Psychopharmacology Tips

Knowledge of the patient’s personality and defense mechanisms might be useful in planning pharmacotherapy.

For instance, a patient with paranoid personality or paranoid traits may be suspicious about medications as well as the physician’s intentions, and may have a tendency to misinterpret medication side effects.

Patients with an underlying narcissistic pathology may argue with the physician and try to handle the side effects on their own.

A person with comorbid obsessive compulsive personality disorder or obsessive compulsive personality traits will need exact instructions as to how to take medication, including exact dosing times, to feel comfortable. He or she will require very detailed discussions of side effects before the treatment begins. An obsessive-compulsive patient will also be careful to watch for side effects and discuss them in detail during treatment. However, the obsessive-compulsive patient is usually more compliant.

Patients with an underlying borderline pathology may stop the medication abruptly because of any side effects. They may also use the issue of side effects in splitting the treating physician and therapist. Borderline patients may require repeated education about the possible side effects and their management.

Patients with histrionic personality disorder or histrionic traits may mix up exact times and feel guilty, and they may also miss doses when the dosing schedule is too rigorous. A seductive histrionic patient may also try to please the treating physician by minimizing the side effects.

In conclusion, one must consider overt personality pathology in treatment-planning as well as side effects management. One might tailor the instructions and information about the medications and their side effects to a patient's underlying personality pathology.

Ref: - Balon, R. (1998) General issues in the management of side effects of psychotropic drugs. In: (Ed) Balon, R., Practical management of the side effects of psychotropic drugs. pp 1- 16, New York: Basel.