Front-line psychopharmacology (Feb 2008)

http://www.apa.org/monitor/feb08/frontline.aspx

Two years ago, a 40-year-old woman with bipolar disorder and fibromyalgia came to Elaine LeVine, PhD, in Las Cruces, N.M., for treatment. “Jane” had just been released from a psychiatric hospital, after trying to kill herself with an overdose of tranquilizers. She was on 11 medications: three psychotropics for her bipolar disorder and eight others for back pain, gastric distress and high blood pressure. She had gained 60 pounds within the year, wasn’t working, couldn’t do housework and was so emotionally distraught she couldn’t drive. She also had marital problems and difficulty communicating with her teenage son.

“She was homebound, in bed a majority of the time,” says LeVine, one of New Mexico’s first civilian prescribing psychologists. Some of Jane’s problems, says LeVine, stemmed from “polypharmacy.” She had visited several physicians and obtained numerous prescriptions, making it difficult to tell where the effects of her medical conditions ended and the medications’ side effects began…

Cases like Jane’s are why many psychologists seek prescription privileges, says LeVine. They want to improve patient care by offering treatments that blend assessment, psychotherapy and medication, and to streamline the number of medications a patient is taking.  So far, prescribing for appropriately trained psychologists is limited to two states, New Mexico and Louisiana. In New Mexico, 13 of the state’s 681 psychologists are certified by the state to prescribe, and in Louisiana, 42 of the state’s 630 psychologists are certified by the state as “medical psychologists” and prescribe…

Psychologists with prescriptive authority are also finding that primary-care physicians increasingly refer patients with mental health concerns to them. Robert Mayfield, PhD, and Marlin Hoover, PhD, work with physicians at the Southern New Mexico Family Practice Center in Las Cruces, where they train family practice residents in behavioral health…

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