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Introduction
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Since the 1950's effective drug treatments have revolutionised the management of many psychiatric disorders. However, there is no such thing as a "miracle cure" and the use of drugs in psychiatry requires psychological as well as pharmacological skills. Because of the sensitivity and complexity of the central nervous system interactions and adverse effects with psychotropic (i.e. psychologically active) drugs are common. The pharmacokinetics and pharmacodynamics of these compounds must therefore be understood. It is not obvious to patients that drugs can improve their psychological difficulties, especially if insight is impaired, and steps to encourage compliance are vital.
Psychosocial effects of taking medication may be positive (e.g. placebo effect) or negative (e.g. less motivation in psychotherapy because tablets are seen as a panacea). Medication is often just one component of a treatment plan that also includes psychosocial therapies. The place of drugs in this combined approach should be explained to the patient.
Compliance is increased by attention to the following:
- Empathy: the patient feels understood.
- Education: about the diagnosis and its implications.
- Explanation: about the drug, its intended action and the likely adverse effect.
- Efficiency: simplify the drug regime as much as possible and avoid polypharmacy.
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