Psychiatrist

Psychiatrist-in-Chief, Boston Medical Center Professor and Chair, Division of Psychiatry, Boston University School of Medicine, Boston, Massachusetts... 

Ecstasy was first synthesised in 1912 and, like LSD, was used in the 1950s as a potential chemical weapon. The feeling of empathy with others produced by Ecstasy has been used by psychiatrists in therapy sessions. However, animal studies indicating that Ecstasy might damage the brain led to it being banned in the USA in 1985. 

Apparently there are psychiatrist and nonpsychiatrist clinicians whose experience convinces them that MDMA can have therapeutic uses, mainly as an adjunct to psychotherapy. Despite these convictions, there appear to be no published data to support these claims. There is an urgent need for objective data from well-controlled, blinded clinical studies, if these claims of therapeutic usefulness are to be taken seriously. If a bona fide use is evident, then it may be possible to produce other drugs with the same desirable action, lacking the toxicity inherent in MDMA. 

Attending Psychiatrist, The Gateway Program Psychiatric Institute of Washington Member, Metropolitan Psychiatric Group 4460 MacArthur Blvd., N.W. 

Assess the patient s severity of symptoms to determine if patient-directed therapy is appropriate or whether a psychiatrist should evaluate the patient. 

The American Academy of Child and Adolescent Psychiatrists and the International Children s Continence Society (ICCS) have published practice guidelines for the assessment and treatment of pediatric enuresis.24,25... 

Foltin, R. W., The importance of drug self-administration studies in the analysis of abuse liability An analysis of caffeine, nicotine, anabolic steroids, and designer drugs. Annual Meeting of the American Academy of Psychiatrists in Alcoholism and Addictions (1990, Santa Monica, California). American Journal on Addictions Spr Vol 1(2), 139-149, 1992. 

Seale, C., Chaplin, R., Lelliott, P. 8cQuirk, A. (2006). Sharing decisions in consultations involving anti-psychotic medication a qualitative study of psychiatrists experiences. Soc. Sci. Med., 62, 2861-73. 

Table 11.1 Dosage of haloperidol (mg/day) prescribed by psychiatrists in Southeast and East Asian countries...

Psychiatrists in Southeast Asia such as Thailand, Malaysia, and Singapore would prescribe 12-14 mg/day of haloperidol while East Asian psychiatrists would prescribe a smaller dose of 9-10 mg/day. The average dose range of haloperidol of 6-10 mg/day was the most commonly prescribed dosage (see Table 11.1). 

Compared to antipsychotics, there are even fewer studies on the prescribing patterns of antidepressants done in Asian countries. Pi etal. (1985) conducted a survey of psychotropic prescribing practices reported by psychiatrists in 29 medical schools in 9 Asian countries. Daily dose range of tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and nortriptyline in Asian countries was comparable to the practice in USA. This is despite differences found between Asian and non-Asian populations in the pharmacokinetics of TCAs (Pi et al, 1993). A questionnaire on the practical prescribing approaches in mood disorders administered to 298 Japanese psychiatrists was reported by Oshima et al. (1999). As first-line treatment, the majority of respondents chose newer TCAs or non-TCAs for moderate depression and older TCAs for severe depression. Combination of antidepressants and anxiolytics was preferred in moderate depression, while an antidepressant and antipsychotic combination was common in severe psychotic depression. Surprisingly, sulpiride was the most favored drug for dysthymia. In a naturalistic, prospective follow-up of 95 patients with major depression in Japan, the proportion of patients receiving 125 mg/day or less of imipramine was 69% at one month and 67% at six months (Furukawa et al., 2000). 

Oshima, A., Higuchi, T., Fujiwara, Y. et al. (1999). Questionnaire survey on the prescribing practice of Japanese psychiatrists for mood disorders. Psychiatry Clin. Neurosci., 53(suppl), S67-S72. 

Udomratn, P. (1999). Prescribing habits of Thai psychiatrists in the treatment of a first episode schizophrenia. /. Psychiatr. Assoc. Thailand, 44(2), 119-24. 

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