Psychotropic Drugs

To date, the effectiveness of psychotherapy for the treatment of most mental disorders is empirically well documented. From an "evidence-based medicine" viewpoint, psychotherapy, as compared to other treatments in medicine, can be regarded as one of the most effective therapeutic approaches. The superiority of psychotherapy over pharmacotherapy is particularly pronounced in long-term treatment outcome studies.

OBJECTIVE: Reported cases of multiple personality disorder have increased dramatically in the last decade. Few data are available on the treatment of multiple personality disorder. Current recommendations are based on the experience of individual clinicians rather than on systematic research. METHOD: A questionnaire study of 305 clinicians representing a spectrum of mental health professionals was conducted to survey the types and relative efficacy of treatment modalities currently used with cases of multiple personality disorder.

Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares. Level A. Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Level A. Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Level B. Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Level B. Clonidine may be considered for treatment of PTSD-associated nightmares. Level C.

Functional capacities, such as attachment and affect regulation, object relations capacity, symbolic function and language development, now documented by neuroscientific research and epigenetics, are reviewed. Results from this research, together with other factors, are posited to have contributed to effective contemporary psychoanalytic and psychotherapeutic treatments for the psychoses and schizophrenias.

Recent discoveries about the effects of drugs of abuse on the brain and the mechanisms of their addictions; new chemical compounds, including immunotherapies; and new actions of available medications are offering many opportunities for the discovery and development of novel medications to treat addictive disorders. Furthermore, advancements in the understanding of the genetic and epigenetic basis of drug addiction and the pharmacogenetics of the safety and/or efficacy of the medications are providing opportunities for more individualized pharmacotherapy approaches.

Biomarkers have been receiving increasing attention, especially in the field of psychiatry In contrast to the availability of potent therapeutic tools including pharmacotherapy, psychotherapy, and biological therapies, unmet needs remain in terms of onset of action, stability of response, and further improvement of the clinical course. Biomarkers are objectively measured characteristics which serve as indicators of the causes of illnesses, their clinical course, and modification by treatment.

The field of genetics, which includes the use of 'omic' technologies, is an evolving area of science that has emerging application in phytotherapy. Omic studies include pharmacogenomics, proteomics and metabolomics. Herbal medicines, as monotherapies, or complex formulations such as traditional Chinese herbal prescriptions, may benefit from omic studies, and this new field may be termed 'herbomics'.

WHAT IS KNOWN AND OBJECTIVE: Psychotherapy has traditionally competed with psychopharmacology. As drugs have become the more dominant treatment in psychiatry and primary care, this approach is increasingly criticized as limited in scope, lacking in robust outcomes and too heavily influenced by the pharmaceutical industry. Our objective is to show that recent advances in neurobiology are clarifying that learning and environmental experiences, such as psychotherapy, change brain circuits as do drugs.

BACKGROUND: Marijuana use by teenagers often predates the use of harder drugs, but the neurobiological underpinnings of such vulnerability are unknown. Animal studies suggest enhanced heroin self-administration (SA) and dysregulation of the endogenous opioid system in the nucleus accumbens shell (NAcsh) of adults following adolescent ?(9)-tetrahydrocannabinol (THC) exposure. However, a causal link between proenkephalin (Penk) expression and vulnerability to heroin has yet to be established.