Task Force on Somatic Therapies: Giving Our Best to Patients

By Rodrigo Muņoz, M.D.
APA President

Psychotherapy and somatic treatments in psychiatry are becoming increasingly better integrated. Following the development of diagnostic criteria that can be used reliably in clinical practice, psychiatrists in the last three decades have moved toward treating patients according to a biopsychosocial plan tailored to their specific needs.

Dr. Jack McIntyre, Dr. Harold Pincus, and other colleagues analyzing data provided by APA's Practice Research Network have greatly contributed to our knowledge of the distribution of diagnoses in psychiatric offices. We now have evidence that psychiatric clinicians spend most of their time with patients who suffer from a relatively small number of very serious disorders, including anxiety and depressive disorders, schizophrenia, chemical dependence, and the dementias.

Our strategies for treating patients with these disorders are increasingly focused and powerful. Central to our clinical approach is providing the "best psychiatric care" (sometimes called "psychiatric management") tailored for each patient. This entails the use of appropriate diagnostic procedures and clinical thought processes that lead to a proper diagnostic formulation and an adequate treatment plan, including family and community interventions. This complex process is incompatible with trying to see patients only for the purpose of "managing their medication."

The best psychiatric management, which is reflected in all of APA's practice guidelines, leads to decisions regarding the use of psychotherapy and somatic interventions. Mounting evidence indicates that patients benefit from having psychiatrists take control of all treatment. Referral to other professionals should be the result of careful evaluation of potential problems and benefits, not a mandate by a financial intermediary (which at face value appears totally illogical anyway).

In the accompanying article Dr. Alan Schatzberg, chair of the department of psychiatry and behavioral sciences at Stanford University, discusses the goals of my initiative on somatic therapies and the need to communicate the latest findings in this area to our members. Psychiatrists are the foremost experts in the clinical use of psychotropic and other medications. Maintaining our expertise requires a constant effort because of a number of factors:

• Pharmaceutical companies spend millions of dollars in research and development for years before a given compound is approved for clinical use. Thus, they have a strong self-interest in pushing their products' advantages. The counterbalance is provided by the careful observations of clinician researchers.



• New strategies and techniques in basic research, new insights about molecular structure and molecular biology, and computer technology are accelerating the creation of compounds with novel actions.



• More clinicians are reporting their experiences with products now in use. Electronic communications technology has led to the rapid testing of hypotheses and faster achievement of consensus.

Dr. Ed Coffey, an expert in electroconvulsive therapy, is a member of APA's Task Force on Somatic Therapies. He will help us address the immediate need to return this therapy to the place in mainstream psychiatry it has deserved for many years. Psychiatrists committed to the best treatment for each patient must have expertise in all effective treatments.