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Fava, 2019 Iatrogenic Factors in Psychopathology


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Psychother Psychosom 2019;88:129–140.

Published online: May 14, 2019


Iatrogenic Factors in Psychopathology

Giovanni A. Fava and Chiara Rafanelli


Source: Psychotherapy and Psychosomatics


Full text is available here: Iatrogenic Factors in Psychopathology




The side effects and risks associated with the medical intervention are defined as iatrogenesis [1]. Adverse drug reactions, malpractice, medical error, and negligence constitute common iatrogenic complications [1]. Examples of important syndromes induced by medications are asthma caused by beta-adrenoceptor antagonists, pulmonary fibrosis associated with cytotoxic agents, gastric bleeding and complications with anti-inflammatory agents, torsade de pointes tachycardia with various drugs, abnormal glucose homeostasis with thiazide and corticosteroids, and osteonecrosis of the jaw with bisphosphonates [2].


In psychiatry, iatrogenesis has traditionally been concerned with medical complications of psychotropic drug treatment [3], such as tardive dyskinesia [4] and insulin resistance [5] with antipsychotic drugs, and cardiac and metabolic disturbances with antidepressant medications [6–8]. The complications may occur due to direct toxicity, drug-drug interactions, intoxication, or withdrawal from psychotropic medications [3]. In more recent years, attention has also been dedicated to the patient experience of negative effects of psychotherapy [9, 10], including the interactions between pharmacotherapy and psychotherapy [11, 12].


As it happened with medical therapy [13], psychiatric treatment has mainly been assessed and evaluated as to its capacity to improve psychiatric symptomatology. Side effects have been conceptualized as the unavoidable drawbacks of any form of medical therapy. Little attention has been paid to the adverse psychological and behavioral effects of psychiatric treatment on psychopathology and illness course. In view of the insufficient body of knowledge on the iatrogenic effects of psychological therapies [9, 10], we will only concentrate on the effects of psychotropic drug treatment. Many of the insights that have been gained in the past 25 years have originated in this journal.



A few points taken from the Conclusion:


  • . . . paradoxical effects, manifestations of tolerance (loss of clinical effect, refractoriness), withdrawal and postwithdrawal disorders . . .  may be responsible for the wide spectrum of disturbances subsumed under the generic rubric of treatment resistance.


  • The notion of psychiatric disease is no longer in line with the changed spectrum of health and the complex interplay of biological, iatrogenic and psychosocial factors [14]. Consideration of iatrogenic factors challenges most of the current practices of prescription of psychotropic drugs [4, 42, 84–86]


  • Recognition of iatrogenic factors in psychopathology runs counter major commercial interests, and not surprisingly is censored in mainstream medical journals, scientific meetings, and guidelines [41].


  • Currently, the prescribing physician is driven by evidence-based medicine and guidelines, the marketing arm of pharmaceutical industry [79], to an overestimated consideration of potential benefits, little attention to the likelihood of responsiveness and neglect of potential vulnerabilities to the adverse effects of treatment [78]


  • Long-term outcomes of psychiatric disorders may be unsatisfactory not because technical interventions are missing, but because our conceptual models that ignore iatrogenic forms of psychopathology are inadequate.






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