[Towards a pragmatic cohabitation of theoretical and clinical models: The example of "Good Psychiatric Management" in the treatment of borderline personality disorder]. / Pour une cohabitation pragmatique des modèles théoriques et cliniques : l'exemple du « Good Psychiatric Management ¼ dans le traitement du trouble de personnalité borderline.

Borderline personality disorder (BPD) is a common disorder in general and clinical populations and is related to potentially severe medical and socio-professional consequences. Treatment of BPD is based on evidence-based psychotherapies (such as Dialectical Behavioral Therapy, Mentalization-Based Therapy, Schema-Focused Therapy or Transference Focused Psychotherapy), which have been shown effective but are poorly available in France. Pharmacological treatments, which are more easily available, are not effective in treating symptoms of the disorder but can be useful in management of comorbidities. In this context, recently called "generalist" models have been developed, which every well-trained psychiatrist can implement in their daily practice, combining practical elements from evidence-based psychotherapies and elements of pharmacological management of symptoms and comorbidities. The purpose of this article is to present one of these models, the Good Psychiatric Management (GPM) and its basic principles and its applications, and to provide one of the first French-speaking resources about this model. In addition, beyond the practical elements proposed by the GPM, we discuss the deeper question that it raises, namely the question of a pragmatic integration of different theoretical and clinical models. Indeed, the treatment of BPD patients is at the junction of different conceptualizations of mental pathology (psychopathological, neurobiological) and different modalities of practice (psychotherapy, biological psychiatry). In a French context, that sometimes separates these two models, and in our opinion GPM constitutes an example of clinical collaboration which shows the interest of the combined role of psychiatrist-psychotherapist.

Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce.

OBJECTIVES: The therapeutic use of nutrient-based 'nutraceuticals' and plant-based 'phytoceuticals' for the treatment of mental disorders is common; however, despite recent research progress, there have not been any updated global clinical guidelines since 2015. To address this, the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Disorders (CANMAT) convened an international taskforce involving 31 leading academics and clinicians from 15 countries, between 2019 and 2021. These guidelines are aimed at providing a definitive evidence-informed approach to assist clinicians in making decisions around the use of such agents for major psychiatric disorders. We also provide detail on safety and tolerability, and clinical advice regarding prescription (e.g. indications, dosage), in addition to consideration for use in specialised populations. METHODS: The methodology was based on the WFSBP guidelines development process. Evidence was assessed based on the WFSBP grading of evidence (and was modified to focus on Grade A level evidence - meta-analysis or two or more RCTs - due to the breadth of data available across all nutraceuticals and phytoceuticals across major psychiatric disorders). The taskforce assessed both the 'level of evidence' (LoE) (i.e. meta-analyses or RCTs) and the assessment of the direction of the evidence, to determine whether the intervention was 'Recommended' (+++), 'Provisionally Recommended' (++), 'Weakly Recommended' (+), 'Not Currently Recommended' (+/-), or 'Not Recommended' (-) for a particular condition. Due to the number of clinical trials now available in the field, we firstly examined the data from our two meta-reviews of meta-analyses (nutraceuticals conducted in 2019, and phytoceuticals in 2020). We then performed a search of additional relevant RCTs and reported on both these data as the primary drivers supporting our clinical recommendations. Lower levels of evidence, including isolated RCTs, open label studies, case studies, preclinical research, and interventions with only traditional or anecdotal use, were not assessed. RESULTS: Amongst nutraceuticals with Grade A evidence, positive directionality and varying levels of support (recommended, provisionally recommended, or weakly recommended) was found for adjunctive omega-3 fatty acids (+++), vitamin D (+), adjunctive probiotics (++), adjunctive zinc (++), methylfolate (+), and adjunctive s-adenosyl methionine (SAMe) (+) in the treatment of unipolar depression. Monotherapy omega-3 (+/-), folic acid (-), vitamin C (-), tryptophan (+/-), creatine (+/-), inositol (-), magnesium (-), and n-acetyl cysteine (NAC) (+/-) and SAMe (+/-) were not supported for this use. In bipolar disorder, omega-3 had weak support for bipolar depression (+), while NAC was not currently recommended (+/-). NAC was weakly recommended (+) in the treatment of OCD-related disorders; however, no other nutraceutical had sufficient evidence in any anxiety-related disorder. Vitamin D (+), NAC (++), methylfolate (++) were recommended to varying degrees in the treatment of the negative symptoms in schizophrenia, while omega-3 fatty acids were not, although evidence suggests a role for prevention of transition to psychosis in high-risk youth, with potential pre-existing fatty acid deficiency. Micronutrients (+) and vitamin D (+) were weakly supported in the treatment of ADHD, while omega-3 (+/-) and omega-9 fatty acids (-), acetyl L carnitine (-), and zinc (+/-) were not supported. Phytoceuticals with supporting Grade A evidence and positive directionality included St John's wort (+++), saffron (++), curcumin (++), and lavender (+) in the treatment of unipolar depression, while rhodiola use was not supported for use in mood disorders. Ashwagandha (++), galphimia (+), and lavender (++) were modestly supported in the treatment of anxiety disorders, while kava (-) and chamomile (+/-) were not recommended for generalised anxiety disorder. Ginkgo was weakly supported in the adjunctive treatment of negative symptoms of schizophrenia (+), but not supported in the treatment of ADHD (+/-). With respect to safety and tolerability, all interventions were deemed to have varying acceptable levels of safety and tolerability for low-risk over-the-counter use in most circumstances. Quality and standardisation of phytoceuticals was also raised by the taskforce as a key limiting issue for firmer confidence in these agents. Finally, the taskforce noted that such use of nutraceuticals or phytoceuticals be primarily recommended (where supportive evidence exists) adjunctively within a standard medical/health professional care model, especially in cases of more severe mental illness. Some meta-analyses reviewed contained data from heterogenous studies involving poor methodology. Isolated RCTs and other data such as open label or case series were not included, and it is recognised that an absence of data does not imply lack of efficacy. CONCLUSIONS: Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders. However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use. It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.

The Normal Human Adult Hypothalamus Proteomic Landscape: Rise of Neuroproteomics in Biological Psychiatry and Systems Biology.

The human hypothalamus is central to the regulation of neuroendocrine and neurovegetative systems, as well as modulation of chronobiology and behavioral aspects in human health and disease. Surprisingly, a deep proteomic analysis of the normal human hypothalamic proteome has been missing for such an important organ so far. In this study, we delineated the human hypothalamus proteome using a high-resolution mass spectrometry approach which resulted in the identification of 5349 proteins, while a multiple post-translational modification (PTM) search identified 191 additional proteins, which were missed in the first search. A proteogenomic analysis resulted in the discovery of multiple novel protein-coding regions as we identified proteins from noncoding regions (pseudogenes) and proteins translated from short open reading frames that can be missed using the traditional pipeline of prediction of protein-coding genes as a part of genome annotation. We also identified several PTMs of hypothalamic proteins that may be required for normal hypothalamic functions. Moreover, we observed an enrichment of proteins pertaining to autophagy and adult neurogenesis in the proteome data. We believe that the hypothalamic proteome reported herein would help to decipher the molecular basis for the diverse range of physiological functions attributed to it, as well as its role in neurological and psychiatric diseases. Extensive proteomic profiling of the hypothalamic nuclei would further elaborate on the role and functional characterization of several hypothalamus-specific proteins and pathways to inform future research and clinical discoveries in biological psychiatry, neurology, and system biology.

Cannabinoids: Emerging developments in neuropsychopharmacology and biological psychiatry.

Cannabinoids from the cannabis plant were one of the earliest psychoactive phytochemicals harnessed by humanity for their medicinal properties and remain one of the most frequently used and misused classes of chemicals in the world. Despite our long-standing history with cannabinoids, much more is said than is known regarding how these molecules influence the brain and behavior. We are in a rapidly evolving discovery phase regarding the neuroscience of cannabinoids. This period of insight began in the mid-1990s when it was discovered that phytocannabinoids (e.g., delta-9-tetrahydrocannabinol) act on G protein-coupled receptors (i.e., CB1/CB2) in the brain to produce their psychoactive effects. Shortly thereafter, it was discovered that endogenous ligands (i.e., endocannabinoids) exist for these receptor targets and, that they are synthetized on demand under a variety of physiological conditions. Thus, we can now study how phytochemicals, endogenous ligands, and synthetic/metabolic enzymes of the endocannabinoid system influence the brain and behavior by activating known receptor targets. Our increased ability to study cannabinoid interactions with the brain and behavior coincides with an increase in international interest in utilizing cannabinoids as a medicine. At the same time, the potency of, and administration routes by which cannabinoids are used is rapidly changing. And, these trends in cannabinoid misuse are producing lasting neural adaptations that have implications for mental health. In this special edition, we will summarize our recent period of discovery regarding how: 1) phytocannabinoids, synthetic cannabinoids and endocannabinoids act on the brain to produce behavioral effects; 2) cannabinoids can be harnessed to produce pharmacotherapeutic utility in the field of medicine; and 3) use of increasingly more cannabinoid variants through unique routes of administration alter the brain and behavior, especially when used in critical developmental periods like pregnancy and adolescence.

Stanley Cobb, the Rockefeller Foundation and the evolution of American psychiatry.

Stanley Cobb founded the Harvard Departments of Neurology (1925) and Psychiatry (1934) with Rockefeller Foundation funding. Cobb was an important transitional figure in both neurology and psychiatry. He and his friend Alan Gregg were the most visible parts of the Rockefeller Foundation psychiatry project, which prepared American psychiatry for the rapid growth of psychiatric research after World War II. Edward Shorter called him the founder of American biological psychiatry, but this misunderstands Cobb and the Hegelian evolution of twentieth-century American psychiatry. I review the major role of the Rockefeller Foundation in the evolution of American academic psychiatry and the disappearance of Cobb's teaching and that of his mentor Adolf Meyer, a founding father of American academic psychiatry.

Ácidos grasos omega-3 y depresión: una revisión sistemática / Omega-3 fatty acids and depression: a systematic review

Introducción y objetivos. Los ácidos omega-3 son grasas poliinsaturadas que deben ser aportadas a través de la dieta, encontrándose de forma preformada fundamentalmente en las variedades del pescado azul. Los ácidos omega-3 se hallan en las membranas lipídicas neuronales en gran proporción, aportando estabilidad a las mismas y optimizando la comunicación sináptica. Una dieta pobre en ácidos omega-3, siendo esta una tendencia en los hábitos alimentarios occidentales en los últimos tiempos, podría figurar como un factor de riesgo para la aparición de depresión. Este artículo de revisión trata de valorar la influencia de los ácidos omega-3 en la prevención o el tratamiento de la depresión. Material y métodos. Es presentada una selección de datos de carácter neurobiológico, epidemiológico y clínico, a través de la revisión de las publicaciones más importantes en este sentido, prestando especial atención a los resultados obtenidos en los diferentes metaanálisis de tipo clínico realizados. Conclusiones. Los ácidos omega-3 pueden figurar hoy en día como un agente coadyuvante más para el tratamiento de la depresión, siendo avalada esta recomendación por varios metaanálisis que implican un alto nivel de evidencia, lo que ha motivado que su uso sea contemplado por guías clínicas o recomendaciones de expertos. Algunos metaanálisis encuentran una superioridad del ácido eicosapentaenoico (EPA) frente al ácido docosahexaenoico (DHA) y recomiendan una mayor proporción del primero en los suplementos si se eligen los omega-3 como agentes coadyuvantes en el tratamiento antidepresivo (AU)

Introduction and objectives. Omega-3 acids are polyunsaturated fatty acids that have to be provided in the diet, mostly being present in oily fish. Omega-3 fatty acids are mostly found in neuronal lipid membranes, providing them with stability, as well as optimising synaptic communication. A diet low in omega-3 acids, which is a recent trend in Western eating habits, could be a risk factor for the development of depression. This review attempts to assess the influence of omega-3 fatty in the prevention and treatment of depression. Material and methods. Neurobiological, epidemiological and clinical data of the most important publications on this subject are presented, paying particular attention to the results obtained in the different clinical meta-analyses conducted. Conclusions. Omega-3 fatty acids may currently appear as an adjuvant agent for the treatment of depression, with this recommendation being endorsed by several meta-analyses that involve a high level of evidence, which has led to their use being contemplated in clinical guidelines or recommendations by experts. Some meta-analyses found superiority of eicosapentaenoic acid (EPA) over docosahexaenoic acid (DHA), and recommend a higher proportion of the former if omega-3 fatty acids are chosen as adjuvants agents in antidepressant treatment (AU)

El abordaje de la depresión en el ámbito del trabajo: recomendaciones clave / Management of depression in the work setting: key recommendations

La depresión en el ámbito del trabajo representa una de las primeras causas de pérdida de productividad, absentismo laboral, incremento de accidentes laborales, utilización de los servicios de salud y jubilación anticipada. Los costes totales atribuibles a la depresión constituyen más del 1% del PIB, por lo que su correcto abordaje repercutirá no solo en el bienestar emocional de los trabajadores sino también en la productividad de las empresas y la sostenibilidad del Sistema Nacional de Salud. La depresión no solo es un problema estrictamente sanitario, sino que hay que enmarcarlo en un contexto mucho más amplio vinculado al bienestar social. El presente documento es el resultado de un proceso de consulta y reuniones entre un grupo multidisciplinar de expertos y ofrece una serie de recomendaciones sobre la definición, detección y opciones de tratamiento de la depresión, con especial interés en el ámbito del trabajo. Entre otras medidas, se propone promover programas que permitan concienciar y ayudar a los empleados y empleadores a reconocer y manejar la depresión en los lugares de trabajo, así como mejorar las políticas y la legislación que les protegen. Esta estrategia multidimensional y efectiva, basada en un acercamiento holístico al problema, debe situar la depresión como un problema clave en las empresas, cuyo abordaje debe ser un objetivo estratégico prioritario (AU)

Depression in the work setting is one of the leading causes of lost productivity, absenteeism, increased accidents, use of health services, and early retirement. As the total costs attributable to depression are more than 1% of GDP, the correct approach will impact not only on the emotional welfare of workers but also on business productivity and sustainability of the National Health System. Depression is not just a health problem, but should be framed it in a much broader context linked to social welfare. This document is the result of a process of consultation and meetings between a multidisciplinary group of experts, and offers a series of recommendations on the definition, detection and treatment options of depression, with special interest in the occupational setting. Among other measures, it intends to promote programs that should raise awareness and help employees and employers to recognise and manage depression in the workplace, and to improve policies and legislation that protect them. This multidimensional and effective strategy, based on a holistic approach to the problem, places depression as a key problem in companies, for which the approach should be a priority strategic objective (AU)

Research on Psychiatric Treatment by Psychiatrists of Chosun-Governor Hospital and Keijo Imperial University Hospital in Korea during Japanese Colonial Rule / 신경정신의학

This review describes the types of psychiatric treatment studied during the Japanese colonial period of 1910–1945 in Korea, known at the time as Chosun. Twenty-nine research papers and abstracts on psychiatric treatment were reviewed, which were published in the Shinkeigaku-zassi (Neurologia), the Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica) and the Journal of Chosun Medical Association, by faculty members of the department of neuropsychiatry, Chosun-Governor Hospital and Keijo (Seoul) Imperial University School of Medicine. The major research area was biological psychiatry and biological treatment, as Japanese pioneers in psychiatry at that time had introduced German psychiatry into Japan. Professor Kubo published the most papers, followed by Dr. Hattori, Dr. Hikari, and Professor Suits. In Chosun-Governor Hospital, research on prolonged sleep therapy was an active field. In the Imperial University Hospital, malarial fever therapy, sulphur-induced fever therapy, and insulin shock treatment were the most frequent research topics. Some were tried for the first time in the Japanese Empire, which reflected the pioneering position of the university. These achievements are attributed to Professor Kubo. Six papers on psychotherapy were published. Among them, two papers were on persuasion therapy, three papers were case reports of psychoanalytic therapy, and one paper on Freud. However, this psychoanalytic therapy research seemed to be limited trials conducted following literal guidance, and no further development was noted. Generally, research was characterized by simple design, small numbers of subjects, lack of objective evaluation method, lack of statistical treatment, and especially lack of ethical consideration comparing with today's standard.

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders. part 2: maintenance treatment of major depressive disorder-update 2015.

These guidelines for the treatment of unipolar depressive disorders systematically review available evidence pertaining to the biological treatment of patients with major depression and produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians assessing and treating patients with these conditions. The relevant data have been extracted primarily from various treatment guidelines and panels for depressive disorders, as well as from meta-analyses/reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into five levels of evidence (CE A-F) and five levels of recommendation grades (RG 1-5). This second part of the WFSBP guidelines on depressive disorders covers the management of the maintenance phase treatment, and is primarily concerned with the biological treatment (including pharmacological and hormonal medications, electroconvulsive therapy and other brain stimulation treatments) of adults and also, albeit to a lesser extent, children, adolescents and older adults.

Research by Psychiatrists of Chosun Chongdokbu Hospital and Keijo Imperial University in Korea during Japanese Colonial Rule / 신경정신의학

Eighty-three of 114 original articles and abstracts of research published by neuropsychiatrists of Chosun Chongdokbu Hospital (the Japanese colonial government hospital in Korea) and Keijo (Seoul) Imperial University Hospital during the Japanese colonial period (1910-1945) in journals including Shinkeigaku-zassi (Neurologia), Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica), and The Journal of Chosun (Korea) Medical Association were reviewed. Most articles were on clinical research based on descriptive and biological psychiatry while only 4 articles were on dynamic psychiatry, probably because Japanese pioneers in psychiatry had introduced German psychiatry into Japan during the 1880s. The first paper was written by Dr. Shim Ho-sub. Professor Kubo of Keijo (Seoul) Imperial University published most articles, followed by Dr. Hikari, Dr. Hattori, and Dr. Sugihara. There were more articles on symptomatic psychosis and morphine addiction, followed by general paralysis, schizophrenia, neurological diseases, narcolepsy, epilepsy, and neurasthenia. The meaningful articles even for today were comparative studies between Japanese and Koreans and articles on opioid use disorder in Korea. Authors reported a markedly lower rate of psychotic inpatients in the population of Koreans compared with Japanese. Japanese researchers argued that, because of simpleness in social life in Korea and less violence or excitement in symptoms, Korean mental patients could be cared for by family or members of the community, or be treated by shamanism rather than bringing them to a public mental hospital, and poverty also prohibited hospital care. Finding of higher ratio of schizophrenia to manic-depressive psychosis among Koreans than Japanese was discussed in relation to delayed cultural development of Korea compared to Japan. In addition, traditional customs prohibiting marriage between relatives in Korea was related to low prevalence of manic-depressive psychosis, local endemic malaria was related to low prevalence of general paresis, and poor general hygiene was related to high prevalence of epilepsy. Unclear (undifferentiated) form of psychotic symptoms including hallucination and delusion was reported in more Koreans than Japanese. Also Korean patients showed a more atypical form in diagnosis. Authors added that they had found no culture-specific mental illness in Korea. However, no Korean psychiatrists were included as author in such comparative studies. Comparative studies on constitution between Koreans and Japanese mental patients and prisoners were also unique. However, no Korean psychiatrists participated in such comparative studies. In studies on morphine addiction in Koreans, Japanese researchers argued that such studies were necessary to prevent introduction of morphine-related criminal phenomena to Japan. Meanwhile, Dr. Kubo had left a notion on adaptation problems of Japanese living in the foreign country, Korea. Nevertheless he reported nothing about psychosocial aspects of mental illness in relation to political, cultural, and economic difficulties Koreans were experiencing under the colonial rule of Japan. These general trends of studies based on German biological and descriptive psychiatry and policies of colonial government to isolate "dangerous" mental patients in hospital appeared to reflect colonial or ethnopsychiatry of those days. These policy and research trends seem to have worsened stigma attached to mental disorders. Japanese tradition of psychiatric research was discontinued by return home of Japanese scholars with the end of WWII and colonial rule.

Eficacia de los ácidos grasos omega-3 como tratamiento suplementario en la esquizofrenia / Efficacy of Omega-3 Fatty Acids as a Supplementary Treatment in Schizophrenia

La teoría de la membrana fosfolípidica en torno a la etiopatogenia de la esquizofrenia sostiene que una deficiencia en la composición de ácidos grasos poliinsaturados (PUFA) de los lípidos en la membrana neuronal es un factor relevante en la fisiopatología de este trastorno. Diversos ensayos clínicos evalúan el papel terapéutico de la suplementación con PUFA omega-3 en la esquizofrenia. Una revisión sistemática de la literatura publicada identificó siete ensayos clínicos realizados en condiciones de doble ciego y control con placebo que evaluaron la eficacia de dicha suplementación. Los resultados de estos estudios son heterogéneos. Parte de los datos indica una eficacia moderada de la suplementación con ácido eicosapentaenoico en dosis de 2 g/día en pacientes con esquizofrenia establecida. Dos estudios se centraron en psicosis incipiente, con resultados alentadores a corto plazo. Sin embargo, los estudios que reclutaron mayor número de pacientes no advirtieron diferencias respecto a placebo (AU)

The phospholipid membrane theory about the aetiopathogenesis of schizophrenia supports the idea that a deficiency in the polyunsaturated fatty acids (PUFA) of the lipids in the neuronal membrane is a significant factor in the pathophysiology of this disorder. Various clinical trials have evaluated the therapeutic role of omega-3 PUFA supplements in schizophrenia. A systematic review of the published literature was performed, identifying 7 double-blind, placebo controlled clinical trials that evaluated the efficacy of these supplements. The study results are heterogeneous. The data suggest that there is a moderate effect with supplements containing eicosapentaenoic acid in a dose of 2 g/day in patients with established schizophrenia. Two studies focused on incipient psychosis, with encouraging results in the short term. However, the studies that recruited a larger number of patients did not observe any differences compared to the placebo (AU)

Talking science and wishing for miracles: understanding cultures of mental health practice.

Science can only offer a limited account of, and prescription for, mental health care. Yet the language of science and faith in the universal applicability of particular scientific methods to the craft of mental health care has come to permeate mental health practice communities. In this paper, the argument that many beliefs held by mental health professionals might be considered to be based on faith rather than science is presented, and the view that culture provides a useful lens for understanding mental health services and these paradoxes is proposed. Clearly there is a grand mental health narrative or colonizing influence of biological psychiatry that in various ways affects all mainstream mental health services. Local health services and professional communities might be considered subcultures. Understanding how mental health professions and practice are embedded in culture might be useful in considering how practice changes and why. Culture and caring practices are mutually embedded in localized subcultures. Therefore, a rich description of context and history is necessary in publication, presentation, or other communications to enable genuine understanding by a global audience. Viewing mental health practice in a cultural context highlights the importance of values and differences, and encourages humility in the face of ambiguity.

Síndrome de Otelo (delirio celotípico monosintomático) inducido por agonistas dopaminérgicos / Othelo syndrome (monosymptomatic jealousy delusion) related with dopaminergic agonists

La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo crónico que produce un grado variable de destrucción de neuronas de los ganglios basales, con la consecuente reducción de la transmisión dopaminérgica. Clínicamente se traduce principalmente en temblor de reposo, rigidez muscular, bradicinesia y alteraciones de la marcha. También aparecen otros síntomas motores y no motores. Entre los no motores se encuentra un amplio espectro de sintomatología psiquiátrica, entre la que destacan la depresión, la ansiedad, la agitación, el delirium, los trastornos del sueño, la hipersexualidad, los trastornos del control de impulsos y diversos síntomas psicóticos. Estos últimos presentan una prevalencia del 45-60% en la EP, predominando los «síntomas menores» (ilusiones visuales y sensaciones de presencia) sobre las alucinaciones y delirios. Entre los delirios destacamos el síndrome de Otelo (SO), un trastorno delirante con síntomas celotípicos poco frecuente en pacientes con EP. Su aparición se relaciona con el tratamiento agonista dopaminérgico, y en la mayoría de los casos se resuelve tras la disminución de la dosis del fármaco agonista. Solo en algunos casos es necesario añadir tratamiento antipsicótico, siendo de elección los atípicos. Por último, nuevos fármacos como la pimavanserina (un agonista inverso selectivo 5-HT2A) están siendo estudiados en el tratamiento de la psicosis asociada a la EP, con resultados prometedores. Presentamos un caso de EP que, tras varios años de tratamiento agonista dopaminérgico, desarrolló un SO que se resolvió tras recibir tratamiento antipsicótico atípico y ajustar el tratamiento antiparkinsoniano (AU)

Parkinson disease (PD) is a chronic, neurodegenerative disorder that produces a degeneration of the basal ganglia, with a variable reduction of dopamine neurotransmission activity. In a clinical point of view, these impairments are translated into tremor, rigidity, bradykinesia, and shuffling gait. Both motor and nonmotor symptoms are characteristics of PD. Nonmotor symptoms include a wide spectrum of psychiatric features: depression, anxiety, delirium, sleep disorders, hipersexuality, impulsivity disorders, and psychotic symptoms. Prevalence of psychotic symptoms in PD is high (45-60%), although "minor symptoms" (visual illusions and "sense of presence") are more frequent than "major" ones (hallucinations and delusions). Considering the delusional disorders, Othelo syndrome (OS) (jealousy delusion) represents a scarce clinical presentation in PD. Jealousy delusion has been related with dopaminergic agonists, and a reduction of dose is the first-line treatment. In several cases, it may be also necessary to add atypical antipsychotics as complementary therapy. Finally, pimavanserine (a selective, inverse agonist 5-HT2A) is currently on research, and it may be a promising option in the treatment of PD related-psychosis in the next future. We present a case-report of PD which developed an OS after several years of agonistic dopaminergic treatment. The dose-adjustment of antiparkinsonian drugs plus atypical antipsychotics was the option played, obtaining resolution of jealousy delusion (AU)

Integrative treatment in psychiatry.

Psychiatry is a medical discipline addressing the study, diagnosis, treatment and prevention of mental disorders. Psychiatric disorders, which may be seen in people of all ages, involve the emotions, the will, and intellectual processes, verbal and non-verbal behaviour. According to current knowledge we cannot speak about only one cause but of the interaction of several etiological factors, mutually pervading and causing the mental illness. Because of this the treatment of mental disorders involves the complex implementation of biological, psycho-therapeutic, and socio-therapeutic methods of treatment. The contemporary principle of integrative psychiatry immanently requires simultaneous treatment of three human components: body, mind, and spirit. The holistic approach emphasizes the importance of the wholeness of the human person, and the inter-dependence of his components.

Transdisciplinary holistic integrative psychiatry - a wishfull thinking or reality?

Modern psychiatry in the last century proposed several aggregative biopsychosocial models as an opposition to prevailing fragmentary, reductionistic and dogmatic approaches. Although the biopsychosocial approach has become the mainstream concept of the present-day psychiatry, it is not fruitful enough because it is excessively broad and provides no real complex field integration and guidance to clinicians and researchers. The postmodern psychiatry alternatives have been appeared as pluralism and integrationism. Holistic and integrative approach in medicine and psychiatry is built on the premise that human beings in health and disease are complex systems of dinamically interacting biological, psychological, social, energetic, informational and spiritual processes. Emerging as a transdisciplinary holistic, complementary and integrative psychiatry implies widely accepted general systems theory on psychopathology, novel integrating interpretative models, new integrative understanding of etiopathogenesis or meanings of symptoms, and novel integrative assessment and treatment approaches addressing those etiopathogenesis and meanings.

Integrative mental health care: from theory to practice, Part 2.

Integrative approaches will lead to more accurate and different understandings of mental illness. Beneficial responses to complementary and alternative therapies provide important clues about the phenomenal nature of the human body in space-time and disparate biological, informational, and energetic factors associated with normal and abnormal psychological functioning. The conceptual framework of contemporary Western psychiatry includes multiple theoretical viewpoints, and there is no single best explanatory model of mental illness. Future theories of mental illness causation will not depend exclusively on empirical verification of strictly biological processes but will take into account both classically described biological processes and non-classical models, including complexity theory, resulting in more complete explanations of the characteristics and causes of symptoms and mechanisms of action that result in beneficial responses to treatments. Part 1 of this article examined the limitations of the theory and contemporary clinical methods employed in Western psychiatry and discussed implications of emerging paradigms in physics and the biological sciences for the future of psychiatry. In part 2, a practical methodology, for planning integrative assessment and treatment strategies in mental health care is proposed. Using this methodology the integrative management of moderate and severe psychiatric symptoms is reviewed in detail. As the conceptual framework of Western medicine evolves toward an increasingly integrative perspective, novel understanding of complex relationships between biological, informational, and energetic processes associated with normal psychological functioning and mental illness will lead to more effective integrative assessment and treatment strategies addressing the causes or meanings of symptoms at multiple hierarchic levels of body-brain-mind.