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Drug-centred psychopharmacology: a non-diagnostic framework for drug treatment

  • David Yeomans, Joanna Moncrieff and Rhodri Huws
Summary

We propose a ‘drug-centred’ framework for understanding the nature of drug treatment in psychiatry. In contrast to the prevailing ‘disease-centred’ model, which suggests that drugs work by targeting underlying abnormalities, the drug-centred model maintains that drugs exert their effects through their psychoactive properties. According to this view, distinctive drug-induced alterations to normal cognition, emotion and behaviour can modify the manifestations of mental disorders independent of diagnosis or aetiological theory. The drug-centred approach already forms the basis of some current practice, particularly off-label prescribing. Within this framework, the matching of drug-induced effects to symptoms or difficulties, taking into account the unwanted aspects of the drug-induced state, becomes the focus of a collaborative endeavour between doctor and patient, consistent with the principles of the recovery model. More research into the full range of effects that psychiatric drugs produce is required to ground a judicious drug-centred practice and inform psychiatric training.

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Copyright
Corresponding author
Dr David Yeomans, Hawthorn House, St Mary's Hospital, Green Hill Road, Leeds LS12 3QE, UK. Email: david.yeomans@nhs.net
Footnotes
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LEARNING OBJECTIVES

• Understand that pharmacological treatments may alleviate mental health problems by affecting thinking, emotion and behaviour, rather than by correcting underlying pathology

• Recognise when psychiatrists use drug treatment outside of the licensing framework and to have an explicit basis for such ‘off-label’ prescribing

• Understand the overall properties of psychiatric medications, including their subjective psychoactive effects

DECLARATION OF INTEREST

D. Y. has received payment from drug companies to speak at meetings. All authors are members of the Critical Psychiatry Network.

For a commentary on this article see pp. 237–239, this issue.

Footnotes
References
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Drug-centred psychopharmacology: a non-diagnostic framework for drug treatment

  • David Yeomans, Joanna Moncrieff and Rhodri Huws
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eLetters

Drug or Disease?

Zekria Ibrahimi, psychiatric patient, West London Mental Health Trust, Coombs Library, Southall, UB1 3EU
18 July 2015

Drugs of abuse such as cocaine produce excess dopamine; anti- psychotics damp down dopamine: both are similar in that they create an 'altered mental state'. They turn on, or they turn off, and both interfere with the brain.

Anti- psychotics are a 'third alternative'- beyond cure or disease. They reboot the brain into a sort of passive numbness. They are not healing schizophrenia, but producing an alternative to it.

The drug- centred scaffolding for prescriptions by psychiatrists would then seem the logical model (1).

To make out that schizophrenia is solely the result of a 'surfeit of dopamine' is simplistic and therefore potentially wrong. The same as most genetic and medical problems, schizophrenia is probably the result of many factors. At least David Taylor was perhaps dangerously honest when he admitted: 'Clozapine, as with other drugs, must be doing something specific and direct; it must have a mode of action, if only we knew what it was.' (2)

While we cannot define adequately the amorphous aetiology of schizophrenia, we do, pace Taylor, appear to know more about how anti- psychotics operate. We seem aware, from a text book such as Stahl's (3), about neurons, neurotransmitters, what receptors each individual drug- from aripiprazole to zuclopentixol- blocks, or partially blocks, whatever.

Surely, then, to focus on the drug a la Yeomans rather than on the disease could be described as more rational.

Anti- psychotics are not a hundred per cent miracle. The ugly side effects- movement disorders and the metabolic syndrome- might account for the dreaded non- compliance that psychiatrists ascribe to lack of insight. Anti- psychotics stem from the dopamine theory of schizophrenia, a broad brush hypothesis. Articles such as that by Yeomans put the anti- psychotics under the spotlight- thus to emphasise all the flaws, all the errors, inevitable in cynical therapy that is only about prescriptions, only about drugs.

REFERENCES:

(1) Drug- centred psychopharmacology: a non- diagnostic framework for drug treatment. D. Yeomans et al. Advances (2015), vol. 21. 229-236.

(2) The straw man of prescribing in psychiatry. D. Taylor. Advances (2015), vol. 21, 237-239.

(3) Anti- psychotics and Mood Stabilisers. S.M.Stahl. CUP. 2008.

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Conflict of interest: None Declared

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