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Ask the Mental Health Expert Archives 2001-2004

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Q. What distinguishes a psychopharmacologist from a psychiatrist? Is the former more specialized than the latter in medicines? Would a patient seek a psychopharmacologist for specialized help that the psychiatrist couldn't normally deliver, the way he might seek a cardiologist for specialized help?

Do psychophamacologists devote any time to diagnosis, or is it all to prescribing, post-diagnosis? After all, how can one accurately assess a mental disorder in a fifteen-minute session? My doctor took 90 minutes!

I am bipolar and active in a couple of mood disorder support groups, where the advice is circulating like wildfire that psychopharmacologists are the only doctors of merit as far as mood disorders are concerned, with psychiatrists to be avoided, as they're somehow lost in antiquity. I thought they were the same thing! Can you tell me the difference?

A. That's a very good question! As with the term "psychotherapist", there is a great deal of ambiguity associated with the designation, "psychopharmacologist." Simply put, there are no national standards that I know of defining this term, or the credentials necessary to call oneself a psychopharmacologist.

In my experience, most pracitioners who call themselves psychopharmacologists are psychiatrists with a long-standing interest--if not expertise--in psychotropic medication. Beyond that, it's anybody's guess what the doctor's knowledge and experience are, with two exceptions: 1. Any psychiatrist with board certification (as per the American Board of Psychiatry and Neurology) has demonstrated a relatively sophisticated knowledge of psychopharmacology, simply by virtue of passing the boards. But--notice I said relatively. There are still some board-certified psychiatrists whose knowledge of psychopharmacology leaves something to be desired, in my view. 2. The American Society of Clinical Psychopharmacology, Inc. (P.O. Box 2257, New York, NY 10116 718-470-4007 Fax: 718-343-7739; http://www.ascpp.org) does sponsor a credentialling examination each year. Only MDs and DOs (osteopathic physicians) currently Board Certified in a medical specialty and with a current medical license are eligible to take this exam, which is reputed to be very rigorous. The names of those who have been so credentialled should soon be available at the ASCP website. However--as someone who considers himself first and foremost a physician and psychiatrist--I would take issue with the notion that only psychopharmacologists have merit, as far as treating mood disorders is concerned. Any board-certified psychiatrist should be able to provide competent, if not stellar, treatment of mood disorders, including bipolar disorder.

Many psychiatrists who do not consider themselves psychopharmacologists are very astute diagnosticians--and without the appropriate diagnosis, there is rarely appropriate treatment. Furthermore, even though bipolar disorder has very strong biochemical and genetic factors driving it, it still requires a comprehensive bio-psycho-social approach--as you evidently appreciate, since you are involved in support groups. Hence, knowledge of psychopharmacology alone does not guarantee optimal treatment of mood disorders (or any psychiatric disorders). All that said--for individuals with suspected or known mood disorders, referral to a specialty clinic is sometimes the best course, if treatment has not been going well. For example, many major medical centers have "Mood Disorder Clinics" within their psychiatry departments that see many thousands of patients per year. Usually--though not always--these are staffed by the most knowledgeable and experienced psychiatric and mental health staff.

January 2004

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