oa Editorial

This is the first issue of Current Psychopharmacology, a new journal designed to present the most recent advancement of research in psychopharmacology. Both preclinical and clinical investigations will be considered and we will publish both systematic reviews and reports of significant results in the main fields of current research. In the last months, many prominent researchers gave their precious contribution to my effort to prepare the first issues of Current Psychopharmacology, accepting to enter the Editorial Board and sending their considerable research articles and updated reviews. So, I had the opportunity to examine a very large number of manuscripts proposed for this and forthcoming issues, that concerned a very wide range of topics from clinics and therapeutics, to genetics, biochemistry and physiopathology. This was a great stimulus to reflect upon the state of research, the current problems and limitations and the future chances of psychopharmacology. In the middle of the last century, psychopharmacology has obtained considerable advances as a basic science and treatment modality of several mental disorders. Since then, further progress has been achieved, but rather slowly because we have still a limited knowledge of the neurobiological basis of psychiatric disturbances. However, the lack of exhaustive information on etiology and pathogenesis of mental disorders does not mean that new therapeutic tools cannot be discovered. In fact, the combined effect of multiple factors, such as systematic efforts of investigators, careful observations of psychiatrists, and, sometimes, chance discoveries and individual determination, can be sufficient to promote significant therapeutic improvements. Moreover, psychopharmacology is a field where is still possible to make relevant innovations, investigating drugs designed to treat different diseases. In the past, the antipsychotic chlorpromazine was found out in a study designed to augment the effects of anesthetics and analgesics. Although some practitioners, regarding psychiatric illnesses as social constructs, still maintain the opinion that psychopharmacological treatments are inappropriate or sometimes harmful, the majority of authors recognize that drug therapies play a central role in clinical practice. The availability of new medications with a favourable tolerability profile has offered a considerable advantage in the management of psychiatric disturbances. The wide variety of molecules now available has much increased the chance to find a specific and useful therapy for a large number of psychiatric patients and has considerably helped them to have an acceptable social functioning and a better subjective quality of life. In addition, the perception of psychiatric drugs in the general population has been subject to a progressive and significant change, shifting from a deeply rooted mistrust and aversion to a much larger acceptance. So, psychopharmacology should now be considered a powerful tool in the hands of psychiatrists. An important question is how a psychotropic medication is chosen and prescribed. Decision making is influenced by several factors. Clinical traditions and practice, marketing strategies of drug companies, and scientific literature, including various contributions from case reports to randomized clinical trials, reviews, and meta-analyses, all participate to form an opinion. Clinicians should be aware of the different factors that influence drug choice to take an appropriate and critical decision in this context (Kane, 2007). Obviously a comprehensive diagnostic evaluation should be performed before prescribing any treatment. Some authors have observed that the categorical classification of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) is a too narrow instrument to support the process of diagnosis. In our opinion, there is actually a need to go beyond the symptoms-based diagnostic criteria and to consider the background of the syndrome in individual and family characteristics, preceding episodes and course of the illness, social contexts and multiple other factors. A significant problem that affects the prescription of drug therapies is that medications are “off-label” for many psychiatric disorder: for example, no psychotropic drugs are officially indicated to treat psychopathology that is secondary to personality disorders, in spite of the high prevalence in general and psychiatric populations and of increasing data supporting the efficacy of pharmacotherapy in these patients. In conclusion, what directions can be proposed for the future development of psychopharmacology? On one hand, the community of clinicians should continue to gain experience in pharmacotherapy, optimizing the use of available drugs and understanding better how they interact with psychosocial interventions, such as psychotherapy and rehabilitation. On the other hand, investigators should be aware that the slow, difficult, but continuous improvement in the knowledge of genetics, physiopathology and pathogenesis of psychiatric disorders can represent the source of unexpected new discoveries and achievements. Current Psychopharmacology has the ambition to contribute to these goals, providing a complete and updated report of preclinical and clinical research in psychopharmacology and making available new data and their therapeutic implications to a growing number of clinical experts and practitioners.