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The Role of Neuropsychopharmacology in Personalized Care in Mental Health Practice- Dr Mani Pavuluri
By: Dr. Mani Pavuluri - Professor of Child Psychiatry
• Clinical trials of any medication, say Drug A is tested versus placebo (inactive dummy pill) or Drug B (that was already proven to be effective to see if drug A measures up to Drug B). So, if Drug A is proven to be significantly better than placebo or equal to or better than Drug B, it is submitted for FDA indication. On approval, we get to have that new drug in our tool box. If indicated for adults, they are tested gradually also in children. As evidence slowly accrues, we can utilize that medicine for children in clinical practice, with or without FDA approval as our American Academy of Child and Adolescent Psychiatry policy explains.
How do you approach treating a person suffering from many disorders?
• This is where clinical psychiatry calls for the knowledge in neuropsychopharmacology.
You need to understand the nature of the chemical imbalance in each of the disorder and find the medications that suit that complex clinical scenario. Simply choosing the drug you think is good for anxiety may cause havoc if there is co-existing bipolar disorder. Therefore, it is critical to learn to pick that first choice of drug from the tool box.
What does the term Neuropsychopharmacology mean for a lay person?
• Neuropsychopharmacology is the knowledge about how medications work. It is a field of medicine where you need to understand the chemical features of individual drug, where exactly do the drugs work in brain and on what neuro-chemical system, how they affect the body physiology, how they interact with other drugs and how they are flushed out of the body. They are all critical factors in choosing the combination of medications. It is almost impossible to test the combination therapy in clinical trials to replicate every step we take in the treatment of any given individual patient as the scenarios are so personalized. This calls for the art and science of neuropsychopharmacology practice.
In this case of flux in treatment where clinical situation changes time to time, how does knowledge in neuropsychopharmacology impact clinical application?
• Many people have more than one disorder or problem and may take more than one medication. Questions that arise are: What is the parsimonious way to treat with least number and doses of medicines and how do they affect and/or complement each other's effect, and the illness itself? Also, how can you solve a problem if a medicine or combination of medicines do not work? How you choose the best option/s among seemingly similar or multiple options at every step will lead to effective medication regime. It is an ongoing process.
Is it possible to personalize pharmacotherapy to an individual? Where do personalizing medicine and evidence-based treatment meet?
• First, if there are several problems or co-existing disorders, you determine the priority and safety, weighing both, and choosing the first problem to be addressed. You, then, also begin with identifying the medicine that has the robust evidence for that specific disorder. You then work your way as treating physician to the next layers of treatment. This is where you realize evidence helps in choosing which drug to pick among several choices based on efficacy and safety. But ultimately, at an individual level, there are vast limitations on just applying clinical trial-based evidence as there are so many other factors to consider. You need to bring in the complementary knowledge on neuropsychopharmacology to build the treatment algorithm.
Visit the website @ http://www.brainandwellness.com/
Dr Mani Pavuluri
Page Updated Last on: May 16, 2018