Academic Psychiatry 23:185-186, December 1999
© 1999 Academic Psychiatry
A Model Psychopharmacology Curriculum for Psychiatric Residency Programs, Training Directors, and Teachers of Psychopharmacology
By the American Society of Clinical Psychopharmacology, New York, 1997, 702 pages, $600.00, Reviewed by Steven L. Dubovsky, M.D.
Steven L. Dubovsky, M.D.
Key Words: Psychopharmacology • Curriculum • Training
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INTRODUCTION
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 TOP
 INTRODUCTION
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s knowledge about psychopharmacology continues to expand and psychiatrists increasingly must apply that knowledge rapidly in the treatment of complex illnesses, it is important to be certain that psychiatric residents learn enough about basic principles and applications of psychopharmacology. This work by highly respected senior members of a committee of the American Society of Clinical Psychopharmacology is an attempt to help psychiatric educators achieve this goal.
The first portion of the book contains recommendations for the content and structure of a psychopharmacology curriculum. There are some useful suggestions for different levels of teaching at different points in the residency, and for the use of case conferences and electronic teaching methods. However, while a few references are made to programmed self-paced learning, and references to the major textbooks of psychopharmacology (one of them 20 years old), the book is of almost no help to educators who want to find videotapes, let alone computerized texts and courses that might be useful to residents learning basic principles of psychopharmacology.
The committee that prepared the "Model Curriculum" appropriately feels that psychopharmacology should be integrated with the overall residency curriculum. However, the final tone of the text seems more disintegrative. For example, there is no attempt to reconcile the content and process suggested by the authors with Residency Review Committee requirements, other national standards, or the current state of most residency programs. The authors' contention that most residencies are biologically or psychosocially oriented may also belie insufficient studies of current programs.
The call for "training directors of psychopharmacology" and a "chief resident in psychopharmacology" may serve to further split psychopharmacology from other routine aspects of psychiatric practice, while the inclusion of content on diagnosis and psychotherapy seems to imply that the expert psychopharmacologist knows more about these areas than other subspecialists.
The second part of the book contains a series of lectures on most major topics in psychopharmacology. In the case of four of the topics (pediatric psychopharmacology, antipsychotic medications, atypical antipsychotics, and combining pharmacotherapy and psychotherapy), notes are provided that explain the accompanying slides. Slides only are provided for all the other topics, which include basic principles, mood disorders, anxiety disorders, substance use disorders, sleep disorders, posttraumatic stress disorder, eating disorders, psychotic disorders, obsessive-compulsive disorder, personality disorders, body dysmorphic disorder, premenstrual dysphoric disorder, adult attention-deficit disorder, traumatic brain injury, violence, dementia, and sexual side effects of antidepressants.
Most of these slides at least use the same format, but many of them seem to come from other lectures the authors have given and are not necessarily directed toward the specific types of courses suggested in the first part of the book. Some of the sections contain important information not readily available elsewhere, while others contain information available in the most basic text. The section on traumatic brain injury is particularly informative and well organized, although it does not contain information about bipolar phenotypes associated with mild head injury.
While no review of such a vast area can possibly be complete, a few additions may help the reader to select additional books and articles to specifically supplement this text. The book contains an excellent section on electroconvulsive therapy (ECT) but has nothing on transcranial magnetic stimulation (TMS), artificial bright light, sleep deprivation, social rhythms therapy, and other "biologically oriented" topics. Warnings about CyP3A4 inhibitors, like ketoconazole, which few psychiatric patients take, might be supplemented by information about grapefruit juice, another potent 3A4 inhibitor. The recommendation for a baseline EKG and EEG for children taking any medication seems whimsical at best, as does the recommendation for monoamine oxidase inhibitors, but not venlafaxine or bupropion, in children. The otherwise excellent discussion of atypical antipsychotic lacks material on Ziprasidone and other new drugs and on IM and depot risperidone and olanzapine, and minimizes the problem of weight gain with olanzapine.
Perhaps the greatest weakness of the model curriculum is that it focuses almost exclusively on current information deemed important by the lecturer and not at all on the weaknesses of today's hypotheses or on the direction tomorrow's hypotheses are likely to take. The resident is given a lot of information but is not taught how to think critically. The authors of the text emphasize the progressive nature of education in psychopharmacology, but the course work offered here does not progress.
An issue raised indirectly in this book that experts in psychopharmacology and postgraduate education should debate further is when psychopharmacology becomes a subspecialty. If notions of separate training directors, chief residents, and educational programs in psychopharmacology continue in the direction suggested in this book, one day there could be separate training programs and certification in psychopharmacology, as has occurred in subspecialty areas such as geropsychiatry and addiction psychiatry. While postresidency training and even certification for a small number of highly subspecialized individuals may eventually be dictated by advances in cell and molecular biology, genetics, and related fields, a premature drive to separate psychopharmacology from other basic aspects of psychiatric practice may enhance the mind-body split many educators are trying desperately to breach. On the other hand, a text that is readily updated electronically, that offers more of the kinds of patient management problems that are found in parts of this book, and that teaches a critical approach to current data and a framework for understanding future work is sorely needed.
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FOOTNOTES
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Dr. Dubovsky is Professor of Psychiatry and Medicine and Interim Chair, Department of Psychiatry, University of Colorado Health Sciences Center, Denver.
Copyright © 1999 Academic Psychiatry.
This article has been cited by other articles:
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I. D. Glick and S. Zisook
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I. D. Glick, D. Janowsky, and S. Zisook
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I. D. Glick, D. S. Janowsky, S. Zisook, R. B. Lydiard, J. R. Oesterheld, N. G. Ward, J. Ellison, J. Halper, P. M. Doraiswamy, D. W. Preven, et al.
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I. D. Glick, D. S. Janowsky, and S. Zisook
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