Manual Implications of Psychopharmacology to Psychiatry: Biological, Nosological, and Therapeutical Concepts

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Psychiatrist Jerrold Bonn M.D.: Understanding Psychiatric Medicines & Their Side Effects

Springer, Berlin Heidelberg , S. Psychoanalysis in Germany.

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Academy Forum 35, H. Int Forum Psychoanal 2: 37 - 43 Int Forum Psychoanal 2: 25 - 33 Il suo modo di affrontare la regressione da un punto di vista odierno.

His handling of regression from today's view]. Biological, Nosological, and Therapeutical Concepts. Springer, Berlin Heidelberg etc Berlin, Ed Sigma , pp - Int Forum Psychoanal 8: 75 - 86 An unusual solution relating to psychostimulants is presented here.

Dialogues in Clinical Neuroscience

Evidence that the dopaminergic system plays a role in depression may enhance the value of such a strategy in the future, particularly in view of the lack of dopaminergic antidepressants. Current pharmacological treatment, especially in drug trials, is nosology-oriented, as a consequence of the requirements stemming from regulatory authorities. This explains why patients are frequently treated in a different way in clinical practice than in trials. Conversely, differing nosological categories may be treated with the same class of psychotropic drugs.

All this has theoretical and practical implications regarding our concepts in psychiatry, chief among which is the future need to treat psychiatric patients according to the same principles as in other disciplines of medicine. This paper uses the example of schizophrenia to look at the pros and cons of expert clinician diagnosis, based on a holistic approach, in comparison with algorithmic diagnosis, based on the DSM-IV and ICD classification systems.

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The author highlights the poor correlation between the two types of diagnostic processes, and points out the low validity and limitations of the DSM-IV and ICD classifications. One of the first of these new drugs was venlafaxine, and one of the last so far was reboxetine.

With the introduction of venlafaxine, a nonselective, but prevailingly 5-HT reuptake inhibitor, the mirror image if imipramine, a nonselective, but prevailingly NE reuptake inhibitor, a full circle of NE and 5-HT reuptake inhibitor antidepressants was completed. With the introduction of reboxetine, a NARI, the circle opened in the early s with the introduction of desipramine, was reopened in the late s virtually unchanged Ban, The difficulties encountered in the demonstration of the therapeutic effect of chlorpromazine in schizophrenia, and imipramine in depression have brought to attention the heterogeneity in pharmacological responsiveness within these diagnostic categories, and triggered research in psychopharmacology, the discipline concerned with the psychopathology affected by psychotropic drugs.

But instead of developing a methodology for resolving the heterogeneity by identifying the treatment responsive subgroups, a methodology with the employment of the randomized clinical trial RCT was adopted for the demonstration of therapeutic efficacy of psychotropic drugs in pharmacologically heterogeneous populations.

To increase the sensitivity of the methodology for the detection of therapeutic effects during the s multi-center, centrally coordinated clinical investigations designed with power statistics replaced single-center, isolated clinical trials. The problem was further compounded by findings in meta-analyses which indicated that none of the antidepressants drugs developed during five decades was superior in efficacy to imipramine, the first effective antidepressant; none of the antipsychotics were found to be superior to CPZ, the first effective antipsychotic; and none of the mood stabilizers to lithium, the first effective mood stabilizer Ban, In fact, there were some findings which indicated that response rates with the SSRIs, introduced in the s and s, might be lower than with imipramine, the first TA introduced in the mids.

In terms of adverse effects, SSRIs have a different side effect profile from the TCAs; they produce more frequently agitation, anxiety, diarrhea, insomnia, nausea and vomiting, whereas TCAs produce more frequently dry mouth, dizziness and constipation Ban, In so far as antipsychotics are concerned undoubtedly, the propensity to develop acute and chronic extrapyramidal signs and hyperprolactinemia, is significantly lower with the primarily 5-HT2A receptor blockers, but 5-HT2A receptor blockers are not necessarily safer than the primarily D2 receptor blockers, because of their considerably higher propensity to induce cardiac complications and metabolic side effects.

These findings were complemented in the s with the results of a multinational survey in which the prevalence of tardive dyskinesia in the treatment responsive unsystematic schizophrenic population was 4. The possibility that in some forms of schizophrenia neuroleptics might not just be ineffective, but may also be harmful Ban, , coupled with concerns that in some forms of depression, or in some people with certain personality structure, SSRIs may lead to suicide Healy, , has created concerns about the indiscriminate use of psychotropic drugs. Research in neuropsychopharmacology --the discipline in which the study of the mode of action of psychotropic drugs provides information on the pathophysiology of psychiatric disease-- is dependent on drugs with well defined therapeutic effects.

Hence, interpretation of findings in neuropsychopharmacological research has remained compromised because of the heterogeneity in pharmacological responsiveness within psychiatric diagnoses to the same psychotropic drug.

Nosologic homotypes are identical in elementary units, i. Ban TA. Prolegomenon to the clinical prerequisite : psychopharmacoogy and the classssification of mental disorders. Progr Neuro-psychopharmacol Biol Psychiatry ; Composite Diagnostic Evaluation of Depressive Disorders. Nashville: JM Productions; Psychopatholo ; Pharmacotherapy of mental illness. A historical analysis.

The Impact of Psychopharmacology on Contemporary Psychiatry

Neurpsychopharmacology and the history of pharnmacotherapy in psychiatry a review of developments in the 20 th century. Reflections on twentieth-century psyhopharmacology. Budapest: Animula; , pp. Carlsson A, Lindqvist M. Acta Pharmacol Toxicol ; - 4. Esquirol JED.

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Fish F. Encephale ; An international survey of tardive dyskinesia. Int Clin Psychopharmacol ; 1: The antiserotonin action of chlorpromazine and some other phnothiazine derivatives. Arch Int Phamacodyn ; Kraepelin E. Leipzig: Barth; Petho B, Ban TA, et al. DCR Budapest-Nashille in the diagnosis and classification fuctional psychoses.

Psychopathology ; 21; Zur Navigation springen. Zum Content springen. Archives Earlier Postings Amsterdam Collection. Angrist Collection. Baldessarini Collection.

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Ban Collection. Chlorpromazine after 50 Years. Second Edition Psychopharmacology and the Classification of Functional Psychoses.

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Thomas A. Beasley Collection. Belmaker Collection.