Psychodynamic psychopharmacology

[F0nzie]

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Found an interesting article some of you might be interested in reading: http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1946385

 

[nitemagi]

Saw it. Interesting. I actually am enrolled in analytic training right now. Relevant to every clinical interaction. Long road for training though.

 

[F0nzie]

I actually am enrolled in analytic training right now. Relevant to every clinical interaction. Long road for training though.

How do you enroll? What's involved?

 

[nitemagi]

Psychoanalytic Training?

http://apsa.org/

Try and find an institute in your area. I waited until I finished training. It's easier since it's part-time and you have more say in your schedule as an attending/staff psychiatrist than as a resident.

 

[F0nzie]

Thanks. Sounds like a good opportunity after residency

 

[whopper]

I remember back in my younger days, taking phsyiological psychology in college, they actually showed circuits in the brain that were theorized to be invovled with the subconcious and evidence supporting the existing theories.

This is stuff that is not taught in psychiatry residency and should be.

 

[NoNoNoNo]

Saw it. Interesting.

Same, I saw it, read it, and found it very interesting.

 

[PETRAN]

I remember back in my younger days, taking phsyiological psychology in college, they actually showed circuits in the brain that were theorized to be invovled with the subconcious and evidence supporting the existing theories.

This is stuff that is not taught in psychiatry residency and should be.

+1


There is a lot of relevant neuroscientific and experimental cognitive research which is not taught in all programs of phd clinical psychology either.(well, ofcourse it depends in the PhD and the psychiatric residency i guess. A PhD in a "top-league" university could be more theory/research based . The same could be for psychiatric residency although a lot of research is highly biased from a molecular-cellular view as far as i know). From a psychological perspective they always teach the traditional same-ol "schools of thought" stuff despite the fact that there have been made huge progressions in various areas e.g. in experimental psychopathology for example.


There is some very interesting research on the "unconsious" (e.g. Lewicki on the complexity of the unconscious, Lotus on repressed memories, Kihlstrom on dissociation and the nature of the unconscious), how "intelligent" really is, if it is like Freud's view (a "repository" of "energy") or more like a highly automized-hyperlearned-network (a lot of evidence about this in modern research) which is based on some striatal and limbic networks (also a lot of evidence about this). Then there is lots of interesting information-processing research about the various alterations in perceptual sensitivity and bias of various mental-health problems, Wegner's experimental research on thought supression and conscious volition, Shallice and Norman's theories about the frontal executive functions and controlled/automatic processes etc.


I think this is the way forward of "mind-science" (well it already is e.g. cognitive/affective science/neuroscience) and there have appeared some very interesting mathematical/probabilistic/Bayesian/non-linear models of brain-function for various processes (perception, action, language-production, emotion). In time, these computational theories would become more "wet" (e.g. involving specific circuits, neurotransmitters and would be more biologically restrained). It would be really interesting (and crazy) if the future of mental health would involve complex maths and psychotherapy (or tMS, or even pharmacotherapy), based on some-kind of complicated non-linear brain-calculus .


Here is Lewicki and his classic famous experimental research on "non-conscious information processing"


http://www.mwbp.org/research/lewicki/



An interesting paper on the modern science of the unscionscious by the master of the subect-Kihlstrom


http://socrates.berkeley.edu/~kihlstrm/Vienna07_precis.htm


And Wegner's very important research on a lot of crucial subjects (among others)



http://www.wjh.harvard.edu/~wegner/



Ofcourse, if you only do drug-consultations this research would make little difference. But i think its good to know the scientific cutting-edge on mental-health-related underlying processes.

 

[nitemagi]

Ofcourse, if you only do drug-consultations this research would make little difference. But i think its good to know the scientific cutting-edge on mental-health-related underlying processes.

Great Post, Petran. A point of the OP though is that in psychodynamic psychopharm, it is actually VERY relevant for drug consultations.

 

[Studious]

I saw this the other day, too. It's very interesting. Prescribing in psychiatry is unlike prescribing in any other field, and the psychiatrist himself is an instrument of treatment. Although the same issues with compliance arise as in any field, there are still more issues that arise when you're dealing with psychopathology.

 

[kugel]

I know I tend to be pretty reductionistic, but "psychodynamic psychopharmacology" seems to be just a fancy way of doing what salespeople are trained to do. I do not mean that to be any sort of an insult. I believe the folks who teach sales at a high level are probably the best applied psychologists working. Now psychodynamic psychopharmacology puts sales into terminology that is familiar to psychiatrists and psychotherapists, and that's very useful for them (us). However, the principles remain the same whether you are teaching them to car salesmen, or vacuum cleaner salesman, or telemarketers, or to door-to-door knife salesmen (as I was at 18).

I truly believe that there are two huge gaps in medical treatment that account for the vast majority of treatment failures (when diagnosed and prescribed properly). Those two gaps are:
1) Selling the treatment.
If you don't get the patient (and often significant others) to buy into the diagnosis and treatment, then it is very unlikely that it will get utilized as intended. The idea of a physician as a salesman may seem crass, but I believe it is very important.
2) Instructing the patient (and significant others).
Without proper instructions (usually written - in the patient's primary language), very few treatments will be utilized properly. When I ask my own father (Masters Degree) what his physician said just a few hours ago, he usually cannot tell me more than 50%. And that was true 30 yrs ago, too. So I know it's not just an artifact of age.

If psychodynamic psychopharmacology is the program that achieves this, then I'm all for it.

 

[Studious]

I know I tend to be pretty reductionistic, but "psychodynamic psychopharmacology" seems to be just a fancy way of doing what salespeople are trained to do.

I agree with that to a point. However, you have an established, long-term relationship with your patient as a psychiatrist, whereas a salesman simply advertises a product to their customer, sells it, and then moves on. They may return to sell more stuff later, but I wouldn't consider it any sort of relationship.

Therefore, within the context of this doctor-patient relationship, there are dynamics that aren't present in the salesman-customer relationship.

 

[swanny]

A couple of articles on this topic

Am J Psychother. 2002;56(3):322-37.

Meaning and medication in the care of treatment-resistant patients.

Mintz D.

J Am Acad Psychoanal Dyn Psychiatry. 2006 Winter;34(4):581-601.
A view from Riggs: treatment resistance and patient authority - III. What is psychodynamic psychopharmacology? An approach to pharmacologic treatment resistance.
Mintz D, Belnap B.

 

[digitlnoize]

I agree with that to a point. However, you have an established, long-term relationship with your patient as a psychiatrist, whereas a salesman simply advertises a product to their customer, sells it, and then moves on. They may return to sell more stuff later, but I wouldn't consider it any sort of relationship.

Therefore, within the context of this doctor-patient relationship, there are dynamics that aren't present in the salesman-customer relationship.

As someone who did sales for 10 years before med school, I beg to differ. Sure, I had some "clients" with whom I had very superficial relationships, but with many of my regular customers I forged a very strong bond, eerily similar to the doctor-patient relationships I'm experiencing now.

Granted, I was doing sales in a music store, so maybe that's different than working for Dunder Mifflin, but I had to make lasting relationships with local band directors, musicians, etc. People would much rather buy from their buddy Bob than from some super-box store down the street, especially if you can get close to or the same price as the big box.

Our company also provided us with a good bit of psych-esque sales training, which I found very useful both then and now. The two fields are more related that you would think.

 

[fiatslug]

thanks for the links, Swanny--I'm looking forward to reading those articles. This is an interesting discussion, as I work in a partial hosp setting, and see pts generally for 3-5 weeks tops. *Most* improve signifincantly with group/individual (CBT-focused) work, along with psychopharm tx, but when I get someone who is *stuck*, it's tough. I have a few "stuck" pts here (most with more than a whiff of Cluster B issues, one with serious somatiform issues thrown in for good measure) now. Tough to get traction in such a short window of tx, esp for those who are waiting for the meds to "kick in" before engaging in any real self-change....