An important role in the treatment of patients having psychological issues belongs to the psychopharmacology. Psychotropic medications are ones of the most commonly prescribed drugs (Lichtblau, 2011). The use of psychopharmacology helped to improve the condition of millions of people with mental illness. However, there are numerous ethical issues in psychopharmacology. Psychotropic drugs might have adverse effects (especially innovative medications); over-reliance on medications might lead to habituation and addiction (Lichtblau, 2011). Psychotropic medications might also affect cognitive abilities in certain cases. Therefore, psychiatrists should possess ethical skills and always consider ethical implications while prescribing psychotropic medications.
1. Treatment decision-making process
Practitioners should carefully review the patient’s characteristics and history before prescribing psychotropic medications. In particular, analysis of the patient’s response to treatment and past symptoms is required. It is also necessary to consider the patient’s concerns and motivations, and to develop a therapeutic strategy focused on reaching maximal therapeutic effect. Ethical responsibility of the practitioner requires that psychopharmacology should only be used when there is strong evidence for doing this (Lichtblau, 2011). Practitioners should be aware of all potential contraindications and adverse effects of the medications, and should clearly explain these to the patient. In many cases, the practitioner and the patient collaborate to identify and range treatment goals. If the patient is working with other therapists, it is reasonable to get in touch with them and to align therapeutic strategy. If the diagnosis is unclear or there are other treatment issues, the practitioner might consult the relevant experts after obtaining the patient’s consent.
2. Informed consent and personal choice
The basis of ethical treatment and therapeutic relationship is informed consent. The practitioner should provide the relevant information to the patient, take into account the decision-making abilities of the patient, and outline the available treatment strategies as well as their alternatives in a maximally comprehensible way (Lichtblau, 2011). The practitioner should focus on alleviating the patient’s suffering and improving the patient’s health in the first place. It is important to provide accurate information about the treatment, and consider potential adverse effects, even if they are rare. If the adverse effects might threaten the patient’s life, the practitioner should necessarily explain this, and explain the results of rejecting the treatment or choosing an alternative treatment.
The practitioner should also evaluate the patient’s decision-making ability; such characteristics as communicative abilities, the abilities to express personal preferences, the ability to think and act rationally and the ability to evaluate the impact of the illness and the treatment on the patient’s life (Lichtblau, 2011). It is necessary to explain all risks and benefits of the treatment to the patient in a manner aligned with the degree of risk associated with the treatment and the patient’s ability to make an authentic decision.
3. Individuals with dual diagnoses
Patients with dual diagnoses might respond differently to the psychopharmacological treatment. It is recommended to document the patient’s reactions to treatment in a consistent manner (Julien, Advokat & Comaty, 2010). The practitioner should consider existing evidence-based strategies in the case of dual diagnosis. Furthermore, if multiple diagnoses are possible or the patient is demonstrating unexpected reactions and his behavior is overly difficult, it is recommended to ask the patient’s permission to collaborate with other persons involved in patient care and treatment (e.g. primary support group, the provider of primary care, psychotherapist, family member, etc.).
4. Individuals with other diagnoses
Before prescribing psychotropic medications to mentally ill patients who also have other diseases (e.g. individuals with cancer), practitioners should always analyze the drug-disease interaction (Julien, Advokat & Comaty, 2010). The disease might change the patient’s reactions to the psychotropic medications, so the practitioner should review the relevant medical literature and drug information. All treatments and responses should e clearly documented. The effect of psychotropic drugs on the patient might be both favorable and deleterious. It is recommended to contact the patient’s doctor in charge and develop a combined treatment strategy. It is essential to ask for the patient’s consent before developing such strategy. In many cases, combined therapeutic strategy will lead to better effect for the patient’s health and well-being (Julien, Advokat & Comaty, 2010).
5. Drug-drug interaction
The practitioners should always analyze the existing medications which the patient is taking, as well as the medications which the patient is likely to purchase over-the-counter, complementary or alternative agents and supplements (Lichtblau, 2011). It is necessary to analyze the potential interaction of the drugs and review available literature and research on such interactions; furthermore, it is recommended to study possible pharmacokinetic alterations and pharmacodynamic effects of the drugs (Lichtblau, 2011). The practitioners might use therapeutic drug monitoring if it is available for the considered psychotropic medications (Julien, Advokat & Comaty, 2010). The practitioner should clearly explain the potential effects of drug-drug interaction and outline the importance of following the prescriptions; it is also necessary to explain the adverse effects of taking unauthorized medications, and ensure that the patient understands the risks and benefits of the treatment.
There are numerous ethical issues in psychopharmacology; these issues tend to be complex and sensitive both for the patient and for the practitioner. The practitioner should pay attention to the importance of informed consent and carefully present the existing situation and treatments to the patient. The practitioner should also work on enhancing ethical skill set and expanding knowledge of boundary interactions of psychotropic drugs, the effects of these drugs on the clinical course of non-mental diseases and the interactions of psychotropic and other drugs.
Julien, R. M., Advokat, C. D., & Comaty, J. E. (2010). A primer of drug action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs. New York, NY: Worth Publishers/Macmillan.
Lichtblau, L. (2011). Psychopharmacology demystified. Clifton Park, NY: /Cengage Learning.