American Psychological Association Announces Guidelines for Psychologist Involvement in Pharmacological Issues

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In the recent yearly “Reports of the Association” issue of the American Psychologist (December 2011), the American Psychological Association announced “Practice Guidelines Regarding Psychologists’ Involvement in Pharmacological Issues.” This report notes several factors that will make psychologists more involved in medication-management issues. One survey noted that the number of Americans using antidepressants increased from 6.7 percent in 1990 to 15.1 percent in 1998. Another study indicates that psychologists reported that 43 percent of their patients were using psychotropic medications. In two states, Louisiana and New Mexico, as well as the US Military, psychologists who have been “appropriately trained” are able to prescribe medications.

The task force that came up with this report noted that there is a continuum among psychologists concerning how involved each is with regard to psychopharmacological issues. This article notes three particular points on the continuum for psychologist involvement in psychopharmacology. First, the group of psychologists with actual prescriptive authority (a small, but growing group). Second, psychologists who actively participate in medication decision-making, such as by offering a consultative recommendation about a class of medicines or even a particular medicine to someone (physician, nurse practitioner), retain the legal responsibility for prescribing. Third, psychologists who provide information that may be relevant to pharmacotherapy decision makers, such as referring someone for a medication evaluation or discussing with patients how to address medication concerns with their prescriber. Following are some of the ideas the Task Force came up with.

Psychologists are encouraged to assess how much they know about pharmacology and they are encouraged to obtain further training to develop competencies before offering guidance or advice. They are urged to evaluate their own feelings toward medication (i.e., countertransferences), as these can affect the information they impart to others. They are advised to be sensitive to developmental delays, age and aging, educational, sex and gender, health status, and cultural/ethnicity factors that may be relevant when discussing psychopharmacology with a particular patient or professional.

Psychologists are urged to evaluate their own need for initial and continuing education, even beyond what is required for licensing or other regulations. Psychologists need to know about side effects of medications in order to watch for adverse events, whether or not they are the prescribing professional for a particular patient. They are encouraged to make use of technological resources that offer extensive and frequently updated information about pharmaceutical agents.

When psychologists have prescriptive privileges, as noted above, currently this is possible in Arizona, Louisiana, and the military, they keep current in knowledge about key procedures, like laboratory tests, to monitor physical and psychological effects of medication. It is important for psychologists who have prescription authority to always remain current on the full medical condition of their patient. The guidelines encourage psychologists to explore issues surrounding the patient’s feelings and compliance with their medication regiment.

Another related thought is that psychologists work with their clients to be open and upfront with their prescriber about whether or not they are continuing to use their medication. Psychologists also should remain open to biopsychosocial factors that impact upon a patient’s condition so that emphasis on medication does not become primary: especially when intervention with these other factors may bring about significant therapeutic change. When a psychologist has prescription privileges, he or she is encouraged to develop an informed consent process that is both comprehensive and ongoing.

Psychologists with prescriptive authority should consider the best interests of the patient, current research, and, when it is appropriate, the needs of the community. They should be very sensitive to influences of marketing by drug companies on professional prescribing behavior. They can also use their own interactions with the patient and his or her reactions to treatment as a way to learn more about how the patient responds to everyday life situations.

This task force report concludes: “Whenever a psychologist is involved in the practice of pharmacotherapy, the psychologist is encouraged to maintain ongoing consultation with the patient’s primary health care provider(s), assuming the patient agrees to such contact. The primary care provider may in turn be reminded to alert the psychologist to any changes in the patient’s health status that could affect the patient’s treatment by the psychologist, whether that treatment involves pharmacotherapy or psychosocial interventions.”

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