The following describes an algorithm-oriented
psychopharmacology course for residents in psychiatry.
HARVARD SOUTH SHORE PSYCHIATRY
RESIDENCY TRAINING PROGRAM
1999-2004
Using Algorithms and Evidence-Based Medicine:
A Curriculum for Teaching Psychopharmacology
FACULTY:
JAMES LEVITT, M.D.,
DAVID N. OSSER,
M.D.
SYLLABUS FOR
1999-2001
Introduction: Goals, Methods, Requirements of the Course.
Evidence-Based Medicine. How to Critique the Evidence.
- Osser DN, Patterson RD, Levitt JJ. Using
algorithms and evidence-based medicine: a curriculum for teaching
psychopharmacology. Unpublished manuscript.
- Safranek S, Dodson S. Strategies for finding
evidence. In: Evidence-based clinical practice: concepts and approaches.
Geymann JP, Deyo RA, Ramsey SD, eds. Boston, Butterworth-Heinemann, 2000:29-40
- Lawrie SM. Making sense of the numbers in
evidence-based medicine. In: Brown T, Wilkinson G, Eds. Critical reviews in
psychiatry, 2nd Ed. Royal College of Psychiatrists. Bell and Bain Limited,
Glasgow, England 2000:5-10.
Module 1: Schizophrenia I
- Year I Syllabus Paper (Y1S): Osser DN, Zarate CA Jr. Consultant for
the pharmacotherapy of schizophrenia. Psychiatric Annals 1999;29:252-267.
- Year I Resident-Determined Paper (Y1R): Beasley CMJr., Tollefson G,
Tran P, et al. Olanzapine vs placebo and haloperidol: acute phase results of
the North American double-blind olanzapine trial. Neuropsychopharmacol
1996;14:111-123.
- Year 2 Syllabus Paper (Y2S): Ho B-C, Miller D, Nopoulos P, Andreasen
NC. A comparative effectiveness study of risperidone and olanzapine in the
treatment of schizophrenia. J Clin Psychiatry 1999;60(10):658-663.
- Year 2 Resident-Determined Paper (Y2R): Glantz LA, Lewis DA.
Decreased dendritic spine density on prefrontal cortical pyramidal neurons in
schizophrenia. Arch Gen Psychiatry 2000;57:65-73.
Module 2: Schizophrenia II
- (Y1S): McEvoy JP, Scheifler PL, Frances A. Treatment of schizophrenia
1999: the expert consensus guideline series. J Clin Psychiatry 1999;60[suppl
11]:8-19.
- (Y1R): Marder SR, Davis JM, Chouinard G. The effects of risperidone
on the five dimensions of schizophrenia derived by factor analysis: combined
results of the North American trials. J Clin Psychiatry 1997;58:538-546.
- (Y2S): Wassef AA, Dott SG, Harris A et al. Randomized,
placebo-controlled pilot study of divalproex sodium in the treatment of acute
exacerbations of chronic schizophrenia. J Clin Psychopharmacol 2000;20:357-361.
- (Y2R): Levinson DF, Umapathy C, Musthaq M. Treatment of
schizoaffective disorder and schizophrenia with mood symptoms. Am J Psychiatry
1999;156(8):1138-1148 and Levitt J, Tsuang MT. The heterogeneity
of schizoaffective disorder: implications for treatment. Am J Psychiatry
1988;145:926-936.
Module 3: Schizophrenia III
- (Y1S): Chiles JA, Miller AL, Crismon, ML, et al. The Texas Medication
Algorithm Project: development and implementation of the schizophrenia
algorithm. Psychiatric Services 1999;50:69-74.
- (Y1R): Corson PW, Nopoulos P, Miller DD, et al. Change in basal
ganglia volume over 2 years in patients with schizophrenia: typical vs atypical
neuroleptics. Am J Psychiatry 1999;156:1200-1204.
- (Y2S): Purdon SE, Jones BDW, Stip E et al. Neuropsychological change
in early phase schizophrenia during 12 months of treatment with olanzapine,
risperidone, or haloperidol. Arch Gen Psychiatry 2000;57(3):249-258.
- (Y2R): Shergill SS, Brammer MJ, Williams SCR et al. Mapping auditory
hallucinations in schizophrenia using functional magnetic resonance imaging.
Arch Gen Psychiatry 2000;57:1033-1038.
Module 4: Depression I
- (Y1S): Osser DN, Patterson RD. Algorithms for the pharmacotherapy of
depression, part one (unipolar, dysthymia). Directions in Psychiatry
1998;18:303-317.
- (Y1R): Feighner J, Targum SD, Bennett ME, et al. A double-blind,
placebo-controlled trial of nefazodone in the treatment of patients
hospitalized for major depression. J Clin Psychiatry 1998;59:246-253.
- (Y2S): Versiani M, Amin M, Chouinard G. Double-blind,
placebo-controlled study with reboxetine in inpatients with severe major
depressive disorder. J Clin Psychopharmacol 2000;20:2834.
- (Y2R): Byrne SE, Rothschild AJ. Loss of antidepressant efficacy
during maintenance therapy: possible mechanisms and treatments. J Clin
Psychiatry 1998;59:279-288.
Module 5: Depression II
- (Y1S): Osser, DN, Patterson RD. Algorithms for the pharmacotherapy of
depression, part two (psychotic, treatment-refractory, comorbid). Directions in
Psychiatry 1998;18:318-333.
- (Y1R): Clerc GI, Ruimy P, Verdeau-Pailles J. A double-blind
comparison of venlafaxine and fluoxetine in patients hospitalized for major
depression and melancholia. Int Clin Psychopharmacol 1994;9:139-143.
- (Y2S): Judd LL, Paulus MJ, Schettler PJ et al. Does incomplete
recovery from first lifetime major depressive episode herald a chronic course
of illness? Am J Psychiatry 2000;157:1501-1504.
- (Y2R): Kornstein SG, Schatzberg AF, Thase MF et al. Gender
differences in treatment response to sertraline versus imipramine in chronic
depression. Am J Psychiatry 2000;157(9):1445-1452.
Module 6: Bipolar Depression
- (Y1S): Dantzler A, Osser DN. Algorithms for the pharmacotherapy of
acute depression in patients with bipolar disorder. Psychiatric Annals
1999;29:270-284.
- (Y1R): Calabrese JR, Bowden CL, Sachs GS, et al. A double-blind
placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar
I depression. J Clin Psychiatry 1999;60:79-88.
- (Y2S): Amsterdam, JD, Garcia-Espana P, Fawcett J et al. Efficacy and
safety of fluoxetine in treating bipolar II major depressive episode. J Clin
Psychopharmacol 1998;18:435-440.
- (Y2R): Calabrese JR, Suppes T, Bowden CL, et al. A double-blind,
placebo-controlled, prophylaxis study of lamotrigine in rapid cycling bipolar
disorder. J Clin Psychiatry 2000;61:841-850.
Module 7: Bipolar Mania
- (Y1S): Post RM, Denicoff KD, Frye MA, Leverich GS. Algorithms for
bipolar mania. In: Rush AJ, ed. Mood Disorders: Systematic Medication
Management. Basel: Karger, 1997:114-145.
- (Y1R): Chou JC-Y, Czobor P, Charles O, et al. Acute mania:
haloperidol dose and augmentation with lithium or lorazepam. J Clin
Psychopharmacol 1999;19:500-505.
- (Y2S): Segal J, Berk M, Brook S. Risperidone compared with both
lithium and haloperidol in mania: a double-blind randomized controlled trial.
Clin Neuropharmacol 1998:21(3):176-180.
- (Y2R): Keck PE Jr., Reeves KR, Harrigan EP. Ziprasidone in the
short-term treatment of patients with schizoaffective disorder: results from
two double-blind, placebo-controlled, multicenter studies. J Clin
Psychopharmacol 2001;21:27-35 and Maj M, Pirozzi R, Formicola AM,
et al. Reliability and validity of the DSM-IV diagnostic category of
schizoaffective disorder: preliminary data. J Affect Disord 2000;57:95-98.
Module 8: Panic Disorder
- (Y1S): Rosenbaum JF, Pollack MH, Friedman SJ. The pharmacotherapy of
panic disorder. In: Rosenbaum JF, Pollack MH, eds. Panic Disorder and its
Treatment. New York: Marcel Dekker, 1998:153-180. and Uhlenhuth
EH, Balter MB, Ban TA, Yang K. International study of expert judgment on
therapeutic use of benzodiazepines and other psychotherapeutic medications: V.
treatment strategies in panic disorder, 1992-1997.
- (Y1R): Wade AG, Lepola U, Koponen HJ, et al. The effect of citalopram
in panic disorder. Br J Psychiatry 1997;170:549-553.
- (Y2S): Pollack MH, Otto MW, Worthington JJ et al. Sertraline in the
treatment of panic disorder. Arch Gen Psychiatry 1998;55:1010-1016
and Rapaport MH, Pollack MH, Wolkow R et al. Is placebo response
the same as drug response in panic disorder? Am J Psychiatry
2000;157(6):1014-1016.
- (Y2R): Rickels K, Lucki I, Schweizer E et al. Psychomotor performance
of long-term benzodiazepine users before, during, and after benzodiazepine
discontinuation. J Clin Psychopharmacol 1999;19:107-113.
Module 9: Posttraumatic Stress Disorder
- (Y1S): Osser DN, Renner JAJr., Bayog R. Algorithms for the
pharmacotherapy of anxiety disorders in patients with chemical abuse and
dependence. Psychiatric Annals 1999;29(5):285-301.
- (Y1R): Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in
PTSD: randomized, double-blind study. Br J Psychiatry 1999;175:17-22
and Hertzberg MA, Butterfield MI, Feldman ME, et al. A
preliminary study of lamotrigine for the treatment of PTSD. Biol Psychiatry
1999;45:1226-1229.
- (Y2S): Hidalgo R, Hertzberg MA, Mellman T et al. Nefazodone in
posttraumatic stress disorder: results from six open-label trials. Int Clin
Psychopharmacol 1999;14:61-68.
- (Y2R): Alarcon RD, Glover S, Boyer W, Balon R. Proposing an algorithm
for the pharmacological treatment of posttraumatic stress disorder. Ann Clin
Psychiatry 2000;12(4):239-246.
Module 10: Social Anxiety Disorder and Generalized Anxiety Disorder
- (Y1S): Marshall RD, Schneier FR. An algorithm for the pharmacotherapy
of social phobia. Psychiatric Annals 1996;26(4):210-216.
- (Y1R): Davidson JRT, Dupont RL, Hedges D, Haskins JT. Efficacy,
safety, and tolerability of venlafaxine ER and buspirone in outpatients with
GAD. J Clin Psychiatry 1999;60:528-535.
- (Y2S): Baldwin D, Bobes J, Stein DJ. Paroxetine in social
phobia/social anxiety disorder: randomized, double-blind, placebo-controlled
study. Br J Psychiatry 1999;175(8):120-126.
- (Y2R): Walker JR, Van Ameringen MA, Swinson R, et al. Prevention of
relapse in generalized social phobia: results of a 24-week study in responders
to 20 weeks of sertraline treatment. J Clin Psychopharmacol 2000;20:636-644.
Module 11: Obsessive-Compulsive Disorder
- (Y1S): Francis A, Docherty JP, Kahn DA. Treatment of
obsessive-compulsive disorder: the expert consensus guideline series. J Clin
Psychiatry 1997;58[suppl 4]:11-27. and Oesterheld JR, Osser DN.
Drug interactions in augmentation strategies for pharmacotherapy of
obsessive-compulsive disorder. Journal of Practical Psychiatry and Behavioral
Health 1999;5(3):179-183.
- (Y1R): Koran LM, McElroy SL, Davidson JRT, et al. Fluvoxamine vs
clomipramine for OCD: a double-blind comparison. J Clin Psychopharmacol
1996;16:121-129.
- (Y2S): Ninan PT, McElroy SL, Kane CP et al. Placebo-controlled study
of fluvoxamine in the treatment of patients with compulsive buying. J Clin
Psychopharmacol 2000;20:362-366.
- (Y2R): Mathew SJ, Simpson BH, Fallon VA. Treatment strategies for
OCD. Psychiatric Annals 2000;30(11):699-708.
Module 12: Agitation in the Patient with Dementia
- (Y1S): Kahn DA, Alexopoulos GS, Silver JM, et al. Treatment of
agitation in elderly persons with dementia: a summary of the expert consensus
guidelines. Journal of Practical Psychiatry and Behavioral Health
1998;4(5):265-276.
- (Y1R): McManus DQ, Arvanitis LA, Kowalcyk BB. Quetiapine, a novel
antipsychotic: experience in elderly patients with psychotic disorders. J Clin
Psychiatry 1999;60:292-298.
- (Y2S): Mayeux R, Sano M. Treatment of Alzheimer’s disease. NEJM
1999;341(22):1670-1679.
Module 13: Eating Disorders
- (Y1S): Goldbloom DS. Evaluating the efficacy of pharmacologic agents
in the treatment of eating disorders. Essential Psychopharmacology
1997;2(1):71-87
- (Y1R): Walsh BT, Wilson GT, Loeb KL, et al. Medication and
psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry
1997;154:523-531.
- (Y2S): Agras WS, Walsh BT, Fairburn CG et al. A multicenter
comparison of cognitive-behavioral therapy and interpersonal psychotherapy for
bulimia nervosa. Arch Gen Psychiatry 2000;57:459-466.
Module 14: Geriatric Psychopharmacology
- (Y1S): Jenicke MA. Geriatric psychopharmacology. Psychiatric Clinics
of North America Annual of Drug Therapy 1996:3:151-203.
- (Y1R): Weihs KL, Settle ECJr., Batey SR, et al. Bupropion SR vs
paroxetine for the treatment of depression in the elderly. J Clin Psychiatry
2000;61:196-202.
- (Y2S): Troy SM, Lucki I, Unruh MA et al. Comparison of the effects of
zaleplon, zolpidem, and triazolam on memory, learning, and psychomotor
performance. J Clin Psychopharmacol 2000;20:328-337.
Module 15: Attention Deficit Hyperactivity Disorder
- (Y1S): Bhandary AN, Fernandez F, Gregory RJ, et al. Pharmacotherapy
in adults with ADHD. Psychiatric Annals 1997;27(8):545-555.
- (Y1R): Wilens TE, Biederman J, Prince J, et al. Six week,
double-blind, placebo-controlled study of desipramine for ADHD. Am J Psychiatry
1996;153:1147-1153.
- (Y2S): Horrigan JP, Barnhill LJ. Low-dose amphetamine salts and adult
attention-deficit/hyperactivity disorder. J Clin Psychiatry 2000;61:414-417.
Module 16: Substance Abuse and Dependence
- (Y1S): Mirin SM, Chair: Work Group on Substance Abuse Disorders.
American Psychiatric Association Practice Guidelines for the Treatment of
Patients with Substance use Disorders: Alcohol, Cocaine, Opioids. American
Journal of Psychiatry 1995;152(11) Supplement:28-43.
- (Y1R): Volpicelli JR, Alterman AI, Hayashida M, O’Brien CP.
Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry
1992;49:876-880.
- (Y2S): Roy-Byrne PP, Pages KP, Russo JE et al. Nefazodone treatment
of major depression in alcohol-dependent patients: a double-blind,
placebo-controlled trial. J Clin Psychopharmacol 2000;20:129-136.
- (Y2R): Green AI, Zimmet SV, Strous RD, Schildkraut JJ. Clozapine for
comorbid substance abuse disorder and schizophrenia: do patients with
schizophrenia have a reward-deficiency syndrome that can be ameliorated by
clozapine? Harvard Rev Psychiatry 1999;6:287-296.
Module 17: Child and Adolescent Psychopharmacology
- (Y1S): Ambrosini PJ, Emslie GJ, Greenhill LL, et al. Selecting a
sequence of antidepressants for treating depression in youth. J of Child and
Adol Psychopharmacol 1995;5(4):233-240.
- (Y1R): Goodnick PJ, Jorge CA, Hunter T, Kumar AM. Nefazodone
treatment of adolescent depression: an open label study of response and
biochemistry. Ann Clin Psychiatry 2000;12:97-100
- (Y2S): Pliszka SR, Greenhill LL, Crismon ML et al. The Texas
children’s medication algorithm project: report of the Texas consensus
conference panel on medication treatment of childhood
attention-deficit/hyperactivity disorder, part I. J Am Acad Child Adolesc
Psychiatry 2000;39(7):908-919.
Algorithm Course
Introduction
Syllabus for 2001-2003
Syllabus for 2003-2005