The Art of Pharmacotherapy: Reflections on Pharmacophobia.
OBJECTIVE
This commentary deals with the neglected issue of the art of psychopharmacology by recounting the authors' journeys.


METHODS
First, a model of medical science situated within the history of medicine is described including (1) a limitation of the mathematical model of science, (2) the distinction between mechanistic science and mathematical science, (3) how this distinction is applied to medicine, and (4) how this distinction is applied to explain pharmacology to psychiatrists. Second, the neglected art of psychopharmacology is addressed by explaining (1) where the art of psychopharmacotherapy was hiding in the first author's psychopharmacology research, (2) how the Health Belief Model was applied to the art of medicine, (3) how the second author became interested in the Health Belief Model, and (4) his studies introducing the Health Belief Model in psychopharmacology. The authors' collaboration led to: (1) study of the effect of pharmacophobia on poor adherence and (2) reflection on the limits of the art of psychopharmacology.


RESULTS
Low adherence was found in 45% (116/258) of psychiatric patients with pharmacophobia versus 22% (149/682) in those with no pharmacophobia, providing an odds ratio of 2.9 (95% confidence interval, 2.2-4.0) and an adjusted odds ratio of 2.5 (95% confidence interval, 1.8-3.5) after adjusting for other variables contributing to poor adherence.


CONCLUSIONS
Different cognitive patterns in different patients may contribute to poor adherence. Specific interventions targeting these varying cognitive styles may be needed in different patients to improve drug adherence.
From the *University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky; and †Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada; ‡Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria; and §Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, Canary Islands, Spain.
Jose
J
de Leon
Carlos
C
De Las Cuevas
D006801:Humans; D055118:Medication Adherence; D001523:Mental Disorders / Q000188:drug therapy*; D008962:Models, Theoretical; D010698:Phobic Disorders; D011600:Psychopharmacology / Q000592:standards*