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Tuesday, 28.09.2021

Carlos Morra and Mateo Kreiker: Psychopathology

Carlos Morra and Mateo Kreiker: Prologue and 1.Thomas A. Ban: Psychopharmacology

 

        It was a commonly held view in the mid-20th century that developments in psychopathology in the prior decades created the foundation for a psychiatry that can be practiced as a medical discipline.  However, by the dawn of the 21st millennium, psychopathology has become the  “forgotten  language of psychiatry” (Ban 2013). Arguably, the loss of a psychopathological foundation was one of the major contributing factors to the impasse of progress in   neuropsychopharmacology research and in the development of more selective psychotropic drugs.  In  this project first we will be posting presentations that should provide some background to this development. Yet, central to this project is a series of presentations in which “psychopathology,”  the “forgotten language,” is revived.

 

Reference:

Ban TA. Neuropsychopharmacology and the Forgotten Language of Psychiatry: Madness from Psychiatry to Neuronology. inhn.org.ebooks. November 14, 2013.

 

July 9, 2020

 

1.     Thomas A. Ban: Psychopharmacology. The Williams & Wilkins Company, Baltimore, 1969 (485 pages)

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,” is 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 behavioural effects with and without 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 of Dr. Heinz E. Lehmann on a grant from the US Public Health Service to support an Early Clinical Drug Evaluation Unit (ECDEU) at the Verdun Protestant (now Douglas) Hospital, a psychiatric inpatient facility in the outskirts of Montreal (Lehmann and Ban 2013).

        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.

 

References:

Ban TA. Psychopharmacology. inhn.org.books. July 11, 2013.

Lehmann H, Ban TA. Early Clinical Drug Evaluation Unit (ECDEU) Progress Report 1961-1963. inhn.org.archives. July 4, 2013.

 

July 9, 2020