A History of the Pharmacological Treatment of Bipolar Disorder.

In this paper, the authors review the history of the pharmacological treatment of bipolar disorder, from the first nonspecific sedative agents introduced in the 19th and early 20th century, such as solanaceae alkaloids, bromides and barbiturates, to John Cade's experiments with lithium and the beginning of the so-called "Psychopharmacological Revolution" in the 1950s. We also describe the clinical studies and development processes, enabling the therapeutic introduction of pharmacological agents currently available for the treatment of bipolar disorder in its different phases and manifestations. Those drugs include lithium salts, valproic acid, carbamazepine, new antiepileptic drugs, basically lamotrigine and atypical antipsychotic agents (olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, asenapine, cariprazine and lurasidone). Finally, the socio-sanitary implications derived from the clinical introduction of these drugs are also discussed.

The persistence of the subjective in neuropsychopharmacology: observations of contemporary hallucinogen research.

The elimination of subjectivity through brain research and the replacement of so-called "folk psychology" by a neuroscientifically enlightened worldview and self-conception has been both hoped for and feared. But this cultural revolution is still pending. Based on nine months of fieldwork on the revival of hallucinogen research since the "Decade of the Brain," this paper examines how subjective experience appears as epistemic object and practical problem in a psychopharmacological laboratory. In the quest for neural correlates of (drug-induced altered states of) consciousness, introspective accounts of test subjects play a crucial role in neuroimaging studies. Firsthand knowledge of the drugs' flamboyant effects provides researchers with a personal knowledge not communicated in scientific publications, but key to the conduct of their experiments. In many cases, the "psychedelic experience" draws scientists into the field and continues to inspire their self-image and way of life. By exploring these domains the paper points to a persistence of the subjective in contemporary neuropsychopharmacology.

[Shock therapy in psychiatry--historical feature]. / Terapia wstrzasowa w psychiatrii--rys historyczny.

2008 brings the 70th anniversary of the first electroconvulsive treatment, which was applied in a Psychiatric Clinic of Rome and introduced a new physical therapy to the clinical practice. The electroconvulsive therapy (ECT)--remains as the only method from the earlier therapies practised in the era preceding modem pharmacotherapy. It survived to the present times despite some difficulties. The ECT is a safe and extremely effective method for the treatment of severe affective disorders and psychoses. The paper presents the development of ECT and others convulsive techniques in a historical context.

The ethics of clinical innovation in psychopharmacology: Challenging traditional bioethics.

OBJECTIVE: To assess the scientific and ethical basis for clinical innovation in psychopharmacology. METHODS: We conducted a literature review, utilizing MEDLINE search and bibliographic cross-referencing, and historical evidence regarding the discovery and development of new medications in psychiatry. Clinical innovation was defined as use of treatments in a clinical setting which have not been well-proven in a research setting. RESULTS: Empirical data regarding the impact of clinical innovation in psychopharmacology are lacking. A conceptual and historical assessment of this topic highlights the ethical and scientific importance of clinical innovation. Ethically, it touches a borderline that, in our judgment, is not adequately framed in contemporary mainstream bioethics. Currently, research is viewed as not at all benefiting the patients who participate in it, while clinical care is viewed as being solely for the benefit of patients. Clinical innovation straddles these two worlds, uncomfortably at times. While many argue that clinical innovation should either be avoided or folded into research projects, we argue that clinical innovation is necessary for progress in psychopharmacology research, and that it can prosper best when guided by the following ethical principles: 1.) The treatment should be based on a viable hypothesis. 2.) Whenever possible, one's clinical observations should be reported so they can be evaluated by the scientific community. 3.) One should be willing to report unexpected observations of drug effects. 4.) A high standard of informed consent should be maintained. Again, this proposal goes against the standard view among bioethicists that research and clinical care are categorically opposed activities, as made clear by the either-or dichotomy of the Belmont Report on bioethics. This approach has so polarized our profession into clinicians versus researchers, that many clinicians will not apply new knowledge produced by clinical research until it eventually gets incorporated into formal treatment guidelines, while researchers have little to guide them as to what kind of new knowledge it is most important to provide. SUMMARY: Clinical innovation brings out the ambiguities in our current ethical conceptions of research versus clinical care. Yet, historically, clinical innovation has been an important contributor to progress in psychopharmacology. We argue that clinical innovation should not be discouraged, but rather it should occur under certain ethical conditions."Almost everyone can and should do research...because almost everyone has a unique observational opportunity at some time in his life which he has an obligation to record.... If one considers the fundamental operations or methods of research, one immediately realizes that most people do research at some time or another, except that they do not call their activity by that name. There are seven operations.... In simple language they are counting, sorting, measuring, comparing, nature-study, guess testing, and reappraisal.... Guess testing is of course what most people think of when the word research is mentioned; except that it is bad manners to call a guess a guess. It should be called an hypothesis. Let us make one plea. Guessing becomes merely a game unless it is done in the context of a plan for action. It is a waste of time elaborating untestable hypotheses 1." John Cade.

La virtud de aquel precioso bálsamo: aproximación a El Quijote desde la vertiente de la psicofarmacología / The virtude of that precious balsam: approach to Don Quixote from the psychopharmacological perspective

La obra cumbre de la literatura española, El Quijote, constituye una fuente donde habitualmente beben los diferentes especialistas que pretenden conocer con mayor profundidad la sociedad renacentista tardía. Esta obra magistral de Miguel de Cervantes ha sido frecuentemente abordada desde la perspectiva psicopatológica para obtener un diagnóstico psiquiátrico de su principal personaje, Alonso Quijano. También son frecuentes los abordajes clínicos desde la traumatología y desde la terapéutica general (análisis de aceites, ungüentos, bálsamos y demás preparados de botica). Nosotros nos acercamos a El Quijote desde la vertiente de la psicofarmacología, un campo escasamente abordado. En el presente trabajo se estudian los remedios terapéuticos empleados en la época cervantina para el tratamiento de los locos y enajenados (sedantes, como el opio; evacuantes, como el eléboro; tónicos, irritantes y técnicas quirúrgicas, como las sangrías y fuentes) y se analizan las escasas e inespecíficas terapias, fundamentalmente de origen herbal, que Cervantes nos revela en su novela (bálsamos, purgantes y eméticos). Entre ellas cabe mencionar la raíz de ruibarbo (Rumex alpinus), las semillas de tártago (Euphorbia lathyris), la hierba de San Juan (Hypericum perforatum), ingrediente del aceite de Aparicio y el romero (Rosmarinus officinalis), ingrediente del célebre bálsamo de Fierabrás. También se analizan las posibles influencias científicas en que se pudo inspirar Cervantes en este campo, fundamentalmente las obras de Juan Huarte de San Juan Examen de ingenios para las ciencias y de Andrés Laguna Dioscorides, acerca de la materia medicinal y de los venenos mortíferos

The most outstanding novel of the Spanish literature, Don Quixote, represents the source to which the different specialists who intend to deepen their knowledge of the late Renaissance society usually address. This masterpiece of Miguel de Cervantes has been frequently approached from the psychopathological perspective to obtain a psychiatric diagnosis of its main character, Alonso Quijano. Also, other clinical approaches from the traumatological and general therapeutical view (oils, ointments, balms and other pharmacy preparations) have been frequent. We have tackled Don Quixote from the psychopharmacological perspective, a barely explored field. In this work, we intend to study the therapeutical cures used during the Cervantine time for the treatment of insane and mentally disturbed people (sedatives like opium, laxatives like hellebore, tonics, irritants and surgical techniques like bloodlettings and «fuentes») and we analyze the limited and unspecific therapies, mainly of herbal origin (balms, purgatives and emetics), which Cervantes reveals to us in his novel. Among them, rhubarb root (Rumex alpinus), seeds of spurge (Euphorbia lathyris), St. John's Wort (Hypericum perforatum), main ingredient of Aparicio's oil, and rosemary (Rosmarinus officinalis), primary component of the famous balsam of Fierabras, should be highlighted. We have also examined the possible scientific influences which might have inspired Cervantes in this field, mainly the works of Juan Huarte de San Juan The examination of men's wits and the one of Andres Laguna Dioscorides' materia medica

History of modern psychopharmacology: a personal view with an emphasis on antidepressants.

OBJECTIVE: This article provides the chemical basis for the molecular modification of H1 antihistamines in the rational development of some antidepressant and antipsychotic drugs. METHODS: A review of the literature and personal experiences have been compiled. CONCLUSIONS: The contributions of many basic scientists, the crucial observations of clinicians, and the desire of the drug industry to make money have resulted in the currently available psychopharmacological treatments. The future development of psychopharmacology depends on better clinical research to generate new hypotheses of the chemical and behavioral pathology of mental disease. Psychosomatic medicine can make a unique contribution in its interdisciplinary role of stressing brain, body, and mind relationships.

[Pre-Columbian indigenous psychopharmacology]. / Psicofarmacología indígena precolombina.

A careful review has been carried out on texts concerning Mexican medicine plants, especially on texts obtained directly from the XVI century Indian reports. The plants utilized for psychiatric purposes have been separated from the huge group of 1 500 medicine plants used by the prehispanic Indians, and have been found about 150 plants which have been classified in the modern way of antipsychotic, antidepressant, minor tranquilizer, hallucinogens, sedatives, hypnotics, brain tonics, stimulants and anticonvulsants. The intention in making this research is to awake the interest of the people in the experimenting field; as experiments have been effected only on hallucinogen up to now, and if these have proved to possess the effects caused to the Indians, supposedly large part of the other plants have the effects according to the indications they have mentioned.