So it was my turn to refresh our consult service mascot, Nigella, by walking her down to the gift shop for her weekly shot of helium. Let me tell you, if you need a way to lift your spirits, you should try strolling across a hospital with a balloon animal. You leave a bright trail of smiles, comments from adults, “Now there goes a cool doctor!”, and small children pointing their tiny fingers, and saying, “Look mommy, giraffe!”
Well anyway, after her shot of gas, Nigella was bogarting my office computer as she usually does. She found this online article in Clinical Psychiatry News (Jancin, B. (2014) Major overhaul of psychotropic drug terminology launched. Clinical Psychiatry News)
about the new neuroscience-based nomenclature for psychotropic drugs. We had a short conversation about it.
Geezer: Can you find another computer, Nigella? I’ve got work to do.
Geezer: What’s that you’re reading?
Nigella: If you must know, it’s a story about a new nomenclature for psychiatric drugs. Instead of calling them “antidepressants,” “antipsychotics,” and whatnot, this committee of the world’s leading neuropsychopharmacology organizations made this new system.
Geezer: Hmmmm. Is that Dr. David Kupfer in that picture?
Nigella: He’s the chair of the DSM-5 task force, the one that got rid of the multiaxial diagnosis system.
Geezer: Yes, you couldn’t get two clinicians to agree on a Global Assessment of Function rating on Axis V. So what’s the structure of the new nomenclature for psychotropic drugs?
Nigella: A multiaxial system.
Nigella: Yeh, Axis 1 for pharmacologic target and mode of action, Axis 2 for approved indications, Axis 3 for the experts’ opinions on medication efficacy which could include off-label uses and side effects, and Axis 4 describing the drug’s neurobiology, mainly of interest to neuroscientists.
Geezer: Why wouldn’t rank-and-file clinicians be interested in the neurobiology?
Nigella: Don’t be silly. You don’t have time for all that.
Geezer: Hey, there’s an app for that?
Nigella: Uh, maybe. I couldn’t download it to your iPad from the App Store. In fact, I couldn’t find it. It looks like you could get it through Google Play, but I think it’s only for the Android smartphone, version 4 and up. One rater said it didn’t work on version 5.
Geezer: Well, I don’t have an Android.
Nigella: I know. Are you ever going to upgrade from that old flip phone?
Geezer: Never mind, Nigella. I’d have to get a another username and password to download it from Google Play. Oh well, at least it would be free.
Nigella: The article doesn’t say how you could integrate it into electronic health record patient notes.
Geezer: I also don’t see any mention of what clinical pharmacists think of it.
Nigella: They were not represented on the committee. You know, I get it that the current drug nomenclature is outdated, driven by marketing, and inaccurate. And Dr. Kupfer says “It’s very clear that clinicians want this.” Do patients want it?
Geezer: It doesn’t look like patients were represented on the committee either. Look here; they say it’s going to be “…the DSM-5 of psychopharmacology.”
Nigella: Why did Dr. Kupfer wince about that?
Geezer: It’s a long story.
Nigella: You know, what I don’t get is how changing the names of the drugs is going to change the treatment of psychiatric disorders. Don’t we need a better understanding of the neurobiology of the disorders themselves? Did changing the names of the somatoform disorders in DSM-5 change the way doctors manage them?
Geezer: Careful, Nigella. After all, let’s remember, you’re just a balloon giraffe and one full of hot air at that.