NEW GENERATION VS. FIRST GENERATION ANTIPSYCHOTICS DEBATE: PRAGMATIC CLINICAL TRIALS AND PRACTICE-BASED EVIDENCE

There has been significant confusion about the relative advantage of new generation antipsychotics over first generation antipsychotics as well as of clinical trials performed to evaluate their efficacy vs. those designed to evaluate their effectiveness. Pragmatic or effectiveness clinical trials like CATIE and CUtLASS sponsored by governments have challenged the current worldview of the greater advantages of new generation over first generation antipsychotics and suggested more clinical applicability of older antipsychotics. Public policy regarding the role and place of modern antipsychotics in schizophrenia treatment is usually guided by the imperfect state of clinical trials and by economic constraints. The right question is not whether new generation antipsychotics are better than first generation antipsychotics in terms of effectiveness, tolerability and safety. How to reach personalized , evidence based and value oriented decision making in the complex treatment of schizophrenia and other psychotic disorders, that is the question now. Personalized medicine in psychiatry is not possible without the availability of enough number of different modern antipsychotics

PSYCHOPHARMACOTHERAPY AND COMORBIDITY: CONCEPTUAL AND EPISTEMIOLOGICAL ISSUES, DILEMMAS AND CONTROVERSIES

Comorbidity is one of the greatest research and clinical challenges to contemporary psychiatry. Mental disorders are often comorbidly expressed, both among themselves and with various sorts of somatic diseases and illnesses. Shifting the paradigm from vertical/mono-morbid interventions to comorbidity and multimorbidity approaches enhances effectiveness and efficiency of human resources utilization. Comorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and efficient treatment including personalized pharmacotherapy

NON-ADHERENCE TO MEDICATION: A CHALLENGE FOR PERSON-CENTRED PHARMACOTHERAPY TO RESOLVE THE PROBLEM

Pharmacotherapy today is claimed to be fascinating, scientific, rational, and objective, very much evidence-based, powerful and fundamental form of treatment for many medical conditions. Non-adherence to medication as an invisible epidemic is argued to be an Achilles’ heel of evidence based medicine. Person-centered psychiatry has an important role in helping medicine to better understand human nature, human behavior and patients’ choice in complex interactions. Non-adherence is a major target for interventions to improve the quality and outcomes of health care

NEW GENERATION VS. FIRST GENERATION ANTIPSYCHOTICS DEBATE: PRAGMATIC CLINICAL TRIALS AND PRACTICE-BASED EVIDENCE

There has been significant confusion about the relative advantage of new generation antipsychotics over first generation antipsychotics as well as of clinical trials performed to evaluate their efficacy vs. those designed to evaluate their effectiveness. Pragmatic or effectiveness clinical trials like CATIE and CUtLASS sponsored by governments have challenged the current worldview of the greater advantages of new generation over first generation antipsychotics and suggested more clinical applicability of older antipsychotics. Public policy regarding the role and place of modern antipsychotics in schizophrenia treatment is usually guided by the imperfect state of clinical trials and by economic constraints. The right question is not whether new generation antipsychotics are better than first generation antipsychotics in terms of effectiveness, tolerability and safety. How to reach personalized , evidence based and value oriented decision making in the complex treatment of schizophrenia and other psychotic disorders, that is the question now. Personalized medicine in psychiatry is not possible without the availability of enough number of different modern antipsychotics

THEORETICAL PSYCHIATRY: MISSING LINK BETWEEN ACADEMIC AND CLINICAL PSYCHIATRY FOR FURTHER SCIENTIFIC AND PROFESSIONAL MATURATION OF PSYCHIATRY

Psychiatry is in the midst of the paradigm shift. The new field called theoretical psychiatry is fundamental for further scientific and professional maturation of psychiatry at the twenty first century. The cross disciplinary interactions and transdisciplinary systems approach are of great importance in science and the paradigm shift

PSYCHOPHARMACOTHERAPY AND COMORBIDITY: CONCEPTUAL AND EPISTEMIOLOGICAL ISSUES, DILEMMAS AND CONTROVERSIES

Comorbidity is one of the greatest research and clinical challenges to contemporary psychiatry. Mental disorders are often comorbidly expressed, both among themselves and with various sorts of somatic diseases and illnesses. Shifting the paradigm from vertical/mono-morbid interventions to comorbidity and multimorbidity approaches enhances effectiveness and efficiency of human resources utilization. Comorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and efficient treatment including personalized pharmacotherapy

THE SIDE EFECTS OF PSYCHOPHARMACOTHERAPY: CONCEPTUAL, EXPLANATORY, ETHICAL AND MORAL ISSUES - CREATIVE PSYCHOPHARMACOLOGY INSTEAD OF TOXIC PSYCHIATRY

The side effects are a major issue in the contemporary psychopharmacotherapy. Treatment choices are largely determined by the side-effect profiles of mental health medications. The effects of psychopharmacotherapy result from highly complex interactions between mental health medications and the patient who takes them as well as from the context in which treatment occurs. A high level of care and caution is necessary during the whole course of psychopharmacotherapy to recognize any side effect and respond promptly and specifically. Creative psychopharmacotherapy demands a broad base of pharmacologic and neuroscience knowledge (evidence based practice), personal experience (practice based evidence) and favourable treatment context (well-being therapy, life coaching)