Abstract
As medicine has advanced and newer medications have been introduced, the therapeutic alliance between the patient and their doctor, and therapeutic adherence related to medication, have become extremely important. There are several aspects to this adherence. Apart from confidence in the physician, the patient responds to medication in a number of ways, from the placebo effect to side effects that inevitably may influence whether the patient continues with their medication or not. In undergraduate and even in some postgraduate teaching, side effects of drugs are not given as much prominence as they deserve. This book is a welcome addition to the literature. Not only are side effects of various drugs described, but also how these can be managed. The first chapter describes the role of the psychiatrist as physician, with a clearly written account of how to differentiate between symptoms of the primary condition and those due to adverse side effects. The chapter also provides information on routine laboratory monitoring for commonly used psychotropic drugs. Nocebo effects (non-specific side effects that occur during treatment with inert compounds) are related to patient expectations of drug effects and past side effects and conditioned expectations. Embedded within these are symptoms of anxiety, depression and predisposition to somatization. All drugs cause side effects, but when drugs are prescribed to deal with a particular symptom and the symptom actually gets worse, this raises interesting research and management questions. The authors discuss the difference between evidence-based research findings and real-world patients cogently and suggest that the illness state under investigation itself will make a difference. One of the significant steps is to determine when the psychiatrist pursues antidotes or switches to another medication. The authors illustrate this with the levels of difficulty. A key to the patient’s engagement in medication is the analysis of the risk–benefit ratio regarding a particular condition or drug, and virtually all clinicians who see patients at some point would have come to this discussion. The following chapters cover pharmacodynamics, pharmacokinetics and pharmacogenomics; vulnerable populations; and adverse effects of medications. Part two deals with specific organ systems, and the last chapter provides summary recommendations. Also of great interest is the chapter on what non-medical therapists should know about drug side effects. This book is a must for all clinicians.