RESUMO
INTRODUCTION: Current classifications of psychotropic drugs, developed in the 1960s, are based on beliefs about clinical effectiveness. This article evaluates the scientific validity of current drug terms and possible alternative classifications. METHODS: A historical, conceptual, and empirical review of the psychopharmacology literature is provided. Consistency of classification is examined by 3 major categories: chemical structure, pharmacodynamic mechanism, and clinical efficacy. RESULTS: Current drug terms based on clinical effectiveness are not valid scientifically, either claiming efficacy which is disproven or ignoring other areas of clinical efficacy. Hence, clinical efficacy is not a consistent and scientifically valid way of classifying psychotropic drugs. Chemical structures are also heterogeneous for drugs with similar clinical efficacy. The most consistent way to define drug classes is pharmacodynamic mechanism. Specific drug groups identified are: monoamine agonists ("antidepressants" and "stimulants"), dopamine blockers ("antipsychotics"), second messenger modifiers ("mood stabilizers), and gabaergic agonists ("anxiolytics" or "hypnotics"). CONCLUSIONS: Consistent with a recent proposal of psychopharmacology organizations, this article proposes a new nomenclature based mainly on biological pharmacodynamic mechanisms. Specific terms that are scientifically valid and clinically practical are suggested. It is hoped that this new language would allow for more meaningful and accurate communication between clinicians and patients.
Assuntos
Psicofarmacologia/classificação , Psicotrópicos/classificação , Ansiolíticos/classificação , Ansiolíticos/uso terapêutico , Antidepressivos/classificação , Antidepressivos/uso terapêutico , Antipsicóticos/classificação , Antipsicóticos/uso terapêutico , Estimulantes do Sistema Nervoso Central/classificação , Estimulantes do Sistema Nervoso Central/uso terapêutico , Humanos , Transtornos Mentais/tratamento farmacológico , Psicofarmacologia/tendências , Psicotrópicos/uso terapêuticoRESUMO
In this paper, I analyze risks and limits of the current psychopharmacology and how both are promoting a new social interpretation of health concept. Besides, I show how such interpretation can be detected in four issues related to safety, equality, psychiatrization of human condition, and autonomy. In the conclusions, I defend, first, the obligation of physician to inform patients about the important long-term uncertainties around psychopharmacology. Second, I justify the necessity of promote more prolonged monitoring of patients treated with such kind of drugs. Third, I insist in the relevance of increasing research about drugs ' adverse effects extended over a long time. And forth, I bring up the utility of health concept to avoid the subjective stigmatization of cognitive or affective traits, to prevent potential problems of inequality and coercion, and to keep from mental disorders caused by attempts of getting psychical states supposedly optimized.
Assuntos
Melhoramento Biomédico/ética , Psicofarmacologia , Psicotrópicos/uso terapêutico , Adolescente , Adulto , Afeto/efeitos dos fármacos , Atitude Frente a Saúde , Melhoramento Biomédico/métodos , Criança , Uso de Medicamentos/estatística & dados numéricos , Europa (Continente) , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , América do Norte , Psicofarmacologia/classificação , Psicofarmacologia/ética , Psicofarmacologia/métodos , Psicofarmacologia/tendências , Psicotrópicos/efeitos adversos , Valores de Referência , Risco , Desejabilidade Social , Espanha , Procedimentos DesnecessáriosRESUMO
This article focuses on possible psychopharmacological interventions in the immediate post disaster setting. As there is little evidence for the efficacy or effectiveness of such interventions-given the difficulty in performing randomized, double-blind, placebo controlled studies with these populations-the article will delineate the neurobiological basis for pathological sequelae and theoretical drug interventions targeting putative disease mechanisms.