Prescribing Together: A Relational Guide to Psychopharmacology

by Warren A. Kinghorn MD ThD, Abraham M. Nussbaum MD MTS

Overview

What if, rather than acting only as dispensers of medication, mental health clinicians and primary care clinicians treating mental disorders were also collaborators with patients in the prescribing relationship? It's a simple but profound shift in how to think about approaching psychopharmacology, and in Prescribing Together, Warren Kinghorn and Abraham Nussbaum argue that this sort of human-to-human relationship-building is critical to prescribing more effectively and to achieving health equity.

While many other books have focused on what to prescribe for given conditions, this volume is more concerned with how to prescribe: how to talk to patients about medications, how to understand the cultural and social factors that affect how both clinicians and patients relate to medication, and how to build trust in the relationship.

Each chapter offers a practical introduction to at least one key concept or skill, from cultural formation and structural competency to medication concordance and deprescribing. Profiles, rich in personal anecdotes, of a diverse group of accomplished clinicians serve as an engaging, real-life foundation for evidence-based strategies for building strong alliances in the context of 13 mental disorder categories, including: • Schizophrenia• Bipolar disorder• Major depressive disorder• Generalized anxiety disorder• Neurocognitive disorders• Borderline personality disorder

In drawing a contrast between a dispenser and a collaborator model, Prescribing Together encourages clinicians not just to look at their patients, but to look with them at their lived experience, to understand their stories and interpersonal and social contexts—all with the aim of returning agency to patients and empowering them to set meaningful goals and to be active particpants in their own flourishing.

Product Details

ISBN-13:	9781615372881
Publisher:	American Psychiatric Association Publishing
Publication date:	06/02/2021
Pages:	296
Product dimensions:	4.50(w) x 8.12(h) x (d)
Age Range:	18 Years

About the Author

Warren A. Kinghorn, M.D., Th.D., is Associate Professor of Psychiatry at Duke University Medical Center; Esther Colliflower Associate Professor of the Practice of Pastoral and Moral Theology and Co-Director of the Theology, Medicine, and Culture Initiative at Duke Divinity School; and Staff Psychiatrist at Durham VA Medical Center in Durham, North Carolina.

Abraham M. Nussbaum, M.D., M.T.S., is Associate Professor of Psychiatry and Assistant Dean of Graduate Medical Education at the University of Colorado School of Medicine, and Chief Education Officer at Denver Health in Denver, Colorado.

Table of Contents

About the Authors vii

Acknowledgments ix

1 Introduction: From Dispensers to Collaborators 1

2 Relationship Matters 17

3 Prescribing Alliances 27

4 Peak Performance: Prescribing in the Context of Attention-Deficit/ Hyperactivity Disorder 49

5 Visions and Voices: Prescribing in the Context of Schizophrenia and Other Psychotic Disorders 69

6 Stabilization Forces: Prescribing in the Context of Bipolar Disorder 91

7 Frayed Edges: Prescribing in the Context of Depressive and Anxiety Disorders 119

8 Unwelcome Strangers: Prescribing in the Context of Obsessive-Compulsive and Related Disorders 139

9 Building Peace: Prescribing in the Context of Trauma- and Stressor-Related Disorders 155

10 When the Body Speaks: Prescribing in the Context of Somatic Distress 173

11 Befriending the Body: Prescribing in the Context of Eating Disorders 191

12 Getting Clean: Prescribing in the Context of Substance Use Disorders 209

13 Knowing and Being Known: Prescribing in the Context of Neurocognitive Disorders 225

14 Strong Emotions: Prescribing in the Context of Borderline Personality Disorder 243

Epilogue: From Fixing to Attending 259

Appendix: Alliance Measures 263

Index 269

Editorial Reviews

Reviewer: Zachary Cohen Hommer, MD (Pine Rest Christian Mental Health Services)
Description: This handbook is designed to help change mental health providers from simply being dispensers of medications to collaborators who work with patients to come up with the most effective treatment plan, with or without medications. It is structured in easy-to-read chapters, the first few serving as an introduction to collaborative care and prescribing, with each of the remaining chapters focusing on a different group of mental illnesses.
Purpose: The aim is to provide a guide to help clinicians focus on "how to prescribe" when working with psychiatric patients, going beyond just "what to prescribe." As the subtitle suggests, the purpose is to help physicians and others view prescribing as integral to the relationship with patients, and that by viewing prescribing as a mutual relationship, they can anticipate better outcomes and prepare more easily for adversity. These are certainly worthy objectives. In the introduction, the authors describe a thought experiment in which psychiatric care is provided by a vending machine, where patients input a list of symptoms and are dispensed a medication. Obviously, this is not the ideal way to treat mental illness, but if not careful, it is easy to imagine medicine moving in that direction. The book does a great job of meeting its objectives.
Audience: The audience is all clinicians who care for psychiatric patients or prescribe psychiatric medications. The authors acknowledge that the majority of mental health prescribing is not done by psychiatrists and make the book accessible to clinicians with a wide variety of expertise. It is ideal for young psychiatric residents as well as advanced practice providers, who often know quite a bit of pharmacology, but may not have gotten adequate training on psychotherapy or the importance of relationships. The authors are well respected in academic psychiatry, but they go beyond their own expertise to highlight the clinical contributions of experts in specific fields of mental health in each chapter, focusing on one physician or psychologist with particular experience and expertise in a field, such as anxiety and depression, bipolar disorder, or eating disorders.
Features: This book focuses on the prescriber-patient relationship and how to enhance it in order to best treat a variety of mental illnesses. Each of the 13 chapters covers a specific type of illness, such as ADHD, neurocognitive disorders, borderline personality, etc. The book is well structured, and each chapter enables clinicians to briefly review and learn some practical strategies for prescribing to treat a specific mental illness. Although there are no chapters on dissociative or somatic disorders, many of the same strategies outlined in the chapters on anxiety, OCD, and BPD would apply to those patients, so I do not see these as major omissions.
Assessment: Overall, this is an important and useful contribution to the field. As prescribing moves more and more towards an algorithmic approach, this book provides an important reminder that the doctor-patient relationship is every bit as important as the pharmacological treatment. It reminds us that prescribing does not exist in a bubble, and that medication treatment is itself a form of psychotherapy. The book draws heavily on the psychodynamic pharmacology work of David Mintz but also extends his work to other areas. It is written in an easily accessible manner, and I recommend it to all new psychiatric prescribers.

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