Behavioral medicine

Behavioral medicine (related to behavioral health, clinical health psychology and psychosomatic medicine) is a related branch of clinical practice in which psychologists emphasize the biopsychosocial approach to medicine, a model which recognizes the importance of addressing the interaction between physical, psychological and social factors in both the prevention and management of disease. Practitioners of behavioral medicine differ from medical psychologists in that they focus on the scientific application of behavioral interventions to a wide variety of medical conditions (e.g., asthma, gastrointestinal illnesses, cardiac conditions, spinal cord and brain injuries, chronic pain, headaches, and addictive illness).

Certifications

The Academy of Medical Psychology defines medical psychology as a specialty trained at the post doctoral level and designed to deliver advanced diagnostic and clinical interventions in Medical and Healthcare Facilities utilizing the knowledge and skills of clinical psychology, health psychology, behavioral medicine, psychopharmacology and basic medical science.^[1]

A specialty of medical psychology has established a specialty board certification, American Board of Medical Psychology and an Academy of Medical Psychology requiring a doctorate degree in psychology and extensive post doctoral training in the specialty and the passage of an oral or written examination.

Although the Academy of Medical Psychology defines medical psychology as a "specialty" and has established a "specialty board certification," it is important to note that the American Psychological Association does not currently recognize medical psychology as a "specialty." However, Louisiana does recognize this area of expertise by statute (the Medical Psychology Practice Act) as a "profession of the health sciences" with prescriptive authority. It is equally important to note than the American Psychological Association does not recognize that the term medical psychology has, as a prerequisite, nor should the term be equated with having, prescriptive authority. In fact, no other organization in the world, outside of Louisiana statute and the Louisiana Academy of Medical Psychology, equates medical psychology with prescriptive authority, as a prerequisite.

In 2006, the American Psychological Association (APA) recommended that the education and training of medical psychologists, who are specifically pursuing one of several prerequisites for prescribing medication, integrate instruction in the biological sciences, clinical medicine and pharmacology into a formalized program of postdoctoral education.

The following Clinical Competencies are identified as essential in the education and training of medical psychologists:

I. Basic Science: anatomy, & physiology, biochemistry;

II. Neurosciences: neuroanatomy, neurophysiology, neurochemistry;

III. Physical Assessment and Laboratory Exams: physical assessment, laboratory and radiological assessment, medical terminology;

IV. Clinical Medicine and Pathophysiology: pathophysiology with emphasis on the principal physiological systems, clinical medicine, differential diagnosis, clinical correlation and case studies, chemical dependency, chronic pain management;

V. Clinical and Research Pharmacology and Psychopharmacology: pharmacology, clinical pharmacology, pharmacogenetics, psychopharmacology, developmental psychopharmacology;

VI. Clinical Pharmacotherapeutics: professional, ethical and legal issues, combined therapies and their interactions, computer-based aids to practice, pharmacoepidemiology;

VII. Research: methodology and design of psychopharmacology research, interpretation and evaluation, FDA drug development and other regulatory processes.

The 2006 APA recommendations also include supervised clinical experience intended to integrate the above seven knowledge domains and assess competencies in skills and applied knowledge.

The above prerequisites are not required or specifically recommended by APA for the training and education of medical psychologists not pursuing prerequisites for prescribing medication.

The national psychology practitioner association (NAPPP; www.nappp.org)and top national certifying body (Academy of Medical Psychology; www.amphome.org)have established the national training, examination, and specialty practice criterion and guidelines in the specialty of Medical Psychology and have established a national journal in the specialty. Such certifying bodies, view psychopharmacology training (either to prescribe or consult) as one component of the training of a specialist in Medical Psychology, but recognize that training and specialized skills in other aspects of the treatment of behavioral aspects of medical illness, and mental illness affecting physical illness is essential to practice at the specialty level in Medical Psychology. The Louisiana Academy of Medical Psychology (LAMP), currently the largest organization of psychologists with prescriptive authority in the world and the only organization representing practitioners of medical psychology in Louisiana as defined by Louisiana statute within any jurisdiction in the United States, no longer recognizes the Academy of Medical Psychology as an adequate certifying body for its practitioners, and its members have resigned from the Academy of Medical Psychology en masse. Similarly, virtually all members of LAMP have also resigned from the Louisiana Psychological Association (LPA) after many LPA members asserted that the LAMP's prescriptive authority movement secretly came to an agreement with Louisiana's medical board to transfer the practice of psychology for psychologists with prescriptive authority to the medical board.