Principles and Practice of Psychopharmacotherapy, Fifth Edition

In the 1970s, the publication of the Feighner Criteria for psychiatric diagnosis (1) highlighted a shift in psychiatry from a focus on psychoanalytic theory to an emphasis on the biological basis, or medical model, of psychiatric illness. Despite this trend, the tendency remains among many psychiatrists and other healthcare professionals to treat symptoms rather than the underlying illness. Forty years later, clinicians far too often use psychopharmacologic agents with little evidence to support their efficacy, defaulting to sloppy polypharmacy practices. As Zorumski stated in his foreword for the most recent edition of Goodwin and Guze's Psychiatric Diagnosis, “In the absence of accurate diagnosis, medicine largely becomes a 'Tower of Babel' where no one understands what is going on” (2). In order to provide optimal evidence-based treatment for our patients, it is imperative that we make a stronger effort to solidify diagnosis. In the most recent edition of Principles and Practice of Psychopharmacotherapy, Janicak, Marder, and Pavuluri place the emphasis back on diagnosis as the basis of treating psychiatric illness. In a user-friendly design, the book is organized into sections based on diagnosis and treatment of the major psychiatric disorders, with relevant discussions of other topics, including therapeutic neuromodulation and the interpretation of efficacy studies. The authors present information regarding various psychopharmacologic agents by detailing the most current studies and take it a step further by critiquing the quality of the research methods employed. Based on this evidence, recommended treatment strategies are outlined for management of numerous clinical presentations. Perhaps most importantly, the reader is encouraged to interpret the available data in a manner that will drive sound clinical decision making in everyday practice. As the authors point out, “unfortunately, efficacy is often assumed on the basis of clinical lore or by uncritically accepting the results of a few studies” (p. 48), urging readers to critically evaluate individual studies before buying into the merits of a new drug.

This textbook is of particular utility to residents in training, who frequently find themselves frustrated with the lack of practical information provided in many textbooks regarding clinical practices, such as dosing and therapeutic drug monitoring. Even the introductory discussion of pharmacodynamics and pharmacokinetics centers on clinical significance, with pertinent case examples highlighting these principles in practice. A more detailed description of each individual drug provides an added benefit to new psychiatrists and other healthcare professionals. But the utility of this book is not limited to physicians in training, as its review of the critical supporting research and subsequent translation into effective practice strategies proves relevant to clinicians at all stages of practice.

The only problem I have with this textbook is that with the rapidly expanding pool of clinical trial data, the research presented in this edition will not be current for long. For now, however, I recommend it as a primary tool for psychiatrists, residents, and other healthcare professionals hoping to expand their knowledge and application of psychopharmacotherapy principles.