John M. Davis
Lolita O. Ang
THE DISCOVERY of the therapeutic uses of the antipsychotic drugs, the tricyclics, the MAO inhibitors, lithium, and the benzodiazepines have revolutionalized psychiatry. 110 In this chapter, we provide an account of advances in psychopharmacology that have occurred since the appearance of the original section on psychopharmacology in volume V of the American Handbook of Psychiatry.
Before we proceed, let us review. Between 1949, when lithium was discovered, and the publication of the most recent chapter on psychopharmacology in the American Handbook of Psychiatry, various psychoactive drugs were introduced. The best way to review their status is to give an overall summary of their efficacy. For purposes of comparison and a general presentation, we have compiled summary data to show the efficacy of new treatment in comparison with the older placebo treatment. These are presented in the context of similar data for the classical antibiotics—streptomycin for tuberculosis and penicillin for pneumococcal pneumonia.
The drug-placebo difference is a meaningful measurement of the overall efficacy of a specific drug administered to patients with a specific disease. In terms of drug-placebo differences, the advance in psychotropic drugs is comparable to major innovations in chemotherapy.
Table 5-1 summarizes data from the National Institute of Mental Health (NIMH) Collaborative Study Number 1 on the efficacy of the treatment of acute schizophrenia with drugs and placebo and from studies by the British Medical Research Council on the efficacy of treatment for tuberculosis with streptomycin. Data on the treatment of pneumococcal pneumonia with penicillin and sulfanilamide and the use of drugs in surgery are also included. The drug-placebo differ-