Wow. I was a bit shocked (although I don’t know why) to see the second slide from Preston et al for who Writes Prescriptions for Psychotropic Medications (Wolfe, 2020, Slide 2). Did I read it correctly, understanding that 40% of psychiatrists prescribe antipsychotics, and 60% of nonpsychiatric medical doctors are prescribing antipsychotics? The antianxiety and depressant groups were largely underrepresented for both the psychiatrists and the nonpsychiatric medical doctor groups if you ask me. Especially from professions that should be reviewing and understanding psychopharmacology There is an obvious gap, but communication through a split treatment model is the key, according to the material for this week.
I think that like with most things, the advantage and disadvantages depend on the situation. In some cases, the split treatment model reduces professional exhaustion with challenging clients Wolfe (2020). For instance, the psychotherapist can work on the developmental processes to engage somatic, emotional, cognitive, and behavioral elements, focusing on education and recognizing early signs of recurrence, assessing risks and benefits of the medications, altering to drug interactions and toxicity implications, and/or encouraging communication overall, while the psychiatrist can help manage some of the immediate physiological imbalances like mood stability with pharmaceutical integration. Having the ability to split the treatment tasks can alleviate not only the potential for exhaustion but can add an element of accountability for either professional as well. Most importantly the advantages offer an array of perspective and treatment modalities for the client to choose from, financial commitments included. It is their journey, after all, were just sitting in the passenger seat, right?
Necessarily, the split models induced accountability effect encourages a prescription for deprescribing and I am really happy about that. According to Gupta et al., (2016), the process of pharmacologic regimen optimization, reduces or completely ceases the use of medications for which the benefit no longer outweighs risks. The meaning and indication of medication are far too often overlooked in both industries in my opinion. Together, we must try to bring it back to a client-centered focus, qualifying the therapeutic alliance over provisions of the market.
Disadvantages include the potential of the professional to diffuse the responsibility while the client falls between the cracks, and/or an undermining/negative bias of each others recommendations/professions (which is common in my opinion and perhaps the main reason for diffusion), and its been mentioned to possibly foster resistance to one model over the other (probably due to the bias between professions, and the reality that medication doesnt fix issues). Never the less, both models offer and deliver useful utility and should be considered regardless.
Gupta, S., and Cahill, J.D., (2016). A prescription for deprescribing in psychiatry. Retrieved from: file:///C:/Users/User/Downloads/14%20Integrating%20Pharm%20with%20Psychotherapy%20by%20Wolfe%20N%202020-4.pdf
Wolfe, N. (2020). Integrating psychotherapy and pharmacotherapy. Retrieved from file:///C:/Users/Ron/Desktop/PsyhcoPharmacology%20PowerPoint/14%20Integrating%20Pharm%20with%20Psychotherapy%20by%20Wolfe%20N%202020.pdf