Psychiatric drugs testing

The development of the human brain continues long after birth and infancy, with significant changes taking place in the number and organization of brain cells into adolescence. When the NIMH (1995) and the FDA held a conference on the future testing and use of psychiatric drugs for children, Vitiello (1998) made a critical disclosure ... 

Perhaps the best laboratory test to compare with pharmacogenetic testing is a drug blood level, technically called therapeutic drug monitoring (TDM), which could be considered a phenotypic test of metabolic enzymes [97]. Almost no studies of TDM cost effectiveness exist [98], except for some studies of antibiotics. However, TDM appears to be standard clinical practice (medical insurers routinely reimburse for it) for classic anticonvulsants, theophylline, digoxin, immunosuppressants, and some psychiatric drugs [98]. 

Donovan, D.M. Kivlahan, D.R. and Walker, D.R. Clinical limitations of neuropsychological testing in predicting treatment outcome among alcoholics. Alcoholism Clin Fxp Res 8 470-475, 1984. Fauman, M.A., and Fauman, B.J. Chronic phencyclidine (PCP) abuse A psychiatric perspective. J. Psvchedel ic Drugs 12 307-315,... 

Evaluation of the anxious patient requires a complete physical and mental status examination appropriate laboratory tests and a medical, psychiatric, and drug history. 

Self-Report Symptom Inventory. Each of the 90 items in the SCL-90 uses a five-point scale of distress. It was designed as a general measure of symptomatology for use by adult psychiatric outpatients in either a research or clinical setting. It rates either the present or previous week. It requires about 15 minutes for the patient to complete this form and about 5 minutes for a technician to verify identifying information. This test is sensitive to drug effects and may be used with inpatients. Nine subscales are measured somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid ideation, and psychoticism. 

For neuropharmaceuticals that target the brain, as in the cases of neurodegenerative disorders (Alzheimer s, multiple sclerosis),psychiatric or psychotherapy, stroke, and infectious diseases, drug candidates are tested using in vivo and in vitro models to assess the transfer of the drug compound across the BBB. 

The third edition is truly remarkable in its scope, depth, and readability. It is both comprehensive and remarkably up-to-date. The field (and the practice) of clinical psychopharmacology has expanded radically over the past few years, in the number and types of drugs available to treat psychiatric disorders, the types of formulations being used (or in testing), and the depth of knowledge of their pharmacodynamics and pharmacokinetics. This parallels the growth in psychiatry and brain science. 

This section reviews the standard medical assessment for the psychiatric patient, summarizes specific tests frequently used in the clinical and research setting, and discusses the laboratory s role in treatment evaluation (e.g., therapeutic drug monitoring) ( 6, 12, 13 and 14). 

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