Drug-centred psychopharmacology: a non-diagnostic framework for drug treatment^†

Abstract

SummaryWe propose a ‘drug-centred’ framework for understanding the nature of drug treatment in psychiatry. In contrast to the prevailing ‘disease-centred’ model, which suggests that drugs work by targeting underlying abnormalities, the drug-centred model maintains that drugs exert their effects through their psychoactive properties. According to this view, distinctive drug-induced alterations to normal cognition, emotion and behaviour can modify the manifestations of mental disorders independent of diagnosis or aetiological theory. The drug-centred approach already forms the basis of some current practice, particularly off-label prescribing. Within this framework, the matching of drug-induced effects to symptoms or difficulties, taking into account the unwanted aspects of the drug-induced state, becomes the focus of a collaborative endeavour between doctor and patient, consistent with the principles of the recovery model. More research into the full range of effects that psychiatric drugs produce is required to ground a judicious drug-centred practice and inform psychiatric training.

Psychopathological profile and antipsychotic treatment may be linked to internalised stigma in schizophrenia – a cross-sectional study

“…Those cues might exist outside the evaluated schizophrenic syndromes: our findings suggest that the associations between pharmacotherapy and self-stigma were independent of the symptoms. This would be in line with an approach known as 'drug-cantered pharmacotherapy' , in which treatment is chosen based on a holistic assessment of all the symptoms together with the other problems presented by the patient, and is not dictated by the diagnosis [29]. This model may also suggest that changes in internalised stigma are drug induced since it is expected that psychiatric medications exert their function via changes in emotional, cognitive or behavioural patterns.…”

Prevenção quaternária em saúde mental

“…); e (b) formatação dos ensaios clínicos em torno do construto teórico de doenças mentais, deixando de explorar o potencial psicoativo das drogas. 5 Esse modelo orienta uma prática de prescrição medicamentosa com base no diagnóstico de doenças e suas etiologias. A Figura 1 resume o processo histórico do surgimento da psiquiatria moderna e o consequente fortalecimento do modelo centrado na doença.…”

Critical psychiatry: a brief overview

“…However, although drugs may reduce unwanted feelings and behaviours, this approach also highlights their adverse effects on other aspects of mental and physical functioning. A more detailed discussion of disease-and drugcentred approaches to the use of psychiatric medication was published in Advances in 2015 (Yeomans 2015). Alongside their established pharmacological properties, the use of psychotropic medicines has psychological, social and ritualistic dimensions, commonly grouped together as the 'placebo effect'.…”

“…However, although drugs may reduce unwanted feelings and behaviours, this approach also highlights their adverse effects on other aspects of mental and physical functioning. A more detailed discussion of disease- and drug-centred approaches to the use of psychiatric medication was published in Advances in 2015 (Yeomans 2015).…”