Field Of Psychopharmacology Research Articles

Le rétablissement, un concept organisateur des soins aux patients souffrant de troubles mentaux sévères

Over the past two decades, research on psychosis has mainly focused on its neurobiological aspects. However, recent findings highlighted the fact that psychosocial factors may affect the risks and the clinical outcomes of psychoses like schizophrenia. In the field of psychopharmacology, the enthusiasm for new generation antipsychotics has been shown to be partially unfounded. In this context it has become necessary to reemphasise psychosocial treatments, which remain the cornerstone of the treatment of patients with severe mental disorders. Psychological recovery denotes the development of a fulfilling life and a positive sense of identity founded on hopefulness and self-determination. It has recently been recognised as an organising principle for the systems of care for the mentally ill that can replace paternalistic, illness-oriented services. Guidelines have been developed to facilitate the transformation of services according to this paradigm. Beyond organisation and training issues, treatment features should include a variety of services that support consumer self-sufficiency, encourage the utilisation of advance directives, provide culturally sensitive treatments, emphasise consumer choice, integrate treatment of co-occurring substance abuse, limit the use of coercive measures, address barriers to access, and provide family services and a full array of training opportunities. In Geneva psychiatric care is organised into sectors, which provide in- and out-patient facilities. This system allows communication between the various units involved in patient care. However, social constraints may hinder the recovery orientation we wish to implement. Firstly, the traditional social network helping people cope with their difficulties has been weakened, leading more individuals to turn to psychiatric or social facilities. Overcrowding of psychiatric facilities may result, thus forming barriers to the treatment of patients who should have priority. Secondly, social reciprocity is difficult to attain in our systems: patients receive assistance without being able to give something back (e.g. do jobs useful for the community). This prevents them from playing a role in society, thus challenging the basis of recovery, i.e. the goal of a fulfilling life and a positive sense of identity. Despite these limitations, some aspects of our care could be improved by considering recovery as an organising principle: Barriers to access should be overcome through increased clinician mobility. Indeed, some patients remain far from care due to their symptoms. Programmes like Assertive Community Treatment can overcome this problem. Additionally, goal assessment should be performed more systematically, particularly for patients with chronic conditions. Efforts should be made to increase motivation when necessary, as the lack of motivation in patients often accounts for their disabilities. In order to feature a wide array of services supporting consumer self-sufficiency, coordination should be fostered across services. Psychodynamic aspects of care should also be considered more thoroughly. Indeed, it is difficult to integrate both behavioural interventions and more psychoanalytically-oriented approaches.

The G196A polymorphism of the brain-derived neurotrophic factor gene and the antidepressant effect of milnacipran and fluvoxamine

Prediction of the response to different classes of antidepressants has been an important matter of concern in the field of psychopharmacology. The purpose of the present study was to investigate whether the G196A polymorphism of the brain-derived neurotrophic factor (BDNF) gene is associated with the antidepressant effect of milnacipran, a serotonin norepinephrine reuptake inhibitor, and fluvoxamine, a selective serotonin reuptake inhibitor. The subjects of our previous study of milnacipran (n = 80) and fluvoxamine (n = 54) were included in the present study. Severity of depression was assessed with the Montgomery Asberg depression rating scale (MADRS). Assessments were carried out at baseline and at 1, 2, 4 and 6 weeks of treatment. Polymerase chain reaction was used to determine allelic variants. In all subjects receiving milnacipran or fluvoxamine, the G/A genotype of the BDNF G196A polymorphism was associated with a significantly better therapeutic effect in the MADRS scores during this study. When milnacipran and fluvoxamine-treated subjects were analysed independently, the G/A genotype group showed greater reduction of MADRS scores than other genotype groups, irrespective of which antidepressant was administered. These results suggest that the BDNF G196A polymorphism in part determines the antidepressant effect of both milnacipran and fluvoxamine.

Does pretreatment testing for serotonin transporter polymorphisms lead to earlier effects of drug treatment in patients with major depression? A decision-analytic model

Background: An estimated 30% to 40% of patients with depression do not sufficiently respond to treatment with selective serotonin reuptake inhibitors (SSRIs) and the period in which treatment efficacy can be assessed is relatively long. Therefore, a test to identify potential nonresponders could be useful in the treatment of depression. Serotonin transporter gene (SLC6A4) variations have been reported to account for differences in the way individuals respond to SSRI treatment. Objective: A decision-analytic model was used to assess whether pretreatment genetic testing for 5-HTTLPR, a polymorphism of the SLC6A4 genotype, could be an efficient tool in the treatment of depression. Methods: A theoretical clinical decision-analytic model was constructed to compare the current treatment strategy in The Netherlands with an alternative strategy for the treatment of depression. Under treatment guidelines in The Netherlands, all patients with depression receive SSRI treatment (nontesting strategy). Under the alternative strategy, genetic testing would be performed to identify which class of antidepressant would be the best choice for initiation of treatment (genetic testing strategy). Probabilities (predicted results) for this model were based on data from previous studies and the opinions of experts in the field of psychopharmacology. To test the robustness of the model, 6- and 12-week remission rates for patients treated with SSRIs were varied in a sensitivity analysis using a predetermined range that was established based on expert opinion. Threshold analyses were performed on the parameters of serotonin transporter genotype frequency and response and nonresponse rates for patients receiving SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) to determine the value for a variable at which it could be concluded that a change in treatment strategy would be preferred. Results: When genetic testing was performed before an antidepressant was prescribed, 64.6% of patients were predicted to be in remission after 6 weeks of treatment compared with 60.0% of patients who did not receive genetic testing. After 12 weeks, 79.5% of patients in the testing group who received an SNRI as initial treatment and 83.2% of those who received a TCA initially were predicted to be in remission compared with 76.7% of patients in the nontesting group. Sensitivity analyses indicated that the model was robust to variation of probability estimates within their plausible ranges. However, these findings were based on a theoretic model and did not include cost assessment. Pretreatment genetic testing must be evaluated further in randomized clinical trials and costs must be assessed before implementing this strategy in routine psychiatric practice can be recommended. Conclusions: The findings of this study suggest that performing genetic testing before prescribing antidepressant treatment may lead to greater numbers of patients experiencing remission early in treatment.

International Congress on Schizophrenia Research: Introduction

Although schizophrenia is considered one of the most serious psychiatric illnesses, at many times during the last century it has been relegated to the background. Focus on schizophrenia research, patient care, and connections with the family members of a person who suffers from schizophrenia began to change during the 1980s. Looking back, several events propelled this change, including the initiation of the Winter Workshop on Schizophrenia Research, the emergence of NAMI as an advocacy and support group for families with a schizophrenic member, the National Plan for Schizophrenia Research initiated by the National Institute of Mental Health (NIMH), and the International Congress on Schizophrenia Research (ICOSR). The ICOSR held its first meeting in 1987 in order to provide a venue for active investigators in schizophrenia research. Nearly every attendee provided a poster, paper, or plenary presentation with the result that the meeting was characterized by the establishment of new collaborations and a wish for the Congress to continue. Since that time, the goal of the first meeting has remained the focus of the ICOSR—a venue for the active investigator. An extension of this goal has been to attract a broad range of investigators from the fields of neuroscience, cognitive neuroscience, basic and clinical psychopharmacology, psychosocial interventions, and genetics. Thus, participation is broad ranging and stimulating. Past meetings have been characterized by the extension of results from basic science to the clinical testing arena as well as the investigation of basic underpininnings of reports from the fields of psychopharmacology and neuropsychology. At the time of the initiation of the ICOSR, there was consensus that too few young faculties had taken an interest in the field of schizophrenia research. Thus, the Young Investigator Program has been a part of all the ICOSR meetings. During the last 3 meetings, the Young Investigator Program has been supported by the NIMH, to whom the organizers express their gratitude. A recent assessment of the recipients of the Young Investigator Awards has revealed that numerous of today's leaders in the field, presenters at the ICOSR, and the mentors of recent Young Investigator Award winners have been initially supported by the Congress. Because schizophrenia is a worldwide illness, the original meeting attracted investigators from outside the United States. The organizers have been pleased to welcome an ever-increasing number of schizophrenia scientists from around the world. For example, at the meeting held in Savannah, Georgia, in 2005, the majority of attendees were from outside the United States and represented more than 45 different countries. The establishment of collaborations has, therefore, extended beyond the boundaries of contingent universities to international programs aimed at solving the problems facing people with schizophrenia. With the growth of interest in schizophrenia research and the ICOSR, has come the challenge of dissemination of the results presented at the meeting. The ICOSR has been pleased to collaborate with Schizophrenia Bulletin and Schizophrenia Research in the publication of abstracts from the meeting. These collaborations allowed for a useful compendium for attendees and distribution to subscribers and libraries around the world. As the International Congress on Schizophrenia Research has expanded from a group of 175 initial delegates to larger than 1500 active investigators, support for the meeting has needed to expand as well. The organizers wish to acknowledge several very instrumental supporters of the Congress, including the NIMH, the William K. Warren Foundation, several very faithful pharmaceutical companies for unrestricted grants to the Congress, the University of Maryland's MPRC, the University of Texas at Southwestern, and the University of Minnesota. The organizers recognize that the financial and administrative support of the groups mentioned above are only a part of the picture of the sustenance of the ICOSR. The most valuable resource for the Congress over the years has been the enthusiasm and careful preparation made by the active investigators attending the meeting. Their excitement for their work, their wish to share and stimulate their colleagues, and their participation with the Young Investigators makes the ICOSR a meeting that is always highly anticipated.

Issues in the Pharmacological Treatment of Anxiety Disorders

To review the most salient issues in the pharmacotherapy of anxiety disorders. These pertain to means of achieving greater efficacy, accelerating the onset of therapeutic action, improving side-effect profile and tolerability, decreasing the propensity to induce therapeutic dependence and achieving better long-term outcome. By and large, pharmacological agents with greater efficacy in anxiety disorders have yet to be developed. Several strategies have been used with some success to make medications for anxiety disorders work faster and to lessen their side-effect burden. The field of psychopharmacology has yet to find ways of lessening or eliminating the problem of therapeutic drug dependence and, even more so, of minimizing the risk of relapse following the cessation of medication.

Issues in the pharmacological treatment of anxiety disorders

To review the most salient issues in the pharmacotherapy of anxiety disorders. These pertain to means of achieving greater efficacy, accelerating the onset of therapeutic action, improving side-effect profile and tolerability, decreasing the propensity to induce therapeutic dependence and achieving better long-term outcome.By and large, pharmacological agents with greater efficacy in anxiety disorders have yet to be developed. Several strategies have been used with some success to make medications for anxiety disorders work faster and to lessen their side-effect burden. The field of psychopharmacology has yet to find ways of lessening or eliminating the problem of therapeutic drug dependence and, even more so, of minimizing the risk of relapse following the cessation of medication.

Cyborg masculinity in the Viagra era

The figure of the cyborg has, to date, been predominantly conceptualized and examined in terms of human–machine or animal–machine hybridization. Outside the field of psychopharmacology, little has been written on cyborgs arising from human–drug combinations. This paper, however, explores the twenty-first century masculinity of Viagra cyborgs, the recent creations of sexuopharmacology. Using material from interviews conducted in 2001 with New Zealand men and women, the ways in which the experiences and perspectives of those using Viagra and engaging in Viagra-assisted sex are reinforcing and/or disrupting the discursive construction of nature and culture, originality, and authenticity are explored and the kinds of stories being told about hyper-masculinity and super-natural erections are investigated.

Placebo in the investigation of psychotropic drugs, especially antidepressants.

The paper presents major ethical, legal and methodological problems related to the use of placebo in mental disorders, especially in depression. It is pointed out that although authoritative groups of experts and numerous publications in the field of psychopharmacology indicate advisability of the double blind design with placebo in clinical trials of antidepressants, in recent years there have been more and more voices questioning legitimacy of this method. Objections of an ethical nature are raised, and reliability of this approach is put into doubt from the methodological viewpoint. These issues are discussed in more detail in the paper. Available alternative solutions should be implemented in psychotropic drug studies. The author shares these objections and doubts of an ethical nature, and believes that the placebo procedure is not a necessity in clinical trials of antidepressants.

A time of promise, a time of promises: ethical issues in advancing psychopharmacological research.

In this extraordinary time of scientific discovery and heightened awareness of the burden of mental illness throughout the world, research to develop effective psychopharmacological treatments for diverse psychiatric diseases holds great promise (Murray and Lopez 1996; DOHSS 1999, 2003). Each day brings valuable findings from studies in the basic, translational, and clinical sciences. Recent efforts to create precise, beneficial medications have been undertaken collaboratively in many nations and in academic, industry, and government settings, leading to remarkable progress (Tallman 1999; Maubach 2003). Interventions for persons with mental illness have already been found to be more helpful than those for other chronic and disabling physical conditions (Agency for Health Care Policy and Research 1999). Taken together, these advances have led to the expectation that the suffering of mental illness will be substantially lessened within the lifetimes of many of our patients. Pursuing this goal has emerged as an imperative for our society. This is a time of justified optimism. This sense of promise exists because of other promises, however. These are the promises made by investigators to honor the scientific and ethical standards of the biomedical research community (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979; Faden 1996; Brody 1998). These are the promises made by institutions and agencies to assure that participants of human studies are treated respectfully, honestly, and fairly and are safeguarded from inappropriate risks (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979; Levine 1986; Roberts 1999). These are the promises that research volunteers are invited into the scientific process with the hope of creating scientific knowledge that will help people now and in the future. These are the promises, implicit and explicit, made by biomedical professionals in fulfilling their responsibilities to a society that has increasingly supported biomedical science as a means of bettering human experience (Bulger 1994; Moreno 1995, 2003; Kelch 2002). This special issue seeks to help fulfill these important promises by highlighting the importance of ethical considerations in psychopharmacological research and related areas. It was the inspiration of one of us (J.K.) and was enthusiastically supported by the international editorial group who shepherd the journal. In creating this special issue, we sought to touch upon several areas of complexity and diversity that exist in the field of psychopharmacology. Our approach to this special issue was also informed by the basic assumption that the empirical study of ethical considerations in psychopharmacology research and intentional efforts to enhance ethics education for investigators will help support the advancement of ethically sound psychopharmacological studies in the future. Accordingly, this peer-reviewed special issue has a three-part structure. First, we highlight pieces on ethical issues in basic and clinical research. Second, we include papers and commentaries that focus on ethical considerations related to psychopharmacology studies and other forms of clinical research involving individuals who L. W. Roberts ()) Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA e-mail: robertsl@mcw.edu

Where Has All the Psyche Gone? Searching for Treatments That Focus on Psychological Issues

The field of psychotherapy can be aided by adopting an integrative model that follows a comprehensive biopsychosocial perspective. Unfortunately, recent advances in the field of psychopharmacology have appeared to overshadow the gains that can be made through psychotherapy. Psychotherapists need to protect the “psyche” that lies at the core of their treatment. Psychotherapy can promote changes in cognitive processes that help to reduce psychiatric symptoms and enhance adaptive functioning. Psychotherapists should not neglect the role of biological or social factors in the etiology or treatment of mental illness. Many clients benefit from a comprehensive biopsychosocial model and interdisciplinary collaboration among mental health professionals. Psychotherapists can maintain a strong emphasis on psychological functioning, while colleagues from other fields focus on the biological and social aspects of mental illness. Furthermore, it seems important for psychotherapists to emphasize the unique qualities of psychotherapy that are distinct from the social support that is provided from a close and confiding friendship.

Rôle de la Société médico-psychologique dans l'évolution des connaissances en psychiatrie

A quick ordering of the activities of the Société médico-psychologique into four dimensions leads to a description of the Society as a system of multiple currents shaped by scientific, sociological and philosophical activating factors. Founded on humanitarian principes, the Society has developed an array of different currents until the middle of the twentieth century and has participated actively in scientific “revolutions”, notably in the field of psychopharmacology. Its opening to the criteriologic perspective has subsequently led to a visible breach, the earlier currents and the exposition of the experiences of the patients were diminished. Psychiatry has thus moved from a modelling perspective into a digital simulation of the categories of the disorders. This rupture can, however, be overcome by means of an epistemological enlightenment and some original methods which offer the possibility of new currents being able to incorporate the earlier ones. The activity of the society thus shows its general orientations in psychiatry, a succession of currents, their integration, and a self reflection which contributes to the development of an inner dynamic. Factors related to the milieu activate it, in spite of certain delays in relation to the general scientific development, and can allow it to overcome the actual epistemological fault. Some practical consequences are indicated.

Topiramate in the Management of Bipolar Disorder

Available therapeutic drugs utilized in both the acute management and the prophylaxis of bipolar disorder are associated with a number of concerns, including insufficient efficacy (both in acute states and in prophylaxis) and WITH the incidence of adverse events in significant numbers of individuals. These factors result in inadequate treatment outcomes and poor patient adherence. Identifying more effective and better-tolerated treatments for the rapid-cycling course of the illness, mixed states, and especially for bipolar depression is thus a high priority area for research. The use of lithium in the acute and prophylactic treatment of bipolar illness remains a watershed event in the field of psychopharmacology. However, in adults, lithium treatment is associated with a 20% to 40% rate of treatment failure particularly among patients with mixed presentations or a rapid cycling course. In addition, the adverse effects of lithium-including tremors, thyroid dysfunction, polyuria, and weight gain-result in a high rate of medication discontinuations. Finally, the narrow therapeutic index for lithium may make it difficult to use, especially in children and adolescents. These factors limit the overall clinical utility of lithium in the child and adolescent patient population. In adults, valproate and carbamazepine have also demonstrated efficacy in the management of bipolar disorder, and particularly in the treatment of acute mania. A pivotal study of divalproex sodium found that 48% of bipolar patients experienced marked improvement, defined as at least a 50% reduction in manic syndrome subscale scores on the Mania Rating Scale, with divalproex sodium treatment compared to 49% for lithium treatment and 25% in those assigned to placebo. Valproate appears to be effective in patients with rapid cycling or mixed episodes. However, as with lithium, valproate treatment is associated with tremors, gastrointestinal side-effects, weight gain, hair thinning, and ovarian cysts that may pose adherence problems in young people. The majority of adult studies also suggest that carbamazepine may be effective in the management of acute mania, but with lower efficacy in prophylaxis. As with lithium, carbamazepine requires gradual dosage titration. Carbamazepine use is associated with significant side effects, including hyponatremia, thrombocytopenia, and rashes. It affects the cytochrome P4503A4 enzyme system and can therefore limit the efficacy of oral contraceptives and other psychotropic agents such as haloperidol, olanzapine, and quetiapine among others. All these issues could hinder its application in a younger patient population. Also, these three agents require monitoring of blood levels as well as liver functions (carbamazepine and valproate), thyroid functions (lithium), and renal

Computerizing Medication Algorithms and Decision Support Systems for Major

In this article, the authors discuss the rationale for the use of computerized medication algorithms and decision support systems in the treatment of major psychiatric disorders. The field of psychopharmacology has advanced tremendously in the last two decades, with the resulting vast array of new information yielding a marked disparity between actual practice and what is commonly called "best practice." As a remedy, clinical practice guidelines and algorithms have been widely developed. These algorithms are used to disseminate up-to-date information, effect change in physician behavior, and reduce untoward variation in care. Review of the literature reveals advantages and limitations in trying to implement these paper and pencil guidelines and algorithms. Available research also suggests that computerized decision support systems have the potential to overcome such limitations, increase the use of treatment guidelines and algorithms, and improve physician adherence to recommended practices. The advantages of computerized medication algorithms and decision support systems are discussed. Finally, the computer platform elements that are necessary to make such systems effective and user-friendly are described.

COGNITIVE NEUROPHARMACOLOGY: NEW PERSPECTIVES FOR THE PHARMACOLOGY OF COGNITION

Taking its roots both in neuropharmacology and in cognitive science, cognitive neuropharmacology is an emerging approach in the field of psychopharmacology. It attempts to use theoretical knowledge to understand the biochemical bases of cognition and the mode of action of the commonly used drugs and to find new brain-targeted therapeutics. The aim of the present article is to throw up the main characteristics of this way of research. It is defined in comparison with its neighbouring approaches and by presenting its own rationale. Its particular methods mainly concern the animal modelling of the highest human cognitive functions and the original means of intra-cerebral drug administration. Finally, we present an illustrative example of a study in cognitive neuropharmacology and propose further perspectives.

Psychopharmacology: The Fourth Generation of Progress

The number 2002 has various connotations in our current thinking: the year of a balanced budget and Medicare bankruptcy. But in the realm of psychopharmacology, 2002 is the number of pages in the latest edition of this definitive book on the subject. At 11 lbs it is a behemoth, but the material therein is an argosy of medical information. It is a major advance over the very good previous edition, Psychopharmacology: The Third Generation of Progress , reviewed in JAMA (1988;259:1392). The 317 contributors from around the world include the best and the brightest minds from the fields of academic and commercial psychopharmacology. Of the 163 chapters, approximately one third deal with the preclinical issues and the remainder with clinical disorders. Subject material extends far beyond the field of psychopharmacology. The use of imaging techniques is not only discussed separately, but also permeates the discussions of both research and clinical issues.

More serotonin: not as simple as it seems.

Serotonin is a current obsession of psychopharmacologists, and not without reason. The atypical antipsychotic drugs clozapine and risperidone potently antagonize serotonin receptors as well as dopamine D, family receptors. (Clozapine differs from risperidone in its relative selectivity for the D,/DZc receptor compared with the D.JD,* receptor.) There is increasing evidence to suggest that serotonin subsystems in the brain may be involved in aggression. Further, it has long been known that the major shared property of LSD-like hallucinogens (once again increasing in rates of abuse) is serotonin receptor agonism. However, the serotonin system has achieved greatest prominence in the field of psychopharmacology because of the success of selective serotoninreuptake inhibitors (SSRIs): in aggregate, these agents have become the most widely prescribed antidepressants in the United States. SSRIs also appear to be therapeutically effective in a remarkably broad range of conditions including panic disorder, obsessive-compulsive disorder, and bulimia. As the name SSRI implies, the initial biological action of these agents upon entering the nervous system is to inhibit the serotonin-reuptake transporter and thus to prolong the life of serotonin in synapses. At therapeutic concentrations these drugs have no significant direct agonist or antagonist effects on any known serotonin receptors. In fact, the actual therapeutic mechanism of action of the SSRIs (and other antidepressants) remains mysterious, with the long lag between initiation of drug therapy and therapeutic efficacy still unexplained. However, the therapeutic effect is almost certainly initiated by reuptake blockade, resulting in increased stimulation of serotonin receptors. What is not always realized is that the neurobiological

The role of quality of life measures in psychopharmacology

AbstractDespite the recent surge in interest in quality of life (QOL) measurement, surprisingly little attention has been paid to QOL in the field of psychopharmacology. Since psychopharmacology is a rapidly developing subject appraising the effect on overall QOL of new drugs is becoming increasingly important. The measurement of QOL in this area raises complex methodological issues; it is argued that there is a need for more QOL research in the field of psychopharmacology.

Strategies for assessing learning and memory, 1978–1987: A comparison of behavioral toxicology, psychopharmacology, and neurobiology

Tests of learning and memory are currently not typically included in first-tier screening batteries even though there is ample evidence that chemical exposure can produce deficits in these cognitive processes. The approach taken in behavioral toxicology has been to restrict these cognitive tests to second tier or hazard characterization studies, yet there is little agreement on which tests are most appropriate. The present survey was designed to determine the current testing strategies in toxicology for detecting and characterizing the effects of chemical treatment on learning and memory, and to make comparisons to similar data from the fields of psychopharmacology and neurobiology. The survey data revealed a number of discipline-dependent effects on the selection of tests. A number of these effects were clearly related to the subject matter as well as the particular chemical/treatment being examined. Given the youth of the field, behavioral toxicology has the advantage of gaining valuable information from both of these disciplines. Behavioral testing in neurotoxicology should consider strategies which maximize unification of these closely related fields of neuroscience.

Neurotransmitters and receptors: Clinical implications

1. With the advent of new techniques such as the radioreceptor binding assay, significant advances have been made in the field of psychopharmacology during the past seven years. 2. In this paper we discuss some of these contributions regarding our understanding about the nature of different psychopathological conditions such as anxiety, depression and schizophrenia.

The Practitioner's Guide to Psychoactive Drugs, ed 2

Without reservation, I can enthusiastically recommend this excellent book for residents in psychiatry, psychiatrists, and primary care physicians who wish to update their knowledge in clinical psychopharmacology. This is an updated version of a book published six years ago. The following new sections have been added to this edition because of the rapid growth of knowledge in the field of psychopharmacology: geriatric psychopharmacology, temporal lobe epilepsy, and the use of psychotropic drugs during pregnancy and nursing. Importantly, the editors include the new psychopharmacologic agents that have been introduced since the first edition. Additionally, brief mentions are made of experimental, but as yet unproved, applications of some drugs or drug combinations. While there are 12 chapters with nine contributors, six of the 12 chapters were written either by Schoonover or Gelenberg. The editors should be commended for their skillful job of creating a book that reads like a novel, enabling the