Psychopharmacology Algorithm

at the Harvard Medical School
Department of Psychiatry, South Shore Program
David N. Osser, M.D., Founder and Series Editor

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Algorithms for

Why We Create Algorithms Evidence-based practices in psychopharmacology often require years to become widely adopted. This project is an effort to speed the adoption of best research evidence into day-to-day treatment of patients. For each algorithm published here the literature is extensively reviewed and published as a peer reviewed article in preparation for creating the algorithm.

Algorithms are also valuable to help avoid the cognitive lapses which are common when we solve problems which rely on uncertain data and many possible choices. For example our recent success or failure with a particular drug is likely to influence our choices more than it should.

Intended Users The algorithms are for psychiatrists. The information in them often proves most helpful in difficult cases where it is necessary to change treatments after the first and second line treatments have failed or given insufficient benefit.

Other physicians, nurses, mental health professionals and patients are welcome to use them. While we avoid jargon the language used is intended for professionals. We hope the algorithms can support informed participation by all who are interested in choice of treatments.

Access the Algorithms

The algorithms are available on all platforms: desktops, laptops, tablets and smart phones. All of the algorithms are in one application called "Psychopharmacology Consults". It can be used over the Web by any device.

Open Psychopharmacology Consults

About Us

This project is headed by David N. Osser, M.D. who has published psychopharmacology algorithms for many years in academic journals and on the Web. He is an Associate Professor of Psychiatry at the Harvard Medical School (Boston, MA) Department of Psychistry, South Shore Program. He currently directs an innovative vidio-conference enabled consltation program for bipolar disorder which assess patients in various cities throughout the Veterans Administration system. For over two decades he worked at the Taunton State Hospital (Mass) which served a severely ill very treatment resistent population. Dr. Osser's biography is in the Authors page.

Robert Patterson, M.D. is a psychiatrist associated with McLean Hospital and Harvard Medical School who provides the computing skills for the project.

A number of other psychiatrists have participated in authoring algotithms. Their biograpies are in the Authors page.

Who Are the Authors?

Here are all the authors who have participated in creating the algorithms. Thier names are also shown on the title pages of the algorithms they wrote.

David Osser is Associate Professor of Psychiatry, Harvard Medical School at the Brockton Division of the VA Boston Healthcare System. There, he is the attending psychiatrist for Domiciliary Care for Homeless Veterans and general editor of the Psychopharmacology Algorithm Project at the Harvard South Shore Program. He has published over 100 academic products with various collaborators, including a book (Psychopharmacology for Medical Students 2009), website, original articles, reviews, courses, decision-support software, and abstracts.

The International Psychopharmacology Algorithm Project publishes algorithms at Osser co-chaired the schizophrenia algorithm. This was completed in 2005 and received endorsement from the World Health Organization. The website also contains algorithms on Posttraumatic Stress Disorder, Generalized Anxiety Disorder, and on the psychopharmacology treatment of different substance dependence disorders. Osser was a consultant on the construction of each of these algorithms.

Osser is on the editorial boards of the Journal of Clinical Psychopharmacology, International Drug Therapy Newsletter (recently renamed Psychopharm Review), Psychiatric Times, (a website where articles are reviewed: he edits the schizophrenia section), and the Model Curriculum for Psychopharmacology of the American Society of Clinical Psychopharmacology (4th through 7th [2012] editions).

He was the recipient of the American Psychiatric Association (APA)'s 2011 Irma Bland, M.D. Award for Excellence in Teaching Residents, and the 2012 APA/American Association of Chairs of Psychiatry Departments Research Mentorship Award.

Disclosures: None. Dr. Osser does not accept any support, honoraria, or grants from any pharmaceutical firms or other commercial entities.

Arash Ansari, M.D. is an Instructor at Harvard Medical School. He teaches Harvard medical students and psychiatric residents in the Harvard Longwood Psychiatry Residency Training Program and practices psychiatry at the Brigham and Women's / Faulkner Hospitals in Boston, MA. Dr. Ansari is the recipient of the Department of Psychiatry Brigham and Women's/ Faulkner Hositals 2008 Arthur R. Kravitz, M.D. Award for Excellence in Psychiatric Teaching and Education. He has authored peer-reviewed articles on psychopharmacology and is the co-author of the book Psychopharmacology for Medical Students (2009). Dr. Ansari does not receive any financial support from the pharmaceutical industry.

Laura Bajor is slated to graduate from the Harvard South Shore Psychiatry Training Program in June of 2011, after which she will begin research fellowship training. She is a 1993 graduate of the US Naval Academy, served 7 years in the fleet, flew search and rescue helicopters, captained patrol boats, and earned an MA in Writing from Johns Hopkins Univeristy before beginning medical training at the Philadelphia College of Osteopathic Medicine.

Lance R. Dunlop, M.D. was a Clinical Fellow in Psychiatry at Harvard Medical School, South Shore Program at the time he collaborated in the preparation of this algorithm. Subsequently, he became the Acting Medical Director at the Cambira County Mental Health/Mental Retardation Clinic in Johnstown, Pennsylvania.

Mohsen Jalali-Roudsari, MD is a research fellow of psychiatry with Harvard Medical School at Beth Israel Deaconess Medical Center. He graduated from the School of Medicine at Mashad University of Medical Science in Iran and then continued his work in psychiatry at the Psychiatry and Psychology Research Center at Tehran University of Medical Science, Iran. There he researched and coordinated studies on patients experiencing first psychotic breaks and those with chronic schizophrenia and mood disorders. He was part of the project to generate and test Iran's first translation of the SCID-I from English to Farsi, assessing its diagnostic validity and reliability.
Dr. Jalali-Roudsari joined the Department of Psychiatry and the Laboratory of Clinical and Experimental Psychopathology at Beth Israel Deaconess Medical Center at the Harvard Medical School in 2009, working under the supervision of Dr. Theo Manschreck and Dr. David Osser.
In addition to psychopharmacology, his interest mostly focuses on the underlying mechanisms of psychosis, including its neurological and cognitive aspects. Family psychoeducation and skills training for patients with psychosis are among other research domains he has been involved in.
Dr. Jalali-Roudsari's research on schizophrenia and mood disorders has been published in several academic journals and he has contributed to studies which were presented at international conferences.
Disclosures: None

Theo Manschreck is Professor of Psychiatry, Harvard Medical School at the Brockton Division of the VA Boston Healthcare System. He is senior investigator at the Harvard Commonwealth Research Center for Excellence at Beth Israel Deaconess Medical Center and Senior Psychiatrist at Massachusetts General Hospital. He has published over 150 research articles and reviews and four books. Dr. Manschreck directs the Laboratory for Clinical and Experimental Psychopathology. In addition to psychopharmacology, the focus of his research has cognition and neurology of schizophrenia. The Laboratory was a site for the NIMH CATIE trial and the PROACTIVE trial on long-acting risperidone compared to oral atypical agents. Dr Manschreck has worked in the NIMH Schizophrenia Trial Network. He maintains collaborations nationally and abroad.<br /><br /> Dr Manschreck is medical and research director at the Corrigan Mental Health Center in Fall River, Massachusetts. He is a member of the Human Studies Committee of the Harvard Medical School. Since 2002 he has been a consultant to the Joslin Diabetes Center where he has helped direct national educational programs on metabolic aspects of antipsychotic drug treatment. A Distinguished Fellow of the American Psychiatric Association, he has received many awards, including a Fulbright Research Award (for studies of cocaine psychosis), the Massachusetts Alliance for the Mentally Ill Rothstein Award for Compassion and Dedication in the Care of the Severely Mentally Ill, and honorary degrees from Dartmouth and Brown, where he also served as professor. Disclosures: none.

Ana Ticlea M.D. Ana N. Ticlea M.D. was educated at Iuliu Hatieganu University of Medicine in Cluj, Romania. She completed residency training at the Harvard South Shore program, where she served as Chief Resident. She is currently a staff psychiatrist at the VA Medical Center in Brockton, Massachusetts.

Harmony Raylen Abejuela, M.D. is a clinical fellow in psychiatry at Harvard Medical School at Children's Hospital Medical Center in Boston.

Conflict of Interest

The authors feel strongly that conflicts of interest must not be allowed to influence the recommendations of the algorithms. Dr. Osser and the other authors have no income from pharmaceutical or other companies which might influence their decisions. There is no advertising support for this project.

Privacy Policy

This site and the downloadable algorithm apps do not collect any personal information - not even registration information. We do not store information in cookies on your device.

Limitations / Warning

The suggestions in these algorithms are only suggestions. Clinical decisions for individual patients require skilled judgment which cannot be mimicked in these algorithms.

We Can Publish Your Algorithm

We welcome submission of algorithms for publication in this series.

Algorithms should be evidence-based and include references. They should be carefully constructed to cover easy as well as difficult situations where there is little or conflicting research and they should handle even unusual clinical situations without leading to erroneous recommendations.

Submitted algorithms should have passed rigorous independent peer revue. Publication in a peer reviewed journal is ideal but other peer revue mechanisms may be adequate.

Authors will be expected to update the algorithms as knowledge advances.

We will assist authors in creating the computerized version. Authors can use the tools we have assembled. The tools (Joomla!, Gvedit, EndNote and our page display scripts), except for EndNote, are free software and do not require technical software knowledge.

Contact David N. Osser (