Feature

Most practicing psychologists think that psychotropic medications can be an effective addition to psychotherapy, a recent study indicates. In 2005, APA hired a pharmaceutical research company--Martin Akel & Associates--to survey a random sample of Monitor readers to learn more about practicing psychologists' views on and experience with psychotropic medications.

The researchers drew participants from a pool of 2,500 randomly selected practicing psychologists who had been Monitor readers for at least a year. Akel & Associates sent questionnaires to this pool, and received 470 valid responses.

All of the respondents said they see many clients taking psychotropics--approximately one in three--and they expect that the number will continue to increase.

These results echo an in-house research study of practitioners conducted by APA in 1999. That survey found that 99 percent of responding psychologists collaborated with physicians who prescribed psychotropic and other drugs. Most respondents--96 percent--had at least one patient on psychotropic medication.

In the current survey, readers also indicated an interest in learning new information about these pharmaceuticals, such as new classes of drugs, their indications and treatment outcomes.

In response to this interest, the Monitor will publish a series of articles addressing the practical issues that practicing psychologists face when treating patients taking psychotropic medications as well as when helping patients discontinue medications. Psychologists with patients taking psychotropics need to become familiar with what the drugs do, what should happen when they work, what may happen when they don't and what kind of side effects to watch for, comments Glenn Ally, PhD, a certified medical psychologist in Lafayette, La. In fact, many survey respondents are already actively consulting with primary-care physicians and psychiatrists, providing them with a diagnosis and thorough assessment of the patient. Most respondents--98 percent--said they refer patients to a physician for possible psychotropic treatment. Almost three-quarters make these referrals on a monthly basis.

Such numbers indicate that psychologists often consult with physicians when decisions are being made regarding such patient-care issues as which drugs are appropriate; whether to change medications or in some cases discontinue medication; and how the medication fits into the patient's overall treatment plan. Indeed, psychologists treating patients who have been prescribed psychotropic drugs are in a good position to monitor compliance, observe possible behavioral or physical side effects and evaluate a drug's effectiveness, notes Michael Enright, PhD, RN, a practicing psychologist in Jackson Hole, Wyo., who, as a licensed RN, has prescriptive authority.

Articles in the new Monitor series will provide psychologists with information they may find helpful when consulting with physicians on--and observing effects of--the integration of drug therapy into a patient's treatment plan or the reduction and discontinuation of psychotropic drug use. Indeed, for psychologists who hold prescriptive authority, the power to prescribe can also be the power to "unprescribe," notes Russ Newman, PhD, JD, APA's executive director for professional practice. The series will provide information about drug trends, side effects and problems; new research on existing medication; and descriptions of new classes or methods of drug therapy.

Psychological and psychotropic issues

The Monitor wants to hear from members about their psychotropic-related knowledge needs (see end note). Here's some of what the survey revealed in that regard:

  • Psychologists treat a fairly broad range of disorders. Although survey respondents list anxiety and mood disorders as the disorders they most often treat, they are also treating everything from personality to psychotic to childhood disorders. In fact, during any given 24-month period, responding psychologists say that they see clients experiencing problems related to six to seven different disorder categories.

  • Respondents see many patients of all ages on psychotropic drugs. On average, 39 percent of the respondents' patients are on drug therapy. Respondents who see children less than 13 years old said that about 22 percent of patients in that age group take psychotropic medications. Survey respondents report that 29 percent of their teenage patients--those 13 to 19 years old--are taking psychotropic medications. However, responding psychologists report that adult patients are more likely to be on drug therapy--46 percent of patients 20 to 59 years old and 43 percent of patients older than 60 years.

Participating psychologists expect that these numbers will increase: 62 percent think that medication will play a greater role in treating mental health disorders over the next three to five years. In addition, 21 percent of surveyed practicing psychologists expect to be more involved in patients' drug therapy in the next few years.

  • Medication can be a useful tool. Most of the survey respondents--99 percent--believe that psychotropic drugs can play a positive role in treating mental health disorders. In the survey, 91 percent of respondents say that psychotropic drugs "often are an effective adjunct to psychotherapy."

Respondents also mentioned other reasons that contributed to their view of psychotropics as playing a positive role in therapy, such as the somatic nature of certain disorders and positive patient feedback. However, respondents still rely heavily on talk therapy: 89 percent report using cognitive or cognitive-behavioral therapy, 52 percent use dynamic/analytic therapy, 35 percent use systems therapy and 24 percent report using play therapy.

  • Practicing psychologists are already involved in patients' drug therapy. Most psychologists cannot prescribe, but 83 percent of respondents say they "frequently" weigh in their own minds and with other medical professionals and with patients whether psychotropic drugs should be used or continue to be used. Only 22 percent say they "rarely" weigh the use of psychotropic drugs with patients. Many responding psychologists--70 percent--report referring on a monthly basis. Most respondents--98 percent--report at some time referring patients to prescribers for possible drug therapy. Out of all of their patients who take psychotropic medications, 42 percent of respondents' patients on drug therapy start medication after the respondent refers them to a prescribing doctor. Two-thirds of respondents report that when prescribing, physicians seek their advice about patients' mental disorders--sometimes even when they haven't referred the patient in question. These discussions often, but not always, include specific classes of drugs. Respondents also discuss possible changes to drug therapy and monitor patients' progress.

The need to know

Because drug therapy is so frequently a part of patients' overall mental health treatment, 82 percent of respondents say that they are interested in learning new information--for both themselves and their patients. The classes of drugs keep growing, and new research--often conflicting--is conducted virtually constantly, notes Elaine LeVine, PhD, a conditional prescribing psychologist in Las Cruces, N.M. There are many issues to consider, and it can be difficult to keep up with all of it. In this new series, debuting this year and running quarterly next, the Monitor hopes to cover useful news, research and information about psychotropic drugs in an easily digestible form.

Further Reading

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