The American Society of Clinical Psychopharmacology, Inc. Model Psychopharmacology Curriculum for Psychiatric Residency Programs, Training Directors, and Teachers of Psychopharmacology. American Society of Clinical Psychopharmacology, New York, 1997, 702 pp. Individuals: ASCP member, $450; nonmember, $750; institutions, $600, pharmaceutical companies, $2,500 per site (soft cover)
First, let me disclose my possible conflict of interest: I am a member of the national board of trustees of the American Society of Clinical Psychopharmacology, Inc. (ASCP). Unfortunately, even being a member of the board of trustees did not preclude me from not knowing about the ASCP Model Psychopharmacology Curriculum until recently. A few months ago, a friend, and, coincidentally, a member of the subcommittee that created this curriculum, asked if I had happened to see the curriculum. Being a teacher and an avid reader with an interest in clinical psychopharmacology, I was immediately interested. Clinical psychopharmacology has grown into a well-recognized clinical discipline. ASCP established itself as an umbrella organization that organizes a certifying examination in clinical psychopharmacology. Numerous psychopharmacology texts have been published. There is also the American Textbook of Psychopharmacology, in its second edition (1). However, many would agree that the teaching of psychopharmacology in many residency programs is not well organized; the knowledge and expertise of teachers are lacking; and the "national standards" for teaching psychopharmacology do not exist. Thus, any attempt to create a model curriculum is meritorious and worth reading and reviewing. The ASCP Curriculum Sub-Committee (Drs. Glick, Doraiswamy, Halper, Janowsky, Klein, Lydiard, Preven, Ward, and Zisook, and Mr. Ross) states that this curriculum is the organization's response to requests from the American Psychiatric Association, residency training directors, and teachers of psychopharmacology.
The Curriculum is divided into a "didactic section" and eight appendices. The first few pages describe its rationale for creating this curriculum, organization of a psychopharmacology program, overview, and educational objectives. The next part of the didactic section is called "What and How to Teach" and first delineates a model didactic program. The authors suggest teaching at three levels: a "crash course" (PGY-1 level), a basic course (PGY-2 and -3 levels), and an advanced course (PGY-4 level). They also suggest that, whenever possible, lectures should be accomplished by seminars, relevant clinically-oriented journal articles, case examples, textbook readings, individual supervision, and case-conferences. They provide general issues and concepts for each class of drugs, a template for lecture topics, and a list of specific lecture topics for various classes of drugs, diagnoses, patient populations, and special topics, such as psychosocial aspects of psychopharmacology. The organization of case-conferences is also discussed. It further includes a table of basic psychopharmacology textbooks, journals, and newsletters (where I missed "Psychiatry Drug Alerts"), an outline for a neuroscience lecture series, and a description of psychopharmacology units. The "didactic session" continues with a discussion of "How to Evaluate" and ends with a section on child and adolescent psychopharmacology (authors: J. Oesterheld and I. Wood). This section consists of printed slides, a lecture outline—comments for slides, four child and adolescent rating scales, a case-study with many questions for discussions, and a Child and Adolescent Psychopharmacology Curriculum Outline. This is a very well-organized section, with a wealth of practical information. The only flaw is the number of typographical errors in the slides.
Appendix A, the main part of the Model Curriculum, contains a 31-lecture series (this count includes the above-mentioned Child and Adolescent part) with over 1,500 hard copies of slides). I agree with the authors that this is probably the largest, most up-to-date, and complete collection of slides on the topic of psychopharmacology ever assembled.
The Basic Courses for Beginning Residents (PGY2) consists of 12 lecture/slide sets: Basic Principles of Pharmacodynamics (C. DeBattista); Pharmacokinetics of Psychotropic Drugs (T. Ketter); Psychopharmacology of Bipolar Disorders (T. Ketter, N. Ward); Antipsychotics in the '90s (J. Halper, D. Goff, S. Marder); Atypical Antipsychotics (J. Halper, D. Goff, S. Marder); Basic on Antidepressants (N. Ward); Substance Abuse—An Overview of Drugs of Abuse, Diagnostic Considerations for the Substance-Related Disorders, Treatment of Substance Use Disorders, Alcohol and Drug Dependence Detoxification, Dual Diagnoses or Comorbidity in the Context of Substance Use Disorders, and Causes of Substance Use Disorders, With an Emphasis on Genetics (M. Schuckit); ECT (electroconvulsive therapy; M. Fink); Sleep Disorders (D. Kripke, N. Ward); The Pharmacotherapy of Violence (P. Candilis); The Diagnosis and Pharmacologic Treatment of Aggression in the Elderly (R. Hales, S. Yudofsky); and Traumatic Brain Injury (R. Hales, S. Yudofsky).
Again, this series contains a wealth of useful material. All the lectures are well-balanced. The lecture on sleep disorders is witty and has a good discussion of melatonin and sleep hygiene and a description of "how to become an insomniac." Some might consider the part on pharmacotherapy of violence and traumatic brain injury overemphasized; however, it is important, especially for residents during their inpatient rotation. I was puzzled, however, by the absence of lectures on benzodiazepines and some other drugs (e.g., cognitive enhancers).
The Advanced Courses (PGY-3 and -4) contain 18 lecture/slide sets: Recognition and Treatment of Panic Disorder (B. Lydiard, N. Ward); Obsessive—Compulsive Disorder (N. Ward); Social Phobia (B. Lydiard); Generalized Anxiety Disorder (B. Lydiard, N. Ward); PTSD (posttraumatic stress disorder) and Adjustment Disorder With Anxiety (N. Ward, B. Lydiard); Atypical Depression (D. Klein, D. Preven); Treatment-Resistant Depression (N. Ward); Treatment-Resistant Depression: Management of Antidepressant- and Lithium-Induced Side Effects (M. Pollack, N. Ward); Bulimia Nervosa (S. Agras); Diagnosis and Treatment of Dementia (J. Harris); Psychoses in the Elderly (D. Jeste); Late-Life Depression (S. Zisook); Combining Pharmacotherapy and Psychotherapy (I. Glick); Psychopharmacology of Personality Disorders (L. Siever); Adult ADHD (attention-deficit hyperactivity disorder; P. Roy-Byrne); Body Dysmorphic Disorder (K. Phillips); Diagnosis and Treatment of Premenstrual Dysphoric Disorder (T. Grady); and Sexual Dysfunction Caused by Depression and Antidepressants (T. Segraves). These slides are mostly good, but, unfortunately, most of the slide sets do not have any accompanying text. The discussion of MAOIs in the whole volume is superficial (for example, Lydiard and Word point out MAOIs' advantage in comorbidity of panic, social phobia, and major depression, but do not discuss their use). The treatments of atypical and treatment-resistant depression are addressed, but what about "ordinary" depression? What about discussing the possible use of MAOIs in PMS? Why outline the treatment of bulimia and not anorexia? The discussion of combining pharmacotherapy and psychotherapy is superficial. Why discuss body dysmorphic disorder and not somatization and hypochondriasis (a much bigger problem, in my clinical experience)? However, these are minor flaws. The amount of clinically important information is invaluable (for example, the use of buprenorphine in treatment-resistant depression, the "disappearance" of avoidant personality symptoms after 1 year on MAOIs, etc.).
Appendix B is a small collection of rating scales used in psychopharmacology. It is a bit biased, as it contains two documents from the Medical University of South Carolina, yet does not have the Montgomery—Asberg Depression Rating Scale or the patient self-rating scales such as the Zung or Beck. The print or copying is poor. Nevertheless, it is useful. Appendix C contains a list of other useful books. Appendix D lists additional journals. Appendix E lists books and associations for patients and their families. Appendix F contains evaluation forms for the trainee, supervisor, and program. Appendix G describes the "Investigative Psychiatry Curriculum: Advanced Psychopharmacology Within the Training." Finally, Appendix H lists ASCP videotaped lectures.
This is a very useful, practical volume. There are a few reparable flaws. I suggest that the ASCP: 1) have slides, and not just hard copies, available for a special discount for the owners of this curriculum (e.g., one dollar/slide); furthermore, 2) consultation over the phone or by e-mail should be available for the owners of the curriculum; finally, 3) several slide sets are "in a vacuum," without accompanying text. Nevertheless, I would, even with my conflict of interest, heartily recommend this curriculum to any residency training director, anyone designated Director of Psychopharmacology Training (a position suggested for each program by the ASCP), or any clinical psychopharmacologist interested and involved in teaching. I dare to state that even those clinicians not directly involved in teaching might benefit from reading and reviewing this volume. You can order it at (212) 268-4260 or fax your order to (212) 268-4434.
This review originally appeared in Annals of Clinical Psychiatry 1999; 11:92—94. Reprinted with permission.