PEP Content Areas

Refers to integrating clinical psychopharmacology with the practice of psychology.

• Knowledge of biopsychosocial variables as determinants of medication utilization and effects (e.g., age, gender, family history, patient belief systems/ culture, economics/ poverty, social support, current environmental circumstances).

• Knowledge of limitations and benefits, patient perceptions (including help-seeking attitudes), and treatment expectations regarding psychopharmacological and psychological interventions as sole, additive, or interactive treatments for given disorders and functional impairments.

• Knowledge of practitioner-patient partnership for case and medication management, including the impact on patient education, medication adherence, the effectiveness of treatment, adverse effects and response to side effects, and implications for the relationship when psychosocial and pharmacological interventions are utilized (e.g., ethnicity/culture, sexual orientation, gender identity, socio-economic factors, religion, refugee status).

• Knowledge of the development and implementation of a coherent and organized integrated treatment plan of psychosocial, cultural (including the participation of traditional healers when appropriate), and pharmacological interventions with attention to comorbidities, as well as evidence-based developments in psychotherapy and pharmacotherapy.         

Refers to the anatomy, physiology, and biochemistry of the nervous system and its interfaces with other major body systems.

• Knowledge of cellular and molecular nervous system biology and regulatory processes (e.g., neurotransmitter and neuromodulator systems, up and down-regulation, tolerance/crosstolerance) needed to understand the pharmacological effect of medications.

• Knowledge of the structure and function of the central and peripheral nervous systems.

• Knowledge of neurodevelopment and neuroplasticity.

• Knowledge of the major neuronal pathways and their functions, and associated messenger systems.    

Refers to disorders of the nervous system resulting in abnormal function or behavioral/ mood disruption. Includes biochemical, structural (congenital or acquired), or neurophysiological abnormalities and their impact on other body systems.

• Knowledge of etiological factors and diagnosis of dementia, delirium, and other cognitive and neurological disorders.

• Knowledge of etiological factors and diagnosis of chronic pain, including headache (e.g., migrainous vs. non-migrainous headache), neuropathic pain, fibromyalgia; and the role of the CNS in pain experience and management.

• Knowledge of etiological factors and diagnosis of sleep disorders.

• Knowledge of common idiopathic movement disorders, their etiological factors, signs, symptoms, and diagnosis (e.g., Parkinson’s, Huntington’s, Tourette’s syndrome).

• Knowledge of common iatrogenic or drug-induced movement disorders, their etiological factors, signs, symptoms, and diagnosis (e.g., extrapyramidal symptoms, dystonias, dyskinesias, akathisia, Dystonic Tremors (DTs)).

• Knowledge of etiological factors and categories of seizure disorders.

• Knowledge of traumatic brain injury and post-concussive or post-concussion syndrome and its impact on prescriptive decisions.

• Knowledge of nervous system pathology (e.g., multiple sclerosis, infectious diseases, exposure to environmental neurotoxins, neoplasms, intellectual/developmental disabilities).

• Knowledge of basic indications for neurodiagnostic imaging and testing (e.g., EEG, CT, MRI, neuropsychological).

Refers to normal physiology and pathophysiology across the life span, and their impact on psychological functioning and psychopharmacology.

• Knowledge of indications for referral to other health care providers for assessment or treatment when organ system pathology is indicated.

• Knowledge at a functional level of cardiovascular system physiology and pathophysiology across the life span (e.g., rhythm and rate disorders such as prolonged QT interval), and their relationship to psychopharmacology and psychopathology (e.g., blood pressure changes secondary to psychotropic medication; mitral valve prolapse related to panic disorder).

• Knowledge at a functional level of pulmonary system physiology and pathophysiology across the life span, and their relationships to psychopharmacology and psychopathology (e.g., beta blockers and asthma, respiratory suppression with CNS depressants).

• Knowledge of etiological factors and diagnosis of central nervous system vascular disorders (e.g., cerebral vascular accidents, transient ischemic attacks).

• Knowledge at a functional level of renal/genitourinary system physiology and pathophysiology across the life span, and their relationships to psychopharmacology and psychopathology (e.g., the effect of psychotropic substances on urinary/sexual functioning; role in excretion of wastes and medications; valproic acid and polycystic ovary syndrome (PCOS); lithium and renal functioning).

Refers to a range of biopsychosocial (psychological, neurological, behavioral, physical, biomedical) and pharmacologic assessment techniques and procedures for baseline and ongoing evaluation of the individual’s physical and psychological health status as well as the assessment of therapeutic efficacy, adverse effects, contraindications for drug usage, drug interactions, and appropriateness for medication continuation, modification, or discontinuation.

• Knowledge of individual and family history-taking procedures and psychological assessments that provide information relevant to prescribing (e.g., review of systems, dietary habits, mental status, behavioral observations, developmental history, social history, academic history, family medical and psychiatric history (including knowledge of diversity-related variations in the incidence/ prevalence of disorders), history of sexually transmitted disease and history of the general level of functioning).

• Knowledge of basic physical and neurological examination procedures (e.g., history and physical examination (HPE); review of systems (ROS)) and variations in these procedures for special populations (e.g., ethnicity and estimated glomerular filtration rate (EGFR)).

• Knowledge of appropriate laboratory tests and assessment procedures before prescribing particular medications (e.g., the implication of disease states, gender, ethnicity, sample timing, and potential effects of medications on those values) and ongoing during treatment (e.g., Psychopharmacology Examination for Psychologists (PEP) 12 therapeutic drug monitoring (TDM) for lithium blood levels, white blood cell monitoring with clozapine use).

• Knowledge of behavioral assessment methods (e.g., rating scales, direct observation of behaviors, parent/ teacher/self-report) at baseline and ongoing monitoring for therapeutic effectiveness, quality of life, and adverse effects of psychopharmacological agents (e.g., akathisia with antipsychotics and SSRIs; rating scales for ADHD; Mini Mental Status Examination (MMSE) for cognitive function; Clinical Global Impression (CGI) scale for global response to treatment).

Refers to the use of comprehensive diagnostic information about a patient to establish an accurate diagnosis from among possible medical and psychological diagnoses to select appropriate treatment modalities and determine the appropriateness of referral to other health care providers.

• Knowledge of medical disorders and their most common symptoms that may also present with psychological symptoms (e.g., ADHD versus PKU versus autism, anxiety versus Graves’ disease, dementia versus depression in the elderly; depression as a primary disorder vs. a prodromal sign of underlying cancer; personality changes in the elderly vs. dementia).

• Knowledge of psychological signs and symptoms (e.g., mental status changes, memory dysfunction, depression, psychosis) secondary to substances of abuse, prescribed and over-the-counter (OTC) medications, most commonly used herbal remedies that have psychological effects, and dietary supplements.

• Knowledge of the psychopharmacological treatment implications related to mental health disorders with multiple symptoms (e.g., one disorder with multiple symptoms vs. comorbid disorders with related symptoms: major depressive disorder with psychotic features vs. major depressive disorder and schizophrenia; anxious depression vs. anxiety disorder and dysthymia; bipolar vs. psychotic depression; behavioral health disorders and substance use disorders).

• Knowledge of iatrogenic effects of medication versus primary symptoms of disease course (e.g., akathisia versus anxiety; anticholinergic effects versus dementia; medication-induced tremor versus idiopathic movement disorders).

Refers to the interactions of drugs with biophysiological systems; encompasses pharmacokinetics, pharmacodynamics, pharmacogenetics, and the epidemiology of various medications such as psychotropics, adjunctive agents, and other medications used in the practice of medicine, as well as substances of abuse, OTC products, and food and dietary supplements. The influence of cultural/ethnic factors, environmental factors, and responses of special populations are considered.

• Knowledge of drug classifications for psychotropic and adjunctive medications (e.g., stimulants, sedatives, antidepressants, anticholinergics), major drug categories used to treat common medical disorders (e.g., antibiotics), OTC medications, herbals, and substances of abuse.

• Knowledge of pharmacokinetic parameters (e.g., absorption, distribution, metabolism, and elimination) and how each phase affects drug action (e.g., delayed-release preparations, routes of administration, area under the curve, lipophilicity and drug transit across membrane barriers, CYP enzymes, drug/drug and drug/food interactions, routes of clearance).

• Knowledge of pharmacodynamic changes caused by medications (receptor up/down regulation; transcription).

• Knowledge of the importance of biological half-life in determining steady state drug concentrations, dosing schedules, accumulation, and toxicity.

• Knowledge of drug properties and characteristics (e.g., therapeutic index, therapeutic blood levels/ prescription doses, potency, bioavailability, efficacy, cognitive and behavioral manifestations of toxicity, dose response relationships).

• Knowledge of types of drugs/receptor interactions (e.g., direct and indirect agonists, antagonists, partial agonists, inverse agonists, competitive vs. non-competitive antagonism and agonism).

• Knowledge of the relationship between neurotransmitters and their receptor targets and the behavioral effects of stimulation vs. inhibition (e.g., 5HT1A and anxiety, beta blockers and performance anxiety, D2 and psychosis; histamine and sedation; ACh and memory).

• Knowledge of the mechanism of action of common therapeutic agents (e.g., receptor stimulation/inhibition; receptor up/down regulation; tolerance, dependence, and withdrawal).

• Knowledge of the theoretical relationship between neurotransmitter systems and psychopathological conditions (e.g., serotonin and norepinephrine in depression, dopamine in psychosis and substance abuse; dopamine in Parkinson’s disease; acetylcholine in Alzheimer’s disease).

• Knowledge of the factors (e.g., biological, ethnic, pharmacodynamic, genetic, pharmacokinetic) related to intra- and inter-individual responses to medications (e.g., variation of blood levels to the same dose across individuals, change in responsiveness within the same individual across administrations of same drug [e.g., pregnancy, obesity, age]).

• Knowledge of drug-induced disease, dysfunction, and adverse reactions (e.g., hepatotoxicity, agranulocytosis, dystonias).

Refers to the application of pharmacology to the management of psychological/behavioral disorders. This includes indications, contradictions, dosing, adverse effects and toxicities of psychotropic and adjunctive medications, interactions with other medications (including other drugs used in medicine for recreational purposes, and available for OTC purchase) as well as the management of adverse reactions, overdoses, and toxicities.

• Knowledge of indications and contraindications for various psychotropic medications, including use of multiple medications both on and off label.

• Knowledge of decision-making strategies for psychotropic medication selection (e.g., risk-benefit analysis, practice guidelines, genetics, ethnicity, cost, pregnancy, disease status, limitations of current diagnostic systems [e.g., DSM, ICD]).

• Knowledge of dosing, time course of therapeutic action, and adverse effects of medication based on patient factors (e.g., weight, gender, ethnicity, culture, age, trauma, pregnancy, concurrent disease).

• Knowledge of dosing strategies (e.g., augmentation, titration, cross taper, discontinuation).

• Knowledge of common signs and symptoms of drug toxicity and the management of adverse reactions to drugs (e.g., referral for appropriate medical care, use of appropriate medications).

• Knowledge of the management of at-risk patients (e.g., relapse prevention, adherence, suicide prevention, patients seeking medication inappropriate or inconsistent with treatment plan).

• Knowledge of potential adverse psychological and physiological signs of drugs used for common medical conditions (e.g., steroids, beta blockers, antibiotics, antivirals), OTCs, and herbals/dietary supplements.

• Knowledge of psychological and physiological signs of common recreational substances and the management of intoxication or addiction, including strategies for assisted withdrawal, maintenance, and relapse prevention.

• Knowledge of how to recognize and manage tolerance, cross-tolerance, dependence, and abstinence syndromes, sensitization/cross-sensitization with respect to specific medications.

• Knowledge of the patient factors (e.g., culture, literacy, stage of change) that need to be considered when informing patients about drug utilization, risks, benefits, potential complications, and alternatives to pharmacotherapy.

Refers to the methodology, standards, and conduct of research on psychoactive substances. The knowledge base facilitates research design and implementation, accurate data interpretation and communication, effective utilization of findings, the accumulation of scientific knowledge, and the improvement of the practice of clinical psychology.

• Knowledge of research designs and analytic techniques used in psychopharmacological research (e.g., open label, single vs double blind, random assignment, placebo control, drug washout, dose response relationships, intent-to-treat analyses, within-subject and group designs, concurrent administration of other drugs, FDA drug development process).

• Knowledge of how to critically review clinical research data including non-evidence-based therapies and emerging research methodologies and use the information for making treatment decisions (e.g., Number needed to treat (NNT), Number needed to harm (NNH), Odds ratio (OR), Risk ratio (RR), effect size).

• Knowledge of influential, non-industry sponsored multi-site research studies relating to psychopharmacology (e.g., CATIE, STAR-D, CUTLASS, MTA).

• Knowledge of evidence-based research regarding complementary and alternative medicines (e.g., Omega-3, folate, dehydroepiandrosterone (DHEA), St. John’s Wort, melatonin).

Refers to the knowledge of ethics, standards of care, laws, and regulations relevant to the practice of psychology involving psychopharmacology.

• Knowledge of relevant legal and ethical codes and standards that pertain to pharmacological practice; and laws and statutes for prescribing psychotropic medications (e.g., DEA regulations, telehealth).

• Knowledge of practice guidelines and standards of care for prescribing psychotropic medications (including a relationship with referring psychologist).

• Knowledge of patients’ rights related to medication treatments and therapy (e.g., informed consent, right to refuse treatment, right to treatment within the least restrictive environment, inappropriate psychotropic restraints, duty to warn, privileged communication, alternative decision maker, living will, durable power of attorney, advance directives).

• Knowledge of ethical issues regarding relationships with pharmaceutical companies (e.g., acceptance of gifts and samples, revealing sources of funding and affiliations, interactions with pharmaceutical reps).