combined trtmts. for mental disorders - m. sammons, et. al., (apa)

COMBINED TREATMENTS FOR MENTAL DISORDERS A GUIDE PSYCHOLOGICAL TO AND PHARMACOLOGICAL INTERVENTION s EDITED BY MORGAN S M O N S T AND NORMAN SCHMIDT B American Psychological Association Washington, DC Contents Contributors vii Introduction: Toward a Psychological Model of Pharmacological Service Provision Morgan 71 Sammons and Norman B Schmidt Combined Treatments for Mental Disorders: Clinical Dilemmas Morgan T Sammons 1 Prescriptive Authority for Psychologists: Law, Ethics, and Public Policy Patrick H DeLeon, Sharon E Robinson Kurpius, and John L Sexton Comparative and Combined Treatments for Obsessive-Compulsive Disorder Martin M Antony and Richard I? Swinson Combined Treatments for Phobic Anxiety Disorders Norman B Schmidt, Margaret Koselka, and Kelly Woolaway-Bickel 33 53 81 Combined Treatments of Insomnia Charles M Morin 11 Combined Treatments for Depression Jeremy W Pettit, Zachary R Voelz, and Thomas E Joiner, Jr 131 Combined Treatments and Rehabilitation of Schizophrenia William D Spaulding, Dale L Johnson, and Robert D Coursey 161 Combined Treatments for Smoking Cessation Marc E Mooney and Dorothy K Hatsukami 191 Combined Treatments for Substance Dependence Kathleen M, Carroll 215 10 Pharmacological and Psychological Treatments of Obesity and Binge Eating Disorder Carlos M Grilo V 239 vi CONTENTS 11 Clinical Outcomes Assessment for the Practicing Clinician James M Meredith, Michael J Lambert, and John I? Drozd 271 Appendix: Generic and Trade Names of Drugs Cited in This Volume 301 Glossary of Technical Terms 307 Author Index 313 Subject Index 337 About the Editors 345 Contributors Martin M Antony, PhD, Anxiety Treatment and Research Centre, St Joseph's Hospital, and Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada Kathleen M Carroll, PhD, Yale University School of Medicine, New Haven, CT Robert D Coursey, PhD, Psychology Department, University of Maryland, College Park, MD Patrick H DeLeon, PhD, JD, Office of Senator Daniel Inouye, U S Senate, Washington, DC J o h n F Drozd, PhD, Capt, USAF, BSC, 10th Medical Group, Life Skills Center, Peterson Air Force Base, CO Carlos M Grilo, PhD, Yale University School of Medicine, New Haven, CT Dorothy K Hatsukami, PhD, Division of Neuroscience Research in Psychiatry, University of Minnesota, Minneapolis, MN Dale L Johnson, PhD, Department of Psychology, University of Houston, Houston, TX Thomas E Joiner, Jr., PhD, Department of Psychology, Florida State University, Tallahassee, FL Margaret Koselka, PhD, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD Sharon E Robinson Kurpius, PhD, Counseling Psychology Program, Arizona State University, Tempe, AZ Michael J Lambert, PhD, Brigham Young University, Salt Lake City, UT J a m e s M Meredith, Lt Col., PhD, Prescribing Psychologist, US Air Force, and PACAF Psychology Consultant, Hickam Air Force Base, HI Marc E Mooney, MA, Clinical Science and Psychopathology Research Program, University of Minnesota, Minneapolis, MN Charles M Morin, PhD, School of Psychology, Lava1 University, Quebec, Canada J e r e m y W Pettit, MS, Department of Psychology, Florida State University, Tallahassee, FL Morgan T Sammons, PhD, Mental Health Department, Naval Medical Clinic, Annapolis, MD Norman B Schmidt, PhD, Department of Psychology, The Ohio State University, Columbus, OH J o h n L Sexton, PhD, Prescribing Psychologist, Naval Medical Center, San Diego, CA William D Spaulding, PhD, Department of Psychology, University of Nebraska at Lincoln, NE vii viii CONTRIBUTORS Richard P Swinson, MD, Department of Psychiatry and Behavioral Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada Zachary R Voelz, BA, Department of Psychology, Florida State University, Tallahassee, FL Kelly Woolaway-Bickel, MA, Department of Psychology, The Ohio State University, Columbus, OH COMBINED TREATMENTS FOR MENTAL DISORDERS Introduction: Toward a Psychological Model of Pharmacological Service Provision Morgan I: Sammons and Norman B Schmidt This book is aimed at psychologists and other mental health practitioners who desire to understand how psychotropic drugs can be combined with psychotherapy and other behavioral treatments to produce optimum patient outcome Readers will discover that the science underlying combined treatments remains underdeveloped This is in part a reflection of the inattention paid to investigating combined treatments, in part a reflection of guild-based biases that champion one form of treatment over another, and in part because of the complexity and increased costs associated with combined-treatment research designs As a number of chapters in this book attest, combined treatments may not represent the best option for many patients In particular, the literature suggests that many anxiety disorders may be better treated with behavioral rather than pharmacological interventions Behavioral treatments for phobic and other anxiety disorders are often more durable than are drug treatments, and they not carry the risks of dependence that accompany the use of some pharmacological interventions for these disorders (the benzodiazepines) Nevertheless, not all patients are amenable to nondrug treatments because of choice, chronicity, or severity of condition All of these factors might mitigate toward the addition of pharmacotherapy as a n adjunct to behavioral treatment It is therefore incumbent on the clinician to keep an open mind and not reject a treatment modality categorically Clinicians who rely exclusively on psychotherapy commit as great a n error as those who rely exclusively on pharmacology, for neither approach is likely to completely address the needs of all those who seek help Flexibility in thinking and attention to the needs of the patient are far better guideposts to successful intervention than is reliance on drug company literature or the opinions of therapists who dogmatically reject all but psychotherapy This book will assist clinicians in understanding the research literature on combined treatments To the extent that the literature allows, algorithms or specific treatment suggestions have been incorporated into each chapter The book will not, in general, instruct the reader in making choices among drugs or in devising pharmacological drug regimens To SAMMONS AND SCHMIDT so well requires a sound grasp of fundamental principles of pharmacology and psychopharmacology that cannot be imparted by this or any other single volume Of course, clinical experience is the most basic prerequisite to effective prescribing, and this can be acquired only by means of appropriately supervised direct experience In the past, acquisition of such clinical experience was limited to psychiatrists and other medical practitioners Now, however, a number of training programs have been initiated to train psychologists, advanced-practice nurses, and other nonmedical professionals in these skills-evidence that nonmedical professions are increasingly aware of the importance and value of education in psychopharmacologyThe book is organized by diagnosis Psychologists wilI recognize that there are certain perils in this approach because of the limitations of syndromic categorizations of mental distress Depressive disorders, for example, often have significant anxiety components, and psychologists have long been sensitive to the fact that patients and their difficulties cannot be reduced to Diagnostic and Statistical Manual of Mental Disorderstype (4th ed., D S M - N , American Psychiatric Association, 1994) checklists with rote treatment plans that are uniform for all More than in any other health care field, the wisdom of the adage that to treat the patient, not the diagnosis, is apropos to mental health interventions Although this book is not a primer on psychopharmacology, each chapter provides a broad overview of current pharmacological interventions and often a preview of pending innovations in pharmacological treatment For readers seeking a n in-depth discussion of basic psychopharmacology or principles of psychotropic drug management, the following resources exist Of the general clinical references designed to help the reader devise appropriate drug intervention strategies, those by Gelenberg and Bassuk (1997); Schatzberg and Nemeroff (1998); or Janicak, Davis, Preskorn, and Ayd (1997) are among the most complete Readers interested in basic principles of psychopharmacology cannot better than to add textbooks by Cooper, Bloom, and Roth (1996); Feldman, Meyer, and Quenzer (1997); o r Bloom and Kupfer (1995) to their bookshelves Stahl's (19961 book is a solid, uncomplicated general reference Pagliaro and Pagliaro (1997,1999) also have added to the literature by providing textbooks of basic clinical psychopharmacology that are written from a psychological perspective W o Should Read This Book? h The primary audience for this book are practicing clinicians who seek to incorporate scientifically informed opinion into treatment planning and case management Psychologists, counselors, and other nonmedical practitioners engaged in behavioral treatment who seek to understand more about the pharmacology and the combined treatment of specific disorders will find this book helpful The book will be equally helpful to medical practitioners who seek to understand more about both combined treatments and behavioral or psychotherapeutic modalities, as well as those INTRODUCTION who wish to update their knowledge regarding current pharmacological treatments Academic psychologists and their students may also find this book of interest, for many of the chapters are written by renowned experts in their fields and represent not only state-of-the-art reviews but also a keen vision of future research and treatment An emerging audience for this book is the small but growing cohort of psychologists who have completed specialized training in psychopharmacology Such psychologists are currently rare, but numerous programs around the United States are now training psychologists to prescribe The chapters in this volume will be of use to instructors and students in such programs in that they provide a truly psychological perspective on the prescription of psychotropics By doing so, i t is hoped that this book will assist in the development of a n academic model that, while providing psychopharmacological training of the highest caliber, is firmly grounded in the discipline of psychology Plan of the Book Chapter 1, by Morgan T Sammons, outlines some hypotheses as to why combined treatments have historically been neglected and offers some general clinical considerations for combining treatments These general clinical guidelines are then expanded on in subsequent chapters that deal with specific disorders Ethical and professional issues involved in psychologists’ acquisition of prescriptive authority are addressed in the chapter 2, by Patrick H DeLeon, Sharon E Robinson Kurpius, and John L Sexton This contribution speaks directly to the experience of psychologists in their pursuit of prescriptive authority Although members of other professions may not at first find the material contained in this chapter to be of direct applicability, closer inspection is warranted The ethical principles outlined in this chapter are rooted in ethical principles for psychologists, yet they are universal in their application and are just as fundamental to good psychiatric or nursing practice Members of nonmedical professions who seek to expand their authority to use medication also will profit from examining this chapter DeLeon et al discuss at length the findings of the recent Pew reports on the changing scope of practice of nonmedical professions This provides a glimpse of the future landscape of health care and the nature of expanded service provision by psychologists, nurses, and other professionals whose practices have been constrained by tradition, but not by logic, from the provision of pharmacological services Chapter 3, by Martin M Antony and Richard P Swinson, and chapter 4,by Norman B Schmidt, Margaret Koselka, and Kelly Woolaway-Bickel, are devoted to a n exploration of anxiety disorders As noted above, some controversy exists regarding the utility of pharmacological interventions in treating anxiety disorders because of the observed durability of behavioral techniques Certain medications, however-notably, benzodiazepines, tricyclic antidepressants, and the selective serotonin reuptake in- 330 AUTHOR INDEX Roehrs, T., 115, 116, 128 Rohde, P., 131, 156 Roland, M., 13, 31 Rolando, R., 211 Rollnick, S., 219,234 Rolls, B J., 265 Romanec, F M., 250,265 Ronchi, P., 57, 74 Rosen, G M., 99, 108 Rosenbaum, J F., 83, 107, 108, 134, 154 Rosenberg, S E., 276, 298 Rosenfeld, H., 128 Rosenfeld, R., 59, 63, 78, 79 Rosenheck, R., 19, 31, 174, 189 Rosenthal, M H., 105 Rosenthal, R N., 219, 235 Roski, J., 207, 212 Rosner, B., 266 Ross, A., 225, 231 Ross, D C., 83, 110 Rosser, W W., 20, 31 Rossiter, E., 255 Rossiter, E M., 253,267, 269 Rossotto, E H., 173, 174, 189 Rost, K., 32 Roth, D., 73, 74 Roth, R H., 4, Roth, T., 115, 116, 117, 127, 128, 129 Roth, W T., 107, 109 Rothenberg, S A,, 112, 128 Rounsaville, B J., 29, 80, 137, 147, 155, 157, 216, 219, 221, 223, 224, 230,232, 233, 234, 235, 236 Rovner, B W., 28, 31 Roy-Byrne, P P., 77, 91, 93, 94, 98, 108, 115, 129 Rozin, P., 31, 31 Rubin, L., 249,266 Rudin, E., 55, 79 Rugg, D., 207,211 Rush, A J., 18, 21, 27,30, 31, 80, 133, 136, 138, 143,153, 155, 157, 159 Russel, J., 30 Russell, J M., 155, 298 Russell, M A H., 213 Ruther, E., 105 Ryan, D H., 262 Rychtarik, R G., 219,234 Sachais, B A., 114, 129 Sachdev, P., 68, 75, 76 Sachs, D P L., 204,212 Sachs, G S., 19, 32, 107 Sackett, D L., 221, 232 Sadock, B J., 136, 155 Safer, D J., 32 Safferman, A., 187, 188 Sage, S R., 30 Salkovskis, P M., 55, 69, 79, 85, 95, 105, 106 Salloum, I M., 232 Saltzman, E., 265 Salzman, D G., 96, 105 Sammons, M T., 12, 32, 36, 37, 51, 85, 108 Sanavio, E., 59, 79 Sandberg, D., 106 Sanderson, W C., 56, 79 Sands, B F., 94, 108 Sanger, T M., 182, 189 Santiago, H T., 90, 108 Saoud, J., 106, 108 Sapirstein, G., 23, 30 Sartory, G., 78, 98, 101, 108 Saskin, P., 120, 129 Satsky, S M., 154 Saunders, C S., 173, 174, 189 Saunders, K., 159 Saunders, S., 247, 261 Savard, J., 142, 150, 157 Savron, G., 57, 79 Sawe, U., 207,213 Sawyer, M., 267 Saxena, S., 64, 79 Sayler, M E., 264 Sbrocco, T., 246, 267 Schade, M., 165, 188 Schafer, J., 70, 75 Scharf, M B., 114, 115, 129 Schatzberg, A F., 4, 10 Scheifler, P., 164, 188 Schick-Boschetto, B., 30 Schiller, H., 128 Schlundt, D G., 246, 267 Schmid, L A., 207, 212 Schmidt, N B., 81, 82, 85, 88, 90, 108, 109 Schmitz, J M., 218, 236 Schneider, J A., 269 Schneider, N G., 194, 195,210 Schneier, F R., 83, 90, 91, 93, 94, 106, 107, 108 Schnoenbeck, G., 254,263 Schoeller, D A., 258, 261, 267 Scholing, A., 92, 93, 94, 95, 108 Schonbrunn, E., 127 Schooler, C., 176, 189 Schooler, N J., 26, 32 Schottenfeld, R S., 229, 233, 236 Schouten, J., 268 Schramm, E., 127 Schramm, P., 30 Schroeder, D R., 210 Schroeder, H., 166, 185 Schroeder-Hartwig, K., 95, 110 Schuckit, M A., 223,232, 236 Schulberg, H C , 139, 155 AUTHOR INDEX Schultz, L., 196 210 Schulz, C., 181, 189 Schulze, M M., 169, 186 Schumacher, D., 249,261 Schiissler, G., 5'7, 80 Schuster, B., 247, 248, 249, 268 Schuster, C R., 228,233, 235, 236 Schwalberg, M D., 57, 79, 253,261 Schwartz, M B., 253,269 Schwartz, S M., 121, 128 Schweitzwer, I.: 186 Schweizer, E., 134, 136, 157 Schwelitz, F D., 36, 51 Sciuto, G., 57, ;'4 Scott, C B., 259, 263 Scott, J., 189 Scott, J E., 164, 188 Scott, J L., 189 Scott, M J., 138, 157 Scoville, B A., 247, 267 Seagle, H M., '250, 267 Seay, S., 63, 64,78 Sederer, L I., 275, 299 Seeley, J R., 1:31, 156 Sees, K L., 211 Seiden, L., 249, 266 Seligman, M El P, 13, 32, 272, 285, 286, 299 Sengun, S., 106 Sensky, T., 169,189 Serlin, R., 106 Serlin, R C., 63, 76, 106 Setler, P E., 78 Settle, E C., 136, 157 Sexton, J L., 34, 36, 51 Seymour, R., 76 Shader, R I., :L9, 22, 32 Shadoan, R., 30 Shank, R P., 61, 79 Shapiro, D A , , 27, 29 Sharp, D M., 87, 108 Shaw, B., 143, 153 Shaw, P., 85, 92, 95, 107, 108, 109 Shea, M T., 2:9,139, 154, 158 Shear, M K., SO, 271,298 Sheehan, D V,82, 83, I Sheehan, M., 259,263 Shekelle, P G., 20, 21, 32 Shelanski, M L., 51 Sheldon, T A,, 158 Shelton R C., 135, 138, 155, 271, 298 Sherman, S I