crossroads of the art of prescribing and clinical and, at times, basic science. The art of prescribing, especially in the case of managing side effects, is not always supported by perfect evidence. Much of our knowledge about side-effect management comes from case reports and case series. It is understandable that there are few large, well-designed studies on side-effect management because there is often no effective way to investigate certain conditions (e.g., neuroleptic malignant syndrome). Given the lack of consistent evidence, managing side effects often involves the art of patient care.

As Glick et al. (2009) noted, “The art of psychopharmacology is found in the management of intricate situations that don’t quite follow the practice guidelines, and it is this art that guides many of everyday decisions clinicians make” (p. 423). They list practical advice that is applicable to our pocket guide, such as the need to always warn patients about major side effects in addition to possible controversies regarding psychiatric medications in the media (many television commercials end their list of side effects with “and death”) and the fact that not every problem that looks like a side effect is necessarily a side effect (which signifies the importance of differential diagnosis). Glick et al. (2009) emphasized the importance of frequent communication with patients and families through psychoeducation and recommended being available via various means of communication. Glick et al.’s (2009) final words tell us that the quality of psychopharmacology practice is based on a combination of knowledge, experience, judgment, and luck. In most clinical situations, diagnosis should precede the setting of goals, which should precede treatment. “How this is done—the process of managing treatment of patients and their families, often over the course of a lifetime—is in part the ‘art of psychopharmacology’” (p. 423). We believe that these words apply to the assessment and management of the serious and emergent side effects covered in this pocket guide and that the information in this book will provide readers with important knowledge to improve patient care.

Richard Balon, M.D.

Mary K. Morreale, M.D.