Fifteen Eighty Four

“Nobody reads books anymore” is the secondhand testimony I hear from colleagues about how current medical students and residents prefer to learn.  “They want soundbytes.”  Short, succinct morsels of information they can consume more like tapas than a heavy four-course dinner.  We would agree that trying to learn from a book can sometimes be an unsatisfying experience, depending on one’s appetite and expectations about the fare.  Books that are fact-based compendiums become repositories of information where one expects to go look something up to answer a particular question and then put the volume back on the shelf.  In psychopharmacology– the subject that has long been closest to our academic hearts — there are plenty of factual things that one can go look up.  Wanting an answer about a P450 interaction or drug bioavailability or the best remedy for bipolar depression is hardly an invitation to an academic bacchanale.  And the world already has a plentiful supply of such resources. 

When we set out to write Practical Psychopharmacology it was with no desire to create yet another compilation of facts about the use of psychiatric drugs.  It was to create a narrative, and to tell a story, for readers interested in how the brain works when it goes awry, how we understand circuits and pathways that misfire in ways that create symptoms (like sensory misperceptions, delusions, obsessions, or problems with attention or impulse control or mood regulation) that cut across psychiatric diagnoses.  The storyline of Practical Psychopharmacology invites the reader to embark on a journey of understanding not so much about how a particular drug works (though that’s relevant to the plot line) but rather how to match the right treatment to a single given patient based on their unique constellation of signs, symptoms, contexts, genetics, and other clinical features (called “moderators”), informed by knowledge of findings from clinical trials.  An alternative title for this book could have been “Detective School for Psychopharmacologists” inasmuch we wanted to draw the reader into a kind of forensic mindset — how to notice particular moderating details within a given patient’s storyline that makes their presentation unique, in turn pointing the way to the best strategy for managing not a diagnosis, but a unique clinical profile. 

Imagine adopting the mindset of a clinical trials investigator, one who looks at every patient as a potential candidate for specific treatments and must then vet the evidence to decide the right fit.   When contemplating medications, outstanding clinicians have a rationale in mind and know what to expect when forecasting how one option will likely fare relative to another.  Detective school then meets culinary school.  The “sommelier” psychopharmacologist possesses not just facts but a depth of knowledge that enables him or her to strike the right balance between every unique patient and a custom-designed medication regimen.  We, the proprietors, would be sad if our customers nibbled and left because we were hoping for a more substantial intellectual feast.  Please do not get this book to look up tidbits of information – it will disappoint.  Get this book if you are a mental health professional who has ever wanted to be Sherlock Holmes, a research scientist, or a chef de cuisine rather than a line cook, and wondered how mindset training can transform a competent practitioner into an outstanding clinical psychopharmacologist.