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Chapter 67. Ethical Considerations in Psychopharmacological Treatment and Research

Jinger G. Hoop, M.D., M.F.A.; Joseph B. Layde, M.D., J.D.; Laura Weiss Roberts, M.D., M.A.
DOI: 10.1176/appi.books.9781585623860.415855

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Excerpt

The discovery of chlorpromazine's effectiveness in treating symptoms of schizophrenia in 1952 (Delay and Deniker 1952) launched the modern era of pharmacological treatment of psychiatric disease and was a critical development in the compassionate care of people living with mental illness and in the reduction of the societal burden of mental disease. Chlorpromazine's introduction was followed in 1958 by the introduction of imipramine as a treatment for depression (Kuhn 1958) and in 1960 by that of chlordiazepoxide for anxiety (Shorter 1997). Within years, these medications eased the symptoms of hundreds of thousands of the most severely and persistently ill individuals—many of whom otherwise would have endured a lifetime of suffering, disability, and institutionalization, as had millions before them.

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FIGURE 67–1. Elements of informed consent.Source. Reprinted from Roberts LW, Dyer AR: "Informed Consent and Decisional Capacity," in Concise Guide to Ethics in Mental Health Care. Washington, DC, American Psychiatric Publishing, 2004, p. 52. Used with permission.

FIGURE 67–2. Decision tree for ethical use of clinical innovation.
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TABLE 67–1. Essential ethics abilities in psychopharmacology
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TABLE 67–2. Glossary of ethics terms
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TABLE 67–3. Ethical tensions in clinical psychopharmacology
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TABLE 67–4. Working therapeutically with patients receiving involuntary medication treatment

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Sample questions:
1.
There are key ethical skills that are crucial to psychiatric practice and of relevance to psychopharmacology. You are asked to evaluate a psychiatric colleague’s clinical practice at your medical center. He is an attending on the inpatient psychiatry unit. You learn that he was recently devastated by the suicide of one of his patients. From a review of his medical records and a discussion with clinical staff on the unit, you learn that he has been much more aggressive in using pharmacotherapy, and there are instances where it appears that patients whom he is treating were not provided with appropriate informed consent to treatment. Which of the ethical skills for this psychiatrist may be affected?
2.
Physicians are in a position of trust with a duty to act on behalf of their patients’ best welfare. What is this responsibility called?
3.
Decisional capacity has been described as consisting of four abilities. Which of the following is not a component of decisional capacity?
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