Psychopharmacology in Clinical Practice

  • Steven G. Wager
  • Gary K. Zammit
Part of the Applied Clinical Psychology book series (NSSB)


Psychopharmacology is the study of natural and synthetic substances (i.e., drugs) that affect cognitive and emotional functioning. Clinical psychopharmacology is an extension of this discipline, and involves the treatment of mental disorders with medication. Due to the many advances in clinical psychopharmacology over the past three decades, a number of mental disorders are now treated with some form of medication. In many cases, these pharmacologic treatments are used in conjunction with psychotherapy, and this combination of treatment modalities has grown increasingly common. As a result, the psychologist often is the primary therapist for patients being treated with medication. In outpatient settings, a psychologist may be the sole person responsible for determining whether to refer a patient for treatment with medication. We believe, therefore, that it is important for clinical psychologists to develop some familiarity with psychopharmacologic agents and the indications for their use.


Anxiety Disorder Tardive Dyskinesia Neuroleptic Malignant Syndrome Manic Episode Clinical Psychopharmacology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed. rev.). Washington, DC: Author.Google Scholar
  2. Arana, G. W., & Hyman, S. E. (1991). Handbook of psychiatric drug therapy. Boston: Little, Brown.Google Scholar
  3. Asberg, M., Cronholm, B., & Sjoquist, F. (1971). Relationship between plasma level and therapeutic effect of nortriptyline. British Medical Journal, 3:331–334.PubMedCrossRefGoogle Scholar
  4. Baldessarini, R. J. (1990). Drugs and the treatment of psychiatric disorders. In A. Goodman Gilman, T. W. Rall, A. S. Nies, & P. Taylor (Eds.), The pharmacological basis of therapeutics (8th ed., pp. 383–435). New York: Pergamon.Google Scholar
  5. Baldessarini, R. J., Cohen, B. M., & Teicher, M. H. (1988). Significance of neuroleptic dose and plasma level in the pharmacological treatment of psychosis. Archives of General Psychiatry, 45, 79–91.PubMedCrossRefGoogle Scholar
  6. Bernstein, J. G. (1988). Handbook of drug therapy in psychiatry. Littleton, MA: PGS.Google Scholar
  7. Bradwejn, J., Shriqui, C., Koszycki, M. A., & Meterissian, G. (1990). Double-blind comparison of the effects of clonazepam and lorazepam in acute mania. Journal of Clinical Psychopharmacology, 10, 403–408.PubMedCrossRefGoogle Scholar
  8. Cade, J. F. J. (1949). Lithium salts in the treatment of psychotic excitement. Medical Journal of Australia, 2, 349–352.PubMedGoogle Scholar
  9. Chouinard, G., Young, S. N., & Annable, L. (1983). Antimanic effect of clorazepam. Biological Psychiatry, 18, 451–466.PubMedGoogle Scholar
  10. Chung, H. K. (1981). Schizophrenics fully remitted on neuroleptics for 3–5 years: To stop or continue drugs? British Journal of Psychiatry, 139, 490–494.CrossRefGoogle Scholar
  11. Clark, W. G., Brater, D. C., & Johnson, A. R. (1988). Goth’s medical pharmacology. St. Louis: C. V. Mosby.Google Scholar
  12. Cohen, L. S., Friedman, J. M., Jefferson, J. W., et al. (1994). A reevaluation of risk of in utero exposure to lithium. Journal of the American Medical Association, 271, 146–150.PubMedCrossRefGoogle Scholar
  13. Cohen, L. S., Rosenbaum, J. F., & Heller, V. L. (1991). Psychotropic drug use in pregnancy. In A. J. Gelenberg, E. L. Basjuk, & S. C. Schoonover (Eds.), The practitioner’s guide to psychoactive drugs (3rd ed., pp. 389–405). New York: Plenum.CrossRefGoogle Scholar
  14. Delay, J., & Deniker, P. (1952). Trente-huit cas de psychoses traitées par la cure prolongée et continué de 4560 RP. Le Congres des Al. et Neurol. de Langue Fr. In Compte rendu du Congrès. Paris: Masson et Cie.Google Scholar
  15. Deniker, P. (1983). Discovery of the clinical use of neuroleptics. In M. J. Parnham & J. Bruinvels (Eds.), Discoveries in pharmacology, Vol. 1. Psycho-and neuro-pharmacology (pp. 163–180). Amsterdam: Elsevier.Google Scholar
  16. Devanand, D. P., & Sackheim, H. A. (1990). Electroconvulsive therapy. Efficacy, side effects, and mechanisms of action. In R. Pohl & S. Gershon (Eds.), Biological bases of psychiatric treatment (pp. 170–210). New York: Karger.Google Scholar
  17. Elia, J., Katz, I. R., & Simpson, G. M. (1987). Teratogenicity of psychotherapeutic medications. Psychopharmacology Bulletin, 47, 531–586.Google Scholar
  18. Fleischhacker, W. W., Roth, S. D., & Kane, J. M. (1990). The pharmacologic treatment of neuroleptic-induced akathisia. Journal of Clinical Psychopharmacology, 10, 12–21.PubMedCrossRefGoogle Scholar
  19. Gardner, D. L., & Cowdey, R. W. (1985). Alprazolan-induced dyscontrol in borderline personality disorder. American Journal of Psychiatry, 142, 98–99.PubMedGoogle Scholar
  20. Garza-Trevino, E. S., Hollister, L. E., Overall, J. E., & Alexander, W. F. (1989). Efficacy of combinations of intramuscular antipsychotics and sedative-hypnotics for control of psychotic agitation. American Journal of Psychiatry, 146, 1598–1601.PubMedGoogle Scholar
  21. Gelenberg, A. J. (1991). Psychoses. In A. J. Gelenberg & E. L. Bassuk, S. C. Schoonover (Eds.), The practitioner’s guide to psychoactive drugs (3rd ed., pp. 125–178). New York: Plenum.CrossRefGoogle Scholar
  22. Gelenberg, A. J., Bassuk, E. L., & Schoonover, S. C. (Eds.). (1991). Practitioner’s Guide to Psychoactive Drugs (3rd ed.). New York: Plenum.CrossRefGoogle Scholar
  23. Gelenberg, A. J., Kane, J. M., Keller, M. B., Lavori, P., Rosenbaum, J. F., Cole, K., & Lavelle, J. (1989). Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. The New England Journal of Medicine, 321, 1489–1493.PubMedCrossRefGoogle Scholar
  24. Gitlin, J. (1993). Lithium-induced renal insufficiency. Journal of Clinical Psychopharmacology, 13, 276–279.PubMedGoogle Scholar
  25. Glassman, A. H., Perel, J. M., Shostak, M., Kantor, S. J., Fleiss, J. L. (1977). Clinical implications of imipramine plasma levels for depressive illness. Archives of General Psychiatry, 34, 197–204.PubMedCrossRefGoogle Scholar
  26. Goodman Gilman, A., Rall, T. W., Nies, A. S., & Taylor, P. (1990). The pharmacological basis of therapeutics (8th ed.). New York: Pergamon.Google Scholar
  27. Goodman, W. K., & Charney, D. S. (1985). Therapeutic applications and mechanisms of action of monoamine oxidase inhibitor and tricyclic antidepressant drugs. Journal of Clinical Psychiatry, 46 (10 section 2), 6–22.PubMedGoogle Scholar
  28. Goodwin, F. K., & Jamison, K. R. (1990). Manic-depressive illness. New York: Oxford University Press.Google Scholar
  29. Goodwin, F. K., Murphy, D. L., & Bunney, W. E. (1969). Lithium carbonate treatment in depression and mania. Archives of General Psychiatry, 21, 486–496.PubMedCrossRefGoogle Scholar
  30. Guyton, A. C. (1991). Textbook of medical physiology (8th ed., pp. 478–494). Philadelphia: W. B. Saunders.Google Scholar
  31. Hamilton, M. (1960). A rating scale for depression. Journal of Neurosurgical Psychiatry, 23, 56–61.CrossRefGoogle Scholar
  32. Jamison, K. R., Gerner, R. H., & Goodwin, T. K. (1981). Patient and physician attitudes toward lithium. Archives of General Psychiatry, 135, 917–922.Google Scholar
  33. Janicak, P. G., Bresnahan, D. B., & Comoty, S. E. (1987). The neuroleptic malignant syndrome: A clinical update. Psychiatric Annals, 17, 551–555.Google Scholar
  34. Jefferson, J. W., Griest, J. H., & Ackerman, D. L. (1987). Lithium encyclopedia for clinical practice. Washington, DC: American Psychiatric Press.Google Scholar
  35. Jeste, D. V., Grebb, J. A., & Wyatt, R. J. (1985). Psychiatric aspects of movement disorders and demyelinating diseases. In R. E. Hales & A. J. Frances (Eds.), APA annual review (Vol. 4, pp. 159–189). Washington, DC: American Psychiatric Press.Google Scholar
  36. Joyce, P. R., & Paykel, E. S. (1989). Predictors of drug response in depression. Archives of General Psychiatry, 46, 89–99.PubMedCrossRefGoogle Scholar
  37. Kane, J. M., Hongfeld, G., Singer, J., & Meltzer, H. (1988). Clozapine for the treatmentresistant schizophrenic: A double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789–796.PubMedCrossRefGoogle Scholar
  38. Kane, J. M., & Kinon, B. J. (1983). Tardive dyskinesia: A review of current knowledge. In A. R. Rifkin (Ed.), Schizophrenia and affective disorders, biology and drug treatment. Boston: John Wright.Google Scholar
  39. Kane, J. M., Rifkin, A., & Quitkin, F. (1982). Fluphenazine versus placebo in patients with remitted, acute first episodes of schizophrenia. Archives of General Psychiatry, 39, 70–73.PubMedCrossRefGoogle Scholar
  40. Kane, J. M., Woerner, M., & Borenstein, M. (1986). Integrating incidence and prevalence of tardive dyskinesia. Psychopharmacology Bulletin, 22, 254–258.PubMedGoogle Scholar
  41. Kocsis, J. H., Frances, A. J., Voss, C., Mann, J. J., Mason, B. J., Sweeney, J. (1988). Imipramine treatment for chronic depression. Archives of General Psychiatry, 45, 253–257.PubMedCrossRefGoogle Scholar
  42. Laborit, H., Huguenard, P., & Alluame, R. (1952). Un neuveau stabilisateur vegetatif (le 4560 RP). Presse Medicale, 60, 206–208.PubMedGoogle Scholar
  43. Lieberman, J. A., Kane, J. M., & Johns, C. A. (1989). Clozapine: Guidelines for clinical management. Journal of Clinical Psychiatry, 50, 329–338.PubMedGoogle Scholar
  44. Liebowitz, M. R., Quitkin, F. M., Stewart, J. W., McGrath, P. J., Harrison, W. M., Markowitz, J. S., Rabkin, J. G., Tricamo, E., Goetz, D. M., & Klein, D. F. (1988). Antidepressant specificity in atypical depression. Archives of General Psychiatry, 45, 129–137.PubMedCrossRefGoogle Scholar
  45. Maas, J. W., Koslow, S. H., Katz, M. M., Bowden, C. L., Gibbons, R. L., Stokes, P. E., Robbins, E., & Davis, J. M. (1984). Pretreatment neurotransmitter metabolite levels and response to tricyclic antidepressant drugs. American Journal of Psychiatry, 141, 1159–1171.PubMedGoogle Scholar
  46. McEvoy, J. P., Hogarty, G. E., & Steingard, S. (1991). Optimal dose of neuroleptic in acute schizophrenia: A controlled study of the neuroleptic threshold and higher haloperidol dose. Archives of General Psychiatry, 48, 739–745.PubMedCrossRefGoogle Scholar
  47. Meijer, J. W. A., Meinardi, H., & Binnie, C. D. (1983). The development of antiepileptic drugs. In M. J. Parnham & J. Bruinvels (Eds.), Discoveries in pharmacology, Vol. I, Psycho-and neuro-pharmacology (pp. 447–488). Amsterdam: Elsevier.Google Scholar
  48. Nelson, J. C., Jatlow, P., Quinlan, D. M., & Bowers, M. B. (1982). Desipramine plasma concentration and antidepressant response. Archives of General Psychiatry, 39, 1419–1422.PubMedCrossRefGoogle Scholar
  49. Owen, R. T., & Tyrer, P. (1983). Benzodiazepine dependence: A review of the evidence. Drugs, 25, 385–398.PubMedCrossRefGoogle Scholar
  50. Pope, H. G., Keck, P. E., McElroy, S. L., Hudson, J. I. (1989). A placebo-controlled study of trazadone in bulimia nervousa. Journal of Clinical Psychopharmacology, 9, 254–259.PubMedCrossRefGoogle Scholar
  51. Pope, H. G., McElroy, S. L., Keck, P. E., & Hudson, J. I. (1991). Valproate in the treatment of acute mania: A placebo-controlled study. Archives of General Psychiatry, 48, 62–68.PubMedCrossRefGoogle Scholar
  52. Potter, W. Z., Rudorfer, M. V., & Manji, H. (1991). The pharmacologic treatment of depression. New England Journal of Medicine, 325, 633–641.PubMedCrossRefGoogle Scholar
  53. Prien, R. F., & Kupfer, D. J. (1986). Continuation of drug therapy for major depressive episodes: How long should it be maintained. American Journal of Psychiatry, 143, 18–23.PubMedGoogle Scholar
  54. Pryor, T., McGilley, B., & Roach, N. E. (1990). Psychopharmacology and eating disorders: Dawning of a new age. Psychiatric Annals, 20, 711–722.Google Scholar
  55. Quitkin, F. M., Rabkin, J. G., Ross, D., & McGrath, P. J. (1984). Duration of antidepressant drug treatment. Archives of General Psychiatry, 41, 238–245.PubMedCrossRefGoogle Scholar
  56. Quitkin, F. M., Stewart, J. W., McGrath, P., Liebowitz, M. R., Harrison, W. M., Tricamo, E., Klein, D. F., Rabkin, J. G., Markowitz, J. S., Wager, S. G. (1988). Phenelzine vs. imipramine in probable atypical depression: defining syndrome boundaries of selective MAOI responders. American Journal of Psychiatry, 145, 306–312.PubMedGoogle Scholar
  57. Rickels, K., Case, W., Schweizer, E. E., Swenson, C, & Fridman, R. B. (1986). Low dose dependence in chronic benzodiazepine users: A preliminary report on 119 patients. Psychopharmacology Bulletin, 22, 407–415.PubMedGoogle Scholar
  58. Rifkin, A., Doddi, S., Karasgi, B., Borenstein, M., & Wachpress, M. (1991). Dosage of Haloperidol for Schizophrenia. Archives of General Psychiatry, 48, 166–170.PubMedCrossRefGoogle Scholar
  59. Risch, S. C., Janowsky, D. S., & Huey, L. Y. (1981). Plasma levels of tricyclic antidepressants and clinical efficacy (pp. 183–217). In Antidepressants: Neurochemical, behavioral and clinical perspectives. New York: Raven Press.Google Scholar
  60. Rosenbaum, J. F., & Gelenberg, A. J. (1991). Anxiety. In A. J. Gelenberg & E. L. Bassuk, S. C. Schoonover (Eds.), The practitioner’s guide to psychoactive drugs (3rd ed., pp. 167–201). New York: Plenum.Google Scholar
  61. Sachs, G. S. (1989). Adjuncts and alternatives to lithium therapy for bipolar affective disorder. Journal of Clinical Psychiatry, 50 (suppl.), 31–39.PubMedGoogle Scholar
  62. Sackheim, H. A. (1992). The cognitive effects of electroconvulsive therapy. In L. J. Thal, W. H. Maas, & E. R. Gamzu (Eds.), Cognitive disorders: Pathophysiology and treatment (pp. 183–228). New York: Marcel Dekker.Google Scholar
  63. Santos, A. B., & Morton, W. A. (1989). Use of Benzodiazepines to improve management of manic agitation. Hospital and Community Psychiatry, 10, 1069–1071.Google Scholar
  64. Schatzberg, A. F. (1988). Depressive disorders. In J. P. Tupin, R. I. Shader, & D. S. Harnett (Eds.), Handbook of clinical psychopharmacology. Northvale, NJ: Jason Aronson.Google Scholar
  65. Schatzberg, A. F., & Cole, J. O. (1991). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Press.Google Scholar
  66. Schneider, P. J. (1824). Entwurf zu einer Heilmittellehre gegen psychische Krankheiten—oder Heilmittel in Beziehung auf psychische Krankheitsformen. Tubingen.Google Scholar
  67. Shader, R. I. (1988). Stress, fear and anxiety. In J. P. Tupin, R. I. Shader, & D. S. Harnett (Eds.), Handbook of clinical psychopharmacology. Northvale, NJ: Jason Aronson.Google Scholar
  68. Shulman, K. I., Walker, S. E., Mackenzie, S., & Knowles, S. (1989). Dietary restriction, tyramine and the use of monoamine oxidase inhibitors. Journal of Clinical Psychopharmacology, 9, 397–402.PubMedCrossRefGoogle Scholar
  69. Siris, S. G., & Rifkin, A. (1983). Drug treatment of acute schizophrenia. In A. R. Rifkin (Ed.), Schizophrenia and Affective Disorders, Biology and Drug Treatment. Boston: John Wright.Google Scholar
  70. Snyder, S. H., Banerjee, S. P., Yamamura, H. I., & Greenberg, P. (1974). Drugs, neurotransmitters and schizophrenia. Science, 184, 1243–1253.PubMedCrossRefGoogle Scholar
  71. Sternbach, L. H. (1972). The discovery of librium. Agents and Actions, 2, 193–196.PubMedCrossRefGoogle Scholar
  72. Stewart, J. W., McGrath, P. J., Quitkin, F. M., Harrison, W., Markowitz, J., Wager, S., Liebowitz, M. R. (1989). Relevance of DSM-III depressive subtype and chronicity of antidepressant efficacy in atypical depression: Differential response to phenelzine, imipramine and placebo. Archives of General Psychiatry, 46, 1080–1087.PubMedCrossRefGoogle Scholar
  73. Strober, M., Morrell, W., Lampert, C., & Burrough, J. (1990). Relapse following discontinuation of lithium maintenance therapy in adolescents with Bipolar illness. A naturalistic study. American Journal of Psychiatry, 147, 457–461.PubMedGoogle Scholar
  74. Suppesit, Baldessarini, R. J., Faedda, G. L., & Tohen, M. (1991). Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Archives of General Psychiatry, 48, 1082–1088.PubMedCrossRefGoogle Scholar
  75. Tallarida, R. J. (1985). Most prescribed drugs. Philadelphia: W. B. Saunders.Google Scholar
  76. Tallarida, R. J., Raffia, R. B., & McGonigle, P. (1988). Principles in general pharmacology. New York: Springer-Verlag.CrossRefGoogle Scholar
  77. Van Putten, T., Mutalipassi, L. R., & Malkin, M. O. (1974). Phenothiazine-induced decompensation. Archives of General Psychiatry, 30, 102–106.PubMedCrossRefGoogle Scholar
  78. Wager, S. G., & Klein, D. F. (1988). Drug therapy strategies for treatment-resistant depression. Psychopharmacology Bulletin, 24, 69–74.PubMedGoogle Scholar
  79. Weibert, R. T., & Norcross, W. A. (1988). Drug interactions index. Ordell, NJ: Medical Economics Books.Google Scholar
  80. Weiden, P. J., Mann, J. J., & Haas, G. (1987). Clinical non-recognition of neuroleptic-induced movement disorders: A cautionary study. American Journal of Psychiatry, 144, 1148–1153.PubMedGoogle Scholar
  81. Weilberg, J. B., & Gelenberg, A. J. (1991). Insomnia. In A. J. Gelenberg, E. L. Bassuk, & S. C. Schoonover (Eds.), The Practitioner’s Guide to psychoactive drugs (3rd ed., pp. 219–240). New York: Plenum.CrossRefGoogle Scholar
  82. Zarin, D. A., & Pass, T. M. (1987). Lithium and the single episode: When to begin long term prophylaxis for bipolar disorder. Medical Care, 25, 576–584.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Steven G. Wager
    • 1
    • 2
  • Gary K. Zammit
    • 3
    • 2
  1. 1.Department of PsychiatrySt. Luke’s-Roosevelt Hospital CenterNew YorkUSA
  2. 2.Columbia University College of Physicians and SurgeonsUSA
  3. 3.Sleep Disorders Institute and Department of PsychiatrySt. Luke’s-Roosevelt Hospital CenterNew YorkUSA

Personalised recommendations