271: Side Effect Mastery in Psychopharmacology: Rawlings–Thompson A-F Classification, Low Slow Titration & Real-World Management with Dr. Michael Cummings & Dr. Blaire Heath
June 19, 2026
AI Summary
5 min readIn a forensic setting, a patient malingered psychotic symptoms to get a single cell, was put on an antipsychotic, and eventually developed tardive dyskinesia—a permanent movement disorder from a drug they never needed. This case, recounted by Dr. Michael Cummings, illustrates a central theme of the episode: every prescription is a medication trial with real risks, and managing those risks requires a systematic framework.
Dr. Cummings, joined by child psychiatrist and pharmacist Dr. Blaire Heath, outlines the Rawlings–Thompson A–F classification of side effects as a practical tool for clinicians. The conversation focuses on how to anticipate, prevent, and manage adverse effects by understanding their mechanisms, titrating thoughtfully, and maintaining diagnostic humility.
The Medication Trial Framework
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What you'll learn
- 1 Side Effect Mastery in Psychopharmacology: Rawlings–Thompson A-F Classification, Low Slow Titration & Real-World Management
- 2 (00:13) **Episode Introduction** - Dr. Cummings and Dr. Heath join to discuss practical approaches to psychopharmacology side effects
- 3 (01:27) **The Medication Trial Framework** - Dr. Cummings outlines the three endpoints of any medication trial
- 4 (03:37) **Response Timing & Titration Speed** - Discussion of how quickly to expect response and how fast to titrate
- 5 (06:36) **Rawlings–Thompson A-F Classification Overview** - The six categories of adverse drug effects explained
- 6 (08:07) **Slow Metabolizers & Titration Strategy** - How metabolism affects dosing and side effect management
- 7 (09:19) **Bedtime Dosing & Divided Dosing** - Consolidating medications to improve tolerability and adherence
+ Full timestamped outline available in the app
Show Notes
Dr. David Puder sits down with psychopharmacology expert Dr. Michael Cummings and Dr. Blaire Heath to discuss Side Effect Mastery in Psychopharmacology. This episode dives deep into the Rawlings–Thompson A-F Classification system for understanding and managing medication side effects, emphasizing low and slow titration strategies to improve tolerability and patient outcomes. They discuss practical, real-world approaches to common challenges, including orthostatic hypotension, excessive sweating (hyperhidrosis from SSRIs/SNRIs), tremor management, alopecia from valproic acid and lithium, anticholinergic burden, and much more. Dr. Cummings shares his insights on receptor dynamics, metabolizer status, bedtime dosing, and when to reconsider diagnosis after treatment failures.
By listening to this episode, you can earn 1.25 Psychiatry CME Credits.
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