Responsibility as a psychologist in treating patients with antipsychotic drugs

Taking paracetamol can make a big difference between whether you are feeling ill and inapt or feeling ok (symptoms have disappeared). In some drugs, there is a fine line between efficacy and danger and this is called the therapeutic index (as shown in the graph below).

Paracetamol is to your headache as lithium carbonate is to manic depression. The daily intake is 900-1800mg divided into 3 doses, although dosage is adapted according to the existing concentration of serum in order to reach 0.8-1. mmol/L

But abusing Lithium carbonate can have side effects such as nausea, diarrhea, dizziness. Toxic reactions occur at >1.5- 2 mmol/L (therapeutic index).

Drugs with a low herapeutic index follow two assumptions:

• Suddenly taking a big amount can be fatal
• Suddenly stopping the treatment can make initial symptoms much worse

 

Drugs with a low therapeutic index are usually very efficient but also rather dangerous. So is it the responsability of the psychologist handling the data about the drugs to ensure the patients are not harmed by using the drug, that maximum protection is raised ?

To start with, it is clear that a statistician should ensure they are producing data which is reliable and valid. So that pharmaceutical companies can rely on these numbers and also so that patients can trust their treatment to be efficient. In order to do this, they should run repeated-mesures tests and should follow detailed and long-lasting evolution of the patient’s state.  As shown in the following graph, both groups of patients with pathological gambling taking the drug and those not taking the drug were tested regularly over several weeks :

Moreover, there seems to be a continuous debate about whether psychologists should be allowed to prescribe drugs to their patients in the first place. And I personally am unsure of which side of the balance weighs more. But if the psychologist is following a patient and the psychiatrist fails to prescribe the appropriate medicine, then who is to blame? Should the responsibility of the psychologist not be to ensure that the correct treatment is being applied? Some argue that psychologists are not physicians (they do not specialize in the body but in the brain and in behaviour) and therefore should not be in control of physiological changes through the use of drugs. This is John Grahol’s view on the matter: http://psychcentral.com/archives/n071498.htm

It seems evident that while psychiatrists remain the prescribors, it is indispensable for psychiatrists and psychologists to be working hand in hand and to keep in constant touch about the patient’s follow-up. Problems of colloboration could otherwise be extremely detrimental to the health of the patient. Robert Resnick argues that has seen some of his patients wait months before they could be given drug treatment and had to solely rely on therpay in the meantime. He believes this seriously delayed the curing of his patients.

See the following link to read the debate and consider both sides of the argument  which relies on a question of responsibility : http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_16-editionID_93-ArticleID_538-getfile_getPDF/thepsychologist%5Capr0

In 1988, the ‘Prescriptive authority for psychologists’ movement won the right for psychologists with doctoral master qualifications to be able to prescribe antipsychotic drugs. And this seems to be a good decision if you consider the following point :

According to the American Institute of Medicine, medicated-related errors are responsible for 7000 deaths each year.

This is due to the fact that :

–       regular testing VS entoxication is not always made

–       40% of patients were found to have been taking a medication with a low therapeutic index, WITHOUT having been warned of the dangerous consequences of abuse in doses

However research has found that when nurses voluntarily report medication administration errors, as few as 10 to 25 percent of errors are reported. Nurses are not qualified to prescribe like doctors and yet they seem to commit less error in medicating drugs. So maybe psychologists are in a similar way more apt to be prescibing drugs to their own patients ?

 

As a matter of fact, a growing population of psychologists are granted the right to prescribe drugs. According to the Ethical Principle and Code of Conduct of the APA, although most psychologists do not have the power to prescribe drugs, the usefulness in terms of meeting the patient’s need (in terms of time and quality of treatment) in this ability to diagnose and treat efficacely is highly recognised. In conclusion, I believe both sides have a valid argument but debate should be a place for improvement in the patient’s interest and money or status should not come in as a motive. Also while in some cases the expertise of a psychiatrist might be necessary, granting the authority’s permission may be a waste of precious time for all.