Thomas A. Ban
Neuropsychopharmacology in Historical Perspective.

Education in the field in the Post-Psychopharmacology Era

Collated 19

Donald F. Klein and John Davis: Diagnosis and Drug Treatment of Mental Disorders and Thomas A. Ban: Psychopharmacology

        In 1969, two major texts in the field were published in Baltimore by the Williams and Wilkins Company. In one, Diagnosis and Treatment of Mental Disorders by Donald F. Klein and John Davis, contemporary pharmacological treatment with the still new psychotropic drugs was presented and discussed. In the other, Psychopharmacology by Thomas A. Ban, developments in the different areas of research (including therapeutic)  in neuropsychopharmacology were reviewed, in order to set a foundation for what was to become translational research in the field.

Donald F. Klein and John M. Davis: Diagnosis and Drug Treatment of Psychiatric Disorders

Baltimore: Williams & Wilkins Company; 1969 (480 pages)

Reviewed by Donald F. Klein

INFORMATION ON CONTENTS: Foreword: Jonothan O. Cole; Introduction: Brief historical summary of somatic psychiatric care; I. Diagnosis and the diagnostic process; II. Psychotropic drug management; III. Diagnosis of schizophrenia; IV. Review of antipsychotic drug literature; V. Treatment of schizophrenia; VI. Diagnosis of affective disorders; VII. Review of mood-stabilizing drug literature; VIII. Treatment of affective disorders; IX. Diagnosis of neuroses and personality disorders; X. Review of minor tranquilizer literature; XI. Treatment of neuroses and personality disorders; XII. Critique of treatment studies; XIII. Theoretical inferences on clinical groupings of psychotropic drugs; Author Index; Subject Index; 36 tables detailing the treatment reviews; 10 figures.

About 1964, John Davis suggested this book to me as a collaboration of clinical trials expertise with a depth of literature review and theoretical concerns.

The initial material included an unusually detailed discussion of the theory of diagnosis and the importance of syndromes.  The belief that psychiatric diagnosis could arise from the multivariate study of scales was criticized.

There was a general chapter on psychotropic drug management, followed by a series of three layer cakes regarding schizophrenia, affective disorders, neuroses and personality disorders. Each first section was a critical statement about the development of this diagnosis and its substantiation.  A critical review of the drug literature followed, documenting each trial.  Such reviews have been effectively superseded by meta-analyses.  However, a detailed comparison of trial designs, analyses and outcome measures is a necessary precursor for fleshing out anonymous effect sizes.  An attempt to integrate clinical trials data, clinical experience and practical matters follows, providing detailed treatment guidance.

Following these data rich chapters, was a critique of the design of treatment studies.  A scheme for large clinical research facilities to facilitate psychopharmacological development was outlined.  Unfortunately, this proved Utopian.  The last chapter emphasized the utility of psychopharmacological dissection.  It emphasized the existence of syndromes and the fact of remission was critical to nosology.  This material shrinks the current over emphasis on endophenotypes and dimensions.  That current psychopathological theory emphasizes either an excess or deficiency of some neurotransmitter — in rheostat fashion — was also criticized as incompatible with known clinical data.  A theory of cybernetic deficiencies of control feedback mechanisms was suggested that is still largely unremarked.

AUTHOR’S STATEMENT: Published in 1969, this was the first clinical textbook of psychopharmacology.  The title of the book was unique in that it emphasized drug treatment.  It was upsetting when we were told by the eminent publisher that due to some incomprehensible technical difficulty that the word “Drug” had been omitted from the book’s cover.  They hoped that I would agree that this was of little consequence.  However, my reaction led to a re-embossed

cover.  A corrected stick-on was provided for the spine, which promptly peeled off.

The book sold well as academic texts go.  We were frequently told by residents that it served as an indispensable solitary, resource.

Over the next decade, the exponential psychopharmacologic development warranted a second edition.  In particular, the entire field of childhood psychopharmacology had blossomed.

November 28, 2013

Thomas A. Ban : Psychopharmacology

Baltimore: The Williams & Wilkins Company 1969 (485 pages)

Reviewed by Thomas A. Ban

INFORMATION ON CONTENTS: “Psychopharmacology” is divided into three parts. In Part One, “General Psychopharmacology,” the development of a psychotropic drug from “synthesis” to “clinical applications” are described in six chapters: (1) “general principles,” (2) “animal pharmacology,” (3) “human pharmacology,” (4) “clinical pharmacology,” (5) “clinical investigations” and (6) “recent progress,” i.e., progress in the methodology of drug evaluation in these different areas of research from the late 1950s to the late 1960s. In Part Two, “Systematic Psychopharmacology,” the information collected in Part One on structurally and pharmacologically different groups of psychotropic drugs in different stages of their development is reviewed in 12 chapters of which one covers drugs with behavioral effects without and with psychotropic action; 10 deal with different groups of psychotropic drugs used in the 1950s and ’60s, such as the “barbiturates,” “amphetamines,” “phenothiazines,” “Rauwolfias,” “butyrophenones,” “thioxanthenes,” “tricyclic antidepressants,” “monoamine oxidase inhibitors,” “propanediols” and “benzodiazepines”; and one is dedicated to “psychotherapeutic” and “psychotopathic” drugs which do not fit any of the eight groups.  In Part Three, “Applied Psychopharmacology,” the clinical use of psychotropic drugs in psychiatry in the late 1960s, with consideration of the information presented in Parts One and Two, is discussed in three chapters of which one deals with new “concepts” and “definitions” related to the new treatments, another with “general therapeutic principles” and the third with treatment of different psychiatric disorders. The Volume includes a Vademecum Psychopharmacorum with the chemical names, therapeutic uses and reported adverse effects of psychotropic drugs available at the time and is supplemented with an Index.

AUTHOR’S STATEMENT: Psychopharmacology was based on my more than 10 years of experience in clinical investigations with psychotropic drugs at the time (1969) as the Co-Principal Investigator with Dr. Heinz E. Lehmann on a grant from the U.S. Public Health Service to support an Early Clinical Drug Evaluation Unit at the Verdun Protestant (now Douglas) Hospital, a psychiatric inpatient facility in the outskirts of Montreal. (See, “Lehmann and Ban’s ECDEU Progress Report, 1961-1963,” in the “Archives” of the INHN Website).

With the steadily accumulating preclinical and clinical information on psychotropic drugs, I became increasingly aware of the heterogeneity of the information provided in pre-clinical brochures and of the inconsistency in the language used in describing drug-induced changes in clinical reports.  The problem was compounded by the lack of integration of information from preclinical and clinical research.  My objective was to bring together and organize the available information on psychotropic drugs generated by researchers working in different disciplines and operating in different frames of references in a manner that would help to translate findings from one level of functioning to the next, e.g., from biochemical to neurophysiological, and from one setting to another, e.g., from laboratory to clinical.

The writing of the text was greatly facilitated by an invitation to conduct a workshop on “What preclinical information does the clinician expect to be given prior to conducting a clinical trial with a new drug” at the 1966 annual meeting of the American College of Neuropsychopharmacology (Abstract, ACNP Bulletin, Volume 4, 1966).  I also benefitted from the request to write a series of reviews on the different groups of psychotropic drugs for Applied Therapeutics (Applied Therapeutics, Vol. 8, 1966: 145-75, 423-7, 530-5, 779-85; Vol. 9, 1967: 66-75, 366-71, 677-80).  There was also my increasing involvement in teaching psychopharmacology to psychiatric residents in the Department of Psychiatry at McGill University.  The material presented at the ACNP Workshop provided the basis of the first part of the book, “General Psychopharmacology”; the papers published in Applied Therapeutics for the second part, “Systematic Psychopharmacology”; and the “handouts” used in teaching for the third part, “Applied Psychopharmacology.”  In my concluding remarks, I pointed out that pharmacotherapy with psychotropic drugs focused attention on the pharmacological (biological) heterogeneity within the traditional nosological categories of mental illness, in terms of therapeutic responsiveness to psychotropic drugs and postulated that progress in pharmacotherapy in psychiatry will depend on how fast this heterogeneity is resolved. Psychopharmacology was published by Williams and Wilkins in 1969.  It was the first comprehensive text in the field.  It shared, in 1970, the Clarke Institute Annual Research Award with Harvey Stancer’s contributions to the role of catecholamines in affective disorders. 

July 11, 2013

            February 6, 2020